Chronic hepatitis B genotype E in African migrants: response to nucleos(t)ide treatment in real clinical practice.

BACKGROUND: Hepatitis B virus (HBV) genotype E is a poorly studied genotype that almost exclusively occurs in African people. It seems to harbour intrinsic potential oncogenic activity and virological characteristics of immune scape but a paucity of information is available on clinical and virological characteristic of HBV genotype E-infected patients as well as on the efficacy of anti-HBV drugs for such patients. The increasing flow of migrants from high endemic HBV sub-Saharan Africa, where genotype E is the predominant one, to Western countries makes improving such knowledge critical in order to deliver proper medical care. METHODS: Prospective observational study of naïve patients of sub-Saharan origin treated for chronic HBV genotype E infection at a Tropical Medicine clinic sited in Spain from February 2004 to January 2018. The aim of the study was to describe the response of chronic HBV genotype E infection to nucleos(t)ide analogues (NA), entecavir or tenofovir, in real clinical practice. RESULTS: During the study period, 2209 sub-Saharan patients were assisted at our Tropical Medicine Unit and 609 (27.6%) had chronic HBV (CHB) infection. Genotype information was available for 55 naïve patients initiating treatment with NA (entecavir or tenofovir), 43 (84.3%) of them being genotype E, although 15 were excluded because they did not meet study inclusion criteria. Thus, a total of 28 CHB genotype E patients were included and followed for 24 months at least. Twenty-one patients were in HBeAg-negative chronic hepatitis phase and 7 patients in HBeAg-positive chronic hepatitis phase. After one year of treatment, among those with good adherence, 89.4% (17/19) of the HBeAg-negative patients and 80% of the HBeAg-positive ones had undetectable viral loads. Response rates reached 100% in both groups after 15-18 months of follow-up. Out of the 7 HBeAg-positive patients, 6 (85.7%) presented HBeAg loss in a median time of 31.8 months. Neither serious adverse effects nor hepatocarcinoma cases happened during the study period. CONCLUSIONS: HBV genotype may influence disease progression and antiviral response. Our study provides precious information on the efficacy and safety of NA treatment for CHB genotype E infection, a fairly unknown genotype with and increasing epidemiological impact.

Impact of COVID-19 on the Pediatric Primary Care Model in Catalonia: Analysis of Changes in the Number and Type of Face-to-Face and Remote Visits.

Background: The outbreak of COVID-19 has turned the care model of health systems around the world upside down. The health care crisis has led to opportunities for digital health to deliver quality care, and the system has been redirected toward telemedicine. In Catalonia, Spain, as of March 2020, the pattern of visits in primary care pediatric consultations changed, such that face-to-face visits decreased in favor of non-face-to-face visits. Objective: This study aimed to analyze variations in the types of pediatric visits in primary care centers in Catalonia before and after the onset of COVID-19. Methods: This was a descriptive observational study based on administrative data. The number and type of visits to primary care pediatric services in Catalonia between January 2019 and December 2022 were studied. Results: A drop of more than 80% in face-to-face visits and an increase of up to 15 times in remote visits were observed as of March 2020 compared to the previous year. Subsequently, the face-to-face attendance rate began to recover, although it did not reach the same rate as before COVID-19. Non-face-to-face visits were maintained, representing more than 20% of the total after more than 2 years of the pandemic. Conclusions: COVID-19 has been the trigger for a transition in the types of visits to primary care pediatric services. The COVID-19 pandemic was a clear catalyst for the integration of telemedicine in Catalan pediatric health care. In this context, although face-to-face consultations have recovered in absolute numbers, after the pandemic period, the weight of telemedicine has increased.

Cardiac manifestations in inherited metabolic diseases.

Inherited metabolic diseases (IMD) are caused by the functional defect of an enzyme, of genetic origin, that provokes a blockage in a specific metabolic pathway. Individually, IMD are considered rare diseases, with an incidence of less than 1/100,000 births. The symptoms are usually multisystemic, but frequently include cardiac manifestations. Of these, the most common are cardiomyopathies, especially hypertrophic cardiomyopathy. In addition, they can cause dilated or restrictive cardiomyopathy and non-compacted cardiomyopathy of the left ventricle. Characteristic signs also include rhythm alterations (atrio-ventricular conduction disturbances, Wolff-Parkinson-White syndrome or ventricular arrhythmias), valvular pathology and ischaemic coronary pathologies. The aim of this study is to present a narrative review of the IMD that may produce cardiac involvement. We describe both the specific cardiac manifestations of each disease and the systemic symptoms that guide diagnosis.

Assessing the impact of haemodynamic monitoring with CardioMEMS on heart failure patients: a cost-benefit analysis.

AIMS: The objective of this study was to perform a cost-benefit analysis of the CardioMEMS HF System (Abbott Laboratories, Abbott Park, IL, USA) in a heart failure (HF) clinic in Spain by evaluating the real-time remote monitoring of pulmonary artery pressures, which has been shown to reduce HF-related hospitalizations and improve the quality of life for selected HF patients. Particularly, the study aimed to determine the value of CardioMEMS in Southern Europe, where healthcare costs are significantly lower and its effectiveness remains uncertain. METHODS AND RESULTS: This single-centre study enrolled all consecutive HF patients (N = 43) who had been implanted with a pulmonary artery pressure sensor (CardioMEMS HF System); 48.8% were females, aged 75.5 ± 7.0 years, with both reduced and preserved left ventricular ejection fraction; 67.4% of them were in New York Heart Association Class III. The number of HF hospitalizations in the year before and the year after the sensor implantation was compared. Quality-adjusted life years gained based on a literature review of previous studies were calculated. The rate of HF hospitalizations was significantly lower at 1 year compared with the year before CardioMEMS implantation (0.25 vs. 1.10 events/patient-year, hazard ratio 0.22, P = 0.001). At the end of the first year, the usual management outperformed the CardioMEMS HF System. By the end of the second year, the CardioMEMS system is estimated to reduce costs compared with usual management (net benefits of €346). CONCLUSIONS: Based on the results, we suggest that remote monitoring of pulmonary artery pressure with the CardioMEMS HF System represents a midterm and long-term efficient strategy in a healthcare setting in Southern Europe.

Description and Analysis of Research on Death and Dying during the COVID-19 Pandemic, Published in Nursing Journals Indexed in SCOPUS.

AIM: To offer an overall picture of the research published regarding the different aspects of death and dying during the COVID-19 pandemic in journals covering the field of nursing in the Scopus database. DESIGN: bibliometric analysis. METHODS: The metadata obtained were exported from Scopus for subsequent analysis through Bibliometrix. Using the VOSviewer co-word analysis function, the conceptual and thematic structure of the publications was identified. RESULTS: A total of 119 papers were retrieved, with the participation of 527 authors. The publications were found in 71 journals covering the nursing area. The main lines of research revolved around the keywords "palliative care" and "end-of-life care" in regard to the ethical, psychological, and organizational challenges faced by the health professionals who cared for these patients. CONCLUSION: The results obtained offer a range of data and images that characterize the scientific production published on this topic, coming to the conclusion that, due to the multifaceted and multidisciplinary approach to the experience of death, care, and accompaniment in the dying process, bibliometric maps improve the comprehensive understanding of the semantic and conceptual structure of this field of research. This study was retrospectively registered with the OSF Registries on the 14 March 2024.

[Imported hookworm infection in Almeria]. / Uncinariasis importada en Almería.

OBJECTIVES: To study the clinical and epidemiological characteristics of immigrant patients diagnosed with a hookworm infection in the Tropical Medicine Unit of the Hospital de Poniente in El Ejido (Almería, Spain). MATERIAL AND METHODS: A retrospective observational study of all immigrant patients diagnosed with hookworm, by direct visualization of eggs in stool samples, from October 2004 until December 2012. RESULTS: Of the 1872patients studied, 253 (13.5%) were diagnosed with a hookworm infection. In patients where hookworm was the only helminthiasis diagnosed, 8.3% had iron deficiency anaemia, 65.7% did not have eosinophilia, and of these, 25.9% had no abdominal pain. CONCLUSIONS: Hookworm is a frequent parasite infestation in the Sub-Saharan immigrant population. Many patients are asymptomatic; thus the implementation of a study protocol for immigrants from endemic areas could diagnose and treat more patients with this disease.

Comparison between self-concept, self-perception, physical exercise and lifestyle variations from 1st to 4th grade students of nursing in Tenerife, Spain.

The aim of this study was to describe and compare the self-concept, self-perception, physical exercise, and lifestyle of students from 1st to 4th year of the Nursing university studies. Descriptive observational cross-sectional study with analytical components. The study sample consisted of 1st and 4th year undergraduate Nursing students. Five questionnaires were used: a sociodemographic survey, the RSES, the GHQ-12, the PAQ-A and the HBSC. The sample consisted of 197 subjects. 44.2% had a low self-concept and a perception of self-value that improved as they progressed academically, while confidence decreased. The PAQ-A showed that 65.5% performed moderate physical activity and 15.7% were sedentary, 58.9% reported a fair lifestyle and 20.8% of the subjects reported an inadequate diet. In the GHQ-12, the perception of self-value subscale showed an improvement with respect to the academic year. The SOC-13 data showed fair coping with traumatic situations, which worsened in the 4th year, being 88.9% in males and 84.6% in females. The study identified low self-concept, an adequate self-perception, moderate physical activity with a tendency towards sedentary lifestyles, and a fair lifestyle. It is significant that adolescents do not perceive the poor figures they obtain in self-concept, physical exercise, diet, sleep, and violence as reflected in their health. It is known that the changes adopted in adolescence will be perpetuated in adulthood. Therefore, influencing this population group, and even more so, if they are potential future health professionals, is deemed necessary.

Research, Reading, and Publication Habits of Nurses and Nursing Students Applied to Impact Journals: International Multicentre Study.

Publishing in JCR and SJR journals has become crucial for curricular development. Results from nursing investigations "compete" for publication in journals which are not specific to the field of care, affecting the academic development of these investigators. This phenomenon may lead to an ongoing adverse effect on nursing researchers and academics engaged in research in nursing care. The aim of this study was to evaluate habits regarding scientific literature consulting, the transfer of published material, and the citation of nursing investigations. A cross-sectional descriptive study by means of questionnaires was carried out, focusing on both Spanish and Portuguese nurses. The findings of the study reveal the following reasons for reading the scientific literature: that the language was understood; for learning and applying what was learnt; that the journal was of open access; for elaborating protocols and work procedures; and that the journal was indexed in scientific databases and in nursing databases. The reasons for reading, using, and publishing in journals were related to knowledge of the language and the associated usefulness of learning and applying knowledge. Creating a specific index of research publications in nursing will have a positive effect on the scientific production of caring methodologies.

Questionnaires Assessing Adolescents' Self-Concept, Self-Perception, Physical Activity and Lifestyle: A Systematic Review.

INTRODUCTION: Adolescence is considered a fundamental time to promote change. During this time, young people consolidate their social and individual identity. By influencing positive changes, chronic diseases can be avoided, delayed or modified in the future. The use of valid and reliable questionnaires is an optimal resource for gathering information and thus useful for this study. OBJECTIVES: The objectives of the study were to: (1). identify the questionnaires that assess self-esteem/self-concept, self-perception, physical exercise and lifestyle of adolescents; (2). analyse the psychometric measures of the questionnaires used to assess the self-esteem/self-concept, self-perception, physical exercise and lifestyle of adolescents; and (3). determine which questionnaires are the most reliable and valid for assessing the self-esteem/self-concept, self-perception, physical exercise and lifestyle of adolescents. METHOD: A bibliographic search was carried out in the following databases: Virtual Health Library, Cochrane, Medline, Cuiden, Scielo, Dialnet, PubMed and Ministry of Health, Consumption and Social Welfare following the PICO method. The recommendations of the PRISMA statement were followed. RESULTS: A total of 71 scientific articles were collected. Within the self-perception/self-concept questionnaires, the Rosenberg Self-Esteem Scale stands out for being an optimal and widely used resource in adolescents. Regarding the questionnaires that evaluate self-perception, the General Health Questionnaire is the most used; it is used in numerous national health surveys in different countries. The Physical Activity Questionnaire for Adolescents ranks first with respect to the rest of the tools. It is a widely used resource internationally and provides enough information on the physical activity carried out by the subject in a given week. Although there are several questionnaires that measure lifestyle, the Health Behavior in School-aged Children instrument was selected. This instrument is at the European level and involves the collaboration of 48 countries and allows us to compare the lifestyle habits of adolescents from different countries. DISCUSSION: The questionnaire that stands out in the assessment of self-esteem/self-concept is the Rosenberg Self-Esteem Scale. The General Health Questionnaire has been selected as the best tool for assessing self-perception. To measure physical exercise, the Physical Activity Questionnaire for Adolescents is identified as the ideal instrument because it is widely used and can be completed quickly. Regarding lifestyle, the Health Behavior in School aged Children is shown to be an effective instrument in assessing lifestyle.

International Comparison of Self-Concept, Self-Perception and Lifestyle in Adolescents: A Systematic Review.

Objectives: Adolescence is considered a vital time to address healthy attitudes and values towards an effective transition to adulthood. The aim of this review was to analyse self-concept, self-perception, physical exercise, and lifestyle in the late adolescent population. Methods: Systematic review of studies assessing the results by the Rosenberg Self-Esteem Scale, the General Health Questionnaire, the Activity Questionnaire for Adolescents, and the Health Behaviour in School-aged Children questionnaires in late adolescents. The PRISMA recommendations were followed. The CASPe quality-check system was applied, excluding articles with a score <8. Results: 1589 studies were found, and 69 articles were selected. Adolescents with high self-concept and self-perception tend to be emotionally stable, sociable, and responsible. No significant differences were found regarding self-concept and self-perception between different countries, but there were differences between men and women. Physical activity and healthy diet improve self-concept and perception of body image. Conclusion: Self-concept and self-perception are associated with responsibility, stability, and mental strength. Most healthy behaviours during adolescence are followed during adulthood. Socio-cultural level of Health Science students is a differential factor for overweight and obesity.

Trends in Research on Art Therapy Indexed in the Web of Science: A Bibliometric Analysis.

Aim: Despite the increase in international research in art therapy, few studies have been developed with a bibliometric approach which describe the situation regarding this area of knowledge. Thus, the aim of this study is to describe and contextualize international scientific production in the visual arts modality in the context of artistic therapies, to offer a broader and more in-depth vision of the structure of this area of knowledge through of a bibliometric analysis of the publications indexed in the core collection of the Web of Science. Methods: This is a retrospective, exploratory and descriptive, cross-sectional study to analyze the bibliographic data retrieved from the databases of the core collection. The analysis parameters included the data corresponding to the production according to type of document, country, journal, and institution. In addition, the main lines of research were located and classified and the subject matter of the most cited articles in each of them was summarized. Four periods were selected, between 1994 and 2020, to facilitate the thematic analysis and offer an evolutionary perspective of art therapy research. Results: A total of 563 works were published, in 250 journals, in the 63 years between 1958, when the first document was published, and April 2021. The annual growth rate was 7.3% with a mean average of 8.7 publications per year, and 83.13% of the published works were articles. A total of 1,269 authors from 56 countries were counted. The mean number of citations per document was 5.6 and the mean number of citations per document and year was 0.6. The main research domains were psychology and/or rehabilitation and the highest production on this topic was concentrated in only three journals. In general, a high degree of variability was observed in the study topics and numerous theoretical and methodological articles. The most used visual arts modalities were in the main drawing, painting and photography. Conclusion: This work did not find previous existence of any bibliometric analysis on the international scientific production in art therapy. In general terms, there has been a substantial growth in the number of publications on the subject over the last decade. However, this research area does not appear to have peaked, but, on the contrary, is still growing and progressing despite its long history in clinical practice.

Prevention and Treatment of Phlebitis Secondary to the Insertion of a Peripheral Venous Catheter: A Scoping Review from a Nursing Perspective.

The objective of this work was to identify available evidence on nursing interventions for the prevention and treatment of phlebitis secondary to the insertion of a peripheral venous catheter. For this, a scoping systematic review was carried out following the guidelines in the PRISMA declaration of documents published between January 2015 and December 2020. The search took place between December 2020 and January 2021. Scielo, Pubmed, Medline, Scopus, WOS, CINHAL, LILACS, and Dialnet databases were consulted, and CASPe, AGREE, and HICPAC tools were used for the critical reading. A total of 52 studies were included to analyze nursing interventions for treatment and prevention. Nursing interventions to prevent phlebitis and ensure a proper catheter use included those related to the maintenance of intravenous therapy, asepsis, and choosing the dressing. With regard to the nursing interventions to treat phlebitis, these were focused on vigilance and caring and also on the use of medical treatment protocols. For the prevention of phlebitis, the highest rated evidence regarding asepsis include the topical use of >0.5% chlorhexidine preparation with 70% alcohol or 2% aqueous chlorhexidine, a proper hygienic hand washing, and the use clean gloves to handle connections and devices. Actions that promote the efficacy and safety of intravenous therapy include maintenance of venous access, infusion volume control, verification of signs of phlebitis during saline solution and medication administration, and constant monitoring. It is recommended to remove any catheter that is not essential. Once discharged from hospital, it will be necessary to warn the patient about signs of phlebitis after PVC removal.

Migration-associated malaria from Africa in southern Spain.

BACKGROUND: The western area of the province of Almeria, sited in southern Spain, has one of the highest immigrant population rates in Spain, mainly dedicated to agricultural work. In recent years, there has been a significant increase in the number of cases of imported malaria associated with migrants from countries belonging to sub-Saharan Africa. The objective of our study is to describe the epidemiological, clinical and analytical characteristics of malaria patients treated in a specialized tropical unit, paying special attention to the differences between VFR and non-VFR migrants and also to the peculiarities of microscopic malaria cases compared to submicroscopic ones. METHODS: Retrospective observational study of migrants over 14 years of age with imported malaria treated from October 2004 to May 2019. Characteristics of VFR and non-VFR migrants were compared. Malaria cases were divided into microscopic malaria (MM) and submicroscopic malaria (SMM). SMM was defined as the presence of a positive malaria PCR test together with a negative direct microscopic examination and a negative rapid diagnostic test (RDT). Microscopic malaria was defined as the presence of a positive RDT and/or a positive smear examination. RESULTS: Three hundred thirty-six cases of malaria were diagnosed, 329 in sub-Saharan immigrants. Of these, 78.1% were VFR migrants, in whom MM predominated (85.2% of cases). In non-VFR migrants, SMM represented 72.2% of the cases. Overall, 239 (72.6%) patients presented MM and 90 (27.4%) SMM. Fever was the most frequent clinical manifestation (64.4%), mainly in the MM group (MM: 81.1% vs SMM: 20.0%; p < 0.01). The most frequent species was P. falciparum. Patients with SMM presented fewer cytopenias and a greater number of coinfections due to soil-transmitted helminths, filarial and intestinal protozoa compared to patients with MM. CONCLUSIONS: Imported malaria in our area is closely related to sub-Saharan migration. VFR migrants are the main risk group, highlighting the need for actions aimed at improving disease prevention measures. On the other hand, almost a third of the cases are due to SMM. This fact could justify its systematic screening, at least for those travelers at greater risk.

Parenteral Cu Supplementation of Late-Gestating and Lactating Iberian Red Deer Hinds Fed a Balanced Diet Reduces Somatic Cell Count and Modifies Mineral Profile of Milk.

: This study describes the effects that Cu supplementation of late-gestating and lactating females (hinds) of Iberian red deer fed a balanced diet have on milk production, composition, and somatic cell count (SCC). Experimental hinds (n = 9) were subcutaneously injected every 42 days with Cu (0.83 mg Cu/kg body weight) from day 202 of gestation until the end of lactation (week 18). Control hinds (n = 8) were injected with a physiological saline solution with the same volume and at the same frequency as the experimental group. Copper supplementation decreased the SCC from 1.64 to 1.36 log 10/mL (p = 0.003) and modified the milk mineral profile. In particular, milk from hinds supplemented with Cu had more Ca (p = 0.02), Mg (p = 0.06), and K (p = 0.03) than milk from control hinds. However, Cu supplementation did not influence the Cu content of milk. Therefore, it can be concluded that Cu supplementation of hinds fed a balanced diet from late-gestation to the end of lactation could be a good strategy to reduce SCC and modify the mineral profile of milk increasing its Ca content.

Methodology Proposal for the Management of Nursing Competencies towards a Strategic Training. A Theoretical Analysis.

Professional and academic legislation relating to nursing skills reflects conceptual and professional developments. In this sense, conceptual and methodological analyses are required to describe the concept of nursing competencies, the individual or group self-perception of competencies, to identify training needs, and to specify the nursing professional profile within the health organization. A sequential mixed methodology was proposed combining qualitative and quantitative approaches. The qualitative methodology involves the Focus Group and the Delphi technique. The quantitative methodology involves surveying and analyzing self-perception (descriptive and analytical in relation to personal and professional variables and levels of excellence). The methodology was piloted among primary care nurses. Competencies were analyzed and distributed across the training program. The combination of qualitative and quantitative methods showed that obtaining a deep insight into the nurses' competencies would be a good process. This proposal is applicable as an approach to global nursing competencies or to a particular specialty.

Relationship between the self-concept and physical activity towards the prevention of chronic illnesses.

The objective of this work is to verify the relationship between the self-perception of health and the self-concept of physical appearance in adolescents, in order to check their influence on the physical activity they perform with the aim of preventing chronic illnesses. To this end, an observational, cross-sectional descriptive study with analytical components was carried out. Opportunistic activity, in which young people, between the ages of 16 and 22, were recruited from 5 secondary schools of the municipality of San Cristóbal de La Laguna, on the island of Tenerife (Spain). Data were collected through the General Health Questionnaire, the Rosemberg Self-esteem Scale, and the physical exercise habits test physical activity questionnaire for adolescents-A, revealing the first 2 that most percentage of responses were grouped on the positive side. The physical exercise habits test physical activity questionnaire for adolescents-A described that the most commonly performed physical activity was walking (75%).

[Prevalence and profile of the frail population in La Palma, Canary Islands]. / Prevalencia y perfil de la persona frágil en la isla de La Palma.

INTRODUCTION: Population ageing requires that health and social systems focus their attention on identifying frailty in the elderly. In the Canary Islands, there are no studies to determine the prevalence of frailty among its population. The objective of this study is to determine the prevalence and profile of frailty in the island of La Palma, Canary Islands, Spain. MATERIAL AND METHOD: A cross-sectional study was conducted to estimate the prevalence and the profile of frailty. The sample were residents over 70 years old, valued by the Fried criteria, and taking into account other related factors. The prevalence is offered with a confidence interval of 95% and is compared with that of other Spanish populations. To determine the profile, a simple comparison of variables was made, followed by using them in logistic regression models. All the tests were bilateral at a P≤0.05 level. RESULTS: The prevalence of frailty in people over 70 years was estimated at 20% (17-23%). This prevalence shows differences with those of other Spanish populations. The factors that showed a relationship with frailty were, being female, widowed, living alone, low physical activity, cognitive impairment, depression, polymedication, and adverse clinical history. Multivariate analysis identifies factors associated with the frailty variables related to marital status, co-existence, polypharmacy, depressive states, and lack of physical exercise. CONCLUSIONS: The elderly population of La Palma have greater frailty compared to that described in other regions of Spain, with their profile being that of a widowed person, with depression, polymedicated, living alone, and not exercising.

Impact of the Case Management Model through Community Liaison Nurses.

The objective of the present study is to assess the model's impact on patients and their families in terms of outcomes and the efficiency results for the health system in Tenerife, Canary Islands, selecting a period of eight years from the time interval 2002-2018. The employed indicators were collected on a monthly basis. They referred to home care and its impact on clinical outcomes and on the use of resources. The comparison between the indicators' tendencies with and without the liaison nurse model was done with the F-test by Snedecor. All these tests are bilateral, with a level of significance of p < 0.05. In those areas with community liaison nurse (CLN), improvements have been found in indicators that describe: (1) the management of the clinical status of patients, (2) the efficiency of the use of resources, and (3) the quality and compliance with the process that also includes home visits and social risk detection and management. It can be said that in the basic areas of primary health care where the work of the CLN develops there are improvements in the management of the patients' clinical condition as well as in the quality and efficiency of care.

Validity and Reliability of the Emergency Severity Index in a Spanish Hospital.

Saturation in hospital emergency departments is one of the main safety problems for the patient, which can generate negative consequences for their health. In response to this issue, triage systems are developed to organize the flow of patients in order to allow the most urgent ones to be treated first. The Emergency Severity Index (ESI) is the most used triage system in the USA and it has been implemented in the General Hospital of La Palma since 2010. The objective of this study is the validation of the ESI adapted to our hospital through the study of its degree of reliability, as well as the criterion validity. The sample consisted of 240 randomly selected cases, with proportional representation of emergencies attended in 2015 and their fraction of urgent ones (Levels 1 and 2). Criterion validity was estimated by sensitivity, specificity, and predictive result values. For reliability, the degree of agreement among the nurses was studied by means of the adapted kappa index kc2. Criterion validity showed a sensitivity of 89% (85-93%) and a specificity of 97% (94-99%), with a positive predictive value of 68% (62-74%) and a negative predictive value of 99% (98-100%) for the discrimination of urgent cases. The reliability analysis showed a kc2 = 0.94 (0.84-0.99) index, a very good agreement according to Landis-Koch criteria. The results of our study have shown adequate validity and reliability in the adaptation and implementation of an ESI triage system suited to the specific conditions of a hospital emergency service in Spain.

Assessment of genetically modified soybean MON 87708 × MON 89788 × A5547-127, for food and feed uses, under Regulation (EC) No 1829/2003 (application EFSA-GMO-NL-2016-135).

Soybean MON 87708 × MON 89788 × A5547-127 (three-event stack soybean) was produced by conventional crossing to combine three single events: MON 87708, MON 89788 and A5547-127. The GMO Panel previously assessed the three single events and did not identify safety concerns. No new data on the single events, leading to modification of the original conclusions on their safety have been identified. The molecular characterisation, comparative analysis (agronomic, phenotypic and compositional characteristics) and the outcome of the toxicological, allergenicity and nutritional assessment indicate that the combination of the single soybean events and of the newly expressed proteins in the three-event stack soybean does not give rise to food and feed safety and nutritional concerns. The GMO Panel concludes that the three-event stack soybean, as described in this application, is as safe as and nutritionally equivalent to its conventional counterpart and the non-GM reference varieties tested. The nutritional impact of food/feed derived from the three-event stack soybean is expected to be the same as that of food/feed derived from the conventional counterpart and non-GM reference varieties. In the case of accidental release of viable seeds of the three-event stack soybean into the environment, this would not raise environmental safety concerns. The post-market environmental monitoring plan and reporting intervals are in line with the intended uses of the three-event stack soybean. Post-market monitoring of food/feed is not considered necessary. The GMO Panel concludes that the three-event stack soybean is as safe as its conventional counterpart and the tested non-GM reference varieties with respect to potential effects on human and animal health and the environment.