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Summary Systematic review of adherence to bisphosphonates for the treatment of osteoporosis finds suboptimal levels of persistence and compliance. Poor bisphosphonate compliance increases fracture risk. Introduction The objectives of the study were to measure the persistence and compliance with bisphosphonates for the treatment of osteoporotic patients, and to estimate the influence of compliance on fracture risk. Methods A systematic review of bisphosphonate adherence in clinical practise provided new evidence to perform a meta-analysis of the means of bisphosphonate persistence and compliance, with a subsequent meta-analysis of fracture risk comparing poorly versus highly compliant patients. Results Fifteen articles, totalling 704,134 patients, met our inclusion criteria. Most of the patients were postmenopausal women treated with bisphosphonates. The 3.95% of the patients received hormone replacement therapy, but the rest received bisphosphonates. The meta-analysis of five articles totalling 236,540 patients, who were followed for 1 year, provided a pooled persistence mean of 184.09 days. The meta-analysis of five articles, totalling 234,737 patients, who were also followed for 1 year, provided a pooled medication possession ratio mean of 66.93%. The meta-analysis of six articles, totalling 171,063 patients, who were followed for varying periods of time between 1 and 2.5 years, provided a pooled 46% increased fracture risk in non-compliant patients versus compliant patients. The increased fracture risk was lower for non-vertebral (16%) and hip (28%) than for clinical vertebral fractures (43%). Conclusions Persistence and compliance are suboptimal for postmenopausal women undergoing bisphosphonate therapy for osteoporosis. The clinical consequence of this low compliance is an increased risk of fracture, which is lower for non-vertebral than for clinical vertebral fractures.

Background Severe sepsis is a challenge for healthcare systems, and epidemiological studies are essential to assess its burden and trends. However, there is no consensus on which coding strategy should be used to reliably identify severe sepsis. This study assesses the use of explicit codes to define severe sepsis and the impacts of this on the incidence and in-hospital mortality rates. Methods We examined episodes of severe sepsis in adults aged ≥18 years registered in the 2006–2011 national hospital discharge database, identified in an exclusive manner by two ICD-9-CM coding strategies: (1) those assigned explicit ICD-9-CM codes (995.92, 785.52); and (2) those assigned combined ICD-9-CM infection and organ dysfunction codes according to modified Martin criteria. The coding strategies were compared in terms of the populations they defined and their relative implementation. Trends were assessed using Joinpoint regression models and expressed as annual percentage change (APC). Results Of 222 846 episodes of severe sepsis identified, 138 517 (62.2 %) were assigned explicit codes and 84 329 (37.8 %) combination codes; incidence rates were 60.6 and 36.9 cases per 100 000 inhabitants, respectively. Despite similar demographic characteristics, cases identified by explicit codes involved fewer comorbidities, fewer registered pathogens, greater extent of organ dysfunction (two or more organs affected in 60 % versus 26 % of cases) and higher in-hospital mortality (54.5 % versus 29 %; risk ratio 1.86, 95 % CI 1.83, 1.88). Between 2006 and 2011, explicit codes were increasingly implemented. Standardised incidence rates in this cohort increased over time with an APC of 12.3 % (95 % CI 4.4, 20.8); in the combination code cohort, rates increased by 3.8 % (95 % CI 1.3, 6.3). A decreasing trend in mortality was observed in both cohorts though the APC was −8.1 % (95 % CI −10.4, −5.7) in the combination code cohort and −3.5 % (95 % CI −3.9, −3.2) in the explicit code cohort. Conclusions Our findings suggest greater and increasing use of explicit codes for adult severe sepsis in Spain. This trend will have substantial impacts on epidemiological estimates, because these codes capture cases featuring greater organ dysfunction and in-hospital mortality.

Data on clinical outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19) in private health facilities in Uganda is scarce. We conducted a retrospective cohort study of patients hospitalized with COVID-19 at Case Hospital, Kampala, Uganda, between June 2020 and September 2021. Data of 160 participants (median age 45 years (interquartile range [IQR]: 37–57) and 63.5% male) was analyzed. Seventy-seven (48.1%) participants had non-severe, 18 (11.3%) severe, and 83 (51.9%) critical COVID-19 illness. In 62 participants with chest computed tomography findings, 54 (87%) had bilateral disease, with 22 (35%) having ground-glass opacities. The median duration of hospitalization was 5 days (IQR: 3–9 days). Overall, 18 (11.3%) participants died. Survival at 14 and 28 days was 89% and 72%, respectively. Factors strongly associated with all-cause mortality were as follows: age >50 years (odds ratio [OR]: 8.6, 95% confidence interval [CI]: 1.1–69.2, and p=0.042), having at least 1 comorbidity (OR: 3.2, 95% CI: 1.1–8.9, and p=0.029), hypertension (OR: 3.2, 95% CI: 1.2–8.6, and p=0.024), diabetes mellitus (OR: 2.9, 95% CI: 1.0–8.5, andp=0.056), and oxygen saturation <92% (OR: 5.1, 95% CI: 1.8–14.4, and p=0.002). In this private health facility, mortality was about 1 in 10 patients, and more people presented with critical illness in the second wave of the pandemic, and most deaths occurred after 2 weeks of hospitalization.

To evaluate the effects of dissolved organic carbon on sorption and mobility of the insecticide imidacloprid [1‐(6‐chloro‐3‐pyridinyl) methyl‐N‐nitro‐2‐imidazolidinimine] in soils, adsorption and column experiments were performed by using a typical calcareous soil from southeastern Spain and two different types of dissolved organic carbon, that is, dissolved organic carbon extracts from a commercial peat (DOC‐PE) and high‐purity tannic acid (DOC‐TA). The experiments were carried out from a 0.01 M CaCl2 aqueous medium at 25°C. The results obtained from the sorption experiments show that the presence of both DOC‐PE and DOC‐TA, over a concentration range of 15 to 100 mg L−1, produces in all cases a decreasing amount of imidacloprid adsorbed in the soil studied. From the column experiments the retardation coefficients (RC) were calculated for imidacloprid by using either 0.01 M CaCl2 aqueous solution (RC = 2.10), 0.01 M CaCl2 DOC‐PE solution (RC = 1.65), or 0.01 M CaCl2 DOC‐TA solution (RC = 1.87). The results indicate that mobility of imidacloprid is increased 21.4 and 11.0% in the presence of DOC‐PE and DOC‐TA solutions, respectively. Dissolved organic carbon reduces imidacloprid sorption by competing with the pesticide molecules for sorption sites on the soil surface, allowing enhanced leaching of imidacloprid and potentially increasing ground water contamination.

This population-based study reveals clinical and epidemiologic characteristics of hospitalised osteoporosis-related vertebral fractures and indicates an association with a substantial hospital burden in Spain. These data provide a basis for assessing the impact of these fractures on the Spanish health-care system and to estimate future care requirements. Vertebral fractures (VF) are recognised as the most frequent complication of osteoporosis. Our objective was to determine the clinico-epidemiological characteristics and health-care burden of hospitalised VF in Spain. From the 2002 National Hospital Discharge Register, records for all osteoporosis-related VF in the Spanish population aged >or=30 years and over were retrieved. Diagnostic categories included the ICD-9-CM codes 805 and 733.xx. Population data were drawn from the National Statistics Institute. In total, 7,100 records were eligible for analysis. According to Deyo-adapted Charlson index, 62% of cases had no associated comorbidity. VF were the cause of hospitalisation in 52% of cases. Overall in-hospital mortality was 3.5%. Men had higher adjusted mortality than women. Mean hospital stay was 11.4+/-0.2 days. Identified cases amounted to a hospitalisation rate of 2.76 cases per 10,000 population aged >or=30 years. Direct inpatient hospital costs exceeded 41 million euros and accounted for 0.078% of Spanish expenditure on hospitalisations and specialised care in 2002. The national discharge database reveals epidemiological features of hospitalised osteoporosis-attributable VF and indicates an association with a substantial hospital burden in Spain. Our data provide a basis for assessing the impact of these fractures on the Spanish health-care system and to estimate future care requirements.

Purpose To analyze the prevalence of hospitalization attributable to psychosis in Spain over the last three decades. Methods Longitudinal analysis (1980–2009) of age-adjusted hospital discharges rates associated with psychosis (ICD9 290–8) in all Spanish hospitals. Data source: Spanish Hospital Morbidity Survey. Results The hospitalization rate associated with psychotic episodes had been gradually increasing since 1980 until 2004; an abrupt turnaround observed in 2004 marks the beginning of a steady decline in the rate. The turning point described is not observed for each of the psychotic diagnoses separately analyzed. However, it is clearly seen when data are grouped in diagnosis-related groups (organic-psychosis, functional psychosis and substance-induced psychosis) since the time course of the diseases within the major diagnostic groups are interrelated as evidenced by shared turning points which collectively display a common time course pattern. Main hospital indicators and antipsychotic drug prescriptions were analyzed for any possible turning point in mid-2000s. Psychiatric hospital beds and length of stays remained stable by 2004; the hospitalizations associated with non-psychotic psychiatric pathologies show no turning point in 2004. However, an abrupt change on antipsychotic drug prescriptions is precisely observed in 2004. Conclusions After decades of linear growth, hospitalizations for psychotic patients begin to decline in 2004, coinciding with the start of last generation atypical antipsychotic drug consumption in Spain. Some of the psychotic diagnostic rates evolve in an interrelated manner which calls into question the diagnosis and nosological boundaries between some of these pathologies.

Rationale The research of individual differences has opened new possibilities for better exploring the neurobiological basis of vulnerability to psychopathological disorders. Objective We extended this approach by using schedule-induced polydipsia (SIP). Methods Outbred male Wistar rats were characterized as either high (HD) or low (LD) drinker according to their behavior in SIP. Subsequently, their performance in the elevated plus maze (EPM) was studied for possible differences in anxiety-like behaviors. Finally, the effects of pentylenetetrazol (PTZ), diazepam, d -amphetamine, and cocaine on individual differences in SIP were investigated. Results HD rats acquired SIP faster and reached higher asymptotic levels than LD. Nose pokes, however, were greater in LD. In the EPM, there were no differences between HD and LD animals. Gabaergic drug effects on SIP did not differ between HD and LD rats. Compared to saline, PTZ reduced and diazepam increased water SIP drinking. On the other hand, amphetamine dose-dependently reduced SIP in HD, whereas the highest dose was required to reduce SIP in LD. HD rats also showed reductions in SIP drinking after cocaine administration. However, the effects of these drugs on nose pokes did not differ between HD and LD. Conclusion These data provide novel evidence that individual differences in SIP are not predictive of behavioral reactivity in animal models of anxiety and suggest an important role for the dopaminergic system in such individual differences. These findings point to SIP as a useful animal model for investigating the neurobiological basis of vulnerability to several psychopathologies in which the dopaminergic system is involved.

Summary Objective Our review analyses the studies that have specifically compared the association iDPP4/metformin with glimepiride/metformin, both in second line pharmacotherapy of type 2 diabetes mellitus (DM2). Methods Systematic literature review with a meta‐analysis of clinical trials comparing glimepiride with any iDPP4, both used together with metformin as a second line treatment of DM2. The effectiveness variables used were as follows: %HbA1c variation, fasting plasma glucose variation, patients achieving the therapeutic objective of HbA1c <7%, treatment dropouts due to lack of effectiveness and rescue treatments needed. The safety variables included were as follows: weight variation at the end of treatment; presentation of any type of adverse event; presentation of serious adverse events; patients who experienced any type of hypoglycaemia; patients who experienced severe hypoglycaemia; treatments suspended due to adverse effects; and deaths for any reason. Results Four studies met the inclusion criteria. The group treated with glimepiride showed better results in all effectiveness variables. Regarding safety variables, the main differences observed were in the greater number of cases with hypoglycaemia in the group treated with glimepiride, and the serious adverse events or treatment discontinuations due to these which occurred in slightly over 2% more cases in this group compared to the iDPP4 group. The remaining adverse events, including mortality, did not show any differences between both groups. The variation in the weight difference between groups (2.1 kg) is not considered clinically relevant. Conclusions A greater effectiveness is seen in the glimepiride/metformin association, which should not be diminished by slight differences in adverse effects, with absence of severe hypoglycaemia in over 98% of patients under treatment. The association of glimepiride/metformin, both due to cost as well as effectiveness and safety, may be the preferential treatment for most DM2 patients, and it offers a potential advantage in refractory hyperglycemic populations, tolerant to treatment.

Background The deinstitutionalisation reform in Spain started after 1980 with the aim of reducing the need for hospitalisation, length of stay and the number of psychiatric hospital beds, as well as fostering psychiatric patient’s involvement in the community. The aim of this study was to review how this reform process has affected the management of schizophrenic patients from 1980 to 2004. Methods Longitudinal (1980–2004) study describing variables related to hospital morbidity in schizophrenia patients. Results Hospital admission rate has gradually increased from 1980 to 2004 from 3.71 admissions per 10,000 inhabitants to 5.89, respectively. Considering the type of admission, emergency or elective, whilst the latter has slightly decreased from 2.24 in 1980 to 1.72 in 2004, the first has almost tripled from 1.47 to 4.17. The point-prevalence of schizophrenic patients receiving inpatient treatment each year has decreased 78% in this period. Length of stay, in days per admission episode, has also decreased from 148 days in 1980 to 35 days in 2004. Conclusion One of the main impacts of the psychiatric health care reform in Spain has been the considerable reduction in hospital capacity devoted to schizophrenic patients, based on the significant decrease in point-prevalence. Thus, it seems relevant to design new studies to quantify the resource reallocation to other areas of care, such as pharmacological treatment and community services.

An original algorithm for the detection of small objects in a noisy background is proposed. Its application to underwater objects detection by sonar imaging is addressed. This new method is based on the use of higher-order statistics (HOS) that are locally estimated on the images. The proposed algorithm is divided into two steps. In a first step, HOS (skewness and kurtosis) are estimated locally using a square sliding computation window. Small deterministic objects have different statistical properties from the background they are thus highlighted. The influence of the signal-to-noise ratio (SNR) on the results is studied in the case of Gaussian noise. Mathematical expressions of the estimators and of the expected performances are derived and are experimentally confirmed. In a second step, the results are focused by a matched filter using a theoretical model. This enables the precise localization of the regions of interest. The proposed method generalizes to other statistical distributions and we derive the theoretical expressions of the HOS estimators in the case of a Weibull distribution (both when only noise is present or when a small deterministic object is present within the filtering window). This enables the application of the proposed technique to the processing of synthetic aperture sonar data containing underwater mines whose echoes have to be detected and located. Results on real data sets are presented and quantitatively evaluated using receiver operating characteristic (ROC) curves.