Areas Of Spain Research Articles

Technological Utopias: Loneliness and Rural Contexts in Western Iberia

Background: Urbanisation and rural migration in some areas of Spain and Portugal have given rise to rural contexts largely defined by ageing and depopulation. Rural populations have suffered from increasing social isolation, with older people living alone in villages with very few inhabitants and limited access to services. The aim of this study is to analyse the extent to which technology serve as a strategy to improve social relations and how technology influences older adults’ loneliness, its uses, meanings, experiences, and perceptions. Methods: Ethnographic research is conducted in several locations in the border area between Spain and Portugal, supported by semi-structured interviews with 17 rural subjects aged 65 years and older. Results: The results underline two main points. Participants’ definitions point to loneliness as an experience built around nostalgia for those who are no longer there, where the disappearance of rituals in the community also leads to a lack of “social happiness”. Conclusions: We note low levels of digital literacy skills and competence among our participants, with most of them rejecting any technology beyond analogue devices.

Hiking accommodation provision in the mountain areas of Valencia Region, Spain: a tool for combating the depopulation of rural areas

ABSTRACT Rural areas in Spain are currently suffering from a serious problem known as depopulation. One of the strategies to reverse the depopulation process is the rise of sports tourism. The main objective of this research is to analyse the offer of hiking accommodation in order to be able to propose sports products and services adapted to the clients. We intend to text whether the accommodation offer meets the needs and expectations of hikers and, therefore, whether the area is attractive and generates a tourist product with added value. A qualitative methodology was used through interviews. The profiles interviewed are made up of the different interest groups that revolve around sports tourism in both the private and public spheres. A total of 16 semi-structured interviews were carried out, lasting between 40 and 70 min. The results indicate that the different hiking lodgings have been adapting their offer to make it more competitive, as indicated by previous research on attraction factors. However, it could be interesting to combine the efforts of the different accommodations in order to improve the destination. The implications of this study are various: they describe the current situation in terms of sports tourism in the inland area of Castellón, laying the foundations for setting possible short and medium-term objectives. On the other hand, they provide a larger corpus of information on the idiosyncrasy of the area studied, which translates into a transfer of knowledge that can be used by public administrations and by private companies.

Nutrition status, obesity and outcomes in patients with atrial fibrillation

Introduction and objectivesA paradoxical protective effect of obesity has been previously reported in patients with atrial fibrillation (AF). The aim of this study was to determine the impact of nutritional status and body mass index (BMI) on the prognosis of AF patients. MethodsWe conducted a retrospective population-based cohort study of patients with AF from 2014 to 2017 from a single health area in Spain. The CONUT score was used to assess nutritional status. Cox regression models were used to estimate the association of BMI and CONUT score with mortality. The association with embolism and bleeding was assessed by a competing risk analysis. ResultsAmong 14 849 AF patients, overweight and obesity were observed in 42.6% and 46.0%, respectively, while malnutrition was observed in 34.3%. During a mean follow-up of 4.4 years, 3335 patients died, 984 patients had a stroke or systemic embolism, and 1317 had a major bleeding event. On univariate analysis, BMI was inversely associated with mortality, embolism, and bleeding; however, this association was lost after adjustment by age, sex, comorbidities, and CONUT score (HR for composite endpoint, 0.98; 95%CI, 0.95-1.01; P=.719). Neither obesity nor overweight were predictors of mortality, embolism, and bleeding events. In contrast, nutritional status—assessed by the CONUT score—was associated with mortality, embolism and bleeding after multivariate analysis (HR for composite endpoint, 1.15; 95%CI, 1.14-1.17; P<.001). ConclusionsBMI was not an independent predictor of events in patients with AF in contrast to nutritional status, which showed a strong association with mortality, embolism, and bleeding.The study was registered at ClinicalTrials.gov (Identifier: NCT04364516).

Impacts of Grazing by Small Ruminants on Hillslope Hydrological Processes: A Review of European Current Understanding

AbstractUnsustainable grazing of animals exerts pressure on a range of environmental factors. This review assessed the impacts of grazing of small ruminants (SRs; sheep and goats) on hydrological processes (e.g., runoff occurrence and erosion) within European pasture lands. It also considered other effects of SRs grazing, such as water pollution. Our research highlights the lack of evidence‐based European literature on the implications of grazing by SRs on the hydrological processes. The available literature is limited to the Mediterranean belt (some areas of Spain and Greece), the British Isles, and the Austrian Alps. The reasons behind the lack of literature are discussed in detail, and the knowledge gaps dealing with SRs have been enumerated. However, there are several articles on the subject within Oceania‐Pacifica and United States settings. Some of the reasons contributing to the limited literature on Europe are the possible underestimation of the significance of the problem, it being considered an unattractive research direction, and/or a lack of research funding. Thus, more research and funding are required to address the European knowledge gaps and limitations related to the impacts of grazing by SRs on the hydrological processes.

Is elective surgery during the COVID-19 pandemic safe? A multi-center prospective study in a high incidence area

The aim of this study was to describe the evolution of patients admitted for elective orthopaedic surgery during the immediate post-COVID-19 peak of the pandemic. This is a multi-center, observational study conducted in 8 high complexity hospitals of Catalonia, one of the highest COVID-19 incidence areas in Spain. We included patients ≥18 years of age undergoing elective surgery (total knee or hip arthroplasty, knee or hip revision arthroplasty, shoulder or knee arthroscopy, hand or wrist surgery, forefoot surgery, or hardware removal) after the COVID-19 peak (between May 5th and June 30th, 2020). The main exclusion criterion was a positive result for SARS-CoV-2 PCR within the 7 days before the surgery. The primary outcomes were postoperative complications within 60 days (+/-30) or hospital readmission due to a COVID-19 infection. Following the recommendations of the International Consensus Group (ICM), elective surgeries were re-started when the nationwide lockdown was lifted. Before the surgery, patients were contacted by phone to rule out any exposure to confirmed COVID-19 cases, a reverse transcription-polymerase chain reaction (PCR) assay was performed in all patients 48-72 hours before hospital admission, and they were asked to maintain home confinement until the day of the surgery. 675 patients were included: 189 patients in the arthroplasty group (28%) and 486 in the ambulatory surgery group (72%). Mean [SD] age was 57.6 [15.3] years. The mean Charlson Comorbidity Index score was 2.21 (SD = 2.01, Min = 0, Max = 13). A total of 84 patients (12.75%) obtained an American Society of Anesthesiologists (ASA) score ≥ 3, showing no association between the ASA score and the risk of developing COVID-19 symptoms at follow-up (χ 2 (4) = 0.77, P = 0.94). The mean occupation rate of hospital beds for COVID-19 patients was 13% and the mean occupation rate of critical care beds for COVID-19 patients was 27% at the time of re-introducing elective surgeries. These were important rates to consider to decide when to reintroduce elective surgeries after lockdown. Surgical time, time of ischemia and intra-operative bleeding were not related with a higher risk of developing COVID-19 post-operatively (χ 2 (1) = 0.00, P = 0.98); (χ 2 (2) = 2.05, P = 0.36); (χ 2 (2) = 0.37, P = 0.83). Only 2 patients (0.3 %) presented with a suspected COVID-19 infection at follow-up. None of them presented with pneumonia or required confirmation by a reverse transcription PCR assay. Hospital re-admission was not needed for these patients. The risk of developing COVID-19 during the immediate post-COVID-19 peak in a region with a high incidence of COVID-19 has not been proved. These data suggest that elective orthopaedic surgeries can be resumed when assertive and strict protocols are followed.

Statistical analysis of road freight transport in Catalonia

Abstract This article describes the links between economic level, investment in Research &amp; development (R&amp;D), and Catalan freight transport between 2006 and 2016. Catalonia is the second most populous area in Spain, northeast of the Iberian Peninsula, whose economy ranks second among the Autonomous Communities, surpassed only by the Community of Madrid, to speak of a significant economic and social region. The study sought to answer the question of what economic contexts exist in the region regarding freight transport. To do all this, it uses mathematical-statistical tools to explore the relationships between real data sets, which were calculated using seven indicators. The analyses suggest a positive increase in the volume of imports and exports of goods in the region. The same is true for GDP per capita. It came as a surprise that virtually no positive correlations existed between R&amp;D and any other indicators. In analysing the indicators, we found that the current economy was pushed back by the 2008 world economic change, similarly to international trends. At the same time, there has been rapid growth since 2010, especially in exports. This also means that Spain, particularly the Catalan region, has serious trade relations, which affect the region’s economic development and the freight transport industry.

Perkembangan Pendidikan Islam di Negara Eropa: Pendidikan Islam di Spanyol

Islamic education in Spain began to develop, marked by the provision of the Spanish state religion department that schools in Spain were officially allowed to provide Islamic religious lessons for their Muslim students. This is due to the growing number of Muslim students in primary and secondary schools so that some areas in Spain have to offer Islamic religion classes. This official recognition from the government opens up opportunities for Muslims in Spain to teach religion in both public and private schools. In addition, there is also the opportunity to build self-managed schools, carry out worship and celebrate religious holidays.

Mapping functional areas in Spain using mobile positioning data

To be effective, territorial development policies must rely on information collected at a proper spatial scale. This commentary compares functional and administrative geographies. We go beyond metropolitan areas and map functional areas across the entire national territory of Spain. These functional areas are delineated using commuting flows based on mobile positioning data. The results obtained revealed the existence of a substantial number of functional areas that do not belong to one sole region. This indicates that there is a discrepancy between the socioeconomic reality and the administrative areas employed for territorial development policy purposes. Functional areas could be particularly useful to address policy challenges in issues like labor market functioning, transport planning, housing, or public service provision.

Application of the Trace Coherence to HH-VV PolInSAR TanDEM-X Data for Vegetation Height Estimation

This article investigates, for the first time, the inclusion of the operator Trace Coherence (TrCoh) in polarimetric and interferometric synthetic aperture radar (SAR) methodologies for the estimation of biophysical parameters of vegetation. A modified inversion algorithm based on the well-known Random Volume over Ground (RVoG) model, which employs the TrCoh, is described and evaluated. In this regard, a different set of coherence extrema is used as input for the retrieval stage. In addition, the proposed methodology improves the inversion algorithm by employing analytical solutions rather than approximations. Validation is carried out exploiting single-pass HH-VV bistatic TanDEM-X data, together with reference data acquired over a paddy rice area in Spain. The added value of the TrCoh and the convenience of the use of analytical solutions are assessed by comparing with the conventional polarimetric SAR interferometry (PolInSAR) algorithm. Results demonstrate that the modified proposed methodology is computationally more effective than current methods on this dataset. For the same scene, the steps required for inversion are computed in 6 min with the conventional method, while it only takes 6 s with the proposed approach. Moreover, vegetation height estimates exhibit a higher accuracy with the proposed method in all fields under evaluation. The root-mean-squared error reached with the modified method improves by 7 cm with respect to the conventional algorithm.

Evaluation of Implementation of Biomass and Solar Resources by Energy Systems in the Coal-Mining Areas of Spain

Energy demand is steadily growing as society becomes more industrialised. Renewable energy sources (RES) have long been used for various applications by thermal energy systems in the European Union (EU). Biomass and solar energy represent important RES in the development of energy transition in some regions such as coal-mining areas of Europe. Bioenergy is a key renewable energy storage mechanism for solar energy which, when combined, can tackle many of the barriers to the use of solar energy. Against this background, this study evaluates the potential implementation of both biomass and solar energy for energy production in coal-mining areas in Spain as a direct alternative to coal. The shown methodology relies on a comprehensive analysis of existing resources and their conversion to thermal energy from a multi-parametric point of view. The obtained results show that the solar–biomass combination can be used for thermal energy systems as a challenging option. The theoretical total hybrid-modular systems if implemented in the study area are equivalent to 1165 MWth and supply thermal energy for 170,000 single-family houses.

Selection and characterization of Spanish Trifolium-nodulating rhizobia for pasture inoculation

Identification of elite nitrogen-fixing rhizobia strains is a continuous and never ending effort, since new legume species can be cultivated in different agro systems or are introduced into new areas. This current study reports on the taxonomic affiliation and symbiotic proficiency of nine strains of Trifolium-nodulating rhizobia isolated from different pasture areas in Spain, as well as three Rhizobium leguminosarum bv. trifolii reference strains, on eleven Trifolium species. Based on 16S rRNA gene sequences the strains belonged to the R. leguminosarum species complex. Additional phylogenetic analyses of the housekeeping genes recA, atpD and rpoB showed the strains were closely related to the species R. leguminosarum, R. laguerreae, R. indicum, R. ruizarguesonis or R. acidisoli. In addition, three strains had no clear affiliation and could represent putative new species, although two of the reference strains were positioned close to R. ruizarguesonis. nodC gene phylogeny allowed the discrimination between strains isolated from annual or perennial Trifolium species and placed all of them in the symbiovar trifolii. Neither geographic origin nor host-plant species could be correlated with the taxonomic affiliation of the strains and a high degree of phenotypic diversity was found among this set of strains. The strong interaction of plant species with the rhizobial strains found for biological nitrogen fixation (BNF) was noteworthy, and allowed the identification of rhizobial strains with a maximum proficiency for certain trefoil species. Several strains showed high BNF potential with a wide range of clover species, which made them valuable strains for inoculant manufacturers and they would be particularly useful for inoculation of seed mixtures in natural or cultivated pastures.

How are Natura 2000 protected areas covering different components of avian diversity in Spain?

Protected areas are a relevant conservation tool at our disposal, especially for developing management strategies of natural habitats. However, explicit tests at large spatial scales about its effectivity protecting different components of biodiversity are still rare. This study explored the spatial matching between the distribution of three components of avian diversity (taxonomic, functional, and phylogenetic metrics) and the network of Natura 2000 protected areas in Spain, the EU country with the most extensive terrestrial coverage.Overall, the spatial distribution of taxonomic, functional, and phylogenetic diversity was slightly spatially congruent, matching with protected areas. However, each avian diversity metric showed differences in the arrangement of spatial clusters, also regarding the environment type. Species richness was higher in forests while it was lower in orchards, mixed environments, and arable lands. Functional dispersion was higher in forest and arable lands, while it was lower in wetlands. In contrast, the highest phylogenetic diversity was associated with wetlands and water bodies, with shrublands showing the lowest levels for this metric.All three avian diversity metrics were overall higher within than outside the Natura 2000 network. The species richness was higher in areas simultaneously protected by the Habitat and Birds Directives. Functional dispersion was higher in protected areas designed under the Birds Directive. Finally, the evolutionary uniqueness was well represented in all protected areas, although areas designed under Birds Directive showed the higher values for this metric. The presence of spatial mismatch among avian diversity componentssuggests the importance of considering taxonomic, functional, and evolutionary metrics simultaneously for a better spatial prioritisation in conservation planning.

RECLAMO: Unlocking the potential of wastewater reuse for agricultural irrigation in Spain

Increasing water scarcity is encouraging the use of unconventional water resources. In recent years, the European Union has launched numerous initiatives to promote and facilitate water reuse for agricultural irrigation. Today, the use of reclaimed water for agriculture has become an alternative, reliable and safe source of water supply and an indispensable water planning tool, especially in the area of southern Europe. However, water reuse for irrigation is currently far below its potential. Numerous barriers prevent its development and call for a detailed analysis of the different aspects affecting reclaimed water reuse, through an integrated and multidisciplinary approach. A multidisciplinary research team from Universidad Politécnica de Madrid, consisting of agronomists, hydrologists, chemists and agricultural economists, will work on the RECLAMO Project (https://blogs.upm.es/reclamo/), with the aim of providing solutions and recommendations aimed at promoting the full development and use of reclaimed water for irrigation in areas of Spain with marked water stress. For this purpose, project activities will be developed in two selected case studies (the Segura Basin, leader in water reuse in Spain and the Guadiana Basin, with success stories, but low levels of water reuse) and organised according to five axes: 1) development of a comprehensive knowledge-base covering the regulatory, technical, socio-economic and environmental aspects of reclaimed water reuse in agriculture; 2) participatory development of future scenarios exploring possible strategies, barriers and opportunities, in relation to the expansion of the use of reclaimed water for irrigation; 3) impact analysis of the strategies identified at different scales (crop, farm, (sub-)basin), through the development of an integrated modelling platform (hydrologic-agronomic-economic models); 4) Development of a roadmap and policy recommendations to achieve the full development and use of reclaimed water reuse for irrigation; 5) Dissemination of knowledge and promotion of science-policy-society dialogue. To this end, RECLAMO will collaborate closely with experts and stakeholder groups that will play a key role in the project in co-creating the scenarios and modelling tools and validating the results. The project will also seek for synergies and complementarities with other similar projects and explore new ways of collaborating with companies and research groups that allow research to continue and expand beyond the spatial and temporal limits of the project. RECLAMO’s results will promote an integrated approach to the sustainable management of water resources in water-stressed areas, including reclaimed water management. The integrated modelling platform developed in the project will allow policy-makers and water users to benefit from an improved understanding of the interactions between the social, economic and environmental aspects of water systems, in the context of climate and socio-economic change that will lead to better informed decision-making to address future water challenges. In addition, RECLAMO is expected to contribute to raising awareness about the use of reclaimed water reuse in agriculture as a safe and sustainable practice and to improve its social acceptance by producing science-based knowledge that provide evidence on the benefits derived from its use.

Non-pharmacological interventions to reduce pain in dementia: A quasi-experimental study

This study evaluated a non-pharmacological intervention nursing protocol for pain control and assessment of its evolution in a cohort of patients with moderate-to-severe dementia residing in three long-term care facilities in a metropolitan area in Spain. The study was a quasi-experimental pre- and post-exploratory intervention. The presence of pain was evaluated before and after the interventions of nursing protocol for 7 days, carried out by nurses. 157 residents of three centers participated (mean age 81.8 years, 58.1% were women, 83.2% had severe or moderately severe dementia and 65.2%) had regularly scheduled analgesic treatment. At baseline evaluation, the prevalence of pain, assessed with the PAINAD scale was 43.9% and this increased to 73.5% when pain was measured during bathing. The implementation of the nursing protocol of non-pharmacological interventions produced a decrease in pain of 11% (p = 0.0001). Multivariate Ancova analysis demonstrated that non-pharmacological interventions were effective independently of other factors as pressure sores or gender. The implementation of non-pharmacological interventions in social health care centers can produce a decrease in pain for those with dementia.

Biomass equations for rockrose (Cistus laurifolius L.) shrublands in North-central Spain

Aims of the study: To construct biomass weight equations for rockrose (Cistus laurifolius L.) shrublands in North-central Spain comparing different methodologies and evaluating the applicability of the current Spanish open PNOA-LiDAR data. Area of study: The growing extension of Mediterranean shrublands associated with a high wildfire risk in a climate change scenario is considered a relevant source of biomass for energy use and bioproducts. Quantifying the biomass load of the shrublands provides essential information for adequate management, calling for the development of equations to estimate said biomass loads in the most extensive monospecific shrublands. Materials and methods: Biomass dry weight from 290 destructive sampling plots (ø4m) and 426 individual plants along with LiDAR data from PNOA were related to dasometric parameters to fit weight per surface and weight per plant equations. Main results: Three new equations improve rockrose biomass estimations in North-central Spain: a) Weight per unit area (tDM.ha-1) equation (Eq. 1) based on apparent biovolume (product of crown cover in percentage by average height in meters) (Radj2 0.69, MAE 26.1%, RMSE 38.4%); b) Weight per plant (kgDM.plant-1) equation (Eq. 2) from height and crown diameter (Radj2 0.87, MAE 26.5%, RMSE 45.2%) and c) Weight per unit area equation (tDM.ha-1) (Eq. 3) based on LiDAR data contrasted with field data (Radj2 0.89, MAE 15.1%, RMSE 22.9%). Research highlights: Eq. 1 and Eq. 3 combined with high resolution LiDAR information offer rockrose (Cistus laurifolius L.) biomass estimations without added field work costs that are an improvement on certain more general studies carried out in other areas of Spain. Keywords: Shrub; wildfire prevention; forest energy; LiDAR; weight biomass equations.

Role of Sesamia nonagrioides and Ostrinia nubilalis as Vectors of Fusarium spp. and Contribution of Corn Borer-Resistant Bt Maize to Mycotoxin Reduction.

Maize expressing Cry1Ab insecticidal toxin (Bt maize) is an effective method to control Sesamia nonagrioides and Ostrinia nubilalis, the most damaging corn borers of southern Europe. In this area, maize is prone to Fusarium infections, which can produce mycotoxins that pose a serious risk to human and animal health, causing significant economic losses in the agrifood industry. To investigate the influence of corn borer damage on the presence of Fusarium species and their mycotoxins, Bt maize ears and insect-damaged ears of non-Bt maize were collected from commercial fields in three Bt maize growing areas in Spain, and differences in contamination were assessed. Additionally, larvae of both borer species were collected to evaluate their role as vectors of these molds. Non-Bt maize ears showed significantly higher presence of F. verticillioides, F. proliferatum, and F. subglutinans than Bt maize ears. For the first time, Fusarium species have been isolated from larvae of the two species. The most frequently found mycotoxins in ears were fumonisins, with non-Bt ears being significantly more contaminated than those of Bt maize. High levels of fumonisins were shown to correlate with the occurrence of corn borers in the ear and the presence of F. verticillioides and F. proliferatum.

Influence of crop-water production functions on the expected performance of water pricing policies in irrigated agriculture

Agricultural economics Water Programming Models (WPM) has found that irrigators in water scarce areas have a rather inelastic response to water prices, making water pricing cost-ineffective towards water saving. We hypothesize that the predicted water saving performance of pricing is significantly underestimated by issues of model structure, due to the exclusion of deficit irrigation from the set of decision variables available to agents in conventional WPM. To test our hypothesis, we develop a model that integrates a continuous crop-water production function into a positive multi-attribute WPM, which allows us to assess agents’ adaptive responses to pricing through deficit irrigation. The model is illustrated with an application to the El Salobral-Los Llanos irrigated area in Spain. Our results show that incorporating deficit irrigation as an adaptation option makes the water demand curve significantly more elastic as compared to an alternative model setting where deficit irrigation is precluded. We conclude that ignoring deficit irrigation can lead to a significant underestimation of the cost-effectiveness of water pricing towards water saving.

Integrating multiple datasets into spatially-explicit capture-recapture models to estimate the abundance of a locally scarce felid

The conservation of animal populations often requires the estimation of population size. Low density and secretive behaviour usually determine scarce data sources and hampers precise abundance estimations of carnivore populations. However, joint analysis of independent scarce data sources in a common modeling framework allows unbiased and precise estimates of population parameters. We aimed to estimate the density of the European wildcat (Felis silvestris) in a protected area of Spain, by combining independent datasets in a spatially-explicit capture-recapture (SCR) framework. Data from live-capture with individual identification, camera-trapping without individual identification and radio-tracking concurrently obtained were integrated in a joint SCR and count data model. Ten live captures of five wildcats were obtained with an effort of 2034 trap-days, whereas seven wildcat independent events were recorded in camera traps with 3628 camera-days. Two wildcats were radio-tagged and telemetry information on their movements was obtained. The integration of the different data sources improved the precision obtained by the standard SCR model. The mean (± SD) density estimated with the integrated model (0.038 ± 0.017 wildcats/km2, 95% highest posterior density 0.013–0.082) is among the lowest values ever reported for this species, despite corresponding to a highly protected area. Among the likely causes of such low density, low prey availability could have triggered an extinction vortex process. We postulate that the estimated low density could represent a common situation of wildcat populations in the southern Iberia, highlighting the need for further studies and urgent conservation actions in the furthermost southwestern range of this species in Europe.

Analysis of vulnerability to heat in rural and urban areas in Spain: What factors explain Heat's geographic behavior?

IntroductionThere is currently little knowledge and few published works on the subject of vulnerability to heat in rural environments at the country level. Therefore, the objective of this study was to determine whether rural areas are more vulnerable to extreme heat than urban areas in Spain. This study aimed to analyze whether a pattern of vulnerability depends on contextual, environmental, demographic, economic and housing variables. MethodsAn ecological, longitudinal and retrospective study was carried out based on time series data between January 01, 2000 and December 31, 2013 in 42 geographic areas in 10 provinces in Spain. We first analyzed the functional relationship between the mortality rate per million inhabitants and maximum daily temperature (Tmax). We then determined the summer temperature threshold (Pthreshold) (June–September) at which increases in mortality are produced that are attributable to heat. In a second phase, based on Pthreshold, a vulnerability variable was calculated, and its distribution was analyzed using mixed linear models from the Poisson family (link = log). In these models, the dependent variable was vulnerability, and the independent variables were exposure to high temperatures, aridity of the climate, deprivation index, percentage of people over age 65, rurality index, percentage of housing built prior to 1980 and condition of dwellings. ResultsRurality was a protective factor, and vulnerability in urban areas was six times greater. In contrast, risk factors included aridity (RR = 5.89 (2.26 15.36)), living in cool summer zones (2.69 (1.23, 5.91)), poverty (4.05 (1.91 8.59)) and the percentage of dysfunctional housing (1.13 (1.04 1.24)). ConclusionsRural areas are less vulnerable to extreme heat than the urban areas analyzed. Also, population groups with worse working conditions and higher percentages of dwellings in poor conditions are more vulnerable.

Predictors of inappropriate dosing of direct oral anticoagulants in nonagenarian patients with atrial fibrillation

Abstract Background Direct oral anticoagulants (DOACs) are presented as a good option for older patients owing to their safety profile. However, the dosing can become challenging especially in this population. Objective Our aim is to evaluate the predictors of inappropriate dosing of DOACs. Methods The authors analyzed the use of DOACs in 726 patients aged ≥90 years with a diagnosis of atrial fibrillation (AF) from a retrospective multicenter registry from 3 health areas in Spain. We studied the dosing, differentiating between appropriate dose, underdosing or overdosing. To evaluate the best predictive model, the Akaike information criterion (AIC) was used. Results Follow-up was 27.7±18.3 months. Mean age was 93.0±5.2 years, and 60.1% of patients were female. 339 patients received rivaroxaban (47.3%), 237 apixaban (33.1%), 105 dabigatran (14.7%) and 35 edoxaban (4.9%). An important proportion of patients received a suboptimal dose (41.5%, n=297): 35.3% underdosed and 6.1% overdosed. The rate of suboptimal dosing was higher for apixaban and lower for dabigatran (Figure 1A). In our registry we found as a predictors of inappropriate dosing: kidney function (Chronic Kidney Disease Epidemiology Collaboration), odds Ratio (OR) 1.04; 95% CI: 1.03–1.05, P&amp;lt;0.001; weight measured in kilograms, OR 1.04; 95% CI: 1.01–1.07, P=0.012; and high blood pressure (HBP), OR 1.61; 95% CI: 1.02–2.53, P=0.041 (Figure 1B). Other variables such as HASBLED, CHADSVASc, anemia, prior bleeding, or concomitant use of antiplatelet therapy, were not significantly associated. Conclusions We want to highlight that the use of an inappropriate dose of DOAC in older patients is common, about 40% in our study. Apixaban was the most frequently underdosed DOAC. HBP, weight, and kidney function were associated with an inappropriate dosing prescription. Therefore, it is important to carefully evaluate the characteristics of the patient to prescribe the appropriate dose that guarantees a correct action. Funding Acknowledgement Type of funding sources: None. Dosing of DOACsPredictors of inappropriate dosing