Madrid Research Articles

Prevalence of Anisakiasis in Madrid (Spain) after 20 Years of Preventive Legislation.

Historical seroprevalence data for Anisakis in Spain vary greatly depending on the sampling region owing to different fish consumption habits. As a result of European Regulation (EC) No. 853/2004, the Royal Decree 1420/2006 on the prevention of parasitosis by Anisakis in fishery products supplied by establishments that serve food to final consumers or to communities came into force in Spain. In this study, a prevalence study of Anisakis in Madrid has been conducted to verify the prophylactic effects of the application of the law. Sera from 500 blood donors from the Fundación Jiménez Díaz University Hospital (Madrid/2021-2023) were collected, and the levels of anti-Anisakis IgG, IgA, and IgE were analyzed by ELISA, comparing them with those obtained with 110 donors from the Red Cross and the "Gómez Ulla" Central Defense Hospital (Madrid/2001-2002). The percentages of positivity in the 2021-2023 donor group were IgG (13.6%), IgA (13.6%), and IgE (2.2%), while in the 2001-2002 donors they were positive for IgG (15.45%), IgA (14.54%), and IgE (11.65%). A reduction of more than 80% was observed in the prevalence of anti-Anisakis IgE in the healthy population of Madrid, which confirmed the positive effect of RD1420/2006, which was later incorporated into RD1021/2022.

Wastewater-based epidemiology to assess pharmaceutical consumption. Spanish perspective

Wastewater-based epidemiology (WBE) is a well-established approach that can provide objective and real-time data on the consumption of substances such as pharmaceuticals. However, most of the studies reported so far compares consumption data obtained using WBE with those derived from prescription data from public health systems, which is often incomplete and might represent a source of uncertainty.This study aims to compare the measured pharmaceutical consumption back calculated with the WBE approach with consumption derived from dispensed pharmaceuticals in two regions of Spain, managed by two different Health Systems. To do so, a group of 17 pharmaceuticals, including the most representative ones of every therapeutic family, were monitored in influent wastewater (IWW) samples collected over a week campaign in spring 2022 at four different wastewater treatment plants (WWTPs) in Spain: two WWTPs in Madrid city (center of Spain) and two WWTPs in Catalonia (Northeast of Spain).Population-normalized daily loads (PNDL) revealed that the patterns of pharmaceutical occurrence in the different WWTPs are very similar, being acetaminophen, 4-acetamidoantipyrine and valsartan the pharmaceuticals with the highest PNDL values: 17162 ± 1457 mg day−1 1000 inh−1 for acetaminophen, 2365 ± 696 and 2429 ± 263 mg day−1 1000 inh−1 for 4-acetamidoantipyrine, 2006 ± 541 and 2041 ± 352 mg day−1 1000 inh−1 for valsartan.Pharmaceutical PNLDs were then transformed into measured pharmaceutical consumption (MC) and compared with dispensed consumption (DC) data obtained from the pharmacies in the catchment area where the WWTPs are located. A ratio MC/DC within 0.8 to 1.2 was obtained for 11 out of the 17 studied pharmaceuticals. Highlighting a match in all the cardiovascular system pharmaceuticals, with the exception of losartan (1.29–1.39 ratio) and valsartan (1.35–1.43) in all WWTPs. In summary, the degree of correlation between MC/DC is higher than those previously reported comparing with the prescribed pharmaceutical consumption.

Comparative Assessment of the Impact of COVID-19 Lockdown on Air Quality: A Multinational Study of SARS-CoV-2 Hotspots.

In response to the global COVID-19 pandemic, nations implemented lockdown measures to contain the virus. This study assessed air pollution levels during and after lockdowns, focusing on the following heavily affected locations: Oulu and Helsinki in Finland, Paris in France, Madrid in Spain, Milan in Italy, and Wuhan in China. Air Quality Index (AQI) data from these locations over two years were analyzed to understand the effects of lockdowns. The study compared COVID-19 lockdowns in these six cities with SARS-CoV-2 measurements using statistical methods. Variations in outdoor pollutants were evaluated through tests, revealing significant differences. Parametric analyses and regression were employed to study the impacts of lockdown measures on pollution and their relationships. The study comprehensively analyzed the effects of COVID-19 lockdowns on air quality, identifying differences, quantifying changes, and exploring patterns in each city. Pollutant correlations varied among cities during the lockdowns. Regression analysis highlighted the impact of independent variables on pollutants. Decreases in NO2 were observed in Helsinki, Madrid, Oulu, Paris, and Milan, reflecting reduced traffic and industrial activities. Reductions in PM2.5 and PM10 were noted in these cities and in Wuhan, except for O3 levels, which increased. The reduction in human activities improved air quality, particularly for NO2 and PM10. Regional variations underscore the need for tailored interventions. The study observed a substantial decrease in both PM2.5 and NO2 levels during the COVID-19 lockdowns, indicating a direct correlation between reduced human activities, such as transportation and industrial operations, and improved air quality. This underscores the potential impact of environmental measures and suggests the need for sustainable practices to mitigate urban pollution.

Social Determinants of Life Expectancy at Birth in the City of Madrid: A Pre-pandemic Analysis

Social Determinants of Life Expectancy at Birth in the City of Madrid: A Pre-pandemic Analysis

Schistosomiasis in migrant children and adolescents in a paediatric tropical referral unit in Spain: diagnosis and long-term management challenges

Globalisation and population movement have led to an increasing number of migrant children residing in areas non-endemic for schistosomiasis. However, diagnosing and managing schistosomiasis in children remain controversial. This study aims to investigate the prevalence of schistosomiasis in migrant children and to describe the diagnostic approach and management strategies, including long-term follow-up, to explore the potential role of serological tests in evaluating treatment response. We conducted a retrospective descriptive study spanning from January 2014–July 2021 at a referral unit for Paediatric Tropical Diseases in Madrid (Spain). The study included patients under 18 years diagnosed with schistosomiasis. Of 679 children screened for schistosomiasis, 73 (10.8%) tested positive. The median age was 16.3 years [IQR 9–17.6], 74% male. The majority originated from Sub-Saharan Africa (47%) and Asia (47%). Only 40% presented with symptoms, with gastrointestinal (18%) and cutaneous (17%) manifestations being the most common. Eosinophilia was observed in 43% (median [IQR]: 1103/mm3 [671–1536]), and ova were visualised in the urine of 2/50 (4.0%). Praziquantel treatment was administered to 92%, and 5 patients required retreatment. Follow-up data were available for 58 (80%) over a median period of 9 months [IQR 6–19.8], revealing a progressive decline in eosinophil count, IgE titres, and ELISA optical density. Conclusion: In this series, the prevalence of schistosomiasis among migrant children was significant (10%), highlighting the importance of including serological tests in migrant health screening. The disease is largely asymptomatic, eosinophilia is often absent, and visualisation of ova in urine is exceedingly rare. Eosinophil count, IgE titres, and ELISA optical density could prove valuable as an initial approach for monitoring inflammation during follow-up assessments.What is Known:• The burden of disease related to schistosomiasis is significant, particulary in children, and it is advisable to screen this vulnerable population.What is New:• Eosinophilia may not be present in parasitic infections, so serological tests are crucial for screening migrant children.• Serological monitoring facilitates long-term management of migrant children with schistosomiasis.

Fostering language awareness for integration through teacher-researcher collaboration in a Spanish bilingual education context

Research on Content and Language Integrated Learning (CLIL) programmes has shown that teachers find it difficult to integrate content and language in their teaching, and that this may be due to a lack of a specific type of teacher language awareness (TLA) for this type of teaching. This study explores how TLA for CLIL is manifested in metatalk in the context of a collaborative professional development activity, which took place in a bilingual secondary school in Madrid (Spain). Content and language teachers in pairs designed content and language integrated instructional sequences, implemented them, and assessed the students’ output. Four sessions in which teachers reflected on the activity, in collaboration with researchers, were audio recorded, transcribed, and analyzed. The data were analyzed using a social realist framework for investigating knowledge-building practices, Legitimation Code Theory (LCT). The analysis showed how content and language teachers refer to three types of knowledge (content, language, and language and content integration) in terms of ‘what’ is known (conceptual frameworks) and ‘how’ it is approached (following specific methods). The results confirm the importance of developing CLIL teachers’ language awareness through on-site collaboration which is closely linked to their normal teaching activities.

Experience of Diagnosis and Initiation of Renal Replacement Therapy in Women with Chronic Kidney Disease.

Chronic kidney disease (CKD) has considerable effects on the quality of life of female patients. Receiving the diagnosis and beginning renal replacement therapy (RRT) has a great personal impact on patients. The purpose of this study was to describe the experience of female patients with CKD at an ambulatory dialysis unit regarding diagnosis, life changes, and initiation of RRT. A qualitative exploratory study was conducted based on a social contructivism framework. Participants were recruited using purposeful sampling. In total, 18 women who received treatment for CKD with RRT were included. The women were attending the Ambulatory Dialysis Unit at a hospital belonging to the public health system of Madrid (Spain). Unstructured and semi-structured in-depth interviews, researchers' field notes, and women's personal letters were used. A systematic text condensation analysis was performed. The criteria used to control trustworthiness were credibility, transferability, dependability, and confirmability. Two themes emerged from the data: (a) A turning point in their lives, and (b) The emotional journey of beginning RRT. The diagnosis of CKD and the beginning of treatment implies changing routines and adapting to a new life with CKD. The first dialysis and puncture of the arteriovenous fistula is a major experience. Support from other CKD patients with more experience is perceived as a necessity and a tool to share their experiences and resolve doubts among peers. The diagnosis and initiation of RRT leads to numerous changes in the lives of women with CKD, which may influence the acceptance of treatment.

Increase in congenital syphilis in a tertiary-care centre from Madrid, Spain: Back to the classics.

Globally, an increase in sexually transmitted diseases worldwide has been reported, including acquired Treponema pallidum infection. Congenital syphilis is the mother-to-child transmission syphilis infection, experiencing an increase in cases returning to incidence rates of years ago. We report three cases of symptomatic congenital syphilis occurring in a tertiary-care hospital in Madrid (Spain). Cases were diagnosed by serology and molecular biology methods. The use of molecular techniques in specimens such as skin lesion, subplacental exudate swabs, bronchoalveolar aspirate, or cerebrospinal fluid could favour the diagnosis of this clinical entity, especially in symptomatic newborns with systemic involvement.

Factor structure and invariance of the 12-item general health questionnaire (GHQ-12) for a sample of people in situations of homelessness

ABSTRACT People in situations of homelessness (PSH) have high levels of psychological impairment. Few studies have analyse the suitability of the instruments used to measure these levels. The aim of this study was to analyse the factorial structure and invariance (sex, age, nationality and housing status) of the 12-item General Health Questionnaire (GHQ-12) for a sample of PSH (n = 603) living in the Community of Madrid (Spain). A quantitative study was designed using a survey that include the GHQ-12 and other health measures (self-assessed health and diagnosis of mental illness). A comparison of three models (unidimensional, two correlated latent factors and bi-factor) showed that the bi-factor model provided the best goodness-of-fit indicators. A latent structure was identified in which each item was loaded into a general factor measuring a single GHQ-12 factor. The number of latent factors and the structure of factorial loads for GHQ-12 items were similar between groups. The GHQ-12 can be used as a screening instrument rather than as an outcome measure in different clinical dimensions. It is an appropriate instrument for assessing psychological impairment among PSH regardless of sex, age, nationality or housing status.

Combination of toxicological and epidemiological approaches for estimating the health impact of atmospheric pollutants. A proof of concept for NO2

BackgroundRegular monitoring of the air pollutant nitrogen dioxide (NO2), an indicator for traffic-related emissions, is a priority in urban environments. The health impacts associated with NO2 exposure are the result of a combination of factors, including concentration, duration of exposure, and interactions with other pollutants. WHO has established air quality guidelines based on epidemiological studies. ObjectiveThis study develops a new concept "Health Impact Pathways (HIPs)" using adversity as a probabilistic indicator of health effects. For this purpose, it integrates available toxicological and epidemiological information, using Adverse Outcome Pathways (AOPs), in order to understand chemical-biological interactions and their consequences on health. MethodsLiterature review and meta-analysis of toxicological data supported by expert judgment were performed to establish: a) adversity pathways, b) quantitative criteria for scoring the observed toxicological effects (adversity indicators), c) NO2 exposure - adversity relationship for both long-term (1–36 months) and shortterm (1–7 days). The NO2 daily concentrations from January 2001 to December 2022, were obtained from Madrid city Air Quality network monitoring database. Adversity levels were compared with relative risk levels for all-cause and respiratory mortality estimated using linear equations from WHO 2021 guidelines. ResultsNon-linear relations were obtained for all long- and short-term NO2 related adversity indicators; for long-term effects, the best fitting was obtained with a modified Haber's law model with an exponential coefficient for the exposure time of 0.25. Estimations are presented for a set of case studies for Madrid city, covering temporal and spatial variability. A clear improvement trend along the two decades was observed, as well as high inter- and intra-station variability; the adversity indicators provided integrated information on the temporal and spatial evolution of population level risk. DiscussionThe proposed HIP conceptual approach offers promising advances for integrating experimental and epidemiological data. The next step is linking the concentration-adversity relationship with population health impacts through probability estimations, the preliminary estimations confirm the need for assessing independently different population groups.

Occurrence of multi-carbapenemase-producing Enterobacterales in a tertiary hospital in Madrid (Spain): A new epidemiologic scenario

IntroductionMulti-carbapenemase-producing Enterobacterales (M-CPE) are increasingly described. We characterized the M-CPE isolates prospectively recovered in our hospital (Madrid, Spain) over two years (2021–2022). MethodsWe collected 796 carbapenem resistant Enterobacterales (CRE) from clinical and surveillance samples. Carbapenemase production was confirmed with phenotypic (immunochromatographic, disk diffusion) and molecular (PCR, WGS) techniques. Antimicrobial susceptibility was evaluated by a standard broth microdilution method. Clinical and demographic data were collected. ResultsOverall, 23 M-CPE (10 Klebsiella pneumoniae, 6 Citrobacter freundii complex, 3 Escherichia coli, 2 Klebsiella oxytoca, and 2 Enterobacter hormaechei) isolates were recovered from 17 patients (3% with CPE, 0.26-0.28 cases per 1000 admissions). OXA-48 + KPC-3 (7/23) and KPC-3 + VIM-1 (5/23) were the most frequent carbapenemase combinations. All patients had prior antibiotics exposure, including carbapenems (8/17). High resistance rates to ceftazidime/avibactam (14/23), imipenem/relebactam (16/23) and meropenem/vaborbactam (7/23) were found. Ceftazidime/avibactam + aztreonam combination was synergistic in all metallo-β-lactamase producers. Clonal and non-clonal related isolates were found, particularly in K. pneumoniae (5 ST29, 3 ST147, 3 ST307) and C. freundii (3 ST8, 2 ST125, 1 ST563). NDM-1 + OXA-48 was introduced with the ST147-K. pneumoniae high-risk clone linked to the transfer of a Ukrainian patient. We identified four possible nosocomial clonal transmission events between patients of the same clone with the same combination of carbapenemases (KPC-3 + VIM-1-ST29-K. pneumoniae, NDM-1 + OXA-48-ST147-K. pneumoniae and KPC-2 + VIM-1-ST145-K. oxytoca). Carbapenemase-encoding genes were located on different plasmids, except for VIM-1 + KPC-2-ST145-K. oxytoca. Cross-species transmission and a possible acquisition overtime was found, particularly between K. pneumoniae and E. coli producing OXA-48 + KPC-3. ConclusionM-CPE is an emerging threat in our hospital. Co-production of different carbapenemases, including metallo-β-lactamases, limits therapeutic options and depicts the need to reinforce infection control measures.

The influence of nationwide COVID-19 lockdown on the functional impairment and long-term survival of dependent people for carrying out basic activities of daily living in a neighborhood of the city of Madrid, Spain: Orcasitas Cohort Longitudinal Study.

Prolonged confinement can lead to personal deterioration at various levels. We studied this phenomenon during the nationwide COVID-19 lockdown in a functionally dependent population of the Orcasitas neighborhood of Madrid, Spain, by measuring their ability to perform basic activities of daily living and their mortality rate. A total of 127 patients were included in the Orcasitas cohort. Of this cohort, 78.7% were female, 21.3% were male, and their mean age was 86 years. All participants had a Barthel index of ≤ 60. Changes from pre- to post-confinement and 3 years afterward were analyzed, and the effect of these changes on survival was assessed (2020-2023). The post-confinement functional assessment showed significant improvement in independence over pre-confinement for both the Barthel score (t = -5.823; p < 0.001) and the classification level (z = -2.988; p < 0.003). This improvement progressively disappeared in the following 3 years, and 40.9% of the patients in this cohort died during this period. These outcomes were associated with the Barthel index (z = -3.646; p < 0.001) and the level of dependence (hazard ratio 2.227; CI 1.514-3.276). Higher mortality was observed among men (HR 1.745; CI 1.045-2.915) and those with severe dependence (HR 2.169; CI 1.469-3.201). Setting the cutoff point of the Barthel index at 40 provided the best detection of the risk of death associated with dependence. Home confinement and the risk of death due to the COVID-19 pandemic awakened a form of resilience in the face of adversity among the population of functionally dependent adults. The Barthel index is a good predictor of medium- and long-term mortality and is a useful method for detecting populations at risk in health planning. A cutoff score of 40 is useful for this purpose. To a certain extent, the non-institutionalized dependent population is an invisible population. Future studies should analyze the causes of the high mortality observed.

Feeding ecology of the common wood pigeon (Columba palumbus) in a major European city.

Urban configuration and food availability influence birds' foraging behaviour and constitute key factors for understanding how they exploit cities. Here, we conducted a field survey in the city of Madrid (Spain) from winter 2021 to autumn 2022 to understand how the common wood pigeon (Columba palumbus) exploits the food resources provided by urban parks and streets across different seasons. The proportion of observations away from parks increased during winter and spring, and the proportion of observations of wood pigeons eating on the ground was the greatest in summer. The common wood pigeon fed from 45 tree species, 60% of which were exotic ornamental species. Most tree species used as food sources coincided with those widely planted in parks, streets and avenues. The preferred trees varied throughout the year, with a greater incidence of exotic species in winter and spring. Our results show that the diversity of trees available in cities and the use of non-native plants with contrasting phenological patterns compared with the local flora are crucial elements in explaining the successful establishment of the common wood pigeon in the city.

Early career researchers in Madrid Salud: Exploring intersectoral dialogue between arts and health

Madrid Salud, a public body of Madrid City Council responsible for prevention, promotion and community healthcare, initiated an early career researcher (ECR) in arts and health programme in 2017. This ongoing programme, in collaboration with Complutense University of Madrid, funded fellowships for Ph.D. students, supporting their training and research in the application of artistic methodologies within Madrid Salud’s teams and centres. This article outlines the programme’s implementation, emphasizing the significance of intersectoral actions for its success. Furthermore, it describes the experiences of ECRs within Madrid Salud, exploring how the arts contribute to contexts of prevention and health promotion.

Lifestyle Clusters of Diet Quality, Sleep, and Screen Time and Associations with Weight Status in Children from Madrid City: ENPIMAD Study.

Childhood overweight and obesity is a global concern and has increased in Spain over the last decades. Combinations of lifestyle behaviors (i.e., diet, sleep, and sedentarism) are highly related to weight status. Therefore, this study aimed to identify lifestyle patterns among children from Madrid City, and analyze associations with the prevalence of overweight, obesity, and abdominal obesity, considering socio-economic factors. A cross-sectional analysis was conducted on 4545 children from the ENPIMAD study with data on diet, sleep, anthropometric, and socio-economic variables. K-means cluster analysis was used to identify lifestyle clusters, and logistic regressions were used to examine the associations between socio-economic indicators and cluster membership, and between clusters and weight status. Findings show three lifestyle clusters (healthy, mixed, and unhealthy), with boys and older children more represented in the unhealthy cluster. Food insecurity and low socio-economic status were associated with unhealthier clusters in boys and girls. Children in unhealthier clusters were more likely to have obesity and abdominal obesity. However, these associations disappeared in girls after controlling for food insecurity. These results provide insight into the combination of behaviors and socio-economic factors associated with childhood obesity that may aid in the design of future interventions.

WRF-Comfort: simulating microscale variability in outdoor heat stress at the city scale with a mesoscale model

Abstract. Urban overheating and its ongoing exacerbation due to global warming and urban development lead to increased exposure to urban heat and increased thermal discomfort and heat stress. To quantify thermal stress, specific indices have been proposed that depend on air temperature, mean radiant temperature (MRT), wind speed, and relative humidity. While temperature and humidity vary on scales of hundreds of meters, MRT and wind speed are strongly affected by individual buildings and trees and vary on the meter scale. Therefore, most numerical thermal comfort studies apply microscale models to limited spatial domains (commonly representing urban neighborhoods with building blocks) with resolutions on the order of 1 m and a few hours of simulation. This prevents the analysis of the impact of city-scale adaptation and/or mitigation strategies on thermal stress and comfort. To solve this problem, we develop a methodology to estimate thermal stress indicators and their subgrid variability in mesoscale models – here applied to the multilayer urban canopy parameterization BEP-BEM within the Weather Research and Forecasting (WRF) model. The new scheme (consisting of three main steps) can readily assess intra-neighborhood-scale heat stress distributions across whole cities and for timescales of minutes to years. The first key component of the approach is the estimation of MRT in several locations within streets for different street orientations. Second, mean wind speed and its subgrid variability are downscaled as a function of the local urban morphology based on relations derived from a set of microscale LES and RANS simulations across a wide range of realistic and idealized urban morphologies. Lastly, we compute the distributions of two thermal stress indices for each grid square, combining all the subgrid values of MRT, wind speed, air temperature, and absolute humidity. From these distributions, we quantify the high and low tails of the heat stress distribution in each grid square across the city, representing the thermal diversity experienced in street canyons. In this contribution, we present the core methodology as well as simulation results for Madrid (Spain), which illustrate strong differences between heat stress indices and common heat metrics like air or surface temperature both across the city and over the diurnal cycle.

Geographical Distribution of Betting Shops and Their Proximity to Schools: (Non-)Compliance with Regulations in the City of Madrid.

The proliferation of betting shops in Spanish cities is causing a heated social debate in response to the undesirable impacts that businesses of this kind can have. As a result, associations and social movements have emerged to try to stem their expansion and, at the same time, regulations have been introduced to prevent the uncontrolled opening of this type of premises. The limitations set out in the legislation include minimum distances between betting shops and schools. In order to understand the spatial dimension of this phenomenon and to find out the extent to which these businesses comply with the regulations in force, in this paper, we study the distribution of betting shops in the city of Madrid and their proximity to each other and to schools. The results reveal certain areas of the city with a high density of betting shops and with schools with high exposure to these businesses. Likewise, results show the significant number of businesses that would have to close (81%; n = 416) if the current moratorium on betting shops that opened their doors before the current legislation came into force did not exist.

Infective endocarditis in pediatric patients: a decade of insights from a leading Spanish heart surgery reference center

Infective endocarditis (IE) is a rare disease in children and is associated with significant morbidity and mortality. In recent years, significant changes have occurred in pediatric care that could have influenced the microbiology and presentation of IE. The aim of this work was to study epidemiological, microbiological, and clinical features of IE treated at a Pediatric Cardiac Surgery Reference Center located in Madrid (Spain) in a 10-years’ period. A descriptive observational retrospective study was performed, including pediatric patients < 16 years old with definite or possible IE admitted to a reference center between January 2012 and December 2021. Thirty-two IE episodes were identified. Twenty-eight (87.5%) had congenital heart disease (CHD), 8 (25.0%) were preterm infants, 1 (3.1%) was immunocompromised and 6 (18.8%) had other chronic conditions; in 11 (34.4%) episodes more than one underlying condition was associated. In 20 (62.5%) episodes there was an indwelling central venous catheter (CVC); children with other comorbidities (preterm, immunocompromised, other chronic conditions) were more likely to have a CVC at diagnosis compared with patients with isolated CHD (p < 0.001). Thirty-six microbiological isolates were obtained in the 32 episodes; 4 (12.5%) episodes had 2 isolated microorganisms. Microbiological isolates were 20 (55.6%) Gram-positive bacteria (GPB), 10 (27.8%) non-HACEK Gram-negative bacteria (GNB), 1 (2.8%) HACEK-group bacterium, 4 (11.1%) fungi and 1 (2.8%) Coxiella burnetii. In 10 (31.3%) episodes, patients were colonized by multidrug-resistant bacteria (MDRB) and the etiology of IE in 3 (30.0%) of those episodes was the colonizing MDRB. MDRB colonization was associated with MDRB IE (p = 0.007). The most common complication was septic embolism: 11 (34.4%) episodes (9 pulmonary and 2 cerebral). In-hospital mortality was 6.3% (n = 2), all of them due to underlying conditions and not to IE or its complications. Clinical features and complications of IE episodes caused by non-HACEK GNB and those caused by GPB were compared, finding no statistically significant differences. Conclusion: Risk factors for developing IE, the proportion of embolic complications, and mortality rate were consistent with previously published findings. Proportion of IE cases attributed to non-HACEK GNB was higher than previously reported, suggesting an evolving epidemiology of IE. One-third of children colonized with MDRB subsequently developed IE caused by the same MDRB strains, so empirical coverage of MDRB organisms must be considered when IE is suspected in MDRB colonized patients. No significant differences in clinical features and complications were observed when comparing IE episodes caused by non-HACEK GNB and those caused by GPB, however larger cohort studies are needed.What is Known:• Infective endocarditis (IE) is a rare disease in children, associated with significant morbidity and mortality.• The main risk factor for developing IE in children is an underlying congenital heart disease.What is New:• With current changing epidemiology in pediatric IE, a higher proportion of IE caused by non-HACEK Gram-negative bacteria should be expected.• A significant percentage of children colonized by multidrug-resistant bacteria can develop an IE due to those bacteria.

Effect of local measures on the update of the circulating vehicle fleet and the reduction of associated emissions: 10 years of experience in the city of Madrid

This paper presents the effects derived from the application of local policies and measures on the update of the circulating vehicle fleet of the city of Madrid in terms of greenhouse gases and urban pollutants emissions. The identification of said effects has been possible thanks to the use of Vehicle Fleet Characterization Studies (VFCS), which have been applied to Madrid for the last 10 years. It explores the evolution of several indicators, such as fleet age or urban emissions, through the analysis of the results obtained in the VFCS performed in 2013, 2017 and 2022. These studies help decisively in the evaluation of traffic emissions, thus being a compelling tool in the elaboration of the urban inventories. They constitute a cornerstone in the assessment of the city environmental issues and the decision-making process to reduce the environmental impact and minimize transport-related problems.The results show that the renovation of the fleet has diminished the emission of nitrogen oxides and particulate matter, improving the air quality. However, the emissions of carbon dioxide stay almost unaffected, which suggests that the climate change policies should be oriented towards the decarbonization of the road traffic, mainly by switching to electric vehicles or low-carbon fuels.

Factor-Augmented Autoregressive Neural Network to forecast NOx in the city of Madrid

Air pollution poses a significant threat to public health and the environment in urban areas worldwide. In the context of urban air quality, nitrogen oxides (NOx), comprising nitrogen dioxide (NO2) and nitric oxide (NO), stand out as key pollutants with well-documented adverse effects. The city of Madrid, as the capital and largest urban center of Spain and the third largest of Europe, is no exception to the challenges posed by NOx pollution. Most of the recent literature on forecasting air pollution, and specifically on NOx, is based on the use of Neural Networks (NN). Little is known about the forecasting ability of factor models in this context. The main aim of this paper is to use Factor-Augmented Autoregressive Neural Networks (FA-ARNN-X) to predict future patterns of NOx pollutants in the territorial monitoring stations of Madrid, using lagged NOx values, meteorological variables and latent factors. The main results indicate that the proposed forecasting model provides statistically more accurate predictions of air pollution than its competing benchmarks and should be used by policymakers for more accurate air pollution monitoring.