Region Of Tarragona Research Articles

New haematologic score to discriminate beta thalassemia trait from iron deficiency anaemia in a Spanish Mediterranean region

Several studies have stablished discriminant formulas (DF) from red blood cell (RBC) data as simple, low time-consuming and inexpensive tools to differentiate β-thalassemia trait (β-TT) from iron deficiency anaemia (IDA). The aim of this work is to introduce new formulas and evaluate them in the differentiation of microcytic anaemia (MA) into either β-TT or IDA in the Mediterranean region of Tarragona. A total of 200 anonymized haematological determinations with MA were collected, 100 diagnosed of β-TT and 100 diagnosed of IDA. The cut-off values of new formulas were designed to differentiate β-TT from IDA groups and their diagnostic performance were compared with other published indices. Specifically, Martín-Sánchez index (MSI-I) = (%Micro-R/MCV) * MCHC * Hb and MSI-II = Hb * (MCHC + %Micro-R)/10. In addition, a new score: MSI-score = MCHC + MSI-I + MSI-II was proposed and evaluated in a transversal study with 200 patients. In our region, MSI-II index and MSI-score have demonstrated the best AUC and Youden’s index (YI) (AUC = 0.956, YI = 81%; AUC = 0.971, YI = 87%, respectively) to discriminate β-TT from IDA groups. In summary, the new MSI-score with the highest AUC, the highest YI and the best percentage (93.5%) of correctly identified patients could be used as an efficient and robust tool in microcytic anaemia mass-screening programs in this region.

Selling antimicrobials without prescription • Far beyond an administrative problem

IntroductionSelling antibiotics without prescription is common in many countries; beyond the administrative restrictions, this practice is a risk for patients and society. The aim of the study was to evaluate the information provided by the staff of the pharmacy to a simulated patient requesting an antibiotic. Material and methodsA prospective study was carried out in January 2013 • February 2014 in the Health Region of Tarragona, in which a mystery shopper visited 220 pharmacies requesting an antibiotic to be sold. ResultsThe actress was not asked about allergies in 73.9% of cases and never was asked about possible pregnancy. Recommendation to see a doctor was observed in 36.1% of cases. When antibiotics were not sold, the explanation provided by the staff was reasoned only in 9.9% of the cases. ConclusionIt is necessary and urgent to improve the training of pharmacists in dispensing antibiotics but also strengthen basic health knowledge among the population.

Evaluation of the activity of a Functional and Interdisciplinary (Social and Healthcare) Geriatric Unit (FISHGU) for hospitalized patients at an acute hospital

Introduction : The Functional and Interdisciplinary (Social and Healthcare) Geriatric Unit (FISHGU) or “UFISS de Gariatria in Spanish” (Unidad Funcional Interdisciplinar Sociosanitaria) is a multidisciplinary team provides management and multidimensional geriatric assessment for hospitalized patients at acute care hospital. They also play a role in the coordination of resources between the different levels of care. The FISHGU (UFISS de Geriatria) of Hospital Sociosanitario Francoli (HSSF) was created and set up in 2002. The team is composed of 2 physicians experienced in geriatric medicine, 1 clinical nurse specialist and 1 social worker. It is located on the 2nd Floor of HSSF, and the standard hours of workdays are 35 hours a week and 7 hours a day from 08:00 to 15:00 hours. Its scope of activity is hospital wards of acute care hospital, basic areas of primary care and coordination with other hospitals. Aims : - Our team completed multidimensional geriatric assessments. - Inpatient care of elderly with multiple co-morbidities (Chronic Complex Patients and Terminal Chronic Diseases Patients) that requires global and close attention (physical, psychological and social) to the special needs (occupational and physical therapy, etc) and geriatric syndromes that arise in this vulnerable population. Functions : - Acute hospital-wide consultation team with direct control over implementation of recommendations. - An ORTHOGERIATRIC collaborative intervention program for fragility fractures. - Comprehensive discharge planning with acute hospital wards. - Coordination with Nurse Case Manager of acute hospital. - Coordination of resources between the different levels of care (primary care teams, intermediate care facilities and acute hospital care). - Collaboration with the Interdisciplinary Assessment Committee of The Healthcare Region of Tarragona (CIMSS). Results : - During 2014, 838 assessments have been conducted. Eighty one patients more than 2013. - 35.2% of assessments were collected from Traumatology and ORTHOPEDIC Surgery, 22% Internal Medicine, 10.1% Neurology, 4.7% Rehabilitation unit, 4.4% Vascular Surgery, 4% Cardiology, 3.8% Gastroenterology, 2.8% Pneumology, 2.5% General Surgery, 2.5% Case Management, 2% Neurosurgery, and 2.3 others. - 99.6% has been evaluated on the same day. The remaining 0.4% % was assessed on the next day. - The time until admission to HSSF since the assessment of the FISHGU was within 48 hours in 33.2% of patients, 28% less than 4th day, and the remaining cases between 6-10 days. - 24% of the total were proactive evaluations. Conclusions : Based on the above mentioned data: - It has been demonstrated 11% increasing activity over the previous year, due to the ORTHOGERIATRIC programme. - Our FISHGU is a multidimensional unit, and growing proactivity (24%) due to the periodic and regular sessions with Traumatology, Neurology, Rehabilitation and Internal Medicine. - We believe that depending on the screening and targeting criteria used to identify eligible patients, the potential for impact could be quite large and raises the question of the physical and manpower capacity of the FISHGU to meet the apparent demand.

Selling antimicrobials without prescription – Far beyond an administrative problem

IntroductionSelling antibiotics without prescription is common in many countries; beyond the administrative restrictions, this practice is a risk for patients and society. The aim of the study was to evaluate the information provided by the staff of the pharmacy to a simulated patient requesting an antibiotic. Material and methodsA prospective study was carried out in January 2013 – February 2014 in the Health Region of Tarragona, in which a mystery shopper visited 220 pharmacies requesting an antibiotic to be sold. ResultsThe actress was not asked about allergies in 73.9% of cases and never was asked about possible pregnancy. Recommendation to see a doctor was observed in 36.1% of cases. When antibiotics were not sold, the explanation provided by the staff was reasoned only in 9.9% of the cases. ConclusionIt is necessary and urgent to improve the training of pharmacists in dispensing antibiotics but also strengthen basic health knowledge among the population.

Epidemiology of Streptococcus pneumoniae causing acute otitis media among children in Southern Catalonia throughout 2007–2013: Incidence, serotype distribution and vaccine's effectiveness

ObjectiveThis study investigated incidence and serotype distribution of Streptococcus pneumoniae causing acute otitis media (AOM) in Catalonian children, evaluating vaccination effectiveness in the current era of extended valency pneumococcal conjugate vaccines (PCVs). MethodsPopulation-based surveillance study that included all AOM cases with isolation of pneumococcus (from otic fluids/otorrea) identified among children ≤14 years in the region of Tarragona (Southern Catalonia, Spain) from 01/01/2007 to 31/12/2013. Prevalence of infections caused by serotypes covered by the different PCVs formulations were calculated for the periods before and after 30/06/2010 (date of PCV7/PCV13 replacement). The indirect cohort method was used to estimate PCV7/13 effectiveness against vaccine-type infections. ResultsA total of 78 children with a pneumococcal AOM were identified across study period, which meant an incidence rate of 23 cases per 100,000 population-year. Thirty-six cases (46.2%) occurred within the late PCV7 era and 42 cases (53.8%) during the early PCV13 era. Overall, the most common serotypes were type 19A (21.7%), type 3 (13.3%) and type 15B (6.7%). Prevalence of cases caused by serotypes included in PCV7 did not substantially change between the first and the second study period (from 10.3% to 12.9%), whereas prevalence of cases caused by PCV13 serotypes showed a decreasing trend between both periods (from 65.5% to 48.4%). The aggregate PCV7/13 effectiveness against vaccine-type infections was 72% (95% confidence interval: −26 to 94). ConclusionPneumococcal conjugate vaccination appears an acceptable preventive option to prevent pneumococcal AOM in infants. However, its serotype coverage and clinical effectiveness are not optimal.

A hierarchical multi-criteria sorting approach for recommender systems

Classification problems refer to the assignment of alternatives to predefined categories. In this work we focus on ordered classification, called sorting, in which the predefined categories indicate several degrees of interest or suitability of alternatives for a certain user. The assignment of alternatives is based on multiple conflicting criteria. This multi-criteria sorting approach is specially interesting for recommender systems aimed at finding the most suitable alternatives for each user. First, we study the ELECTRE-TRI-B sorting method, which follows the outranking approach based on comparing the evaluations of alternatives with the profile limits separating the categories. The complexity of some recommenders systems requires the extension of the classical ELECTRE-TRI-B method to manage a taxonomical organization of the set of criteria. In this paper we consider a set of criteria in the form of a hierarchy. The intermediate criteria in such a hierarchy correspond to different aspects of the recommendation procedure, such as content, context or cost. At each of these criteria, a sorting problem must be solved. Therefore, we propose extending ELECTRE-TRI-B to handle assignments of alternatives on several levels of the hierarchy. A hierarchical procedure for sorting is proposed, called ELECTRE-TRI-B-H. Secondly, the paper explains the integration of ELECTRE-TRI-B-H into a recommender system of touristic activities related to wine, called GoEno-Tur. This system is developed for the region of Tarragona, Catalonia (Spain), which is a well-recognized area of wine and cava production.

De la marca comercial a la marca de territorio. Los casos de la DOC Priorat y DO Montsant

Wine production and its origin values give territories a great opportunity of differentiation in a context of high competition among geographical spaces. In Catalonia, the county of Priorat and its identitary relationship with wine Protected Denomination Origin PDO Priorat and PDO Montsant has represented and example of local development and geographical positioning of this region of Tarragona. Therefore, this article aims to analyze the process of economical revitalization and identity projection of Priorat through both wine PDOs.

Incidencia y letalidad del ictus isquémico en la población mayor de 60 años del área de Tarragona, España (2008-2011)

Data available about the epidemiology of stroke is limited. This study investigated incidence and lethality of ischaemic stroke among the general population over 60 years in the region of Tarragona. Population-based cohort study that included 27,204 individuals >= 60 years assigned to nine Primary Care Centers in the Tarragones county (Catalonia, Spain), who were prospectively followed between December 1st, 2008 and November 30th, 2011. During follow-up, all episodes of ischaemic stroke were recruited among cohort members. Only confirmed ischaemic cases (confirmed by neuroimaging and validated alter checking hospital medical records) were included. An amount of 343 confirmed cases of ischaemic stroke were observed, which means a global incidence rate of 453 episodes per 100,000 persons/year (95% confidence interval = 408-504). Incidence was higher among men than in women (531 vs 392 per 100,000; p < 0.001) and increases substantially with increasing age (195 vs 517 vs 1,006 per 100,000 in 60-69 years, 70-79 years and >= 80 years, respectively; p < 0.001). Incidence was eight times greater among persons with history of prior ictus as compared with those without history of ictus (2,962 vs 340 per 100,000; p < 0.001). Overall lethality rate was 13%, reaching 21% among patients >= 80 years. Morbid-mortality by ischaemic ictus remains considerable among our population. Preventive measures and more efficacious therapies are imperative.

Evolution of the antipneumococcal vaccination coverage among children in the region of Tarragona, Spain, 2002-2011

In Catalonia, as in most Spanish regions, the conjugate pneumococcal vaccine is not publicly funded, except for immunocompromised or high-risk children. This study assessed current vaccine coverage in the region of Tarragona, analyzing trends in vaccine uptakes throughout the 2002-2011 period by analyzing uptakes by year of birth. Cross-sectional multicenter study that included all children <10 years attended between 01/12/2011 and 02/12/2011 in pediatric ambulatory visits in 9 Primary Care Centers in the region of Tarragona (N=521 children). Pneumococcal vaccine status was determined after clinical record review. Vaccine coverages were compared by chi-squared test. Among the total 521 children, 45.1% (95% confidence interval [CI]: 40.8-49.5) had received CPV. Vaccine coverages were 18.5% (95% CI: 9.3-31.4) for children born between 2002-2003, 38.6% (95% CI: 27.2-51.0) in 2004-2005, 62.5% (95% CI: 51.0-73.0) in 2006-2007, 50.8% (95% CI: 41.7-59.8) in 2008-2009 and 44.6% (95% CI: 36.8-51.3) in 2010-2011 (p<0.001). Vaccine coverage can be considered as intermediate/low. In our population, after a rapid initial increase, vaccination uptakes have decreased in the last 4 years, coinciding with the current economic crisis. In our population, after a rapid initial increase, vaccination uptakes have decreased in the last 4 years.

Incidence of pneumococcal infections among children under 15 years in southern Catalonia throughout the heptavalent conjugate vaccine era, 2002–2009

Updating epidemiological studies to document current incidences of pneumococcal diseases are greatly needed in the current era of new pneumococcal conjugate vaccines (PCVs). The aim of this study is to analyze the incidence and distribution of different serotypes causing pneumococcal infections among the pediatric population in southern Catalonia, Spain, throughout the 2002-2009 PCV7 eras. A population-based surveillance study was conducted among children aged ≤ 14 years in the region of Tarragona (Catalonia, Spain) during the period 2002-2009. All cases of pneumococcal infections (invasive and non-invasive cases) were included in the study. Incidence rates (per 100,000 population-year) and prevalence of infections caused by serotypes included in different PCV formulations were calculated for the 2002-2005 and 2006-2009 periods. Globally, across the total 2002-2009 period, the incidence of pneumococcal infections was 48.2 per 100,000 children-year (22.4 and 25.8 for invasive and non-invasive infections, respectively). Between 2002-2005 and 2006-2009, the incidence rates largely decreased among children aged <2 years (from 171 to 111 per 100,000 children-year; p = 0.059), but they did not substantially vary among children aged 2-14 years. The percentages of cases caused by serotypes included in PCV7 (60.0 vs. 16.7 %; p < 0.001), PCV10 (75.0 vs. 47.4 %; p = 0.028), and PCV13 (85.0 vs. 70.5 %; p = 0.190) decreased in both periods. In this study, which was conducted in a setting with intermediate PCV7 uptakes, a considerable protective direct effect of vaccination occurred among young infants, but an indirect protective effect did not emerge in the rest of the pediatric population. Despite new PCVs with higher serotype coverage, an important proportion of pneumococcal infections is still not covered by these vaccines.

SigTur/E-Destination: Ontology-based personalized recommendation of Tourism and Leisure Activities

SigTur/E-Destination is a Web-based system that provides personalized recommendations of touristic activities in the region of Tarragona. The activities are properly classified and labeled according to a specific ontology, which guides the reasoning process. The recommender takes into account many different kinds of data: demographic information, travel motivations, the actions of the user on the system, the ratings provided by the user, the opinions of users with similar demographic characteristics or similar tastes, etc. The system has been fully designed and implemented in the Science and Technology Park of Tourism and Leisure. The paper presents a numerical evaluation of the correlation between the recommendations and the user's motivations, and a qualitative evaluation performed by end users.

Comparison of three predictive rules for assessing severity in elderly patients with CAP

This study compares the ability of the Pneumonia Severity Index (PSI) and the British Thoracic Society CURB-65 and CRB-65 rules in predicting short-term mortality among elderly patients with community-acquired pneumonia (CAP). It is a population-based study including all people over 65 years old with a radiographically confirmed CAP in the region of Tarragona (Spain) between 2002 and 2008. Treatment setting and clinical variables were considered for each patient. PSI, CURB-65 and CRB-65 scores were calculated at the moment of diagnosis and 30-day mortality was considered as a main dependent variable. The rules were compared based on sensitivity, specificity and area under the receiver operating characteristic curve (AUC). Of the total 590 CAP cases, mortality rate was 13.6% (15.3% in hospitalised and 1.4% in outpatient cases; p = 0.001). Mortality increased with increasing PSI score (None in class II, 6,9% in class III, 14,4% in class IV and 29,5% in class V), CURB-65 score (7.5%, 14.5%, 26.7%, 53.3% and 100% for scores 1,2,3,4 and 5 respectively) and CRB-65 score (6.6%, 26.1%, 40.5% and 50% for scores 1,2,3 and 4 respectively). The three rules performed too similarly to predict 30-day mortality, with a ROC area of 0.727 [95% confidence interval (CI): 0.67-0.79] for the PSI, 0.672 (95% CI: 0.61-0.74) for the CURB-65, and 0.719 (95% CI: 0.65-0.78) for the CRB-65. Our data shows that the analysed rules perform equally well among elderly people with CAP which supports the recommendation for using the simplified CRB-65 severity score among elderly patients in primary care or emergency visits.

Invasive pneumococcal disease in Catalonian elderly people, 2002–2009: Serotype coverage for different anti-pneumococcal vaccine formulations at the beginning of the new conjugate vaccines era

Population-based surveillance study conducted among persons 65 years or older from the region of Tarragona (Southern Catalonia, Spain) during 2002–2009. All cases with isolation of pneumococcus from normally sterile bodily fluids were included. Incidence rates of invasive pneumococcal disease (IPD) and prevalence of infections caused by serotypes included in different pneumococcal conjugate vaccines (PCVs) and the 23-valent pneumococcal polysaccharide vaccine (PPV-23) were calculated. Overall, 176 IPD cases were observed, which means an incidence of 48 episodes per 100,000 person-year throughout the study period. The most dominant serotypes were 7F (10.1%), 14 (9.4%), 19A (9.4%), 3 (8.6%), 6A (7.9%) and 1 (7.2%). IPD cases due to PCV-7 types (from 37.2% to 14.6%; p=0.003) and PCV-10 types (from 60.5% to 32.3%; p=0.002) considerably decreased between 2002–2005 and 2006–2009 periods. Percentage of cases due to PCV-13 types (76.7% vs 62.5%; p=0.099) and PPV-23 types (81.4% vs 68.8%; p=0.122) did not significantly change between both periods. As main conclusion, in our setting, the PCV-13 has almost similar serotype coverage to the PPV-23 in preventing IPD among the elderly population, which suggests a possible future use of the conjugate vaccine in all age groups.

Utilidad de la escala CRB-65 en la evaluación pronóstica de los pacientes mayores de 65 años con neumonía adquirida en la comunidad

Background and objective The assessment of severity may be important to decide hospitalisation and type of treatment in community-acquired pneumonia (CAP) cases. This study evaluated the ability of the severity rule CRB-65 for the management of older adults with CAP. Patients and methods Population-based study including 473 patients 65 years or older with a radiographically confirmed CAP in the region of Tarragona (Spain). Treatment setting and clinical variables were considered for each patient, CRB-65 score (confusion, respiratory rate ≥30, systolic blood pressure <90 mmHg or diastolic ≤60 mmHg, age ≥65 years) was calculated at the time of diagnosis, and 30-day mortality was considered as a main dependent variable. Results Overall mortality rate was 12.7% (15.5% among hospitalised and 1.7% in outpatient cases). Mortality was directly associated with the CRB-65 score, being 6.8% in score 1 (2.4% among patients 65–74 years and 10.1% in patients 75 years or older; P=.005), 26.1% in score 2, 41.7% in score 3 and 66.7% in score 4. For a breakpoint of CRB-65 score ≥2, sensitivity was 60% (95% CI: 42–78) and specificity was 80% (95% CI: 76–84). Conclusions The CRB-65 has an acceptable ability to classify mortality risk in elderly patients with CAP. Patients with CRB-65=1 have a relatively small mortality rate , which suggests that they could be managed as outpatients.

Rationale and design of the CAPAMIS study: Effectiveness of pneumococcal vaccination against community-acquired pneumonia, acute myocardial infarction and stroke

BackgroundThe 23-valent polysaccharide pneumococcal vaccine (PPV-23) is recommended for elderly and high-risk people, although its effectiveness is controversial. Some studies have reported an increasing risk of acute vascular events among patients with pneumonia, and a recent case-control study has reported a reduction in the risk of myocardial infarction among patients vaccinated with PPV-23. Given that animal experiments have shown that pneumococcal vaccination reduces the extent of atherosclerotic lesions, it has been hypothesized that PPV-23 could protect against acute vascular events by an indirect effect preventing pneumonia or by a direct effect on oxidized low-density lipoproteins. The main objective of this study is to evaluate the clinical effectiveness of PPV-23 in reducing the risk of pneumonia and acute vascular events (related or nonrelated with prior pneumonia) in the general population over 60 years.Methods/DesignCohort study including 27,000 individuals 60 years or older assigned to nine Primary Care Centers in the region of Tarragona, Spain. According to the reception of PPV-23 before the start of the study, the study population will be divided into vaccinated and nonvaccinated groups, which will be followed during a consecutive 30-month period. Primary Care and Hospitals discharge databases will initially be used to identify study events (community-acquired pneumonia, hospitalisation for acute myocardial infarction and stroke), but all cases will be further validated by checking clinical records. Multivariable Cox regression analyses estimating hazard ratios (adjusted for age, sex and comorbidities) will be used to estimate vaccine effectiveness.DiscussionThe results of the study will contribute to clarify the controversial effect of the PPV-23 in preventing community-acquired pneumonia and they will be critical in determining the posible role of pneumococcal vaccination in cardiovascular prevention.

Drug-resistance in Streptococcus pneumoniae isolates among Spanish middle aged and older adults with community-acquired pneumonia

BackgroundPneumococcal diseases remain a major cause of morbidity and mortality worldwide. Updated data on drug-resistance from different populations may be important to recognize changes in disease patterns. This study assessed current levels of penicilin resistance among Streptococcus Pneumoniae causing pneumonia in Spanish middle age and older adults.MethodsAntimicrobial susceptibility was tested for 104 consecutive isolates of Streptococcus pneumoniae recovered from patients 50 years or older with radiographically confirmed pneumonia in the region of Tarragona (Spain) between 2002 and 2007. According to the minimum inhibitory concentration of tested antimicrobials (penicillin, erythromycin, cefotaxime and levofloxacin) strains were classified as susceptible or resistant. Antimicrobial resistance was determined for early cases (2002–2004) and contemporary cases (2005–2007).ResultsTwenty-seven (25.9%) were penicillin-resistant strains (19 strains with intermediate resistance and 8 strains with high resistance). Penicillin-resistance was higher in 2002–2004 than in 2005–2007 (39.5% vs 18.2%, p = 0.017).Of 27 penicillin-resistant strains, 10 (37%) were resistant to erythromycin, 8 (29.6%) to cefotaxime, 2 (7.4%) to levofloxacin, and 4 (14.8%) were identified as multidrug resistant. Case-fatality rate was higher among those patients who had an infection caused by any penicillin susceptible strain (16.9%) than in those with infections due to penicillin-resistant strains.ConclusionResistance to penicillin among Streptococcus pneumoniae remains high, but such resistance does not result in increased mortality in patients with pneumococcal pneumonia.

Pressurised liquid extraction of polycyclic aromatic hydrocarbons from gas and particulate phases of atmospheric samples

Pressurised liquid extraction (PLE) was applied to determine the atmospheric levels of 16 polycyclic aromatic hydrocarbons (PAHs) in the gas and particulate phases. The method involved high-volume air sampling with quartz fibre filters (QFFs) and polyurethane foam (PUF) plugs and analytes were subsequently extracted from the samples by PLE, and determined with GC-MS. We optimised the PLE conditions for the solvent, the number of cycles and extraction temperature. Recoveries were higher than 90% for most compounds. Method LODs and LOQs were between 0.001 and 0.02 ng/m(3) and between 0.01 and 0.05 ng/m(3). Air samples were taken from a site in the region of Tarragona in Catalonia, Spain, where one of the largest petrochemical complexes in southern Europe is located. The total concentration of PAHs were from 6.7 to 27.66 ng/m(3), with predominant levels of PAHs appearing in the gas phase (48-81%), and an average level of benzo[a]pyrene, the most carcinogenic PAH, of 0.86 ng/m(3).

Epidemiology of community-acquired pneumonia in older adults: A population-based study

This study assessed incidence, aetiology, clinical outcomes and risk factors for community-acquired pneumonia (CAP) in older adults. This was a population-based cohort study that included 11,241 community-dwelling individuals aged 65 years or more, who were followed between 2002 and 2005 in the region of Tarragona, Spain. Primary endpoints were all-cause CAP (hospitalised and outpatient) and 30-day mortality after the diagnosis. All cases were radiographically proved and validated by checking clinical records. Incidence rate of overall CAP was 14 cases per 1000 person-years (10.5 and 3.5 for hospitalised and outpatient cases, respectively). Incidence was almost three-fold higher among immunocompromised patients (30.9 per 1000) than among immunocompetent subjects (11.6 per 1000). Maximum incidences were observed among patients with chronic lung disease and long-term corticosteroid therapy (46.5 and 40.1 cases per 1000 person-years, respectively). Overall 30-day case-fatality rate was 12.7% (2% in cases managed as outpatient and 15% in hospitalised patients). Among 358 patients with an aetiological work-up, a total of 142 pathogens were found (single pathogen in 121 cases and mixed pathogens in 10 cases). Streptococcus pneumoniae was the most common pathogen (49%), followed by Pseudomonas aeruginosa (15%), Chlamydia pneumoniae (9%) and Haemophilus influenzae (6%). In multivariable analysis, the variables most strongly associated with increasing risk of CAP were history of hospitalisation for CAP in the previous 2 years and presence of any chronic lung disease. CAP remains a major cause of morbidity and mortality in older adults. Incidence rates in this study largely doubled prior rates reported in Southern European regions.

Further naturalised Cactaceae in northeastern Iberian Peninsula

During the floristic work carried out in 2004 in the Baix Camp region of Tarragona (NE Spain) we found four new species of alien naturalised Cactaceae. Of these, three are reported for the second time from Europe and the other is new to Catalonia region. Southern Catalonia, with eleven species of Cactaceae, harbours the highest diversity of the family in Europe. Our results demonstrate that this diversity is even higher than previously believed. The introduction of these exotic taxa is, once again, due to the development of gardening based exclusively on foreign elements, to the unscrupulous and uncontrolled dumping of their remains in the natural environment, and to the existence of a favourable climate.

Integración, Etnicidad y Acción educativa

In this article we present the results of a study carried out in primary and infant schools in the region of Tarragona. In this study we analysed the development of the relationship between the autochthonous and the non-EU immigrant populations within the framework of education action. We also observed the practices carried out by teachers and schools for tackling any problems due to the effects of immigration. The study combined quantitative techniques (577 questionnaires completed by primary and infant teachers) and qualitative techniques (118 in-depth interviews with the head teachers of all the schools with non-EU immigrant pupils and various discussion groups in which teachers and immigrant and autochthonous parents all took part).