Valencia Region Of Spain Research Articles

Enterovirus D68 disease burden and epidemiology in hospital-admitted influenza-like illness, Valencia region of Spain, 2014-2020 influenza seasons.

Enterovirus D68 (EV-D68) is an emerging agent for which data on the susceptible adult population is scarce. We performed a 6-year analysis of respiratory samples from influenza-like illness (ILI) admitted during 2014-2020 in 4-10 hospitals in the Valencia Region, Spain. EV-D68 was identified in 68 (3.1%) among 2210 Enterovirus (EV)/Rhinovirus (HRV) positive samples. Phylogeny of 59 VP1 sequences showed isolates from 2014 clustering in B2 (6/12), B1 (5/12), and A2/D1 (1/12) subclades; those from 2015 (n = 1) and 2016 (n = 1) in B3 and A2/D1, respectively; and isolates from 2018 in A2/D3 (42/45), and B3 (3/45). B1 and B2 viruses were mainly detected in children (80% and 67%, respectively); B3 were equally distributed between children and adults; whereas A2/D1 and A2/D3 were observed only in adults. B3 viruses showed up to 16 amino acid changes at predicted antigenic sites. In conclusion, two EV-D68 epidemics linked to ILI hospitalized cases occurred in the Valencia Region in 2014 and 2018, with three fatal outcomes and one ICU admission. A2/D3 strains from 2018 were associated with severe respiratory infection in adults. Because of the significant impact of non-polio enteroviruses in ILI and the potential neurotropism, year-round surveillance in respiratory samples should be pursued.

Imaginaries and the Commons: Insights From Irrigation Modernization in Valencia, Spain

In this article we introduce the notion of imaginaries as a conceptual entry to study and better understand how and why commons re-create and transform. We do so by first exploring imaginaries as assemblages, and second by analytically dividing imaginaries in dominant and alternative imaginaries. While the former refer to how people imagine and live their social existence around built expectations and their underlying notions, the latter refers to imaginaries that critique instituted society and through it create ‘germs’ that can lead to transformation. Through this lens we analyze contestations that have emerged around the introduction of drip irrigation in two irrigation communities in the Valencia Region of Spain. These two case studies (Carcaixent and Potries) show how, among the commons, alternative imaginaries are challenging the dominant imaginaries of drip irrigation. We show how these alternative imaginaries result from a different way of assembling irrigation and the social, cultural, material, and economic relations around it. These insights, we argue, open up avenues that allow us to better understand the imaginary creations that reproduce a specific existing order, as well as the germ(s) that can lead to transformations and change.

From entrepreneurial and innovation ecosystems to the social economy ecosystem

Despite the broad academic and political interest aroused by the ecosystem concept, little scientific attention has been paid to its social dimension and especially to the social economy enterprises ecosystems. This paper aims to conceptualize the latter by establishing its defining features and its goals, and to provide empirical evidence from two worldwide known social economy ecosystems, one in the Valencia region of Spain and the other in the Emilia Romagna region of Italy. The results show that the balance between the economic objectives and the creation of social value and social innovation, collective social entrepreneurship and specific institutional components are key features of social economy ecosystems. The proactive role of the axiological, cognitive and institutional elements of these ecosystems, embedded in knowledge and culture, enable, when properly applied to an operational sphere, the achievement of social value and the start-up and scaling up of the social economy model.

Feasibility of a hybrid clinical trial for respiratory virus detection in toddlers during the influenza season

BackgroundTraditional clinical trials are conducted at investigator sites. Participants must visit healthcare facilities several times for the trial procedures. Decentralized clinical trials offer an interesting alternative. They use telemedicine and other technological solutions (apps, monitoring devices or web platforms) to decrease the number of visits to study sites, minimise the impact on daily routine, and decrease geographical barriers for participants. Not much information is available on the use of decentralization in randomized clinical trials with vaccines.MethodsA hybrid clinical trial may be assisted by parental recording of symptoms using electronic log diaries in combination with home collected nasal swabs. During two influenza seasons, children aged 12 to 35 months with a history of recurrent acute respiratory infections were recruited in 12 primary health centers of the Valencia Region in Spain. Parents completed a symptom diary through an ad hoc mobile app that subsequently assessed whether it was an acute respiratory infection and requested collection of a nasal swab. Feasibility was measured using the percentage of returned electronic diaries and the validity of nasal swabs collected during the influenza season. Respiratory viruses were detected by real-time PCR.ResultsNinety-nine toddlers were enrolled. Parents completed 10,476 electronic diaries out of the 10,804 requested (97%). The mobile app detected 188 potential acute respiratory infections (ARIs) and requested a nasal swab. In 173 (92%) ARI episodes a swab was taken. 165 (95.4%) of these swabs were collected at home and 144 (87.3%) of them were considered valid for laboratory testing. Overall, 152 (81%) of the ARIs detected in the study had its corresponding valid sample collected.ConclusionsHybrid procedures used in this clinical trial with the influenza vaccine in toddlers were considered adequate, as we diagnosed most of the ARI cases on time, and had a valid swab in 81% of the cases. Hybrid clinical trials improve participant adherence to the study procedures and could improve recruitment and quality of life of the participants and the research team by decreasing the number of visits to the investigator site.This report emphasises that the conduct of hybrid CTs is a valid alternative to traditional CTs with vaccines. This hybrid CT achieved high adherence of participant to the study procedures.Trial registration2019–001186-33 (EudraCT).

Retrospective screening for SARS-CoV-2 among influenza-like illness hospitalizations: 2018-2019 and 2019-2020 seasons, Valencia region, Spain.

On 9 March 2020, the World Health Organization (WHO) Global Influenza Programme (GIP) asked participant sites on the Global Influenza Hospital Surveillance Network (GIHSN) to contribute to data collection concerning severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). We re‐analysed 5833 viral RNA archived samples collected prospectively from hospital admissions for influenza‐like illness (ILI) in the Valencia Region of Spain by the Valencia Hospital Surveillance Network for the Study of Influenza and Other Respiratory Viruses (VAHNSI) network (four hospitals, catchment area population 1 118 732) during the pre‐pandemic 2018/2019 (n = 4010) and pandemic 2019/2020 (n = 1823) influenza seasons for the presence of SARS‐CoV‐2. We did not find evidence for community‐acquired SARS‐CoV‐2 infection in hospital admissions for ILI in our region before early March 2020.

Industry 4.0 in industrial districts: regional innovation policy for the Toy Valley district in Spain

ABSTRACT This study is focused on how Industry 4.0 is diffused within a Marshallian industrial district (MID) through collective action. It explains how MIDs adopt Industry 4.0 through collective initiatives for digitization, bypassing many barriers to change through the utilization of a collective project built upon a key feature of MIDs: cooperation. Results from interviews show a real living lab built upon a place-based bottom-up-oriented policy initiative co-designed by policymakers, collective actors and local firms, aimed at facilitating transition into Industry 4.0 in the Toy Valley district in the Valencia region of Spain. The results contribute to the emergent literature on district digitization.

Cut-Off Lows and Extreme Precipitation in Eastern Spain: Current and Future Climate

This study presents a seasonal synoptic climatology of cut-off lows (COLs) that produced extreme precipitation in the Valencia region of Spain during 1998–2018 and uses simulations with the Weather Research and Forecasting (WRF) model to study how extreme COL precipitation may change in a future warmer climate. COLs were shown to be the main producer of extreme precipitation in the Valencia region, especially during the transition seasons. The strongest raining COL events occurred during September–November. Six-day composites of thermodynamic and dynamic fields and precipitation show that COLs that produce extreme precipitation in this region remain stationary over Spain for 2–3 days and tend to produce precipitation over the Valencia region for at least two consecutive days. In the low levels these COLs are characterized by low pressure over the Mediterranean sea and winds with an easterly, onshore component thus fueling precipitation. Comparison of current and future climate ensembles of WRF simulations of 14 September–November extreme precipitation producing COL events suggest that in a warmer climate extreme COL precipitation may increase by as much as 88% in northeastern Spain and 61% in the adjoining Mediterranean Sea. These projected increases in extreme COL precipitation in the northeast of Spain present additional challenges to a region where COL flooding already has significant socio-economic impacts. Additionally, about half of the future climate COL event simulations showed increases in precipitation in the Valencian region of eastern Spain. These results provide important nuance to projections of a decreasing trend of total precipitation in the Iberian Peninsula as the climate warms.

Mechanical Thinning of Mandarins with a Branch Shaker

Thinning is the process of removing some flowers or fruit to increase fruit size at harvest. In the Valencia region of Spain, the thinning operation for citrus fruit (Citreae) is performed for some mandarin varieties. This is always performed manually; however, this method is very expensive. The goal of this research study was to assess the mechanical thinning of mandarin (Citrus reticulata) using a hand-held branch shaker. Different thinning treatments were conducted over a 3-year period. The gasoline-powered branch shaker was capable of detaching fruit four- to five-times faster than manual thinning. Final fruit size was significantly higher using manual and mechanical thinning compared with a no thinning treatment. Similar final fruit size was obtained with manual and mechanical thinning. However, no significant differences were found in final fruit yield by weight among no thinning, mechanical thinning, and manual thinning treatments. The use of a branch shaker could be recommended for thinning operations to increase efficiency, reduce labor costs, and obtain larger and higher-quality fruit.

Green Public Procurement at a Regional Level. Case Study: The Valencia Region of Spain.

Research on current practices and the state of green public procurement enables the identification of areas that can be improved, as well as opportunities to improve the tendering procedures from an environmental point of view. To understand the behaviour of local, provincial, and regional administrations concerning green public procurement, a case study on the Valencia region of Spain is made. The Valencian region is one of the most important communities in terms of population, number of contracting authorities, and weight in the Spanish Gross Domestic Product. In this study, a total of 967 procedures were analysed from calls for tenders made by municipal, provincial, and regional administrations in2016 and 2017.The results of this study show that the use of environmental criteria is 19.7% and the average weight is 4.1 out of 100. The civil engineering subsector, more than the building subsector, employs environmental criteria, particularly in projects tendered by regional administrations, whereas for projects with large budgets the level of use is similar for both subsectors. It is necessary to encourage plans to improve Green Public Procurement (GPP) practices in the Valencian administrations, especially those with a local scope such as municipalities.

The typological classification of tourist destinations: The region of Valencia, a case study

This study establishes a classification of the tourist destinations of the Region of Valencia in Spain. A cluster analysis has been conducted on a wide range of indicators related to the tourism activity of the destinations, which has then been applied a set of 60 coastal destinations and 482 inland municipalities in the region. Spatial reference frameworks are essential for applying and developing tourism planning and promotion policies. The results obtained reveal their sensitivity to the configurations generated by these data analysis techniques, the variables used in the analysis and the group of destinations taken as a reference for the classification. They also confirm the exceptionality of the case of Benidorm and the existence of tourism dynamics and processes that are manifested unequally across the territory. The latest advances within this technique are applied which will improve the robustness of the results.

Pulmonary Versus Extrapulmonary Tuberculosis Associated Factors: A Case-Case Study.

Background:Tuberculosis (TB) incidence remains low in health departments of Castellon and La Plana-Vila-real, but TB elimination is challenging. The objective of this study was to estimate associated factors of pulmonary tuberculosis (PTB) compared with extrapulmonary tuberculosis (ETB) and investigate epidemiological characteristics of these pathologies to orient control and prevention actions.Materials and Methods:A prospective case-case study was implemented by comparing PTB and ETB incidences during 2013-2016 from notification reports, epidemiological surveillance, and microbiological results of hospitals’ laboratories Hospital General Castellon and La Plana-Vila-Real in the province of Castellon of Valencia region in Spain. In this design, cases were patients with PTB and controls were patients with ETB. Directed acyclic graph approach was used for selection of potential risk and confounding factors. Adjusted odds ratios (AORs) were estimated by logistic regression models.Results:The study included 136 patients with PTB and 57 patients with ETB, with microbiological confirmation of 93.4% and 52.6%, and the annual median of incidence rates were 7.5 and 3.1 per 100 000 inhabitants, respectively. In general, patients with PTB were younger with higher male proportion than patients with ETB. Risk factors of PTB were smoking tobacco (AOR = 3.98; 95% confidence interval [CI] = 1.66-9.56), social problems (social marginalization, homeless, residence in shelters for the poor, or stay in prison) (AOR = 3.39; 95% CI = 1.05-10.94), and contact with patients with TB (AOR = 2.51; 95% CI = 1.06-5.95). No-smoking tobacco and no-drug abuse interaction decrease PTB risk (AOR = 0.27; 95% CI = 0.12-0.64). From these results, specific measures of health promotion and prevention can be addressed.Conclusions:The estimated associated factors of PTB may be prevented, and it was demonstrated that the case-case design is useful in the study of TB.

Coffee Drinking and Associated Factors in an Elderly Population in Spain

Coffee consumption is highly prevalent worldwide, and many studies have reported positive and inverse associations of coffee with many diseases. However, factors associated with coffee consumption remain poorly characterized in some populations, such as the elderly. This study aimed to assess the factors associated with total, caffeinated and decaffeinated coffee consumption in an elderly population in Spain. Data were analyzed from 903 participants, aged 65 years and above, from two population-based studies carried out in the Valencia region in Spain (Valencia Nutritional Survey (VNS) and European Eye Study (EUREYE-Study). Total, caffeinated and decaffeinated coffee consumption was assessed through two specific questions using a validated food frequency questionnaire. Information on personal characteristics, anthropometry and lifestyles was collected in personal interviews. Multinomial logistic regression analysis was used to estimate the adjusted relative risk ratios (RRR) and confidence intervals (95% CI). The prevalence of total, caffeinated and decaffeinated coffee consumption was 70%, 38% and 32%, respectively. The consumption of caffeinated coffee was positively associated with: Educational level, RRR = 1.63 (1.09–2.44); body mass index (≥30), RRR = 2.03 (1.05–3.95); tobacco smoking, RRR = 1.96 (1.13–3.39); alcohol intake [≥12 g/day category intake vs. no-alcohol intake, RRR = 6.25 (3.56–10.95)]; and energy intake (p < 0.05). Consumption of caffeinated coffee was negatively associated with: Age (≥75 years), RRR = 0.64 (0.43–0.94); and pre-existing hypertension, RRR = 0.67 (0.45–0.98). The consumption of decaffeinated coffee was positively associated with: Alcohol intake, RRR = 2.63 (1.19–4.64); pre-existing diabetes, RRR = 1.67 (1.06–2.62); and energy intake (p < 0.01). The consumption of coffee is high among elderly people in Spain. It is a novelty in this study with elderly population that tobacco smoking and alcohol drinking were the two main factors associated with higher coffee consumption. Self-reported hypertension was associated with a lower consumption of caffeinated coffee, and pre-existing diabetes was associated with a higher consumption of decaffeinated coffee. These associations should be taken into account when the health effects of coffee consumption are investigated.

Primary Nonadherence to Oral Anticoagulants in Patients with Atrial Fibrillation: Real-World Data from a Population-Based Cohort.

Primary nonadherence (not filling a first prescription) is an important yet unstudied aspect of adherence to oral anticoagulant (OAC) therapy. To estimate the rates of primary nonadherence to OACs and determine associated factors in real-world practice. This population-based retrospective cohort study set in the Valencia region of Spain (about 5 million inhabitants) included all patients with atrial fibrillation who were newly prescribed OACs during 2011-2014 (N = 18,715). Primary nonadherence was obtained by linking electronic prescription and dispensing data and assessed by type of OAC-vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs). Covariates were obtained from diverse databases, including electronic medical records. Multivariate logistic regression models were used to assess characteristics associated with primary nonadherence, adjusting for a propensity score to minimize confounding by indication. Primary nonadherence to OACs was 5.62% (VKA 4.29% vs. NOAC 10.81%; P < 0.001), with varying rates among specific drugs (acenocoumarol 4.2%, warfarin 10.9%, apixaban 5.0%, dabigatran 7.9%, and rivaroxaban 15.5%). After adjusting for potential confounders, the likelihood of not filling the first prescription was higher for NOAC patients than for VKA patients (OR = 2.76, 95% CI = 2.41-3.15). High coinsurance in the older groups (OR = 2.63, 95% CI = 1.47-4.69 for patients aged 66-75 years and OR = 3.02, 95% CI = 1.58-5.76 for patients aged > 75 years); being a non-Spanish European (OR = 1.49, 95% CI = 1.12-1.99); and having dementia (OR = 1.72, 95% CI = 1.37-2.16) were positively associated with primary nonadherence. Electronic transmission of prescriptions (OR = 0.85, 95% CI = 0.74-0.96); liver disease (OR = 0.73, 95% CI = 0.54-0.99); and polypharmacy (OR = 0.59, 95% CI = 0.50-0.70) were inversely associated with primary nonadherence. Overall, primary nonadherence to OACs was relatively low (5%). However, important differences were found between VKAs and NOACs. After adjustment, patients prescribed NOACs nearly tripled the likelihood of nonadherence compared with patients prescribed VKAs, which could negatively affect their effectiveness in clinical practice. Identified correlates were similar to those shown in the limited evidence for other medications. This work was partially supported by the 2013 Collaboration Agreement between the Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO) from the Valencia Ministry of Health and Boehringer Ingelheim, a nonconditioned program to conduct independent research in chronic health care, pharmacoepidemiology, and medical practice variation. Rodriguez-Bernal was funded by the Instituto de Salud Carlos III, Spanish Ministry of Health, and cofinanced by the European Regional Development Fund (grant number RD12/0001/0005). The views presented here are those of the authors and not necessarily those of the FISABIO Foundation, the Valencia Ministry of Health, or the study sponsors. The funding sources had no access to study data and did not participate in any way in the design or conduct of the study, data analysis, decisions regarding the dissemination of findings, the development of the manuscript, or its publication. Peiró has received fees for participation in scientific meetings and courses sponsored by Novartis and Ferrer International. In 2014, Sanfélix-Gimeno participated in an advisory meeting of Boehringer Ingelheim. García-Sempere is a former employee of Boehringer Ingelheim. Rodriguez-Bernal and Hurtado have no relationships relevant to the contents of this article to disclose. This work was previously submitted as an abstract (podium presentation) at the 31st International Society of Pharmacoepidemiology (ISPE) Annual Conference; August 22-26, 2015; Boston, Massachusetts.

Scientific collaboration: new challenges for university libraries

The aim of this poster is to present the challenges of scientific collaboration and how university libraries can contribute to solve them. Survey responses from 3070 researchers (N=11090) of the main universities of the Valencia region in Spain, were analyzed. 76,35% of the professors of Valencia Region universities in Spain, participated in collaborative research in 2015-2016; from this group, 94.34% value collaboration as critical or essential. University Libraries should engage with and promote: • The development and dissemination of information services (provide technical resources, multipurpose database [funding, impact, researchers, teams or institutions] and provide physical meeting spaces and events). • Expansion of services (provide support and access, conduct training activities, and develop systems for evaluating the cooperative work and activities of research groups/research teams). • Specialized services provided within research teams (librarians embedded in research teams, and participating in writing and reviewing manuscripts).

A Multilevel Analysis of Real-World Variations in Oral Anticoagulation Initiation for Atrial Fibrillation in Valencia, a European Region.

Introduction: Beyond clinical trials, clinical practice guidelines, and administrative regulation, treatment decision-making can be influenced by individual and contextual factors. Our goal was to describe variations in the patterns of initiation of anticoagulation therapy in patients with atrial fibrillation by Health Areas (HA) in the region of Valencia in Spain and to quantify the influence of the HAs on variations in treatment choice.Methods: We conducted a population-based retrospective cohort study of all atrial fibrillation patients who started treatment with oral anticoagulants between November 2011 and February 2014 in each of the region's 24 HAs. We described patient and utilization characteristics per HA and initiation patterns over time, and we identified contextual and individual factors associated with differences in initiation patterns.Results: 21,879 patients initiated treatment with an oral anticoagulant in the 24 HAs. Initiation with direct oral anticoagulants (DOAC) in the first year was 14.6%. In November 2013 the ratio was 25.4%, with HA ratios ranging from 3.8 to 57.1%. DOAC-initiating patients had less comorbidity but were more likely to present episodes of previous ischemic stroke, hemorrhagic stroke, or TIA when compared with patients initiating with VKA treatment. Variability among HAs was statistically significant, with the majority of HAs ranking above or below the regional initiation average (ICC ≈ 8%).Conclusion: There was high variability in the percentage of DOAC initiation and in the choice of DOAC among HAs. Interventions aimed to improve DOAC initiation decision-making and to reduce variations should take into account the Health Area component.

Model-Assisted Estimation of Small Area Poverty Measures: An Application within the Valencia Region in Spain

This paper introduces small area estimators of poverty indexes, with special attention to the poverty rate (or Head Count Index), and studies the sampling design consistency and the asymptotic normality of these estimators. The estimators are assisted by nested error regression models and are model-assisted counterparts of model-based empirical best predictors. Simulation studies show that these estimators present a good balance between sampling bias and mean squared error. Data from the 2013 Spanish living conditions survey with respect to the region of Valencia are used to determine the performance of this new method for estimating the poverty rate.

The decline of autochthonous leprosy in the Valencia Region of Spain: patterns and trends 1940–2015

Objectives: The aim of this study was to describe the patterns and trends of autochthonous leprosy in the Valencia Region (Spain). Methods: We included all new leprosy cases originating from the Valencia Region between the years 1940 and 2015. Patients originating from other countries or other Spanish regions were excluded. New cases were analysed by age, sex, clinical type, occupation, and geographic distribution. Results: A total of 442 patients with presumably autochthonous leprosy were included. Incidence rates consistently declined over the study period. Mean age at onset gradually increased from 34.2 years during the period 1940-1949 to 59.5 years during 2000-2015. There were no cases with clinical onset after 2006 and no cases born after 1973. Patients were predominantly males (57.7%) and 85.4% had multibacillary leprosy. The proportion of multibacillary cases increased gradually after 1970. The majority of male patients (67.9%) worked in agriculture. Most of the cases, especially during the later periods, were concentrated in the coastal regions. Conclusions: Our findings are consistent with trends described in other regions with declining leprosy incidence rates and suggest that the transmission of M. leprae infection in this area may well have now stopped. Autochthonous leprosy in this region has had a male predominance and a high proportion of multibacillary cases. The geographic distribution and the high incidence in agricultural workers suggest that environmental factors should be further explored.

Productivity of wastewater treatment plants in the Valencia Region of Spain

This study analyses the evolution of productivity over the 2008–2012 period for a homogenous set of 199 wastewater treatment plants that are located in the Valencia Region of Spain and utilize the same treatment technology, using the smoothed bootstrap Malmquist productivity index based on Data Envelopment Analysis (DEA). The results reveal a negative trend in productivity that is mainly the result of resource management rather than an inappropriate level of innovation or use of new technologies. In addition, the effect of exogenous factors on productivity is analysed using the Kruskal-Wallis (KW) test, finding that productivity levels were affected by the quality of the influent water and the size of the plants, but not by the other factors considered.

Earliest Evidence of Neolithic Collective Burials from Eastern Iberia: Radiocarbon Dating at the Archaeological Site of Les Llometes (Alicante, Spain)

AbstractIn the Valencia region of Spain, the dominant use of natural caves for collective burials during the Late Neolithic and Chalcolithic periods has been documented. Collective burials are central to the hypothesis about social relationships in Copper Age societies from Iberia, and key to interpreting kinship-based societies. Les Llometes (Alcoi, Alicante) is one of the biggest collective burial sites existing in eastern Iberia. This article presents the direct14C dates on 25 skeletal remains at the site. The results indicate that the site was used as a burial place from the end of the 5th millennium cal BC until the end of the 4th millennium cal BC, and is a first milestone for future studies that will shed light on the transition towards social structure through the use of a cemetery space. Moreover, this research is one of the few investigations of Late Neolithic collective burials in Iberia that comprises an extensive accelerator mass spectrometry (AMS)14C data set of almost all the individuals reported at a single site. This case also serves to highlight the utility of revisiting materials from historic excavations by14C dating all the skeletal remains that define the minimum number of individuals, and therefore ensuring a more complete picture of the prehistoric human record.

Lagged effects of the Mistral wind on heavy precipitation through ocean-atmosphere coupling in the region of Valencia (Spain)

The region of Valencia in Spain has historically been affected by heavy precipitation events (HPEs). These HPEs are known to be modulated by the sea surface temperature (SST) of the Balearic Sea. Using an atmosphere-ocean regional climate model, we show that more than 70 % of the HPEs in the region of Valencia present a SST cooling larger than the monthly trend in the Northwestern Mediterranean before the HPEs. This is linked to the breaking of a Rossby wave preceding the HPEs: a ridge-trough pattern at mid-levels centered over western France associated with a low-level depression in the Gulf of Genoa precedes the generation of a cut-off low over southern Spain with a surface depression over the Alboran Sea in the lee of the Atlas. This latter situation is favourable to the advection of warm and moist air towards the Mediterranean Spanish coast, possibly leading to HPEs. The depression in the Gulf of Genoa generates intense northerly (Mistral) to north-westerly (Tramontane/Cierzo) winds. In most cases, these intense winds trigger entrainment at the bottom of the oce-anic mixed layer which is a mechanism explaining part of the SST cooling in most cases. Our study suggests that the SST cooling due to this strong wind regime then persists until the HPEs and reduces the precipitation intensity.