Valencian Community Research Articles

Non-destructive characterisation of dolerite archaeological artefacts

A methodological proposal for the characterisation of dolerite rock aiming to test a non-destructive and non-invasive analytical approach has been developed. Geological samples were collected from several natural outcrops and studied together with seven archaeological stone tools found in a Chalcolithic site of the southern Valencian Community (Spain). The samples were analysed employing portable energy dispersive X-ray fluorescence spectroscopy, Raman microspectroscopy and Fourier transform near infrared spectroscopy. The obtained data were statistically processed in order to evaluate affinities and differences among the geological outcrops and to evaluate the possible provenance of the stone tools. The results of the different techniques were compared and evaluated. The three techniques showed results that were in most of the cases consistent one with each other, suggesting that combining multielement analysis and Raman could be a good way to identify stone tools raw material procurement, being the prior step for the reconstruction of ancient exchange networks.

HIV screening and linkage to care in a health department in Valencia, Spain: Lessons learned from a healthcare quality improvement project.

Spain’s rate of new human immunodeficiency virus (HIV) diagnoses exceeds that of the European Economic Area average (8.6 vs 5.6:100,000 in 2018). The country has failed to meet the first of United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets for HIV control by 2020, with 87.0% of people living with HIV knowing their status, and late presentation rates of 47.6% and 51.5% country-wide and in the Valencian autonomous community, respectively. Advancing screening and linkage to care (SLTC) practices is necessary to effectively control the epidemic. The Valencia Viral Screening (CRIVALVIR) project adopted the TEST model for opportunistic and systematic HIV SLTC in individuals aged 18 to 80 who required blood work for any purpose, as of February 2019. SLTC was integrated into routine clinical workflow across primary care centers serving a population of 360,000 people in Valencia, Spain. Our project successfully upscaled total HIV testing by 194% to over 32,000 patients tested in 14 months. We found an overall prevalence of 0.13% (0.08–0.21) among those screened per protocol (n = 13,061), with foreign-born citizens presenting a 12.5 times significantly higher likelihood of acquiring HIV (95% confidence interval 4.63–33.96, P < .0001). We improved late presentation by 18.2 percentage points and prevented an estimated 58 to 70 new secondary infections. HIV screening of the general population in primary care is an effective strategy for achieving timely diagnosis and preventing new infections. Opportunistic, systematic, opt-out approaches are essential to control the HIV epidemic.

Health Determinants Associated with the Mediterranean Diet: A Cross-Sectional Study.

Introduction: The Mediterranean diet (MD) has been shown to be a good tool for the prevention of obesity and other chronic noncommunicable diseases (NCDs) and to have a low environmental impact. The aim of the present study was to evaluate the relationship between declared morbidity, lifestyles and other sociodemographic factors with high adherence to the MD (AMD) in an adult population in southeastern Spain. Material and Methods: We conducted a cross-sectional study of a sample (n = 2728) representative of a non-institutionalized population ≥16 years. The data corresponded to the 2010-11 Nutrition Survey of the Valencian Community. The AMD was assessed using the Mediterranean Diet Adherence Screener questionnaire. The association of variables and high AMD was assessed by univariate and multivariate logistic regression determining crude and adjusted odds ratios. Results: Multivariate analysis showed that age 45 years or older, living with a partner, eating between meals, and not smoking were associated with high AMD. The age groups 45–64 years and 65 years or older showed the strongest association with high AMD in both sexes. Conclusion: The investigation showed a generational loss of AMD. People older than 45 years and living in company are more likely to adhere to DM, the risk group being young people living alone and smokers.

Knowledge of legal dentistry and of health regulations by the dentists and stomatologists of the Valencian Community

ObjectivesThe main objective of this study is to analyze the knowledge of the dentists and stomatologists registered in Alicante, Castellón, and Valencia, the 3 provinces that make up the Valencian Community, in Spain, with regard to legal dentistry and the current health legislation and regulations, and to quantify the relationship between level of training, specialization, work experience, position, and workplace with the degree of knowledge. Material and methodsAn anonymous survey was designed and validated, consisting of 33 multiple-choice questions. The survey included questions regarding their professional profile and key questions regarding current dental law, forensic science, and expertise. ResultsThe level of knowledge is moderate, with only 63% of the questions answered correctly. Neither their level of training nor work experience correlates significantly with their degree of knowledge. Dentists specialized in General and Aesthetics Dentistry were found to be more knowledgeable about ethical issues. Regarding the workplace, those working as university teachers tended to stand out from the other professionals in terms of legal and ethical knowledge whilst self-employed and employee dentists show a lower level of knowledge than the rest of the sample. ConclusionsThe conclusions obtained from this study highlight the need for dentists to complete and update their knowledge of legal dentistry and current health legislation, as having proper knowledge is a means of avoiding possible legal problems, which not only means better legal protection for the dentist but is also a means of guaranteeing adequate patient care.

Herramienta Entornos de Vida: innovación en el análisis participativo de salud con enfoque de equidad

Municipal governments have the capacity to tackle the social determinants of health that play a role in their territories. The Valencian Community's local health action strategy promotes an intersectoral, participatory and equity-oriented approach to health inequalities affecting neighborhoods and municipalities across the region. To guide local health action, there is a need to adopt methodologies that capture community-based knowledge and experiences, encouraging community engagement at all stages. This article presents a methodology to carry out a local health needs assessment applying the Entornos de Vida tool. This tool enables the analysis of neighborhoods and municipalities through identifying how their characteristics have an impact on the health and well-being of their inhabitants.

Fusion of Different Image Sources for Improved Monitoring of Agricultural Plots.

In the Valencian Community, the applications of precision agriculture in multiannual woody crops with high added value (fruit trees, olive trees, almond trees, vineyards, etc.) are of priority interest. In these plots, canopies do not fully cover the soil and the planting frames are incompatible with the Resolution of Sentinel 2. The present work proposes a procedure for the fusion of images with different temporal and spatial resolutions and with different degrees of spectral quality. It uses images from the Sentinel 2 mission (low resolution, high spectral quality, high temporal resolution), orthophotos (high resolution, low temporal resolution) and images obtained with drones (very high spatial resolution, low temporal resolution). The procedure is applied to generate time series of synthetic RGI images (red, green, infrared) with the same high resolution of orthophotos and drone images, in which gray levels are reassigned from the combination of their own RGI bands and the values of the B3, B4 and B8 bands of Sentinel 2. Two practical examples of application are also described. The first shows the NDVI images that can be generated after the process of merging two RGI Sentinel 2 images obtained on two specific dates. It is observed how, after the merging, different NDVI values can be assigned to the soil and vegetation, which allows them to be distinguished (contrary to the original Sentinel 2 images). The second example shows how graphs can be generated to describe the evolution throughout the vegetative cycle of the estimated values of three spectral indices (NDVI, GNDVI, GCI) on a point in the image corresponding to soil and on another assigned to vegetation. The robustness of the proposed algorithm has been validated by using image similarity metrics.

Characteristics and technical survival of home hemodialysis in the Valencian Community (1976–2020)

IntroductionHome hemodialysis (HDD) is implemented in the Valencian Community with a higher prevalence than to the rest of the national territory, with a prevalence of 13.4 patients pmp in December 2018. We carried out an assessment of the patients characteristics and the overall and technical survival in HDD depending on the historical moment of onset and its origin. Material and methodsWe conducted a retrospective and descriptive study including patients of the Valencian Registry of Renal Patients from the beginning of data reported until December 2020. We calculated overall survival (combined event death-technical failure, censoring transplantation) and technical survival (event technical failure, censoring exitus and transplantation). Comparing technical survival according to the starting era: ancient (1976−2000) vs modern (2001−2020) and according to the modality of origin. We performed univariate and multivariate Cox regression in the total series for both overall and technical survival. Results236 patients on HDD (611.4 patient-years of follow-up), mean age 49.7±16.3 years; median time of prior renal replacement therapy 0.2 years. The ratio of transplantation, death, and technical failure were 13.2, 4.4, and 7 events per 100 patient-years, respectively. In the comparison by ancient (n=57) vs modern (n=179) eras, age (37.5 vs 53.5 years), DM (3.5 vs 13.4%) and chronic tubuleinterstitial nephropathy (24.6 vs 8.9%) as a cause of chronic kidney disease were statistically significant. The probability of coming from outpatient consultation (33.3 vs 48.6%) and peritoneal dialysis (1.8 vs 12.8%) were higher in modern era with statistical significance. In the ancient era a single hospital centralized 57.9% of the patients, and in the modern era between two hospitals centralized 55.8% of the patients. Overall survival in the ancient era was 83.7% at 1year, 77.4% at 2 years, and 61% at 5 years; and in the modern era 87.3% per year, 83% 2 years and 47.8% 5 years (Log Rank 0.521). Technical survival in the ancient era was 85.4% at 1year, 79% 2 years, and 64.1% 5 years; and in the modern era 91.4% per year, 88.5% 2 years and 74.5% 5 years (Log Rank 0.195). There were no statistical differences in the comparison based on technical of provenance. In the Cox regression it was statistically significant for overall survival: the age and being diagnosed with heart disease, vascular disease or active neoplasia and for technical survival liver disease or social problem, both in univariate and multivariate. ConclusionsIn the modern era there is a considerable increase in HDD patients in the Valencian Community. There was a center effect in the development of HDD programs, most of the patients depended on few healthcare centers. The patients were older and had greater comorbidity in the modern era, despite this without affecting the technical and overall survival of the HDD.

Critical nitrogen dilution curve and dry matter production parameters for several Mediterranean vegetables

• Twelve typical Mediterranean vegetables were studied. • The average and critical nitrogen dilution curve coefficients were obtained. • The dry/fresh matter ratios and harvest indexes were also obtained. • There were no differences between the average and critical dilution curves. • Differences of dry matter yield did not affect any of the parameters. Inadequate nitrogen fertilizing practices lead to low nitrogen uptake efficiency (NUE), which increases water NO 3 − pollution, as well as N 2 O emissions to the atmosphere. In order to increase the NUE and decrease the N losses as NO 3 − and N 2 O from the soil-plant system, accurate data about optimum crop N concentrations and dry matter production throughout the growing season are still needed for many vegetables typically grown under Mediterranean climate. For this reason, several N fertilization trials were set up for globe artichoke, carrot, cauliflower, chard, chinese cabbage, early potato, leek, lettuce, onion, red cabbage, romanesco, and spinach, under the semiarid Mediterranean conditions of the Valencian Community (Eastern Spain) during several years. The fresh and dry matter weight ( W ), as well as the nitrogen concentration in the dry matter (% N ) in both the marketable and non-marketable crop parts, was measured between 3 and 7 times throughout their respective growing seasons. The a and b coefficients of the average N dilution curve (% N = a W − b ), for which all % N and W data were used, and the critical N dilution curve (% N c = a W c − b ), for which only the minimun % N for maximum W data were used if available, in addition to the dry/fresh yield matter ratio ( DM ) and the harvest index ( HI ), were calculated for all these crops. No significant differences were observed between the average and critical N dilution curve coefficients in this work. Interestingly, the coefficients of both N dilution curves differed from the ones found in the literature with the exception of those obtained for similar cultivars, e.g., early potatoes, and under similar climatic conditions, i.e., Mediterranean. Besides, there were neither differences of DM and HI among the several N fertilization treatments. Therefore, due to the absence of changes in the N dilution curve and dry matter production coefficients for the different N supplies, all these parameters were estimated on the basis of the whole dataset, i.e., regardless of the N input. The use of the critical nitrogen dilution curve coefficients and dry matter production parameters presented in this work should contribute to better fit the N fertilizer additions to N demands of these vegetables under Mediterranean conditions, mainly, by their use through simulation models. Therefore, the NUE in horticulture should increase and the N losses as NO 3 − to inland and sea waters in these environments, and as N 2 O to the atmosphere should decrease.

Back-Health-Related Physical Activity and Exercise Knowledge in Adolescents: A Cross-Sectional Study.

Knowledge is a determining factor for the development of postural habits; it could be considered as the first step in the establishment of changes. The aim of this study was to analyze the level of specific back-health-related physical activity and exercise knowledge in adolescents. A cross-sectional study was conducted on a sample of 1500 high school students between the ages of 13 and 18 (mean age = 15.18 ± 1.44). Students from the Valencian Community (Spain) were recruited with a confidence level of 95% and an accepted standard error of ± 2.53%. Self-report questionnaires were used to record back-health-related physical activity knowledge. The level of specific knowledge of back-health education related to physical activity and exercise in adolescents was low (X = 2.05 ± 2.26). Only 10.9% of the students passed the specific knowledge test, achieving a score equal or superior to 5. The boys’ average score was higher (X = 2.17 ± 2.31) than the girls’ (X = 1.94 ± 2.21) with statistically significant differences (p = 0.048). The level of specific knowledge increased with age (p < 0.001). Secondary school students show a low level of specific knowledge concerning back health. It is recommended that back care education be a part of school curriculum.

Properties of the Spanish Version of the Place Standard Tool.

(1) Background: The social determinants that maintain health inequalities are organized in the physical, social, and economic contexts of neighborhoods and municipalities. Their characteristics influence the behaviors and choices of the people living in them, with an impact on their health and well-being. In recent years, several local applications and urban development tools have been designed to learn how to promote the development of health and wellness environments. Aim: The purpose was to test the properties of the Spanish adaptation of the Place Standard Tool through its implementation in a Valencian community municipality. (2) Methods: Metric properties were analyzed from a sample of 242 participants. Descriptive statistics were used to analyze the sociodemographic data and to describe item responses. Cronbach’s alpha was used to provide a measure of the internal consistency, whereas the Kaiser–Meyer Olkin test was relied upon to study the relationship between different variables. (3) Results: The questionnaire showed an internal consistency index of 0.849 and a KMO of 0.842, with a single factor variance of 81.50%. (4) Conclusions: The Spanish adaptation of the Place Standard Tool is a valid tool for assessing neighborhoods and municipalities with a focus on social determinants of health and equity.

Language attitudes and third language writing in a multilingual educational context

The study explores the impact of language attitudes on third language (English) writing. A total of 40 participants (20 from the B2 level and another 20 from the C2 level) from an Official Language School in the Valencian Community took part in the study. Data were collected by means of semi-structured interviews and a questionnaire adapted from Lasagabaster and Huguet (2007), together with and a written composition evaluated using Jacobs et al.’s (1981) taxonomy. Findings from the study show that students' attitudes towards languages are in line with the sociolinguistic status of each language in the Valencian Community. In addition, the present study shows that those students that use both official languages (Spanish and Catalan) at home got better results in the evaluation of their English writings. Our findings indicate the impact of multilingualism on students' L3 writing and suggest the advantages of multilingualism in language learning.

Dynamic paramyxovirus type 1 seroprevalence maps in broilers in the Valencian Community (eastern Spain) during a five-year period (2008-2012)

Newcastle disease is a devasting disease in poultry production worldwide, thus it is important to implement control measures to avoid entrance of the disease and its spread in the field. In this context, the aim of this study was to design and implement a seroprevalence map based on business intelligence for avian paramyxovirus type 1 (APMV-1) in broilers in the Valencia Community (eastern Spain). This tool consists in software mapping based on data collection, data analysis and data representation. In order to obtain the serological data, 12 495 sera from 131 broiler farms over 5 years were analysed (2008–2012). The data were represented on a map of the Valencian Community including geographical information of flock locations to facilitate disease monitoring. No clinical signs of APMV-1 were reported in the studied flocks. The data from this study showed no evidence contact with APMV-1 in broiler flocks and the novel software mapping tool as a valuable method for easily monitoring the serological response to avian paramyxovirus type 1 (APMV-1) including geographical information.

Health impact assessment of local policies: methodology and tools.

The aim of this work was to design some tools and a procedure for performing the Health Impact Assessment of municipal policies. A working group made up of municipal and public health specialists from the Valencian Community (Spain) was set up. After reviewing the tools used in other contexts, the Fem Salut? questionnaire for the simplified Health Impact Assessment of regional policies was adapted for use at the local level. A pilot study was carried out in six municipalities and local initiatives promoted by different sectors were analysed. Two workshops were held per municipality (with specialists and with citizens) and participatory techniques were used to identify the possible impacts on the social determinants of health, the population groups more particularly affected and the proposals for improvement. The feasibility of the methodology and the difficulties involved in carrying it out were discussed. A procedure was defined for the Health Impact Assessment of local initiatives in six steps: Describe (the municipality and the project), Extract (screening phase), Co-produce (participatory workshops), Integrate (the scientific evidence with the qualitative information obtained), Disseminate (to politicians, specialists and community) and Evaluate (direct and indirect results) (DECIDE). A guide was developed to facilitate its application at the local level along with two complementary tools (a questionnaire and worksheets). The technical group rated the process as simple and flexible, as well as being easy to adapt to the characteristics of the municipality and project. In addition to the cross-sectoral approach, the incorporation of citizen participation in the process is an important added value.

Sources of Energy Poverty: A Factor Analysis Approach for Spain

This study estimates housing quality and features explaining energy poverty in Spain and its regions. By using the EU-SILC dataset for 2008–2019, it calculates the hidden links between energy poverty indicators and housing features, controlled by other variables such as type of household, poverty, and housing tenancy. Confirmatory factor analysis is used to identify the role of different dimensions in explaining energy poverty at the household level. The empirical evidence finds three hidden factors associating energy poverty with poverty, poor housing quality, and housing size and outskirts location. These three factors enable classifying households accordingly, revealing their distribution across Spain and three of its 17 Spanish regions: Madrid, Cataluña, and Valencian Community. Findings indicate how the impact of energy poverty differs by region, rejecting the general hypothesis that all households in poverty live in poor housing because they cannot afford the maintenance costs, thus causing energy poverty. Results suggest that energy poverty due to poor housing quality and location affects many households that are not necessarily poor, with different impacts depending on location. The association between energy poverty and larger houses located on the outskirts represents new evidence in the literature and is one of the contributions of this study, together with the methodology for classification. Results suggest that retrofitting investment would be crucial in reducing energy poverty problems in Spain.

REAL WORLD IMPACT OF BLOOD PRESSURE CHANGES ON MORBIDITY AND MORTALITY IN TYPE 2 DIABETES

Objective: To assess the impact of BP changes on the risk of cardiovascular events and mortality in type 2 diabetes. Design and method: The sample was selected using the HER of the Valencian Community. Type 2 diabetics were selected through ICD codes and retrospectively evaluated from January 2012 to December 2016. To evaluate BP changes, the follow-up time was divided in six-month blocks and the average of BP for each interval was considered. SBP was categorized: &lt; 120 mmHg; 120–129 mmHg (reference); 130–139 mmHg; 140–149 mmHg; &gt; 150 mmHg. To evaluate the influence of DBP, the population was stratified according to categories of average DBP: &lt; 60 mmHg; 60–69 mmHg; 70–79 mmHg; &gt; 80 mmHg. Information about cardiovascular events, including Stroke and Acute Coronary Syndrome (ACS) was extracted from the ICD codes. Total mortality was determined by matching records and death certificates. Time-varying Cox regression for SBP stratified by DBP categories was used to assess the risk associated with changes of SBP. The models were adjusted by age, sex, HBA1c, KDIGO, previous cardiovascular events and use of cardiovascular drugs. Results: 156 363 type 2 diabetics patients were included (mean age 69.5(11.5), 48.7% females, mean glycated Hb 7.05 (1.35%) 21% in secondary prevention, 21.4% under insulin treatment). The average number of BP measurements was 14. During an average follow-up of 4.18 y, there were 13399 deaths, 15100 strokes and 6295 ACS. In the fully adjusted time-varying Cox regression, having a SBP&lt; 120 mmHg was a significant risk factor for death across all categories of DBP, whereas SBP&gt; 130 mmHg conferred protection. For the case of ACS and stroke, a J-curve phenomenon was observed with significantly higher risk for those with SBP&gt; 150 mmHg or &lt; 120 mmHg across categories with DBP&gt; 60 mmHg. This J-curve phenomenon was also observed graphically using restricted cubic splines (Figure). Conclusions: Although difficult to achieve in clinical practice, lower boundaries for BP goals in diabetics have to be taking into account.

Evaluation of a multicomponent intervention consisting of education and feedback to reduce benzodiazepine prescriptions by general practitioners: The BENZORED hybrid type 1 cluster randomized controlled trial.

Current benzodiazepine (BZD) prescription guidelines recommend short-term use to minimize the risk of dependence, cognitive impairment, and falls and fractures. However, many clinicians overprescribe BZDs and chronic use by patients is common. There is limited evidence on the effectiveness of interventions delivered by general practitioners (GPs) on reducing prescriptions and long-term use of BZDs. We aimed to evaluate the effectiveness of a multicomponent intervention for GPs that seeks to reduce BZD prescriptions and the prevalence of long-term users. We conducted a multicenter two-arm, cluster randomized controlled trial in 3 health districts in Spain (primary health centers [PHCs] in Balearic Islands, Catalonia, and Valencian Community) from September 2016 to May 2018. The 81 PHCs were randomly allocated to the intervention group (n = 41; 372 GPs) or the control group (n = 40; 377 GPs). GPs were not blinded to the allocation; however, pharmacists, researchers, and trial statisticians were blinded to the allocation arm. The intervention consisted of a workshop about the appropriate prescribing of BZDs and tapering-off long-term BZD use using a tailored stepped dose reduction with monthly BZD prescription feedback and access to a support web page. The primary outcome, based on 700 GPs (351 in the control group and 349 in the intervention group), compared changes in BZD prescriptions in defined daily doses (DDDs) per 1,000 inhabitants per day after 12 months. The 2 secondary outcomes were the proportion of long-term users (≥6 months) and the proportion of long-term users over age 65 years. Intention-to-treat (ITT) analysis was used to assess all clinical outcomes. Forty-nine GPs (21 intervention group and 28 control group) were lost to follow-up. However, all GPs were included in the ITT analysis. After 12 months, there were a statistically significant decline in total BZD prescription in the intervention group compared to the control group (mean difference: -3.24 DDDs per 1,000 inhabitants per day, 95% confidence interval (CI): -4.96, -1.53, p < 0.001). The intervention group also had a smaller number of long-term users. The adjusted absolute difference overall was -0.36 (95% CI: -0.55, -0.16, p > 0.001), and the adjusted absolute difference in long-term users over age 65 years was -0.87 (95% CI: -1.44, -0.30, p = 0.003). A key limitation of this clustered design clinical trial is the imbalance of some baseline characteristics. The control groups have a higher rate of baseline BZD prescription, and more GPs in the intervention group were women, GPs with a doctorate degree, and trainers of GP residents. A multicomponent intervention that targeted GPs and included educational meeting, feedback about BZD prescriptions, and a support web page led to a statistically significant reduction of BZD prescriptions and fewer long-term users. Although the effect size was small, the high prevalence of BZD use in the general population suggests that large-scale implementation of this intervention could have positive effects on the health of many patients. ISRCTN ISRCTN28272199.

Obstetric-Neonatal Care during Birth and Postpartum in Symptomatic and Asymptomatic Women Infected with SARS-CoV-2: A Retrospective Multicenter Study.

This study analyses the obstetric–neonatal outcomes of women in labour with symptomatic and asymptomatic COVID-19. A retrospective, multicenter, observational study was carried out between 1 March 2020 and 28 February 2021 in eight public hospitals in the Valencian community (Spain). The chi-squared test compared the obstetric–neonatal outcomes and general care for symptomatic and asymptomatic women. In total, 11,883 births were assisted in participating centers, with 10.9 per 1000 maternities (n = 130) infected with SARS-CoV-2. The 20.8% were symptomatic and had more complications both upon admission (p = 0.042) and during puerperium (p = 0.042), as well as transfer to the intensive care unit (ICU). The percentage of admission to the Neonatal Intensive Care Unit (NICU) was greater among offspring of symptomatic women compared to infants born of asymptomatic women (p < 0.001). Compared with asymptomatic women, those with symptoms underwent less labour companionship (p = 0.028), less early skin-to-skin contact (p = 0.029) and greater mother–infant separation (p = 0.005). The overall maternal mortality rate was 0.8%. No vertical transmission was recorded. In conclusion, symptomatic infected women are at increased risk of lack of labour companionship, mother–infant separation, and admission to the ICU, as well as to have preterm births and for NICU admissions.

SARS-CoV-2 Delta-variant breakthrough infections in nursing home residents at midterm after Comirnaty® COVID-19 vaccination.

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) Delta variant breakthrough infections in nursing home residents following vaccination with Comirnaty® COVID‐19 vaccine were characterized. In total, 201 participants (median age, 87 years; range, 64–100; 133 female) from two nursing homes in the Valencian community (Spain) were included. SARS‐CoV‐2‐Spike (S) antibody responses were determined by a lateral flow immunocromatography (LFIC) assay and by quantitative electrochemiluminescent assay in LFIC‐negative participants. SARS‐CoV‐2‐S‐IFNγ T cells were enumerated by flow cytometry in 10 participants. Nasopharyngeal SARS‐CoV‐2 RNA loads were quantified by real‐time polymerase chain reaction assays. Vaccine breakthrough COVID‐19 due to the Delta variant occurred in 39 residents (median age, 87 years; range, 69–96; 31 female) at a median of 6.5 months after vaccination (nine requiring hospitalization). Breakthrough infections occurred at a higher rate (p < 0.0001) in residents who had not been previously infected with SARS‐CoV‐2 (naïve) (33/108; 18%) than in those with prior diagnosis of SARS‐CoV‐2 infection (experienced) (6/93; 6.4%), and were more likely (p < 0.0001) to develop in residents who tested negative by LFIC (20/49) at 3 months after vaccination as compared to their LFIC‐positive counterparts (19/142). Among LFIC‐negative residents, a trend towards lower plasma anti‐RBD antibody levels was noticed in those developing breakthrough infection (p = 0.16). SARS‐CoV‐2 RNA loads in nasopharyngeal specimens were lower in SARS‐CoV‐2‐experienced residents (p < 0.001) and in those testing positive by LFIC (p = 0.13). The frequency of SARS‐CoV‐2‐S‐reactive T cells at 3 months was similar in LFIC‐negative residents with (n = 7) or without (n = 3) breakthrough infection. Prior history of SARS‐CoV‐2 infection and detection of S‐reactive antibodies by LFIC at 3 months is associated with a lower risk of Delta‐variant breakthrough infection in nursing home residents at midterm after Comirnaty® COVID‐19 vaccination.

The Finding of the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) in a Wild Eurasian River Otter (Lutra lutra) Highlights the Need for Viral Surveillance in Wild Mustelids.

Animals have been involved in the three known outbreaks of severe respiratory syndromes due to coronaviruses (years 2005, 2012, and 2019). The pandemic nature of the SARS-CoV-2 outbreak increases the likelihood of infection from humans of susceptible animal species that, thus, could become secondary viral hosts and even disease reservoirs. We present evidence of spillover infection of wild mustelids by reporting the presence of SARS-CoV-2 in a Eurasian river otter found near a water reservoir in the Valencian Community (Spain). We detected the virus using two different commercial RTqPCR assays on RNA extracted from the nasopharynx (swabbing) and from lung tissue and mediastinal lymph node homogenates. The corresponding samples from two additional otters from distant sites tested negative in identical assays. The diagnosis in the positive otter was confirmed by two-tube RT-PCR assay in which RNA was first retrotranscribed, and then specific regions of the spike (S), nucleocapsid (N), and ORF10 genes were separately amplified from the produced cDNA, followed by electrophoretic visualization and Sanger sequencing. The sequences of the amplified products revealed some non-synonymous changes in the N and ORF10 partial sequences, relative to the consensus sequence. These changes, identified already in human patient samples, point to human origin of the virus, although their specific combination was unique. These findings, together with our previous report of SARS-CoV-2 infection of feral American mink, highlight the need for SARS-CoV-2 surveillance of wild or feral mustelids to evaluate the risk that these animals could become SARS-CoV-2 reservoirs.

Cultural Competence and the Role of the Patient’s Mother Tongue: An Exploratory Study of Health Professionals’ Perceptions

The role of the patient’s mother tongue in clinical communication is of vital importance and yet it is not always dealt with adequately by healthcare professionals and healthcare systems. Cultural competence should deal with and redress asymmetries in doctor–patient communication, including those having an impact on the patient’s mother tongue. The aim of this study was to answer a research question: what are the health professionals’ perceptions of the importance and role of the patients’ mother tongue in diglossic situations? To answer our research question, we carried out two focus groups, one with doctors and another with nurses working in public hospitals in the Valencian Community (Spain) where two languages share officiality, Catalan and Spanish. Yet, Catalan is a right and Spanish a duty. The results showed that perceptions of professionals in relation to the importance of the patient’s mother tongue in situations in which two official languages coexist in an asymmetric relationship vary a great deal and seem to form a continuum of positive and negative judgements. Different values were represented in the participants’ perceptions, ranging from respect for and full alignment with the patient’s perspective to negative perceptions. More qualitative and quantitative research on health professionals’ attitudes and values is needed to understand the role of the patient’s mother tongue in clinical communication. Educational and institutional efforts are also needed to redress the linguistic and cultural asymmetries that have a negative impact on patients in terms of inequality, inefficiency, and even exclusion.