ABSTRACT Shiga toxin-producing Escherichia coli (STEC) infections are responsible for acute illnesses and deaths in humans. Cattle and humans are exposed to STEC through faeces and contaminated food and water. The big six and O157 STEC serogroups are important food and water-borne human pathogens. Additionally, Stx1a, Stx2a and Stx2c subtypes are highly associated with the haemolytic uremic syndrome. This study aimed to determine Shiga toxin-subtypes, the presence of antigen 43 families, the genotypic and phenotypic antimicrobial susceptibility profiles, O-serogrouping, phylotypes and phylogenetic relatedness of STEC of calf origin. Sixteen STEC isolates from calf origin were analysed. PCR was performed to determine Stx subtypes, serogroups, the presence of ag43 I and II and phylotypes. The antimicrobial profile was evaluated and the presence of PMQR and fosfomycin genes was determined by PCR. The clonal relatedness of STEC was studied by PFGE. The genotypes stx1a+c, stx1a+, stx1a+/stx2e+, stx1a+c/stx2e and stx2a were detected. Ag43 II was the most prevalent among subfamilies. STEC isolates were serotyped as O103 (n=5) and O111 (n=6). Fifty per cent of the isolates were classified as B1 phylogroup, 4/16 as E, 1/16 as C, and 1/16 as F. Non-O157 STEC isolates showed a high level of diversity, independent of the geographical and farm-origin. Isolates were resistant to ampicillin, ciprofloxacin, gentamicin, and fosfomycin-trometamol. The gene fosA7 was detected in 1 isolate. The virulence profiles, including Shiga toxin-subtypes and serogroups, denote the potential harm of non-O157 STEC isolates to humans. We also confirmed that circulating non-O157 STEC from cattle present genetic heterogeneity and are susceptible to antibiotics.

Objective: To analyze information needs and search strategies among women with breast cancer in Spain. An additional aim was to explore how the internet, as a source of health information, influences the autonomy and active management of this disease among patients. The research was conducted in 2010 and 2011. Method: This study forms part of a broader qualitative study that focuses on describing patients' experiences of breast cancer and the trajectory of the disease, with the aim of creating a platform of integrated information resources for patients, relatives and healthcare professionals (PyDEsalud: http://www.pydesalud.com). We carried out 41 in-depth, semi-structured interviews with breast cancer patients in different stage of the disease, who were aged between 32 and 69 years. The interviewees' were selected by intentional sampling, which included 15 Spanish regions. The field work was carried out from June to August, 2010. The interviews were recorded on videotape or audio. Based on patients' narratives of their disease, a thematic-inductive analysis was performed of the information gathered. Results: The findings show the importance of the internet as a source of health information. Moreover, the internet is a resource that is able to promote the empowerment process among patients and, consequently, to aid improvement in disease management. Conclusions: Users need access to web sites with high quality health information, adapted to their needs and objectives.

Objetivo: Analizar las necesidades de información y las estrategias de búsqueda que emprenden personas afectadas de cáncer de mama en el contexto español, así como explorar cómo está influyendo la utilización de Internet, en tanto fuente de información sanitaria, en la promoción de la autonomía y en la gestión activa de la enfermedad. La investigación fue desarrollada durante los años 2010 y 2011. Método: Este trabajo forma parte de una investigación cualitativa más amplia destinada a analizar la experiencia de pacientes con cáncer de mama sobre la trayectoria de su enfermedad, con el propósito de crear una plataforma de recursos informativos integrados para pacientes, familiares y profesionales sanitarios (PyDEsalud: http://www.pydesalud.com). Se ha desarrollado un estudio cualitativo basado en 41 entrevistas en profundidad con un guión semiestructurado a personas con cáncer de mama, en diferentes estadios, de 32 a 69 años de edad, seleccionadas mediante muestreo teórico intencionado, en 15 comunidades autónomas españolas. El trabajo de campo se realizó entre junio y agosto de 2010. Las entrevistas se grabaron en formato audiovisual y se realizó un análisis temático inductivo a partir de la narración de la enfermedad. Resultados: Los hallazgos muestran la relevancia del uso de Internet en la búsqueda de información sanitaria y como herramienta que puede favorecer el empoderamiento de los pacientes y mejorar la gestión de su enfermedad. Conclusiones: Se evidencia la necesidad de los usuarios de acceder a sitios web que contengan información sanitaria de calidad, adaptados a sus necesidades y demandas.

Objective: To analyze information needs and search strategies among women with breast cancer in Spain. An additional aim was to explore how the internet, as a source of health information, influences the autonomy and active management of this disease among patients. The research was conducted in 2010 and 2011. Method: This study forms part of a broader qualitative study that focuses on describing patients' experiences of breast cancer and the trajectory of the disease, with the aim of creating a platform of integrated information resources for patients, relatives and healthcare professionals (PyDEsalud: http://www.pydesalud.com). We carried out 41 in-depth, semi-structured interviews with breast cancer patients in different stage of the disease, who were aged between 32 and 69 years. The interviewees' were selected by intentional sampling, which included 15 Spanish regions. The field work was carried out from June to August, 2010. The interviews were recorded on videotape or audio. Based on patients' narratives of their disease, a thematic-inductive analysis was performed of the information gathered. Results: The findings show the importance of the internet as a source of health information. Moreover, the internet is a resource that is able to promote the empowerment process among patients and, consequently, to aid improvement in disease management. Conclusions: Users need access to web sites with high quality health information, adapted to their needs and objectives.

Objetivo: Analizar las necesidades de información y las estrategias de búsqueda que emprenden personas afectadas de cáncer de mama en el contexto español, así como explorar cómo está influyendo la utilización de Internet, en tanto fuente de información sanitaria, en la promoción de la autonomía y en la gestión activa de la enfermedad. La investigación fue desarrollada durante los años 2010 y 2011. Método: Este trabajo forma parte de una investigación cualitativa más amplia destinada a analizar la experiencia de pacientes con cáncer de mama sobre la trayectoria de su enfermedad, con el propósito de crear una plataforma de recursos informativos integrados para pacientes, familiares y profesionales sanitarios (PyDEsalud: http://www.pydesalud.com). Se ha desarrollado un estudio cualitativo basado en 41 entrevistas en profundidad con un guión semiestructurado a personas con cáncer de mama, en diferentes estadios, de 32 a 69 años de edad, seleccionadas mediante muestreo teórico intencionado, en 15 comunidades autónomas españolas. El trabajo de campo se realizó entre junio y agosto de 2010. Las entrevistas se grabaron en formato audiovisual y se realizó un análisis temático inductivo a partir de la narración de la enfermedad. Resultados: Los hallazgos muestran la relevancia del uso de Internet en la búsqueda de información sanitaria y como herramienta que puede favorecer el empoderamiento de los pacientes y mejorar la gestión de su enfermedad. Conclusiones: Se evidencia la necesidad de los usuarios de acceder a sitios web que contengan información sanitaria de calidad, adaptados a sus necesidades y demandas.

Objective: To identify the main benefits and risks related to the implementation of telemedicine programs in Spain, based on the experience of the actors influencing the decision-making process. Participants and methods: We performed a qualitative study based on audiotaped semi-structured telephone interviews. Eleven interviews were carried out, and the perspective of four physicians, three administrators, two researchers and two telecommunications industry workers were included. Theoretical sampling was used and thematic inductive analysis was performed. Results: The following factors were identified as necessary to successfully resolve problems by using telemedicine programs: the commitment of the persons involved, technological aspects, economic and institutional support, acceptance by healthcare professionals and patients, the existence of protocols adjusted to the context, the need for information and training prior to the development of telemedicine programs, a forward-looking approach, routine use and full acceptance of telemedicine programs in the organization, and the need to defend equity for professionals and users. Conclusions: Successfully developing a telemedicine program requires a favorable environment in which risk can be foreseen. The main key element seems to be the human factor. The factors identified in this study should be considered when developing strategies to increase the chances of success of telemedicine programs in Spain.

Objetivo: Identificar los principales beneficios y riesgos en el proceso de implantación de los programas de telemedicina en España, a partir de la experiencia de los profesionales que influyen en la toma de decisiones. Participantes y métodos: Estudio cualitativo basado en entrevistas semiestructuradas grabadas telefónicamente, con análisis temático inductivo. Se realizaron 11 entrevistas que incluyeron la perspectiva de 4 facultativos, 3 gestores, 2 investigadores y 2 responsables de producto de la industria de telecomunicaciones. Se llevó a cabo un muestreo teórico. Resultados: Se identificaron una serie de factores necesarios para alcanzar con éxito la resolución del problema mediante un programa de telemedicina: el compromiso de las personas involucradas, los aspectos tecnológicos, el apoyo económico e institucional, la aceptación por parte de clínicos y pacientes, la existencia de protocolos que se adapten al contexto, la necesidad de informarse y formarse previamente, la visión de futuro e innovación, la normalización del programa en el sistema organizativo, y la necesidad de mantener el principio de equidad con relación a clínicos y usuarios. Conclusiones: Para que un programa de telemedicina tenga éxito es necesario desarrollarlo en un contexto favorecedor, en el cual se puedan prever los riesgos. El factor humano se revela como la clave principal. Los factores identificados en este estudio cualitativo deberían considerarse a la hora de elaborar estrategias que permitan incrementar las posibilidades de éxito en la implantación de futuros programas de telemedicina en nuestro medio.

Objective: To identify the main benefits and risks related to the implementation of telemedicine programs in Spain, based on the experience of the actors influencing the decision-making process. Participants and methods: We performed a qualitative study based on audiotaped semi-structured telephone interviews. Eleven interviews were carried out, and the perspective of four physicians, three administrators, two researchers and two telecommunications industry workers were included. Theoretical sampling was used and thematic inductive analysis was performed. Results: The following factors were identified as necessary to successfully resolve problems by using telemedicine programs: the commitment of the persons involved, technological aspects, economic and institutional support, acceptance by healthcare professionals and patients, the existence of protocols adjusted to the context, the need for information and training prior to the development of telemedicine programs, a forward-looking approach, routine use and full acceptance of telemedicine programs in the organization, and the need to defend equity for professionals and users. Conclusions: Successfully developing a telemedicine program requires a favorable environment in which risk can be foreseen. The main key element seems to be the human factor. The factors identified in this study should be considered when developing strategies to increase the chances of success of telemedicine programs in Spain.

Objetivo: Identificar los principales beneficios y riesgos en el proceso de implantación de los programas de telemedicina en España, a partir de la experiencia de los profesionales que influyen en la toma de decisiones. Participantes y métodos: Estudio cualitativo basado en entrevistas semiestructuradas grabadas telefónicamente, con análisis temático inductivo. Se realizaron 11 entrevistas que incluyeron la perspectiva de 4 facultativos, 3 gestores, 2 investigadores y 2 responsables de producto de la industria de telecomunicaciones. Se llevó a cabo un muestreo teórico. Resultados: Se identificaron una serie de factores necesarios para alcanzar con éxito la resolución del problema mediante un programa de telemedicina: el compromiso de las personas involucradas, los aspectos tecnológicos, el apoyo económico e institucional, la aceptación por parte de clínicos y pacientes, la existencia de protocolos que se adapten al contexto, la necesidad de informarse y formarse previamente, la visión de futuro e innovación, la normalización del programa en el sistema organizativo, y la necesidad de mantener el principio de equidad con relación a clínicos y usuarios. Conclusiones: Para que un programa de telemedicina tenga éxito es necesario desarrollarlo en un contexto favorecedor, en el cual se puedan prever los riesgos. El factor humano se revela como la clave principal. Los factores identificados en este estudio cualitativo deberían considerarse a la hora de elaborar estrategias que permitan incrementar las posibilidades de éxito en la implantación de futuros programas de telemedicina en nuestro medio.

Background: Survival rates after curative surgery for gastric cancer are disappointing. Therefore adjuvant therapeutic strategies are required. Aim: To analyze survival and side effects of treatment among gastric cancer patients treated with adjuvant chemo radiotherapy after curative resection of gastric adenocarcinoma. Material and methods: Retrospective review of medical records of 74 patients aged 20 to 74 years, treated with complete resection of gastric adenocarcinoma followed by adjuvant chemo radiation. Survival analysis was based on the records and information from the National Mortality Registry. Results: Five years survival fluctuated from 50% among patients in stage IB to 25% among those is stage IV. Significant acute toxicity was observed in 23 patients (31%). No patients died due to acute toxicity. Eleven patients (16.4%) developed significant late toxicity, with two possible deaths related to treatment. Conclusions: Postoperative chemo radiotherapy is feasible in our experience. Continues infusion of 5-fluoruracil is recommended to reduce toxicity.

Structure and dynamics of plant populations in pastoral systems are mainly controlled by inter and intraspecific competition and herbivory within the constraints imposed by soil characteristics and climate. Defoliations caused by herbivores have a direct impact on plant populations, but also an indirect effect through changes in the intensity of competition. We evaluated the effects of mechanic defoliations and nitrogen fertilization on the structure of a Festuca arundinacea Schreb. population in a mixed pasture, and discussed the effects of these two agronomic tools on the intensity of intraspecific competition. A four-block factorial experiment combining two regimes of mowing frequency (1 and 4 mowings/year) and two levels of nitrogen fertilization (0 and 50 kg N/ha/year), was installed on a mixed pasture composed of F. arundinacea and Lotus glaber Mill. Data was obtained from eight subplots randomly arranged inside each plot. High frequency mowed plots had higher density and lower size asymmetry than the low frequency ones, whereas total cover did not differ between treatments. On the contrary, nitrogen fertilization diminished population density, increased size asymmetry and augmented total cover. Overall, there was a negative association between log10 mean size and log10 density; the estimated slope of the linear relation was closer to -3/2 in fertilized than in nonfertilized plots. Finally, crowding decreased significantly with plant size. These results suggest that the dynamics of F. arundinacea in the experimental plots were strongly controlled by intraspecific competition when nitrogen availability was high and mowing frequency was low. Lack of fertilization and frequent mows would limit individual growth and hence intensity of competition. Furthermore, the intensity of competition seems to have been more closely related to nitrogen availability than to mowing frequency. Additional data showed that the abundance of companion species was precluded in fertilized plots and in low frequency mowed plots, suggesting that F. arundinacea is a highly competitive species, which maximizes vegetative growth in productive, relatively undisturbed conditions. Overall, our results indicate that resource supply could intensify plant competition instead of relax it.

La estructura y la dinámica de las poblaciones vegetales de los sistemas pastoriles están principalmente controladas por la competencia intra e interespecífica y por la herbivoría, en el marco impuesto por el ambiente edáfico y el clima. Las defoliaciones producidas por los herbívoros impactan directamente sobre las poblaciones vegetales, pero también indirectamente, mediante el control de la intensidad de la competencia. En este trabajo evaluamos los efectos de la frecuencia de defoliaciones mecánicas y de la fertilización con nitrógeno sobre la estructura poblacional de Festuca arundinacea Schreb. sembrada en una pastura mixta y discutimos los efectos de estas prácticas agronómicas sobre la competencia intraespecífica. Sobre una pastura compuesta por F. arundinacea y Lotus glaber Mill. instalamos un experimento factorial que combina dos niveles de frecuencia de cortes (uno y cuatro cortes anuales) y dos de fertilización nitrogenada (0 y 50 kg N/ha/año) en cuatro bloques. Los cortes frecuentes resultaron en mayor densidad y menor jerarquización de tamaños y no modificaron la cobertura total en comparación con los cortes poco frecuentes. En cambio, la fertilización nitrogenada disminuyó la densidad, generó mayor jerarquización de tamaños y aumentó la cobertura total. El log10 del tamaño promedio estuvo negativamente asociado con el log10 de la densidad; la pendiente estimada de la relación lineal fue más cercana a -3/2 para las parcelas fertilizadas que para las no fertilizadas. El apiñamiento de individuos (medido en una escala de 0.25 m²) disminuyó significativamente con el aumento del tamaño individual. Nuestros resultados sugieren que la dinámica de F. arundinacea estuvo fuertemente controlada por la competencia intraespecífica en condiciones de baja frecuencia de disturbios y alta disponibilidad de nitrógeno. Además, indican que la adición de un recurso posiblemente limitante puede intensificar la competencia intraespecífica en lugar de relajarla.