Immunoglobulin G/immunoglobulin M autoantibody ratios in incomplete systemic lupus erythematosus.

OBJECTIVE: Immunoglobulin G (IgG) autoantibodies in systemic lupus erythematosus (SLE) are considered pathogenic, whereas immunoglobulin M (IgM) autoantibodies may have protective effects. The aim of this study was to identify whether IgG/IgM autoantibody ratios differ between patients with incomplete systemic lupus erythematosus (iSLE), patients with SLE, and healthy controls (HCs), and whether IgG/IgM autoantibody ratios relate to progression from iSLE to SLE. METHOD: This prospective cohort study included 34 iSLE patients, 41 SLE patients, and 11 HCs. IgG and IgM anti-dsDNA, anti-Ro52, and anti-Ro60 were measured by fluoro-enzyme immunoassay in serum samples obtained at baseline in all groups and in follow-up samples of up to 5 years for iSLE patients. Correlations between IgG/IgM autoantibody ratios, interferon signature, and clinical parameters were also assessed. RESULTS: At baseline, IgG anti-dsDNA, anti-Ro52, anti-Ro60, and IgM anti-dsDNA were elevated in iSLE and SLE patients. IgG/IgM anti-dsDNA and anti-Ro52 ratios were similar between groups, while IgG/IgM anti-Ro60 ratios were significantly elevated in iSLE and SLE patients compared to HCs. IgG/IgM autoantibody ratios were not correlated with interferon signature or clinical parameters. IgG/IgM ratios at baseline were similar and remained relatively stable during a median follow-up of 18 months in non-progressors and six iSLE patients who progressed to SLE. CONCLUSION: IgG anti-dsDNA, anti-Ro52, anti-Ro60, and IgM anti-dsDNA were elevated in iSLE and SLE patients, which was not apparent from the respective IgG/IgM ratios only. IgG/IgM autoantibody ratios remained relatively stable over up to 5 years in iSLE non-progressors and six patients who progressed to SLE.

Analysis of tourism sustainability synthetic indicators. A case study of Aragon.

Tourism sustainability is a long-term exploration process of human beings seeking to coexist harmoniously with the ecological environment. The core of sustainable tourism development is to achieve the harmonious development of the economy, society, and environment. Aragon's rich tourism resources attract many tourists, and the local government has formulated a sustainable development strategy to develop tourism vigorously. This paper constructs a tool to assess the sustainable development of tourism in Aragon based on the theory of sustainable tourism development and related methods. It proposes the construction of synthetic indicators based on the environmental-social-economic triad model, identifies individual indicators suitable for the study of the region based on indicators that appear more frequently in related studies, and defines and evaluates these indicators. We construct the matrices by questionnaire and expert consultation method and find that environmental and social factors significantly impact sustainable development. The indicators are then standardized and weighted using hierarchical analysis to determine the level of sustainable development of the local tourism industry based on the standard for assessing sustainable tourism development. The steps and methods of constructing synthetic indicators proposed in this paper can guide future analysis of the strengths and weaknesses of tourism development in Aragon and similar areas under different conditions, as well as for the study of factors affecting tourism development, and provide targeted suggestions for improving the competitiveness of local tourism, taking into account regional tourism characteristics and actual conditions.

Medida por consenso del estado de la innovación en medicina física y rehabilitación / Consensus measurement of innovation in physical medicine and rehabilitation

Objetivo: Valorar el estado actual y el potencial de innovación del colectivo de profesionales de la especialidad médica de medicina física y rehabilitación (MFRHB) en España. Método: Se aplicaron 3técnicas consecutivas mediante herramientas digitales para el consenso entre profesionales: primero de forma síncrona a un colectivo de 17 profesionales, después se extendió a un colectivo de 169 que participaron de forma asíncrona y la tercera técnica se realizó de forma síncrona con 25 médicos especialistas en MFRHB. Resultados: Se dispuso del análisis consensuado por los propios profesionales sobre el potencial de innovación del colectivo realizado en octubre y noviembre del 2020: situación de partida, puntos fuertes y puntos débiles, así como sus prioridades en innovación. Conclusiones: Los médicos especialistas en MFRHB consideran que la innovación podría mejorar el coste efectividad de los servicios y podría aumentar su eficiencia clínica; también consideran que para innovar necesitan una relación estrecha con la industria.(AU)

Objective: To measure by consensus the level of innovation and its potential within the physical medicine and rehabilitation (PM&R) medical specialists. method: Three consecutive techniques are applied using digital tools for consensus among professionals, first synchronously to a group of 17 professionals; posteriorly extended to a group of 169 professionals who participate asynchronously and the third technique is done synchronously with 25 physiatrists. Results: The analysis of the consensus done by the PM&R physicians on the innovation potential of the group during October and November 2020 shows: starting situation, strengths and weaknesses, as well as their innovation priorities. Conclusions: PM&R physicians believe that innovation could improve the cost-effectiveness of their departments, and could increase their clinical efficiency, also that to innovate they need a close relationship with the industry.(AU)

[Consensus measurement of innovation in physical medicine and rehabilitation]. / Medida por consenso del estado de la innovación en medicina física y rehabilitación.

OBJECTIVE: To measure by consensus the level of innovation and its potential within the physical medicine and rehabilitation (PM&R) medical specialists. METHOD: Three consecutive techniques are applied using digital tools for consensus among professionals, first synchronously to a group of 17 professionals; posteriorly extended to a group of 169 professionals who participate asynchronously and the third technique is done synchronously with 25 physiatrists. RESULTS: The analysis of the consensus done by the PM&R physicians on the innovation potential of the group during October and November 2020 shows: starting situation, strengths and weaknesses, as well as their innovation priorities. CONCLUSIONS: PM&R physicians believe that innovation could improve the cost-effectiveness of their departments, and could increase their clinical efficiency, also that to innovate they need a close relationship with the industry.

Effect of non-ionic surfactant in the solvothermal synthesis of anatase TiO2 nanoplates with a high percentage of exposed {001} facets and its role in the photocatalytic degradation of methylene blue dye.

The synthesis of anatase TiO2 nanoparticles with controlled morphology and increased {001} facets exposed without the presence of fluorine-derived substances is a challenge. Herein, we report a highly effective approach to fabricate anatase TiO2 nanoplates with exposed {001} facets and their exploitation as robust photocatalytic materials for dye remediation. These materials were synthesized under controlled hydrolysis and condensation reactions, using titanium (IV) n-butoxide in an ethanolic solution, with acetic and sulfuric acids, by a solvothermal method at 190 °C with or without the presence of the non-ionic surfactant Triton® X-100 and then characterized. During TiO2 crystal synthesis, the effect of a non-ionic surfactant on the TiO2 particle growth was investigated. Our results demonstrate that the proposed method can synthesize pure and crystalline anatase TiO2 square nanoplates that form nanostructured spheres with high surface area, uniformly sized mesopores, and exposed {001} facets. The presence of non-ionic surfactant increased the exposed {001} facets percentage of the formed nanoplates from 69 to 80%, decreased the crystallite thickness, but unaffected its crystalline phase and band gap energy. The kinetic constants (Ka e Kb) for the synthesized TiO2 anatase nanoplates are considerably higher than the commercial TiO2 anatase constant (Kc). The synthesized photocatalysts show higher efficiency in the photocatalytic removal of methylene blue (MB) than commercial TiO2 (for t = 120 min).

Methanol Synthesis from CO2: A Review of the Latest Developments in Heterogeneous Catalysis.

Technological approaches which enable the effective utilization of CO2 for manufacturing value-added chemicals and fuels can help to solve environmental problems derived from large CO2 emissions associated with the use of fossil fuels. One of the most interesting products that can be synthesized from CO2 is methanol, since it is an industrial commodity used in several chemical products and also an efficient transportation fuel. In this review, we highlight the recent advances in the development of heterogeneous catalysts and processes for the direct hydrogenation of CO2 to methanol. The main efforts focused on the improvement of conventional Cu/ZnO based catalysts and the development of new catalytic systems targeting the specific needs for CO2 to methanol reactions (unfavourable thermodynamics, production of high amount of water and high methanol selectivity under high or full CO2 conversion). Major studies on the development of active and selective catalysts based on thermodynamics, mechanisms, nano-synthesis and catalyst design (active phase, promoters, supports, etc.) are highlighted in this review. Finally, a summary concerning future perspectives on the research and development of efficient heterogeneous catalysts for methanol synthesis from CO2 will be presented.

Data on TGA of precursors and SEM of reduced Cu/ZnO catalysts co-modified with aluminium and gallium for methanol synthesis.

The modification of Cu-Zn catalysts with low amount of Al and Ga (Al+Ga = 3%) was investigated and data corresponding to its influence on the decomposition of the calcined precursors and on the nanomorphology and surface concentration of reduced catalysts were presented in this contribution. The data presented here are supplementary material of the catalysts presented in the research article "Structure and activity of Cu/ZnO catalysts co-modified with aluminium and gallium for methanol synthesis" published in Catalysis Today [1].

Conocimiento sobre biosimilares en Atención Primaria: Un estudio de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN) / Knowledge about Biosimilars in Primary Care: a study by the Spanish Society of Primary Care Physicians (SEMERGEN)

Introducción: El objetivo de este estudio fue evaluar el grado de conocimiento y las necesidades de formación sobre fármacos biosimilares en los médicos de Atención Primaria (AP). Material y métodos: Estudio observacional, descriptivo y transversal mediante encuesta con cuestionario de 34 preguntas cumplimentado electrónicamente por médicos de familia a través de la página web de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Las áreas de conocimiento incluidas en la encuesta fueron: definición de biosimilar, marco regulatorio, prescripción de biosimilares, trazabilidad, intercambiabilidad, farmacovigilancia, biosimilares autorizados en AP y contribución a la sostenibilidad. El programa utilizado para el análisis y proceso de los datos fue el Barbwin 7.5. Resultados: Se analizaron 701 encuestas; el 57% fueron cumplimentadas por mujeres y el 60,9% eran procedentes del ámbito urbano. El 58% de los respondedores desconoce la definición de biosimilar y el 73% no sabe que el manejo de biosimilares no es equiparable al del genérico. La mayoría de los respondedores (84%) desconoce que el desarrollo requerido para la autorización de biosimilares es distinto del de los biológicos de referencia, el 66% no conoce ningún biosimilar en el ámbito de AP en España y el 94% desconoce el marco legal para el manejo de los biosimilares. Conclusiones: El conocimiento de los médicos de AP sobre biosimilares es bajo. Es necesaria la formación específica sobre biosimilares en AP y sobre los aspectos legales de su prescripción, intercambiabilidad y farmacovigilancia. Seis de cada 10 médicos no conocen ningún biosimilar utilizado en AP en España

Introduction: The objective of this study was to evaluate the awareness and training needs on biosimilar drugs in Primary Care (PC) physicians. Material and methods: Descriptive cross-sectional study based on an on-line questionnaire with a total of 34 multiple choice questions, published on the SEMERGEN website. The main Knowledge areas were: biosimilar definition; regulatory and legal framework; prescription, traceability, interchangeability and pharmacovigilance; availability of biosimilars in the PC setting, and the biosimilars contribution to sustainability. The software used for the analysis and data processing was the Barbwin 7.5. Results: An analysis was performed on the responses from 701 questionnaires completed. There was a slight majority (57%) of women participants. The majority of participant worked in urban centres (60.91%). The definition of biosimilar was not known by 58% of those that responded, and 73% were unaware that the management of biosimilars and generics was not comparable. Most (84%) of those that responded were not aware that the studies required for the approval of biosimilars is different from reference biological medicines. Around two-thirds (66%) those that responded did not know of any biosimilars available in PC setting, and the 94% were also unaware of the Spanish legal framework for the management of biosimilar medicines. Conclusions: The current knowledge about biosimilars among PC physicians is low. The critical areas in need of further training include specific information on biosimilars currently available in PC setting, as well as key aspects regarding prescription, interchangeability and pharmacovigilance requirements. Six out of ten doctors do not know of any biosimilar used in PC in Spain

[Knowledge about Biosimilars in Primary Care: a study by the Spanish Society of Primary Care Physicians (SEMERGEN)]. / Conocimiento sobre biosimilares en Atención Primaria: Un estudio de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN).

INTRODUCTION: The objective of this study was to evaluate the awareness and training needs on biosimilar drugs in Primary Care (PC) physicians. MATERIAL AND METHODS: Descriptive cross-sectional study based on an on-line questionnaire with a total of 34 multiple choice questions, published on the SEMERGEN website. The main Knowledge areas were: biosimilar definition; regulatory and legal framework; prescription, traceability, interchangeability and pharmacovigilance; availability of biosimilars in the PC setting, and the biosimilars contribution to sustainability. The software used for the analysis and data processing was the Barbwin 7.5. RESULTS: An analysis was performed on the responses from 701 questionnaires completed. There was a slight majority (57%) of women participants. The majority of participant worked in urban centres (60.91%). The definition of biosimilar was not known by 58% of those that responded, and 73% were unaware that the management of biosimilars and generics was not comparable. Most (84%) of those that responded were not aware that the studies required for the approval of biosimilars is different from reference biological medicines. Around two-thirds (66%) those that responded did not know of any biosimilars available in PC setting, and the 94% were also unaware of the Spanish legal framework for the management of biosimilar medicines. CONCLUSIONS: The current knowledge about biosimilars among PC physicians is low. The critical areas in need of further training include specific information on biosimilars currently available in PC setting, as well as key aspects regarding prescription, interchangeability and pharmacovigilance requirements. Six out of ten doctors do not know of any biosimilar used in PC in Spain.

Keratitis secondary to Fusarium spp. in Spain 2012-2014. / Queratitis secundaria a Fusarium spp. en España 2012-2014.

OBJECTIVE: To describe the clinical-epidemiological characteristics of a case series of fungal keratitis associated with Fusarium spp.., in Spain during the years 2012 to 2014. METHODS: A retrospective study of a case series was conducted on a systematic random sample of 10% of patients identified in Health Centres of provincial capitals (n=250). The centres were asked whether they had been presented with cases of Fusarium spp. keratitis characterised by microbiological methods. Of the 23 centres that responded, 14 had detected cases, with 13 of them accepting to participate, and 11 of them completing the study. The latter being sent a previously validated questionnaire. The variables analysed were: age, gender, habitual residence, profession, disease and medical history (previous systemic and ocular diseases, previous eye surgeries), and their outcomes. RESULTS: The response rate was 92%, identifying 23 cases of Fusarium spp.. of which 21 (91.3%) of them lived in urban areas. The professions most affected by the disease included chefs, administrative, and technical, with 13 cases (56.5%). The treatment guidelines established to confirm the infection showed the combined use of topical antibiotics associated with antiviral and/or antifungal agents. The use of contact lenses (86.9%) was the main risk factor. DISCUSSION: This study showed that this is a rare disease in Spain, but that a large percentage of people who present with the disease are resident in urban areas, and they work in closed environments, focusing attention on microtraumas caused by use of contact lenses.

Highly active Cu/ZnO-Al catalyst for methanol synthesis: effect of aging on its structure and activity.

The influence of aging of precipitates on the physical and catalytic properties of a copper/zinc oxide-aluminium (Cu/ZnO-Al) catalyst with an optimized composition (low Al concentration, Cu/Zn/Al = 68/29/3) prepared using co-precipitation has been investigated in detail. The change in the structure of precipitates with aging (from amorphous zincian georgeite to crystalline zincian malachite) strongly influences the micro- and nano-structure (Cu and ZnO crystallite size, exposed copper surface area, Cu-ZnO interactions and stability of ZnO) of the final Cu/ZnO-Al catalysts obtained after calcination and reduction of the precipitates. The results of catalytic activity in methanol synthesis from syngas show the higher intrinsic activity of the catalysts derived from aged zincian malachite precipitates as consequence of the increase in the exposed copper surface area and the Cu-ZnO contacts. The stability of catalysts under the reaction conditions was also improved in the catalysts derived from precipitates aged after crystallization of malachite. The catalyst derived from the precipitate removed close to the point of crystallization of malachite shows very poor activity in the methanol synthesis as consequence of its segregated large Cu crystallites in low contact with ZnO derived from the absence of carbonate retention after calcination of the precipitate and the presence of sodium species after conventional washing which favour the strong sintering and crystallization of Cu during reduction.

Production and stability of mechanochemically exfoliated graphene in water and culture media.

The preparation of graphene suspensions in water, without detergents or any other additives is achieved using freeze-dried graphene powders, produced by mechanochemical exfoliation of graphite. These powders of graphene can be safely stored or shipped, and promptly dissolved in aqueous media. The suspensions are relatively stable in terms of time, with a maximum loss of ∼25% of the initial concentration at 2 h. This work provides an easy and general access to aqueous graphene suspensions of chemically non-modified graphene samples, an otherwise (almost) impossible task to achieve by other means. A detailed study of the stability of the relative dispersions is also reported.

Human lactoferrin triggers a mitochondrial- and caspase-dependent regulated cell death in Saccharomyces cerevisiae.

We have previously shown that the antifungal activity of human lactoferrin (hLf) against Candida albicans relies on its ability to induce cell death associated with apoptotic markers. To gain a deeper understanding of the mechanisms underlying hLf-induced apoptosis, we characterized this cell death process in the well-established Saccharomyces cerevisiae model. Our results indicate that hLf induces cell death in S. cerevisiae in a manner that requires energy and de novo protein synthesis. Cell death is associated with nuclear chromatin condensation, preservation of plasma membrane integrity, and is Yca1p metacaspase-dependent. Lactoferrin also caused mitochondrial dysfunction associated with ROS accumulation and release of cytochrome c. Pre-incubation with oligomycin, an oxidative phosphorylation inhibitor, increased resistance to hLf and, accordingly, mutants deficient in the F1F0-ATP synthase complex were more resistant to death induced by hLf. This indicates that mitochondrial energetic metabolism plays a key role in the killing effect of hLf, though a direct role of F1F0-ATP synthase cannot be precluded. Overexpression of the anti-apoptotic protein Bcl-xL or pre-incubation with N-acetyl cysteine reduced the intracellular level of ROS and increased resistance to hLf, confirming a ROS-mediated mitochondrial cell death process. Mitochondrial involvement was further reinforced by the higher resistance of cells lacking mitochondrial DNA, or other known yeast mitochondrial apoptosis regulators, such as, Aif1p, Cyc3p and Aac1/2/3p. This study provides new insights into a detailed understanding at the molecular level of hLf-induced apoptosis, which may allow the design of new strategies to overcome the emergence of resistance of clinically relevant fungi to conventional antifungals.

Structure and Activity of Pt-Ni Catalysts Supported on Modified Al2O3 for Ethanol Steam Reforming.

Modification of alumina with La-, Ce-, Zr- and Mg-oxides was studied with the aim to use them as supports of bimetallic Pt-Ni catalysts for the steam reforming of ethanol. Activity results showed that modifications of Al2O3 support with the incorporation of La, Ce, Zr or Mg oxides play an essential role in the catalytic behaviour of PtNi catalysts. Bimetallic PtNi catalyst supported on bare Al2O3 showed evolution of the reaction products with time on stream consisting in the increase of C2H4 production with concomitant decrease of CH4 and CO2 production. The addition of Mg or Zr to γ-A1203 did not inhibit the appearance of ethylene but delayed its production. In the case of Ce- or La-supported catalysts, the product selectivities were stable with time-on-stream, with no changes being observed in the product distribution for 24 h. Characterization results showed that La- and Ce-containing supports improves the Pt and Ni metal exposure values. The better stability achieved for Ce and La containing catalysts was inferred to be related with a participation/assistance of lanthanum and cerium entities in the gasification of coke deposits together with a modification of Pt and Ni dispersion which lower the probability of the nucleation of coke precursors on their surfaces.

Biohydrogen production from lactose: influence of substrate and nitrogen concentration.

Hydrogen produced from renewable sources may be considered the energy vector of the future. However, reducing process costs is imperative in order to achieve this goal. In the present research, the effect of nitrogen (N), initial pH and substrate content for starting up the dark fermentative process was studied using the response surface methodology. Anaerobic digested dried sludge (biosolid pellets) was used as the inoculum. Synthetic wastewater was used as the substrate in batch reactors. A decrease in H2 production was observed with the increase in N and lactose concentrations. This drop was considerably greater when the concentration of lactose was at its lower level. Although the increase in lactose concentration results in a lower H2 production, the effect of N on the response is attenuated at higher levels of lactose. On the other hand, the effect of initial pH on the fermentation system was not significant. The evaluation on the process under semi-continuous conditions was performed using anaerobic sequencing batch reactors (ASBRs). The process was evaluated at different C/N ratios using synthetic wastewater. Results showed higher hydrogen yields with the gradual decrease in nitrogen content. The addition of cheese whey to the ASBR resulted in a H2 production rate of 0.18 L H2 L(-1) d(-1).

A photoresponsive graphene oxide-C60 conjugate.

An all-carbon donor-acceptor hybrid combining graphene oxide (GO) and C60 has been prepared. Laser flash photolysis measurements revealed the occurrence of photoinduced electron transfer from the GO electron donor to the C60 electron acceptor in the conjugate.

Reduced graphene oxide supported piperazine in aminocatalysis.

Reduced graphene oxide (rGO) has been used as a support for piperazine to provide a heterogeneous bifunctional organocatalyst (rGO-NH) that is able to efficiently promote vintage organic transformations such as Knoevenagel, Michael and aldol reactions. The obtained results suggest a significant role of the support in the course of these reactions.

Valorisation of used cooking oil sludge by codigestion with swine manure.

The addition of lipid wastes to the digestion of swine manure was studied as a means of increasing biogas production. Lipid waste was obtained from a biodiesel plant where used cooking oil is the feedstock. Digestion of this co-substrate was proposed as a way of valorising residual streams from the process of biodiesel production and to integrate the digestion process into the biorefinery concept. Batch digestion tests were performed at different co-digesting proportions obtaining as a result an increase in biogas production with the increase in the amount of co-substrate added to the mixture. Semi-continuous digestion was studied at a 7% (w/w) mass fraction of total solids. Co-digestion was successful at a hydraulic retention time (HRT) of 50 d but a decrease to 30 d resulted in a decrease in specific gas production and accumulation of volatile and long chain fatty acids. The CH4 yield obtained was 326 ± 46 l/kg VSfeed at an HRT of 50 d, while this value was reduced to 274 ± 43 l/kg VSfeed when evaluated at an HRT of 30 d. However these values were higher than the one obtained under batch conditions (266 ± 40 l/kg VSfeed), thus indicating the need of acclimation to the co-substrate. Despite of operating at low organic loading rate (OLR), measurements from respirometry assays of digestate samples (at an HRT of 50 d) suggested that the effluent could not be directly applied to the soil as fertiliser and might have a negative effect over soil or crops.

Risk factors for colonization with extended-spectrum beta-lactamase-producing enterobacteriaceae on admission to rehabilitation centres.

Patients newly admitted to rehabilitation centres are at high risk of colonization with multidrug-resistant bacteria because many of them have experienced prolonged stays in other healthcare settings and have had high exposure to antibiotics. We conducted a prospective study to determine the prevalence of and risk factors for colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in this population. Subjects were screened by rectal swab for ESBL-PE within 2 days of admission. Swabs were plated on chromagar ESBL plates and the presence of ESBL was verified by a central laboratory. A multilevel mixed effects model was used to identify risk factors for ESBL-PE colonization. Of 2873 patients screened, 748 (26.0%) were positive for ESBL-PE. The variables identified as independently associated with ESBL-PE colonization were: recent stay in an acute-care hospital for over 2 weeks (OR=1.34; 95% CI, 1.12, 1.6), history of colonization with ESBL-PE (OR=2.97; 95% CI, 1.99, 4.43), unconsciousness on admission (OR=2.59; 95% CI, 1.55, 4.34), surgery or invasive procedure in the past year (OR=1.49; 95% CI, 1.2, 1.86) and antibiotic treatment in the past month (OR=1.80; 95% CI, 1.45, 2.22). The predictive accuracy of the model was low (area under the ROC curve 0.656). These results indicate that ESBL-PE colonization is common upon admission to rehabilitation centres. Some risk factors for ESBL-PE colonization are similar to those described previously; however, newly identified factors may be specific to rehabilitation populations. The high prevalence and low ability to stratify by risk factors may guide infection control and empirical treatment strategies in rehabilitation settings.

A multinational study of colonization with extended spectrum ß-lactamase-producing Enterobacteriaceae in healthcare personnel and family members of carrier patients hospitalized in rehabilitation centres.

The study aims were: (i) to define the prevalence of and risk factors for colonization by extended spectrum ß-lactamase (ESBL) -producing Enterobacteriaceae (EPE) among healthcare workers (HCWs) and family members (FMs) of EPE-colonized patients in rehabilitation units and (ii) to compare EPE isolates from these three groups. The study included 286 FMs of 194 EPE-carrying patients identified in five rehabilitation units located in Israel, Italy, France and Spain. The EPE were detected in rectal swabs from 26 (9%) of 286 FMs screened. In multivariate analyses, older age of FM, greater mean number of hours spent with the patient, being a daughter or a female spouse of a patient, and chronic lung disease of the patient were significantly associated with carriage in the FM. Escherichia coli was the most common organism (76%), followed by Klebsiella pneumoniae (19%). Isolates were typed by pulsed field gel electrophoresis and multilocus sequence typing, and ESBLs were identified by PCR sequencing. A comparison of paired species isolates from FMs and their respective patient showed that 17 of 23 strains were indistinguishable. EPE were detected in 35 (3.5%, E. coli = 34) of the 1001 HCWs screened. Feeding patients was associated with EPE carriage by HCWs. Only 7 of 23 E. coli subclones cultured from HCWs were also represented among 376 patient-derived ESBL-producing E. coli isolates from the same rehabilitation units. In Spain, a higher proportion of HCWs and FMs were ESBL carriers than elsewhere (p <0.05). In conclusion, the molecular and epidemiological data suggest that FMs are at higher risk of EPE acquisition from their relative patients than HCWs.