Objectives To analyse the characteristics and predictors of death in hospitalized patients with coronavirus disease 2019 (COVID-19) in Spain. Methods A retrospective observational study was performed of the first consecutive patients hospitalized with COVID-19 confirmed by real-time PCR assay in 127 Spanish centres until 17 March 2020. The follow-up censoring date was 17 April 2020. We collected demographic, clinical, laboratory, treatment and complications data. The primary endpoint was all-cause mortality. Univariable and multivariable Cox regression analyses were performed to identify factors associated with death. Results Of the 4035 patients, male subjects accounted for 2433 (61.0%) of 3987, the median age was 70 years and 2539 (73.8%) of 3439 had one or more comorbidity. The most common symptoms were a history of fever, cough, malaise and dyspnoea. During hospitalization, 1255 (31.5%) of 3979 patients developed acute respiratory distress syndrome, 736 (18.5%) of 3988 were admitted to intensive care units and 619 (15.5%) of 3992 underwent mechanical ventilation. Virus- or host-targeted medications included lopinavir/ritonavir (2820/4005, 70.4%), hydroxychloroquine (2618/3995, 65.5%), interferon beta (1153/3950, 29.2%), corticosteroids (1109/3965, 28.0%) and tocilizumab (373/3951, 9.4%). Overall, 1131 (28%) of 4035 patients died. Mortality increased with age (85.6% occurring in older than 65 years). Seventeen factors were independently associated with an increased hazard of death, the strongest among them including advanced age, liver cirrhosis, low age-adjusted oxygen saturation, higher concentrations of C-reactive protein and lower estimated glomerular filtration rate. Conclusions Our findings provide comprehensive information about characteristics and complications of severe COVID-19, and may help clinicians identify patients at a higher risk of death.

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Institutional trust is in decline in many western democracies. Since the 2008 global economic and financial crisis, this increasing distrust has been closely related to trust in political institutions. Trust in institutions is one of the pillars of democracy, and its decline is one of the most evident and shared symptoms of the recession, especially in those contexts where it has been particularly acute. This article has both substantive and methodological aims. From a substantive point of view, it deals with trust in political institutions in Europe, and its decline during the recession. Differences are found among European countries, depending on the severity of the economic crisis. From a methodological point of view, the article compares two methodologies for cross-cultural analyses: the more traditional Multiple-Group Confirmatory Factor Analysis, and the newer Alignment method. Recommendations for the use of the newer method in certain circumstances are provided.

IntroductionThe public's justifiability of euthanasia has increased as more countries have adopted laws permitting a range of end-of-life practices. Despite this trend, there is a dearth of longitudinal and comparative studies investigating attitudes toward euthanasia. Consequently, it remains unclear whether this rise in justifiability is a period-specific trend or generational change.MethodsWe analyzed data from the European and World Values Survey from 1981 to 2021 to examine period variations, between-cohort differences, and within-cohort changes across 35 affluent countries. This analysis was conducted using dynamic comparative multilevel regression and a comparative version of the cross-classified random effects regressions.ResultsOur descriptive results supported our hypotheses, indicating an increase in euthanasia's justifiability in virtually all surveyed countries, with both overall and within-cohort changes gravitating toward higher degrees of justifiability. Furthermore, newer periods and younger cohorts were found to be more permissive than their older counterparts. These consistent increases in the justifiability of euthanasia were verified by the multilevel models.DiscussionOur results were in line with modernization theory, observing a gradual change in attitudes between cohorts due to generational replacement. However, we also identified intra-cohort changes related to the processes of human development across various countries. Some robustness checks produced ambiguous results in distinguishing period and cohort effects, yet the combination of these components aligns with substantive theory.ConclusionOur findings indicate a more complex pattern of change than predicted by the impressionable years model, a leading approach in political socialization research. This study contributes significantly to our understanding of evolving attitudes toward euthanasia, bridging the gap in longitudinal and comparative studies on the subject.

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La ubicación en la escala izquierda-derecha es una de las formas más extendidas que utilizan los ciudadanos para expresar sus posiciones políticas en las democracias occidentales. Existe una gran cantidad de literatura que explica los factores en los que se basa la posición en dicha escala, principalmente, la estructura social, los valores y el partidismo. Este artículo se centra en las posiciones de los ciudadanos en la escala izquierda-derecha en el contexto español utilizando las oleadas de 2008 y 2017 de la Encuesta Europea de Valores (EVS) para presentar un modelo explicativo completo para las posiciones izquierda-derecha, que incluye, a nuestro entender, el espectro más amplio de la dimensión de valores examinadas hasta la fecha, concluyendo que el partidismo es el factor más importante que explica el autoposicionamiento en la escala.

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