EAACI guidelines on environmental science for allergy and asthma: The impact of short-term exposure to outdoor air pollutants on asthma-related outcomes and recommendations for mitigation measures.

The EAACI Guidelines on the impact of short-term exposure to outdoor pollutants on asthma-related outcomes provide recommendations for prevention, patient care and mitigation in a framework supporting rational decisions for healthcare professionals and patients to individualize and improve asthma management and for policymakers and regulators as an evidence-informed reference to help setting legally binding standards and goals for outdoor air quality at international, national and local levels. The Guideline was developed using the GRADE approach and evaluated outdoor pollutants referenced in the current Air Quality Guideline of the World Health Organization as single or mixed pollutants and outdoor pesticides. Short-term exposure to all pollutants evaluated increases the risk of asthma-related adverse outcomes, especially hospital admissions and emergency department visits (moderate certainty of evidence at specific lag days). There is limited evidence for the impact of traffic-related air pollution and outdoor pesticides exposure as well as for the interventions to reduce emissions. Due to the quality of evidence, conditional recommendations were formulated for all pollutants and for the interventions reducing outdoor air pollution. Asthma management counselled by the current EAACI guidelines can improve asthma-related outcomes but global measures for clean air are needed to achieve significant impact.

The impact of outdoor pollution and extreme temperatures on asthma-related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma.

Air pollution is one of the biggest environmental threats for asthma. Its impact is augmented by climate change. To inform the recommendations of the EAACI Guidelines on the environmental science for allergic diseases and asthma, a systematic review (SR) evaluated the impact on asthma-related outcomes of short-term exposure to outdoor air pollutants (PM2.5, PM10, NO2, SO2, O3, and CO), heavy traffic, outdoor pesticides, and extreme temperatures. Additionally, the SR evaluated the impact of the efficacy of interventions reducing outdoor pollutants. The risk of bias was assessed using ROBINS-E tools and the certainty of the evidence by using GRADE. Short-term exposure to PM2.5, PM10, and NO2 probably increases the risk of asthma-related hospital admissions (HA) and emergency department (ED) visits (moderate certainty evidence). Exposure to heavy traffic may increase HA and deteriorate asthma control (low certainty evidence). Interventions reducing outdoor pollutants may reduce asthma exacerbations (low to very low certainty evidence). Exposure to fumigants may increase the risk of new-onset asthma in agricultural workers, while exposure to 1,3-dichloropropene may increase the risk of asthma-related ED visits (low certainty evidence). Heatwaves and cold spells may increase the risk of asthma-related ED visits and HA and asthma mortality (low certainty evidence).

The impact of exposure to tobacco smoke and e-cigarettes on asthma-related outcomes: Systematic review informing the EAACI guidelines on environmental science for allergic diseases and asthma.

To inform the clinical practice guidelines' recommendations developed by the European Academy of Allergy and Clinical Immunology systematic reviews (SR) assessed using GRADE on the impact of environmental tobacco smoke (ETS) and active smoking on the risk of new-onset asthma/recurrent wheezing (RW)/low lung function (LF), and on asthma-related outcomes. Only longitudinal studies were included, almost all on combustion cigarettes, only one assessing e-cigarettes and LF. According to the first SR (67 studies), prenatal ETS increases the risk of RW (moderate certainty evidence) and may increase the risk of new-onset asthma and of low LF (low certainty evidence). Postnatal ETS increases the risk of new-onset asthma and of RW (moderate certainty evidence) and may impact LF (low certainty evidence). Combined in utero and postnatal ETS may increase the risk of new-onset asthma (low certainty evidence) and increases the risk of RW (moderate certainty evidence). According to the second SR (24 studies), ETS increases the risk of severe asthma exacerbations and impairs asthma control and LF (moderate certainty evidence). According to the third SR (25 studies), active smoking increases the risk of severe asthma exacerbations and of suboptimal asthma control (moderate certainty evidence) and may impact asthma-related quality-of-life and LF (low certainty evidence).

The impact of indoor pollution on asthma-related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma.

Systematic review using GRADE of the impact of exposure to volatile organic compounds (VOCs), cleaning agents, mould/damp, pesticides on the risk of (i) new-onset asthma (incidence) and (ii) adverse asthma-related outcomes (impact). MEDLINE, EMBASE and Web of Science were searched for indoor pollutant exposure studies reporting on new-onset asthma and critical and important asthma-related outcomes. Ninety four studies were included: 11 for VOCs (7 for incidenceand 4 for impact), 25 for cleaning agents (7 for incidenceand 8 for impact), 48 for damp/mould (26 for incidence and 22 for impact) and 10 for pesticides (8 for incidence and 2 for impact). Exposure to damp/mould increases the risk of new-onset wheeze (moderate certainty evidence). Exposure to cleaning agents may be associated with a higher risk of new-onset asthma and with asthma severity (low level of certainty). Exposure to pesticides and VOCs may increase the risk of new-onset asthma (very low certainty evidence). The impact on asthma-related outcomes of all major indoor pollutants is uncertain. As the level of certainty is low or very low for most of the available evidence on the impact of indoor pollutants on asthma-related outcomes more rigorous research in the field is warranted.

Strategies to Reduce the Use of Antibiotics in Fresh and Chilled Equine Semen.

The study assessed the impact of four equine semen processing techniques on sperm quality and microbial load immediately post-processing and after 48 h of refrigeration. The aim was to explore the potential reduction of prophylactic antibiotic usage in semen extenders. Semen from ten adult stallions was collected and processed under a strict hygiene protocol and divided into four aliquots: Simple Centrifugation with antibiotics (SC+), Simple Centrifugation (SC-), Single-Layer Colloidal Centrifugation (CC-), and Filtration (with SpermFilter®) (F-), all in extenders without antibiotics. Sperm motility, viability, and microbial load on three culture media were assessed. No significant differences were observed in the main in the sperm quality parameters among the four protocols post-processing and at 48 h (p < 0.05 or p < 0.1). Microbial loads in Columbia 5% Sheep Blood Agar and Schaedler vitamin K1 5% Sheep Blood Agar mediums were significantly higher (p < 0.10) for raw semen than for CS+, CC-, and F- post-processing. For Sabouraud Dextrose Agar medium, the microbial load was significantly higher (p < 0.10) in raw semen compared to CS+ and F-. No significant differences (p < 0.10) were found in 48 h chilled samples. Regardless of antibiotic presence, the evaluated processing methods, when combined with rigorous hygiene measures, maintained semen quality and reduced microbial load to the same extent as a traditional protocol using antibiotics.

Presence of metallic components in transdermal drug delivery systems and risk of skin burns. / [Artículo traducido] Presencia de partículas metálicas en parches transdérmicos de medicamentos y riesgo de quemaduras.

OBJECTIVE: Skin burns are associated with the presence of metallic components in transdermal drug delivery systems during Magnetic Resonance Imaging, cardioversion or defibrillation procedures. The aim of the study was to review the presence of metallic components in marketed products of transdermal drug delivery systems in Spain. METHOD: For each presentation, the summary of product characteristics was reviewed. If the information was not provided, manufacturers were contacted. RESULTS: We identified 59 marketed products of transdermal drug delivery systems of 12 different active substances. 59.3% of patches contained metallic components or their presence could not be ruled out. Information regarding the need to remove the patch was only included in 8 summaries of product characteristics (13.6%). A table was elaborated and included the following aspects: product, active substance, manufacturer, need to remove the patch before the exposure to magnetic or electric fields and references. CONCLUSION: More than a half of the patches at the time of the study contained metals or their absence could not be confirmed by the manufacturer. However, this information was only included in 13.6% of summaries of product characteristics.

Consensus document on the management of hyperkalemia.

Hyperkalaemia is a common electrolyte imbalance with potentially serious short-, medium- and long-term consequences on morbidity and mortality rates and the use of national health service resources. The fact that different medical specialities can manage hyperkalaemia makes it important to have a unified approach, and the recent availability of new specific drug treatments means that the approach needs to be updated. This consensus document from the scientific societies most directly involved in the management of hyperkalaemia (Sociedad Española de Cardiología [Spanish Society of Cardiology], Sociedad Española de Endocrinología y Nutrición [Spanish Society of Endocrinology and Nutrition], Sociedad Española de Medicina Interna [Spanish Society of Internal Medicine], Sociedad Española de Medicina de Urgencias y Emergencias [Spanish Society of Accident and Emergency Medicine] and Sociedad Española de Nefrología [Spanish Society of Nephrology]) first of all reviews basic aspects of potassium balance and blood potassium. Then it goes on to focus on the concept, epidemiology, pathophysiology and diagnostic and therapeutic approaches to hyperkalaemia. The available evidence and the main published studies have been reviewed with the aim of providing a useful tool in the multidisciplinary approach to patients with hyperkalaemia.

Asistencia médica a bordo de los buques en altamar basada en la telemedicina / Medical assistance via telemedicine on ships at sea

Introduction: Statistical study about the health care provided to seafarers on board their ships by the Spanish Radio Medical Center of the Marine Social Institute (Ministry of Employment and Social Security). Material and results: In 2015, 1658 calls were received requesting medical assistance and 1014 patients were attended (average: 1.64 calls / case). The use of satellite communication was the most common means of communication used (92.2%). The mean age of the patients was 44.51 (standard deviation = 9.892). The average age of Spanish and European Union crew members is higher than those of other origin (p < 0.01). Trawlers account for the 76.4% of the calls asking for medical assistance, merchant ships the 13.2%, travelling ships 1%, yachts 0.5% and others 8.8%. No significant differences were found between the pathology seen and the type of vessel (p> 0.1). 25% of medical consultations were due to trauma conditions and 75% to other diseases. In trauma patients, the affected body regions were: the upper limbs (40.2%), the head (10.8%), the lower limbs (16.7%) and the trunk (12.7%). Isolated eye traumas represented the 11.2% of cases. 81.6% of all the cases were treated on board until port destination. In the 18.4% of the cases, rescue was required (3.2% per helicopter). In the trauma cases, only 61.26% were able to remain on board. Rescue was more frequent in the event of trauma (p < 0.01). Conclusions: Assistances due to diseases are more frequent than those due to trauma. Most patients could be assisted on board. It was observed that seafarer population is becoming older.

Introducción: Estudio estadístico de la atención sanitaria prestada por el Centro Radio Médico Español del Instituto Social de la Marina a los marinos a bordo de sus buques. Material y resultados: Durante un año, se asistieron 1014 pacientes y se recibieron 1658 llamadas demandando consulta médica (media: 1.64 llamadas/caso). El satélite es el medio de comunicación más empleado para la consulta (92.2%). La media de edad de los pacientes fue de 44.51 (desviación estándar = 9.892). La media de edad de los tripulantes españoles y de la Unión Europea es mayor que el resto (p = 0,00). Los pesqueros representan un 76.4% de las asistencias; los mercantes, 13.2%; pasaje, 1%; buques de recreo, 0.5%, y otros, 8.8%. No se han encontrado diferencias significativas entre la afección consultada y el tipo de buque (p > 0.1). El 25% de las atenciones se debieron a accidentes y el 75% a enfermedades. En los accidentes, las regiones corporales afectadas fuern: miembros superiores (10%), cabeza (5.5%), miembros inferiores (4.1%) y tronco (3.2%). Los ojos representan el 2.8% de los casos. El 81.6% de todos los casos fue atendido a bordo hasta la siguiente llegada a puerto. En el 18.4% fue necesaria la evacuación (3.2% por helicóptero). En el caso de los accidentados, sólo el 6.26% pudo permanecer a bordo. La evacuación es más frecuente en caso de accidente (p = 0.00). Conclusiones: Son más frecuentes las asistencias por enfermedad que por accidente. La mayoría de los pacientes pueden permanecer a bordo. Se observa un envejecimiento de la población embarcada.

Google trends, una herramienta útil para detectar la presencia de polen atmosférico / Google trends, useful tool in airborne pollen detection

La polinosis es una de las alergias más comunes en el mundo, condicionando de manera directa la calidad de vida de la población, siendo la polinosis al olivo una de las más frecuentes en zonas de clima Mediterráneo. La previsión de los niveles de polen en la atmósfera se ha convertido en un objetivo fundamental para alergólogos y aerobiólogos, tratando de prevenir los síntomas de la polinosis. Google trends es una herramienta desarrollada por Google, que nos facilita información acerca de la dinámica de búsquedas de los usuarios a través de internet. Como objetivo principal de este trabajo se pretende realizar un valoración preliminar de la utilidad de esta herramienta para detectar la presencia de polen en la atmósfera y para explorar el impacto de polinosis entre la población.Para alcanzar dichos objetivos se han empleado datos aerobiológicos sobre concentración de polen de olivo en la atmósfera de Córdoba (España) y datos sobre tendencias de búsqueda en el buscador Google de las palabras ôAlergiaõ, ôPolenõ y ôOlivoõ. Se ha observado una elevada correlación y relación geográfica entre la tendencia de búsquedas de palabras relacionadas con polinosis y las concentraciones reales de polen atmosférico. Esta herramienta posee una gran potencial en la lucha contra la polinosis, ya que permite conocer información instantánea acerca de los síntomas en la problación, a diferencia de los métodos tradicionales que presentan un desfase de la información. De este modo, el presente trabajo ofrece evidencias acerca del potencial de Google trends para detectar la presencia de aeroalérgenos y para estudiar el impacto de la polinosis...

Pollinosis is one of the most extended allergies in the world, determining directly the quality of life of the population. Airborne pollen forecasting has become a key objective for allergists and aerobiologists trying to prevent the symptoms of hay fever. Google trends is a tool developed by Google, which provides information about the dynamics of user searches through internet. The main aim of this work is to conduct a preliminary assessment of the usefulness of this tool to detect the presence of large concentrations of pollen in the atmosphere and to explore the impact of pollinosis among the population.To achieve these objectives, the analysis is based on data for olive pollen concentrations in the atmosphere of Cordoba (Spain) and search counts in Google of the words "Allergy", "Pollen" and "Olive". We observed a high correlation and a high geographic relationship between the number of searches for words related to pollen allergy, and the actual concentrations of atmospheric pollen. This tool possesses a great potential in the fight against allergy because it can provide instant and on-line information about symptoms in population, unlike traditional methods that have a mismatch of information. Thus, the present study provides evidence about the potential of Google trends to detect the presence of aeroallergens and to study the impact of pollinosis...

Theoretical assumptions of Maffesoli's sensitivity and Problem-Based Learning in Nursing Education / Pressupostos teóricos da sensibilidade de Maffesoli e Aprendizagem Baseada em Problemas na Educação de Enfermagem / Presupuestos teóricos de la sensibilidad de Maffesoli y Aprendizaje Basado en Problemas en Educación en Enfermería

OBJECTIVE: understand the everyday and the imaginary of Nursing students in their knowledge socialization process through the Problem-Based Learning (PBL) strategy. METHOD: Action Research, involving 86 students from the second year of an undergraduate Nursing program in Spain. A Critical Incident Questionnaire and Group interview were used. Thematic/categorical analysis, triangulation of researchers, subjects and techniques. RESULTS: the students signal the need to have a view from within, reinforcing the criticism against the schematic dualism; PBL allows one to learn how to be with the other, with his mechanical and organic solidarity; the feeling together, with its emphasis on learning to work in group and wanting to be close to the person taking care. CONCLUSIONS: The great contradictions the protagonists of the process, that is, the students experience seem to express that group learning is not a form of gaining knowledge, as it makes them lose time to study. The daily, the execution time and the imaginary of how learning should be do not seem to have an intersection point in the use of Problem-Based Learning. The importance of focusing on the daily and the imaginary should be reinforced when we consider nursing education. .

OBJETIVO: compreender o cotidiano e o imaginário dos alunos de Enfermagem em seu processo socializador do conhecimento, através da estratégia de Aprendizagem Baseada em Problemas. MÉTODO: Pesquisa-Ação, desenvolvida com 86 alunos da segunda turma de um curso de graduação em Enfermagem, na Espanha. Utilizou-se um Questionário de Incidências Críticas e Entrevista Grupal, análise temática/categorial, triangulação de investigadores, sujeitos e técnicas. RESULTADOS: os estudantes indicaram a necessidade de se ter uma visão de dentro, reforçando a crítica contra o dualismo esquemático; a Aprendizagem Baseada em Problemas possibilita: aprender a estar com o outro, com sua solidariedade mecânica e orgânica; o sentir juntos, com ênfase no aprender a trabalhar em grupo e querer estar próximo daquele que cuida. CONCLUSÕES: as grandes contradições vividas pelos protagonistas do processo, os estudantes, parecem expressar que a aprendizagem grupal não é uma forma de ganhar conhecimentos, ao tirar seu tempo para estudar. O cotidiano, o tempo de execução e o imaginário de como precisa ser a aprendizagem parece não possuir um ponto de encontro na utilização da Aprendizagem Baseada em Problemas. Reforça-se a importância de enfocar o cotidiano e o imaginário quando se pensa na educação em enfermagem. .

OBJETIVO: comprender lo cotidiano y lo imaginario de los alumnos de Enfermería en su proceso socializador del conocimiento a través de la estrategia del Aprendizaje Basado en Problemas (ABP). MÉTODO: Investigación Acción, desarrollada con 86 alumnos de 2º curso de Grado en Enfermería en España. Se utilizó Cuestionario de Incidencias Críticas y Entrevista grupal. Análisis temático/categorial, triangulación de investigadores, sujetos y técnicas. RESULTADOS: los estudiantes señalan la necesidad de tener una visión desde dentro, reforzando la crítica al dualismo esquemático; el ABP posibilita aprender a estar con otro, con su solidaridad mecánica y orgánica; el sentir juntos, con su énfasis en aprender a trabajar en grupo y querer estar próximo de aquel que cuida. CONCLUSIONES: Las grandes contradicciones que viven los protagonistas del proceso, los estudiantes, parecen expresar que el aprendizaje grupal no sea una forma de adquirir conocimientos, al incidir en que les quita tiempo para estudiar. Lo cotidiano, el tiempo de ejecución, y lo imaginario de cómo precisa ser el aprendizaje, parecen no tener un punto de encuentro en la utilización del Aprendizaje Basado en Problemas. Reforzar la importancia de enfocar lo cotidiano y lo imaginario, cuando pensamos en la educación en enfermería. .