The SARS-CoV-2 and other human coronavirus spike proteins are fine-tuned towards temperature and proteases of the human airways.

The high transmissibility of SARS-CoV-2 is related to abundant replication in the upper airways, which is not observed for the other highly pathogenic coronaviruses SARS-CoV and MERS-CoV. We here reveal features of the coronavirus spike (S) protein, which optimize the virus towards the human respiratory tract. First, the S proteins exhibit an intrinsic temperature preference, corresponding with the temperature of the upper or lower airways. Pseudoviruses bearing the SARS-CoV-2 spike (SARS-2-S) were more infectious when produced at 33°C instead of 37°C, a property shared with the S protein of HCoV-229E, a common cold coronavirus. In contrast, the S proteins of SARS-CoV and MERS-CoV favored 37°C, in accordance with virus preference for the lower airways. Next, SARS-2-S-driven entry was efficiently activated by not only TMPRSS2, but also the TMPRSS13 protease, thus broadening the cell tropism of SARS-CoV-2. Both proteases proved relevant in the context of authentic virus replication. TMPRSS13 appeared an effective spike activator for the virulent coronaviruses but not the low pathogenic HCoV-229E virus. Activation of SARS-2-S by these surface proteases requires processing of the S1/S2 cleavage loop, in which both the furin recognition motif and extended loop length proved critical. Conversely, entry of loop deletion mutants is significantly increased in cathepsin-rich cells. Finally, we demonstrate that the D614G mutation increases SARS-CoV-2 stability, particularly at 37°C, and, enhances its use of the cathepsin L pathway. This indicates a link between S protein stability and usage of this alternative route for virus entry. Since these spike properties may promote virus spread, they potentially explain why the spike-G614 variant has replaced the early D614 variant to become globally predominant. Collectively, our findings reveal adaptive mechanisms whereby the coronavirus spike protein is adjusted to match the temperature and protease conditions of the airways, to enhance virus transmission and pathology.

Impact of the Salud Mesoamerica Initiative on delivery care choices in Guatemala, Honduras, and Nicaragua.

BACKGROUND: The Salud Mesoamérica Initiative (SMI) is a public-private collaboration aimed to improve maternal and child health conditions in the poorest populations of Mesoamerica through a results-based aid mechanism. We assess the impact of SMI on the staffing and availability of equipment and supplies for delivery care, the proportion of institutional deliveries, and the proportion of women who choose a facility other than the one closest to their locality of residence for delivery. METHODS: We used a quasi-experimental design, including baseline and follow-up measurements between 2013 and 2018 in intervention and comparison areas of Guatemala, Nicaragua, and Honduras. We collected information on 8754 births linked to the health facility closest to the mother's locality of residence and the facility where the delivery took place (if attended in a health facility). We fit difference-in-difference models, adjusting for women's characteristics (age, parity, education), household characteristics, exposure to health promotion interventions, health facility level, and country. RESULTS: Equipment, inputs, and staffing of facilities improved after the Initiative in both intervention and comparison areas. After adjustment for covariates, institutional delivery increased between baseline and follow-up by 3.1 percentage points (ß = 0.031, 95% CI -0.03, 0.09) more in intervention areas than in comparison areas. The proportion of women in intervention areas who chose a facility other than their closest one to attend the delivery decreased between baseline and follow-up by 13 percentage points (ß = - 0.130, 95% CI -0.23, - 0.03) more than in the comparison group. CONCLUSIONS: Results indicate that women in intervention areas of SMI are more likely to go to their closest facility to attend delivery after the Initiative has improved facilities' capacity, suggesting that results-based aid initiatives targeting poor populations, like SMI, can increase the use of facilities closest to the place of residence for delivery care services. This should be considered in the design of interventions after the COVID-19 pandemic may have changed health and social conditions.

Rate of dementia diagnoses according to the degree of aging of the population.

BACKGROUND: There is a lack of information regarding geographical differences in the incidence and prevalence of dementia diagnosis according to the degree of aging of the population. The objectives of this study were to analyze the rate of dementia diagnoses, and to compare the dementia subtypes and the clinical characteristics of the patients depending on the degree of aging of their municipalities. METHODS: We used data from the Registry of Dementias of Girona (ReDeGi), containing the cases of dementia diagnosed in the memory clinics of the Health Region of Girona, in Catalonia (Spain), during 2007-2012. The municipalities were classified by a cluster analysis as aged or young municipalities according to their proportion of older people using population ageing indicators. The incidence rates of dementia diagnosis in each type of municipality were compared. RESULTS: The ReDeGi registered 4,314 cases in the municipalities under surveillance. The clinical incidence of dementia was lower in aged municipalities (4.5 vs. 6.1 cases per 1,000 person-years aged 65 and over). Patients from young municipalities had an increased frequency of behavioral and psychological symptoms of dementia. CONCLUSIONS: The environment may influence the clinical manifestations of dementia that predispose people to visit health specialists and obtain a diagnosis.

Intestinal Dysbiosis: Exploring Definition, Associated Symptoms, and Perspectives for a Comprehensive Understanding - a Scoping Review.

Dysbiosis is a clinical condition marked by altered gut microbiota resulting from external and internal host factors. It is strongly associated with gastrointestinal and extraintestinal alterations, so its symptomatology is broad and nonspecific. To date, gaps remain that limit professionals from making a timely diagnosis and prescribing the appropriate treatment. We aim to synthesize existing literature regarding clinical parameters for the early detection of patients with intestinal dysbiosis and the clinical events in which the use of probiotics as adjuvant therapy is most frequently reported. A scoping review of the literature was conducted in PubMed, Embase, Cochrane, and BVS (Biblioteca Virtual en Salud in Spanish) databases for articles published in the last 5 years. Primary studies and literature reviews related to clinical presentation, dysbiosis screening, and probiotics as adjuvant therapy for adult and pediatric patients were included. Twenty-three articles were retrieved in which the most frequently reported symptoms were abdominal distension, abdominal pain, and diarrhea. Chronic and metabolic diseases where the conditions most strongly associated with dysbiosis. Depending on symptomatology and etiology, dysbiosis is often treated with probiotics. Dysbiosis, often linked to diarrhea, should be considered with other symptoms like abdominal distension and pain, along with predisposing conditions and patient risk factors. Probiotics are commonly used as co-adjuvant treatments for antibiotic-associated diarrhea, irritable bowel syndrome, and childhood allergic diseases. The most commonly used probiotics were Weizmannia coagulans (formerly B. coagulans), Alkalihalobacillus clausii (formerly Bacillus clausii), Lacticaseibacillus rhamnosus, Limosilactobacillus reuteri, and Saccharomyces boulardii.

Pain treatment and its cost in old people with dementia: a descriptive analysis from the Registry of Dementias of Girona (ReDeGi).

BACKGROUND: Pain prevalence is high among elderly people, and equally prevalent in those with dementia. The aim of this study was to describe the use analgesics, as well as the cost of these treatments in old people with dementia. METHODS: We used a cross-sectional design using 1186 cases registered by the Registry of Dementias of Girona from 2007 to 2008. All drugs were categorized following the Anatomic Therapeutic Chemical classification and grouped according to the World Health Organization (WHO) analgesic ladder steps. Descriptive statistical methods were used. RESULTS: Analgesics were prescribed to 78.6% (95% CI, 76.2-81.0) of the registered cases. Of them, 80.6% (95% CI, 78.0-83.2) were treated following step 1 of the WHO analgesic ladder, 16.8% (95% CI, 14.4-19.3) following step 2 and 2.6% (95% CI, 1.5-3.6) following step 3. Pain treatment in old people with dementia had a cost of 42.1 € per patient and year, with no significant differences depending on the subtype of dementia. CONCLUSIONS: The use of analgesics in our sample was not associated to age or to dementia severity, which are themselves risk factors for increased pain. Moreover, no differences were detected depending on the subtype of dementia.

Exemestane versus anastrozole as front-line endocrine therapy in postmenopausal patients with hormone receptor-positive, advanced breast cancer: final results from the Spanish Breast Cancer Group 2001-03 phase 2 randomized trial.

BACKGROUND: Several aromatase inhibitor studies have reported variations in the inhibitory potency of these agents that could lead to differences in clinical outcomes. In the current study, the authors formally evaluated the activity of anastrozole and exemestane in postmenopausal women with hormone-responsive, advanced breast cancer. METHODS: Postmenopausal women who had measurable disease according to Response Evaluation Criteria in Solid Tumors and had not received previous endocrine therapy for advanced breast cancer were randomized to receive either oral exemestane 25 mg daily or oral anastrozole 1 mg daily until they had disease progression. The primary endpoint was the objective response rate (ORR), and secondary endpoints included the clinical benefit rate (CBR), time to progression (TTP), overall survival, and safety. Crossover to the other aromatase inhibitor was permitted at the time of disease progression; ORR, CBR, and TTP after second-line treatment also were explored. RESULTS: In total, 103 patients were enrolled. The median patient age was 71.6 years, 52.4% of patients had visceral disease, and 75.8% of patients had ≥ 2 disease sites. Half of the patients had received previous tamoxifen, and 60% had received previous chemotherapy. The efficacy observed in the exemestane and anastrozole groups was an ORR of 36.2% and 46%, respectively; a CBR of 59.6% and 68%, respectively, and a TTP of 6.1 months and 12.1 months, respectively. At progression, 28 patients crossed over to the other aromatase inhibitor, including 16 patients who switched to exemestane (CBR, 43.7%; TTP, 4.4 months) and 12 patients who switched to anastrozole (CBR, 8.3%; TTP, 2 months). Both drugs were generally well tolerated, and no study drug-related serious adverse events were reported. CONCLUSIONS: In this phase 2 randomized trial, no significant differences in clinical activity were observed in favor of exemestane to justify a superiority phase 3 trial design in the first-line setting.

Central nervous system drug consumption depending on the time between symptom onset and the diagnosis of Alzheimer's disease: an analysis by the Registry of Dementias of Girona.

AIMS: To describe central nervous system (CNS) drug consumption patterns depending on the time to diagnosis of Alzheimer's disease (AD), and to check whether the cases diagnosed later are associated with greater severity and consuming more CNS drugs. METHODS: Cross-sectional study using 952 cases of the Registry of Dementias of Girona. A binary logistic regression was used to detect variables associated with the use of CNS drugs depending on the time to diagnosis. RESULTS: CNS drugs were consumed by 95.8% of the AD patients. Only antipsychotics presented a statistically significant increase in the frequency of prescription to patients with longer time elapsed from symptom onset to AD diagnosis. CONCLUSION: Longer time elapsed from the onset of symptoms to the diagnosis resulted in increased probability of antipsychotic consumption.

Predicting fertility from sperm motility landscapes.

Understanding the organisational principles of sperm motility has both evolutionary and applied impact. The emergence of computer aided systems in this field came with the promise of automated quantification and classification, potentially improving our understanding of the determinants of reproductive success. Yet, nowadays the relationship between sperm variability and fertility remains unclear. Here, we characterize pig sperm motility using t-SNE, an embedding method adequate to study behavioural variability. T-SNE reveals a hierarchical organization of sperm motility across ejaculates and individuals, enabling accurate fertility predictions by means of Bayesian logistic regression. Our results show that sperm motility features, like high-speed and straight-lined motion, correlate positively with fertility and are more relevant than other sources of variability. We propose the combined use of embedding methods with Bayesian inference frameworks in order to achieve a better understanding of the relationship between fertility and sperm motility in animals, including humans.

Long-term outcome of hepatitis C virus infections acquired after pediatric liver transplantation.

The outcomes and characterization of hepatitis C virus (HCV) infections after pediatric liver transplantation (LT) have rarely been reported. We describe our experience with HCV infections after pediatric LT. Ten of 207 children (4.8%) who underwent LT at our institution (1985-2010) developed previously undiagnosed HCV disease. Eight received a liver graft before blood product and donor screening for HCV became available. The mean age at transplantation was 8.9 ± 4.3 years, and the median time from transplantation to the diagnosis of HCV was 15.1 years (range = 0.2-19.7 years). The genotypes were 1 (n = 8), 3 (n = 1), and undetermined (n = 1). At the time of this writing, all the patients were still alive with a mean follow-up of 7.3 ± 5.5 years after the diagnosis of HCV. Five patients did not receive treatment; 2 of these patients achieved spontaneous viral clearance (SVC). Four of the 5 treated patients achieved a sustained virological response, and 3 had an early virological response (EVR). Two of these 4 patients developed chronic rejection while they were on treatment, but this was resolved with a conversion from cyclosporine A to tacrolimus. The remaining patient was continuing treatment and had achieved EVR. In conclusion, despite the limitations of our series, de novo HCV infections after pediatric LT seem to have a slow histological progression. Even with genotype 1, the patients have a good long-term prognosis and respond well to treatment. Nevertheless, chronic rejection during antiviral therapy may develop. In addition, SVC may occur in this population.

Community Dermatology in Argentina.

All around the globe the population has limited access to dermatologic care, and there are too few dermatologists to accommodate the high demand for skin care. Education of the community and frontline health workers is key to obtaining long-term impact in the skin health of a population. Reaching a community as a whole is challenging for dermatologists coming from distant cities, because cross-cultural obstacles often arise. This article describes some simple and positive ways of addressing the community directly while training health care workers in the recognition of prevalent skin diseases and effective pathways of management of these conditions.

Impact of Using a Novel Gastric Feeding Tube Adaptor on Patient's Comfort and Air Leaks During Non-invasive Mechanical Ventilation.

INTRODUCTION: The presence of oral or naso-enteral probes during non-invasive mechanical ventilation (NIMV) increases the risk of leakage and patient discomfort. The objective of this study was to evaluate the effectiveness of a novel tube adapter for NIMV (TA-NIMV) in relation to leakage and comfort level. METHODS: A non-randomized quasi-experimental design was performed in an adult intensive care unit of a highly complex hospital, in which patients were their own controls. We included adult patients who required NIV with oronasal mask and who simultaneously had oral or naso-enteric tubes. The interventions were as follows: every participant received two therapies, one with the TA-NIMV and one conventional therapy of NIMV (CT-NIMV). Comfort could be evaluated in 99 patients with a Glasgow Coma Scale of 15. The outcomes of interest was the average percentage of air leak and patient comfort during each intervention. RESULTS: 196 patients were included in the study during a 16-month period. The mean air leak percentage was 9.2% [standard deviation (SD), 7.7] during TA-NIMV and 32.5% (SD, 12.5) during CT-NIMV (p<0.001). 84.9% reported being comfortable or very comfortable during TA-VMNI. 66.7% Uncomfortable or Very uncomfortable during CT-NIMV (p<0.001). CONCLUSION: Higher comfort levels and lower air leakage volume percentages were achieved using the TA-NIMV than those achieved by CT-NIMV.

Programa educativo sobre la actividad física: repercusión en el estado neurocognitivo de las personas prejubilables / Educational program on physical activity: impact on the neurocognitive state of early retirement

RESUMEN Fundamento: las sociedades civilizadas se han propuesto estrategias para fortalecer la calidad de vida, el validismo e independencia de los adultos mayores prejubilables o con vínculo laboral activo extendido. Objetivo: determinar modificaciones en el afrontamiento a los acontecimientos vitales y en el estado neurocognitivo en personas en etapa de prejubilación al aplicar un programa educativo basado en la actividad física. Métodos: se realizó un estudio de intervención con diseño cuasiexperimental en el Policlínico Universitario "Marta Abreu", de Santa Clara, Villa Clara, Cuba, entre abril 2017-mayo 2019. Se aplicaron métodos teóricos, empíricos, estadísticos-matemáticos y una batería de exploración neuropsicológica basada en los postulados de Luria, que permitió el diagnóstico de las alteraciones del pensamiento. Luego se procedió a la aplicación del programa educativo basado en la actividad física en el grupo estudio; y finalmente se compararon los resultados en un antes y un después en el grupo estudio, y entre este y el grupo testigo. Resultados: se observó mayor cuantificación de los procesos intelectuales eficientes, mejoría en el pensamiento lógico-verbal, práctico-constructivo y rumiativo en el grupo estudio; mientras en el grupo testigo no se reflejaron estos cambios. Conclusiones: se determinaron modificaciones positivas en el grupo estudio, evidenciadas en progresos neurocognitivos en las personas prejubilables, lo cual demostró la efectividad del programa educativo basado en la actividad física, una vez aplicado.

ABSTRACT Background: civilized societies have proposed strategies to strengthen the quality of life, validity and independence of early retirement or with extended active employment relationship. Objective: to determine modifications in the coping with life events and in the neurocognitive state in people in pre-retirement stage when applying an educational program based on physical activity. Methods: an intervention study with a quasi-experimental design was carried out at the "Marta Abreu" University Polyclinic, Santa Clara, Villa Clara, Cuba, from April 2017 to May 2019. Theoretical, empirical, statistical-mathematical methods and a battery of neuropsychological examination based on Luria's postulates, which allowed the diagnosis of thought disorders. Then the educational program based on physical activity was applied in the study group; and finally the results were compared in a before and after in the study group, and between this and the control group. Results: greater quantification of efficient intellectual processes, improvement in logical-verbal, practical-constructive and ruminative thinking was observed in the study group; while in the control group these changes were not reflected. Conclusions: positive modifications were determined in the study group, evidenced in neurocognitive progress in early retirement, which demonstrated the effectiveness of the educational program based on physical activity, once applied.

Adherence to Clinical Practice Guidelines during Dementia Work-Up in a Real-World Setting: A Study from the Registry of Dementias of Girona.

BACKGROUND: There are several position statements and clinical practice guidelines (CPG) for diagnosing dementia. OBJECTIVE: Our aims were to evaluate the adherence to CPG among specialists in the 7 memory clinics included in the Registry of Dementias of Girona (ReDeGi), and to compare the results between 2007-2011 and 2012-2015. We also determined the time and number of visits required to achieve a diagnosis, the supplementary tests ordered, and the drugs prescribed according to dementia subtypes. METHODS: Medical charts of a stratified random sample of 475 ReDeGi cases were reviewed. Basic dementia work-up was evaluated using as a reference evidence-based CPG. An Index of Adherence (AI) was calculated using the following items in the medical chart: cognitive symptomatology; functional disability evaluation; physical examination; neurological examination; psychiatric examination; brief cognitive examination; activities of daily living performance examination; blood test; structural neuroimaging (CT-scan or MRI). RESULTS: The mean AI to CPG among specialists was of 8.2 points, and it improved from 7.9 points in 2007-2011 to 8.5 points in 2012-2015 (Cohen's d = 0.46). A lower adherence was detected in the most severe cases. A dementia diagnosis required 3.5 visits, regardless of the subtype of dementia, although milder cases required more time, more visits, and more supplementary tests than severe cases. CONCLUSION: The adherence to CPG in the catchment area of the ReDeGi is high, and an epidemiological surveillance system such as the ReDeGi may help in improving it. Dementia guidelines should establish procedures adapted to clinical practice, with simplified recommendations for most severe cases.

La musicoterapia como una modalidad terapéutica reguladora de las emociones en las personas prejubilables / Music therapy as a therapeutic modality regulating emotions in early retired people

RESUMEN Introducción: la prejubilación es un proceso de relevancia social por la alta tasa de crecimiento de la población activa envejecida, cuya preocupación más relevante surge por la extensión, quizás sobredimensionada, de la vida laboral. Objetivo: determinar los resultados de la musicoterapia en personas prejubilables. Métodos: se realizó una intervención musicoterapéutica con el objetivo de regular las emociones en personas prejubilables, ante el dilema del cese del vínculo laboral o la continuidad de este; se realizó un estudio cuasi-experimental en el Policlínico Docente «Marta Abreu¼, Villa Clara, en el período de enero 2017 a febrero 2019. Se emplearon procedimientos, métodos y técnicas con aplicación de la musicoterapia en un grupo estudio de 200 personas prejubilables, de 55 a 65 años de edad. Se utilizaron métodos teóricos, empíricos y estadísticos-matemáticos. Se aplicaron técnicas psicológicas antes y después de la musicoterapia en el grupo estudio y en el grupo control. Resultados: se constataron resultados relevantes en el grupo estudio, y se registraron cambios muy significativos: más estados emocionales ansiosos bajo y depresivo leve, autoestima alta, y notable mejoría en la vulnerabilidad al estrés. En el grupo control no se reflejaron cambios favorables. Conclusiones: la musicoterapia resultó efectiva por el logro de cambios positivos en el estado emocional en personas prejubilables del grupo estudio. La identificación prometedora de potencialidades en el lenguaje musical, con la utilización mínima de la palabra en la atención integral a personas en etapa de prejubilación, constituyó una novedad.

ABSTRACT Introduction: early retirement is a process of social relevance due to the high growth rate of the aging workforce, whose most relevant concern arises from the extension, perhaps oversized, of working life. Objective: to determine the results of music therapy in early retired people. Methods: a music therapy intervention was carried out with the aim of regulating emotions in early retired people, faced with the dilemma of the termination of the employment relationship or its continuity; a quasi-experimental study was carried out at "Marta Abreu" Teaching Polyclinic, Villa Clara, from January 2017 to February 2019. Procedures, methods and techniques with application of music therapy were used in a study group of 200 early retired people aged 55 to 65 years. Theoretical, empirical and statistical-mathematical methods were used. Psychological techniques were applied in the study group before and after music therapy and in the control group without intervention. Results: relevant results were found in the study group, and very significant changes were recorded: more low anxiety and mild depressive emotional states, high self-esteem, and notable improvement in vulnerability to stress. No favorable changes were reflected in the control group. Conclusions: music therapy was effective for achieving positive changes in emotional state in early retired people from the study group. The promising identification of potentialities in musical language, with the minimum use of spoken language in comprehensive care for people in early retirement, was a novelty.

Influencia de los factores pronósticos en la rehabilitación de pacientes geriátricos con ictus isquémico / Influence of prognostic factors in the rehabilitation of geriatric patients with ischemic ictus

RESUMEN Fundamento: la enfermedad cerebrovascular es en la actualidad uno de los problemas de salud más importantes, tanto en países desarrollados como subdesarrollados. Objetivo: valorar el grado de independencia funcional alcanzada en el proceso de rehabilitación en pacientes geriátricos con ictus isquémico según los factores pronósticos presentes. Métodos: se realizó un estudio prospectivo en pacientes geriátricos en la sala de rehabilitación del policlínico Santa Clara de enero de 2017 a diciembre de 2018 con diagnóstico clínico y radiológico de ictus isquémico. El universo de estudio estuvo constituido por 31 pacientes, se identificaron los factores pronósticos y se aplicó el Índice de Barthel al inicio y final de realizar el tratamiento neurorehabilitador. En el análisis estadístico se utilizaron pruebas no paramétricas, independencia basada en la distribución chi cuadrado y para muestras relacionadas, homogeneidad marginal. Resultados: predominaron los pacientes con edad entre los 60 y 69 años del sexo masculino. Los factores pronósticos encontrados en mayor frecuencia fueron la afectación del hemisferio dominante, retracciones osteotendinosas, desarrollo psicológico negativista y la colaboración pasiva. Previo al tratamiento en pacientes con menos de dos factores pronósticos, predominó la dependencia leve y al final se igualan los dependientes leves e independientes, en los pacientes con dos o más factores, al inicio del tratamiento predominaron los dependientes moderados y al final los dependientes leves. Conclusiones: la rehabilitación neurológica mejoró en la independencia de las actividades de la vida diaria de los pacientes geriátricos con ictus isquémico, que se hace más evidente cuando este se asocia a menos de dos factores pronósticos.

ABSTRACT Background: cerebrovascular disease is currently one of the most important health problems, both in developed and underdeveloped countries. Objective: to value the grade of functional independence reached in the rehabilitation process in patient geriatrics with ischemic ictus according to the factors present presage. Methods: a prospective study was carried out in geriatric patients in the rehabilitation room of the Santa Clara Polyclinic from January 2017 to December 2018 with a clinical and radiological diagnosis of ischemic ictus. The study universe was constituted by 31 patients, the prognostic factors were identified and the Barthel Index was applied at the beginning and end of the neuro-rehabilitation treatment. In the statistical analysis, nonparametric tests were used. (Independence based on the Chi square distribution and for related samples, marginal homogeneity). Results: male patients with age between 60 and 69 years of age are predominant. The prognostic factors found most frequently were the involvement of the dominant hemisphere, osteotendinous retractions, negative psychological development and passive collaboration. Prior to treatment, in patients with less than two prognostic factors, mild dependence predominated and in the end mild and independent dependents are equalized; in patients with two or more factors, moderate dependents predominated at the start of treatment and mild dependents at the end. Conclusions: neurological rehabilitation improves independence in the activities of daily life of geriatric patients with ischemic ictus that becomes more evident when this is associated with less than two prognostic factors.

Development of a protocol for multiple staining with fluorochromes to assess the functional status of boar spermatozoa.

The aim of this study was to design a simple and reliable method for the simultaneous evaluation of the nucleus, the acrosome, and the mitochondrial sheath of boar spermatozoa. Sperm samples coming from healthy and sexually mature Pietrain boars were incubated with two nuclear fluorochromes--bis-benzamide specific for viable cells, and propidium iodide specific for nonviable cells--the fluorochrome Mitotracker Green FM specific for functional mitochondria, and the lectin Trypsin inhibitor from Soybean (SBTI) conjugated with the fluorochrome Alexa Fluor 488 specific for proacrosin. The results obtained from assessing the functional status of the spermatozoa using fluorochromes were compared with the conventional sperm parameters of sperm vitality using the eosin exclusion test (EE test), and sperm motility and morphology using the computer-assisted semen analyzer SCA 2002Producció. Applying the multiple staining test, it was found that the frequency of viable spermatozoa with intact acrosome and intact mitochondria was not different from the frequency of viable spermatozoa obtained with the EE test, and also correlated positively with the frequency of motile spermatozoa and the frequency of mature spermatozoa. Therefore, this technique is useful to characterize the status of boar spermatozoa by assessing the nuclear, acrosomal, and mitochondrial integrity. Moreover, it provides reliable diagnostic information about the fertility potential of boars.

Adoption of health information technologies by physicians for clinical practice: The Andalusian case.

OBJECTIVES: We investigated the level of adoption of Health Information Technologies (HIT) services, and the factors that influence this, amongst specialised and primary care physicians; in Andalusia, Spain. METHODS: We analysed the physicians' responses to an online survey. First, we performed a statistical descriptive analysis of the data; thereafter, a principal component analysis; and finally an order logit model to explain the effect of the use in the adoption and to analyse which are the existing barriers. RESULTS: The principal component analysis revealed three main uses of Health Information Technologies: Electronic Health Records (EHR), ePrescription and patient management and telemedicine services. Results from an ordered logit model showed that the frequency of use of HIT is associated with the physicians' perceived usefulness. Lack of financing appeared as a common barrier to the adoption of the three types of services. For ePrescription and patient management, the physician's lack of skills is still a barrier. In the case of telemedicine services, lack of security and lack of interest amongst professionals are the existing barriers. CONCLUSIONS: EHR functionalities are fully adopted, in terms of perceived usefulness. EPrescription and patient management are almost fully adopted, while telemedicine is in an early stage of adoption.

[Toward a national plan to control health effects of mercury in Colombia]. / Hacia un plan nacional para el control de los efectos del mercurio en la salud en Colombia.

INTRODUCTION: The problem of mercury effects on humans and the environment is global, and it has different impacts on health. It is necessary, therefore, to address this issue from a broad overview to identify populations at risk of exposure, health effects, the production processes involved and the actions aimed at reducing exposure and mitigating the impact. OBJECTIVE: To design a conceptual and operational framework to develop strategies for prevention, control and mitigation of mercury effects on health and on the environment in Colombia. MATERIALS AND METHODS: We conducted a two-phase study: a literature review following the Cochrane methodology and forums with national and international experts using a comprehensive planning methodology to identify priority actions and establish a national research agenda. RESULTS: The results of the review were structured into four components: mercury effects on health, legal framework in Colombia, emission inventory for the country and health plans and programs. We made recommendations for the design of an intervention plan considering five lines of action: technologies for exposure management, institutional strengthening for exposure prevention and control, strategies for strengthening diagnosis and care, health education on mercury risks, and knowledge generation. CONCLUSION: We detected information gaps, technical weaknesses, and the need of administrative and other resources in this field in Colombia. We proposed priority actions to reduce the economic, social and health impact from exposure to mercury.

Testing an egg yolk supplemented diet on boars to aid in sperm adaptation at 5°C.

In many species, extended semen can be stored at low temperatures to slow bacterial growth. However, boar semen performs poorly at temperatures below 15 °C and this poses unique challenges, as it is not easy to maintain a constant 15-19 °C during shipment. Some extenders have been formulated with egg yolk for storage at 5 °C but the addition of egg yolk is not applicable in the majority of commercial operations. The purpose of this study was to evaluate if boar dietary supplementation with powdered egg yolk imparts any protective effects on sperm quality when stored at 15 °C and 5 °C for up to 11 days in a conventional extender. Ten boars were fed a commercial diet with the addition of 0.11 Kg of powdered egg yolk for 10 weeks. Ejaculates collected on weeks 4, 6, 8, and 10 were processed for storage at both 15 °C and 5 °C and compared with ejaculates from boars fed a standard diet. Throughout an 11-day storage period, sperm quality was assessed including several motility and morphologic parameters and select plasma membrane properties (fluidity, integrity, and triacylglycerol content). Linear regression models were used to describe effects of treatment, storage day, week and temperature on all sperm parameters. Overall, there were minimal beneficial effects of egg yolk treatment on sperm quality parameters. Sperm from egg yolk supplemented boars did have a slower decline in viability and plasma membrane fluidity than that observed in the control sperm when stored at 5 °C (p < 0.001). Additionally, there was an increase in total morphologic abnormalities in sperm from egg yolk fed boars compared to controls at week 10 (p < .001). In conclusion, the results of this study do not support a significant benefit to sperm quality or resistance to cold storage when feeding a 10-week dietary supplementation of 0.11 Kg powdered egg yolk to crossbred boars.