[Exploitation and socio-labor insecurity, the reality of migrant agricultural workers in Spain]. / Explotación y precariedad sociolaboral, la realidad de las personas migrantes trabajadoras en agricultura en España.

El trabajo agrícola de temporada en España se caracteriza por un gran desgaste físico, un bajo requerimiento de cualificación y unas precarias condiciones laborales. Estos elementos han generado que los autóctonos hayan ido abandonando paulatinamente este nicho laboral para ser remplazados por migrantes internacionales de una amplia variedad de orígenes. Otra particularidad de este mercado laboral es la corta duración de los puestos de trabajo al vincularse con las temporadas de cosecha del producto agrícola. Así, a lo largo del año, diferentes campañas que atraen a miles de personas en la búsqueda de un trabajo, desde la recolección del fruto rojo en Huelva hasta a la cosecha de la fruta dulce en Lleida durante el verano, pasando por la agricultura intensiva de mayor duración como la horticultura murciana y almeriense. El movimiento constante entre las diferentes explotaciones agrarias ha llevado a que este colectivo sea conocido como los temporeros.

Social Emotional Health Survey-Secondary (SEHS-S): A Universal Screening Measure of Social-Emotional Strengths for Spanish-Speaking Adolescents.

The Social Emotional Health Survey-Secondary (SEHS-S), which is a measure of core psychological assets based on a higher-order model of Covitality, is comprised of 36 items and four latent traits (with three measured subscales): belief in self (self-efficacy, self-awareness, and persistence), belief in others (school support, family coherence, and peer support), emotional competence (emotional regulation, behavioral self-control, and empathy), and engaged living (gratitude, zest, and optimism). Previous international studies have supported the psychometric properties of the SEHS-S. The present study extended this research by examining the psychometric properties of a Spanish-language adaptation with a sample of 1042 Spanish adolescents (Mage = 14.49, SD = 1.65.). Confirmatory factor analyses replicated the original factorial structure, with hierarchical omega between 0.66-0.93, with 0.94 for the total score. Factorial invariance across genders revealed small latent mean differences. A path model evaluated concurrent validity, which revealed a significant association between Covitality and bidimensional mental health (psychological distress and well-being). Specifically, correlational analyses showed a negative association with internalizing/externalizing symptoms, and positive associations with subjective well-being, health-related quality of life, and prosocial behaviors. This study provides an example of a culturally relevant adaptation of an international tool to measure student strengths, which is critical to planning school programming and policy.

Impact of funding harm reduction programs for people who inject drugs in Mexico / Impacto del financiamiento de programas de reducción del daño para personas que se inyectan drogas en México

Abstract Introduction Despite evidence from harm reduction programs, there are limited data on their impact in Mexico. The Mexican National HIV Program has supported harm reduction programs implemented by community-based organizations both financially and technically. Objective To obtain an estimate of HIV infections averted from 2015 to 2018. Method A deterministic model was developed to estimate the number of infections, with harm reduction projects financed by CENSIDA and implemented by Community-Based Organizations, using data reported from the period 2015 to 2018. The benefit was obtained by estimating the costs of providing prevention programs and comparing the latter to the costs of providing care. Results An analysis of 66,973 people included in harm reduction programs showed that an estimated 869 HIV infections were averted between 2015 and 2018. Potential savings obtained by providing these harm reduction services exceeded over $600,000 Mexican pesos for every infection averted. Discussion and conclusion Harm reduction services play a key role in reducing the incidence of HIV in Mexico. Ensuring their financing is necessary since, combined with other services, they are a cost-effective tool for reducing the economic and public health burden of HIV/AIDS.

Resumen Introducción A pesar de la evidencia que aportan los programas de reducción de daños, hay pocos datos sobre el impacto que tienen en México. El Programa Nacional de VIH en México ha apoyado técnica y financieramente la implementación de proyectos de reducción de daños operados por la sociedad civil. Objetivo Estimar el número de infecciones de VIH evitadas en el periodo de 2015 a 2018. Método Se desarrolló un modelo determinista para estimar el número de infecciones evitadas con los proyectos de reducción de daños financiados por CENSIDA e implementados por organizaciones de la sociedad civil a partir de los datos reportados durante el periodo 2015-2018. El beneficio se obtuvo al estimar el costo de proveer programas de prevención comparado con el costo de proveer tratamiento. Resultados Del análisis de 66,973 personas contactadas con los programas, se estimaron 869 infecciones de VIH evitadas entre 2015 y 2018. El ahorro potencial de proveer estos servicios de reducción de daños fue de más de $600 mil pesos por infección evitada. Discusión y conclusión Los servicios de reducción de daños cumplen un papel importante en la reducción de la incidencia de VIH en México. Asegurar su financiamiento es necesario ya que es una herramienta costo-efectiva si se le combina con otras estrategias para reducir la carga económica y de salud pública del VIH/sida.

Assessment of Dietary Iodine Intake in School Age Children: The Cross-Sectional ANIVA Study.

Iodine deficiency is one of the most important health problems in the world. It intervenes in the synthesis of thyroid hormones, which carry out important functions, so that a deficit of this mineral causes alterations of different kinds such as those related to growth. The objective of the present study was to know the prevalence of iodine deficit in the diet of Valencian children from 6 to 8 years old and their relationship with anthropometry. The analysis of the dietary intake was carried out through questionnaires. Thirteen schools participated in the study. The sample studied consists of 661 school children belonging to the Valencian Community, between 6 and 8 years of age: 298 boys and 363 girls. 79.12% of the children did not meet recommended daily iodine intakes. When comparing the groups of girls and boys with an inadequate intake, in general, girls show worse nutritional adequacy. When comparing the groups of girls and boys with sufficient iodine intake, no statistically significant differences were observed. No immediate effects of iodine deficiency on children's anthropometry were observed. Intake of dairy products, fish and iodized salt is recommended, since they can contribute to the diet the iodine required to avoid a deficiency.

Organization of the Orexin/Hypocretin System in the Brain of Holostean Fishes: Assessment of Possible Relationships with Monoamines and Neuropeptide Y.

Holosteans form a small group of actinopterygian fishes considered the sister group of teleosts. Despite this proximity to the biggest group of vertebrates, relatively few studies have been conducted to investigate the organization of the central nervous system of this group of fishes. In this study, the neuroanatomical distribution of orexin/hypocretin-like immunoreactive (OX-ir) cell bodies and fibers was analyzed in the brain of 3 representative species of the 2 orders of extant holosteans, the spotted gar Lepisosteus oculatus, the Florida gar Lepisosteus platyrhincus, and the bowfin Amia calva. Antibodies against orexin-A (OXA) and orexin-B (OXB) were used, which labeled the same cells and fibers throughout the brain. In addition, double immunohistofluorescence was performed for the simultaneous detection of OXA and OXB with tyrosine hydroxylase, serotonin, and neuropeptide Y (NPY), in an attempt to localize the orexinergic structures precisely and study the possible interactions between these neuroactive substances. The pattern of distribution of OX-ir cells in the 3 species was largely similar, showing labeled cells in the preoptic area (POA), and the tuberal and retrotuberal hypothalamic regions, with only subtle differences between species in the density of labeled cells. OX-ir fibers were found in all main brain subdivisions of the 3 species, mostly in the ventral subpallial areas, POA, hypothalamus, posterior tubercle, thalamus, and mesencephalic tectum. Different densities of orexinergic fibers were observed in relation to catecholaminergic and serotoninergic cell groups, as well as an absence of colocalization between orexins and NPY in the same hypothalamic neurons. The comparison of these results with those obtained in other vertebrates highlights a constant pattern of distribution of this system of neurotransmission among different groups of actinopterygian fishes, especially in teleosts. Conserved features shared by all vertebrates studied were also observed, such as the presence of OX-ir cells in the basal hypothalamus, reflecting the preserved functions of these neuropeptides over the course of evolution.

Immunohistochemical Localization of DARPP-32 in the Brain of Two Lungfishes: Further Assessment of Its Relationship with the Dopaminergic System.

The distribution of DARPP-32 (a phosphoprotein related to the dopamine D1 receptor) has been widely used as a means to clarify the brain regions with dopaminoceptive cells, primarily in representative species of tetrapods. The relationship between dopaminergic and dopaminoceptive elements is frequently analyzed using the catecholamine marker tyrosine hydroxylase (TH). In the present study, by means of combined immunohistochemistry, we have analyzed these relationships in lungfishes, the only group of sarcopterygian fishes represented by 6 extant species that are the phylogenetically closest living relatives of tetrapods. We used the Australian lungfish Neoceratodus forsteri and the African lungfish Protopterus dolloi. The DARPP-32 antibody yields a distinct and consistent pattern of neuronal staining in brain areas that, in general, coincide with areas that are densely innervated by TH-immunoreactive fibers. The striatum, thalamus, optic tectum, and torus semicircularis contain intensely DARPP-32-immunoreactive cell bodies and fibers. Cells are also located in the olfactory bulbs, amygdaloid complex, lateral septum, pallidum, preoptic area, suprachiasmatic nucleus, tuberal hypothalamic region, rostral rhombencephalic reticular formation, superior raphe nucleus, octavolateral area, solitary tract nucleus, and spinal cord. Remarkably, DARPP-32-immunoreactive fibers originating in the striatum reach the region of the dopaminergic cells in the mesencephalic tegmentum and represent a well-established striatonigral pathway in lungfishes. Double immunolabeling reveals that DARPP-32 is present in neurons that most likely receive TH input, but it is absent from the catecholaminergic neurons themselves, with the only exception of a few cells in the suprachiasmatic nucleus of Neoceratodus and the solitary tract nucleus of Protopterus. In addition, some species differences exist in the localization of DARPP-32 cells in the pallium, lateral amygdala, thalamus, prethalamus, and octavolateral area. In general, the present study demonstrates that the distribution pattern of DARPP-32, and its relationship with TH, is largely comparable to those reported for tetrapods, highlighting a shared situation among all sarcopterygians.

Economic Evaluation of Health Services Costs During Pandemic Influenza A (H1N1) Pdm09 Infection in Pregnant and Non-Pregnant Women in Spain.

BACKGROUND: The healthcare and socio-economic burden resulting from influenza A (H1N1) pdm09 in Spain was considerable. Our aim was to estimate and compare the management (resource utilization) and economic healthcare impact in an at-risk group of unvaccinated pregnant women with an unvaccinated group of non-pregnant woman of childbearing age (15-44 yr old). METHODS: We addressed this question with a longitudinal, observational, multicentre study. Inputs were the requirements in managing both groups of women. Outcome measures were healthcare costs. Direct healthcare (including medical utilisation, prescriptions of antivirals, medication, diagnostic tests, and hospitalisation) costs and indirect (productivity loss) costs were considered. Unit of cost was attributed to the frequency of health service resources utilisation. The mean cost per patient was calculated in this group of women. RESULTS: We found that the influenza clinical pattern was worse in non-pregnant women as they had a high medical risk of 20.4% versus 6.1% of pregnant women. Non-pregnant required more antipyretics and antibiotics, and needed more health service resource utilisation (338 medical visits in non-pregnant women vs. 42 in pregnant women). The total cost of non-pregnant women was higher (€4,689.4/non-pregnant and €2,945.07/pregnant). CONCLUSIONS: Cost per (H1N1) pdm09 was lower for pregnant women, probably due to more preventive measures adopted for their protection in Spain. The highest costs were incurred by hospitalisations/day and work absenteeism for non-pregnant than for pregnant women. These data will allow better future pandemic influenza planning.

Central nervous system (CNS) cancer in children and young people in the European Union and its involvements with socio-economic and environmental factors.

Malignant central nervous system (CNS) tumors are the leading cause of death by cancer in children and the second commonest pediatric cancer type. Despite several decades of epidemiologic research, the etiology of childhood CNS tumors is still largely unknown. A few genetic syndromes and therapeutic ionizing radiation are thought to account for 5-10% of childhood cancer, but the etiology of other cases remains unknown. Nongenetic causes, like environmental agents, are thought to explain them. However, as very few epidemiologic studies have been conducted, it is not surprising that nongenetic risk factors have not been detected. The biggest difference between cancers for which there are good etiologic clues and those for which there are none could be the number of relevant studies. This study, which covers the 1980-2011 period, identified links between CNS cancer evolution and the socio-economic and environmental indicators in the same space and time limits in the European Union.

[Assessment for learning: experience in an undergraduate medical theoretical course]. / Evaluación para el aprendizaje: experiencia en un curso teórico de pregrado en medicina.

BACKGROUND: Assessment for learning is a paradigm that is taking shape in the field of medical education. This approach aims to embed the assessment process within the educational and learning process. AIM: To evaluate the impact of curricular changes, from a focus of assessment of learning to one of assessment for learning, in the perception of undergraduate students of medicine and their final grades obtained in a theoretical course (TCG). MATERIAL AND METHODS: In the year 2011 lectures were reduced and intermediate assessments followed by a feedback session were introduced. The activities of each program course, surveys about student perceptions of the course and the final grades of students (assessments with multiple choice questions) were compared between the periods prior and after curricular changes (2005-2010 and 2011-2013). RESULTS: As a consequence of curricular changes, time for lectures was reduced by 19.5%, time for summative assessments was increased by 8.5%, and feedback activity, occupying 7.3% of the course time was added. There were significant improvements in student is perceptions in all areas assessed by surveys, emphasizing feedback and assessments. The overall grade assigned to the course dictated after implementing the changes increased from 6.18 to 6.59 (p < 0.001, 1-7 scale). The grades of students also improved from an average of 5.78 to 6.43 (p < 0.001, 1-7 scale). CONCLUSIONS: Assessment for learning achieved the desired educational impact without increasing the assigned curricular time. Programmatic assessment is favorably perceived by students.

Evaluación para el aprendizaje: experiencia en un curso teórico de pregrado en medicina / Assessment for learning: experience in an undergraduate medical theoretical course

Background: Assessment for learning is a paradigm that is taking shape in the field of medical education. This approach aims to embed the assessment process within the educational and learning process. Aim: To evaluate the impact of curricular changes, from a focus of assessment of learning to one of assessment for learning, in the perception of undergraduate students of medicine and their final grades obtained in a theoretical course (TCG). Material and Methods: In the year 2011 lectures were reduced and intermediate assessments followed by a feedback session were introduced. The activities of each program course, surveys about student perceptions of the course and the final grades of students (assessments with multiple choice questions) were compared between the periods prior and after curricular changes (2005-2010 and 2011-2013). Results: As a consequence of curricular changes, time for lectures was reduced by 19.5%, time for summative assessments was increased by 8.5%, and feedback activity, occupying 7.3% of the course time was added. There were significant improvements in student is perceptions in all areas assessed by surveys, emphasizing feedback and assessments. The overall grade assigned to the course dictated after implementing the changes increased from 6.18 to 6.59 (p < 0.001, 1-7 scale). The grades of students also improved from an average of 5.78 to 6.43 (p < 0.001, 1-7 scale). Conclusions: Assessment for learning achieved the desired educational impact without increasing the assigned curricular time. Programmatic assessment is favorably perceived by students.

Assessment of the microbiological quality of groundwater in three regions of the Valencian Community (Spain).

Urban groundwater development was traditionally constrained by concerns about its quality. This study was conducted in the regions of La Ribera Alta and Ribera Baja and La Plana de Requena-Utiel of the Valencian Community (Valencia, Spain) where population density, demand for drinking water and agricultural activities are high. Groundwater bodies (GWBs) are regarded as management areas within each territory, and were used to establish protection policies. This study analyzed eleven GWBs. We used two databases with microbiological measurements from 154 wells over a 7-year period (2004-2011), risk factors and groundwater information. Wells were grouped according to frequency of microbiological contamination using E. coli measurements, category <1, or wells with low-frequency microbiological contamination and high-frequency wells or category 1-100, according to World Health Organization (WHO) quality criteria of drinking water. Of all wells, 18.12% showed high-frequency microbiological contamination with a majority distribution in the Ribera Alta region (26.98%, p < 0.001). No significant differences were found between the two risk categories for flow, static level, well depth and distance from population centres. This paper reveals that the vulnerability classes established by the Geological and Mining Institute of Spain (IGME) do not match the microbiological results, and that only eight wells with high-frequency contamination coincide with the high vulnerability areas.

Pleural fluid C-reactive protein contributes to the diagnosis and assessment of severity of parapneumonic effusions.

BACKGROUND AND AIMS: Prompt identification of parapneumonic effusions has immediate therapeutic benefits. We aimed to assess whether C-reactive protein (CRP) and routine biochemistries in pleural fluid are accurate markers of parapneumonic effusions, and to evaluate their properties as indicators for drainage (complicated parapneumonic effusion). METHODS: A retrospective review of 340 non-purulent parapneumonic effusions and 1,659 non-parapneumonic exudates from a single center was performed and the discriminative properties of pleural fluid routine biochemistries and, when available, CRP were evaluated. CRP, along with classical fluid parameters, was also applied to classify patients as having complicated or uncomplicated parapneumonic effusions. ROC analysis established the threshold of CRP for discriminating between groups. RESULTS: Pleural fluids with neutrophilic predominance and CRP levels >45 mg/dL were most likely to be parapneumonic in origin (likelihood ratio=7.7). When attempting to differentiate non-purulent complicated from uncomplicated effusions, a CRP >100mg/L had the same performance characteristics (area under the curve=0.81) as the widely accepted biochemistries pH and glucose. Combinations of CRP with pH or glucose resulted in incrementally discriminating values, pertaining to either sensitivity (75-80%) or specificity (97%), for complicated effusions. CONCLUSION: Pleural fluid CRP may be a useful adjunctive test in pleural effusions, both as a marker of parapneumonics and, particularly, as a differentiator between complicated and uncomplicated effusions.

Unemployment and pregnancy outcomes: a study within the Danish National Birth Cohort.

AIMS: To explore the relation between employment status, type of unemployment and pregnancy outcomes. METHODS: A cohort study of 7,282 pregnancies of unemployed women and 56,014 pregnancies among women in paid jobs was performed within the Danish National Birth Cohort. Pregnancy outcomes were ascertained and information about lifestyle, occupational, medical, and obstetric factors was obtained. Logistic regression was used to calculate odds ratios (OR) for fetal loss, congenital anomalies, multiple births, sex ratio, preterm and very preterm birth and small for gestational age status, adjusting for lifestyle, medical and obstetric factors. RESULTS: There were no differences in pregnancy outcomes between employed and unemployed women but women receiving unemployment benefit had an increased risk of preterm birth (adjusted OR (aOR) 1.16, 95% confidence interval (95% CI) 1.03-1.31) and having a small for gestational age child (aOR 1.08, 95% CI 1.00-1.19) compared with employed women. Women receiving sickness or maternity benefit had an increased risk of multiple birth (aOR 1.70, 95% CI 1.43-2.04), preterm (aOR 1.47, 95% CI 1.22-1.77) and very preterm birth (aOR 1.88, 95% CI 1.22-2.89), while those receiving an unreported type of support had an increased risk of preterm birth (aOR 1.40, 95% CI 1.02-1.93). CONCLUSIONS: We found no indication that being unemployed during pregnancy benefits or endangers the health of the child. Within the subgroups of unemployed women, we observed that women receiving unemployment and sickness or maternity benefits were at higher risk for some adverse pregnancy outcomes.

Socio-occupational status and congenital anomalies.

BACKGROUND: The aim of this study is to investigate the association between socio-occupational status and the frequency of major congenital anomalies in offspring. METHODS: The study population comprised 81,435 live singletons born to mothers enrolled in the Danish National Birth Cohort between 1996 and 2002. A total of 3352 cases of major congenital anomalies (EUROCAT criteria) were identified by linkage to the National Hospital Discharge Register. Malformations were recorded at birth or in the first year of life. Information about maternal and paternal socio-occupational status was collected prospectively using telephone interviews in the second trimester of pregnancy and was categorized as high, middle or low. Associations were measured as relative prevalence ratios using the highest socio-occupational status within the couple as the reference group. RESULTS: The prevalence of all recorded major congenital anomalies was similar, about 4%, in all the socio-occupational categories. Low social status of the couple did, however, correlate with a higher prevalence of congenital anomalies of the 'respiratory system'. No association was substantially attenuated when we adjusted for maternal and paternal age, smoking status, maternal alcohol habits, folic acid intake and body mass index. When malformations of the heart and the cardiovascular system were grouped together, they were more frequent in families where both parents presented a low socio-occupational status. CONCLUSION: We detected an association between low socio-occupational status and congenital anomalies of the respiratory system, the heart and the circulatory system. These malformations are good candidates for a large study on occupational, environmental and social determinants.

Pilot assessment of the response of several pulmonary hemodynamic variables to sublingual sildenafil in candidates for heart transplantation.

OBJECTIVE: To determine the acute vasodilator effect of sublingual sildenafil in heart transplant candidates with severe pulmonary hypertension due to severe left ventricular dysfunction (LVD). BACKGROUND: Pulmonary hypertension confers an increased risk of early graft failure. PATIENTS AND METHODS: Seven patients, (mean age of 53+/-8) with severe LVD (mean EF: 19+/-1.7%, functional class III-IV) due to coronary artery disease, dilated cardiomyopathy and valvulopathy were evaluated for heart transplant. All patients presented a mean transpulmonary gradient >12 mmHg and pulmonary vascular resistances >2.5 W.U., despite full treatment for advanced heart failure. The following hemodynamic data were obtained at basal state and then 15, 30 and 45 min after administration of 100 mg of sublingual sildenafil: right atrial, mean pulmonary artery pressure (mPAP), mean pulmonary capillary wedge pressures, mean transpulmonary gradient (mTPG), blood pressure, cardiac output, pulmonary vascular resistances (PVR) and systemic vascular resistances. Sublingual sildenafil was given without changing the previous treatment of heart failure. RESULTS: After 30 min of sublingual sildenafil, mPAP decreased from 37 (28-61) to 30 (16-42) mmHg and PVR decreased from 5.2 (1.9-13.8) to 2.5 (1.4-3.9) W.U. after 45 min. Mean TPG decreased from 19 (16-33) to 12 (8-14) mmHg at 45 min. Mean pulmonary capillary wedge pressure, cardiac output, systemic vascular resistances and mean blood pressure were unchanged. Sublingual sildenafil was well tolerated, with only transient facial flushing in 4 patients and mild headache in 2. CONCLUSIONS: Based on this initial study, sublingual sildenafil may be a useful alternative drug to perform acute vasodilator test in heart transplant candidates with significant pulmonary hypertension due to severe LVD. Nevertheless, further studies are warranted to confirm our results.

Immunohistochemical localization of DARPP-32 in the brain of the turtle, Pseudemys scripta elegans: further assessment of its relationship with dopaminergic systems in reptiles.

A previous study in the lizard Gekko gecko has revealed that the distribution of DARPP-32 (a phosphoprotein related to the dopamine D(1)-receptor) largely resembles the pattern observed in birds and mammals, at least as far as basal ganglia structures are concerned. On the other hand, several specific features of DARPP-32 distribution in the gekkonid brain were noted that deserved further attention, e.g. cellular co-localization of DARPP-32 and tyrosine hydroxylase (TH) immunoreactivity in hypothalamic and caudal rhombencephalic areas. To assess the primitive or derived character of these features, DARPP-32 and TH antibodies have been applied to the brain of the turtle, Pseudemys scripta elegans, which belongs to a different radiation of reptiles. Areas in Pseudemys that are densely innervated by TH-immunoreactive fibers, such as the striatum and amygdaloid complex, display strong immunoreactivity for DARPP-32 in somata and neuropil. Strongly immunoreactive fiber plexuses were found in the substantia nigra pars reticulata and in the ventromedial part of the rhombencephalon. Cellular co-localization of DARPP-32 and TH was observed in the ventral hypothalamus but, in contrast to Gekko, not at caudal rhombencephalic levels. Moreover, cellular DARPP-32 immunoreactivity was not seen in the raphe nuclei and spinal cord of Pseudemys. Other notable species differences in DARPP-32 distribution were found in the olfactory bulb, dorsal ventricular ridge and pretectum. In conclusion, the present account on the distribution of DARPP-32 in Pseudemys confirms and extends previous findings in a gekkonid lizard. At the same time, however, it demonstrates that substantial species differences exist, some of which may be related to differences previously observed in the dopaminergic systems.