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BACKGROUND: Co-morbid anxiety and depression in older adults is associated with worse physical and mental health outcomes and poorer response to psychological and pharmacological treatments in older adults. However, there is a paucity of research focused on testing the efficacy of the co-morbid treatment of anxiety and depression in older adults using psychological interventions. Accordingly, the primary objective of the current study was to test the effects of a group cognitive behavior therapy (CBT) program in treating co-morbid anxiety and depression in a sample of older age adults. METHOD: A total of 133 community-dwelling participants aged ⩾60 years (mean age = 67.35, s.d. = 5.44, male = 59) with both an anxiety disorder and unipolar mood disorder, as assessed on the Anxiety Disorder Interview Schedule (ADIS), were randomly allocated to an 11-week CBT group or discussion group. Participants with Mini-Mental State Examination scores <26 were excluded. Participants were assessed pre-treatment, post-treatment and at 6 months follow-up on the ADIS, a brief measure of well-being, Geriatric Anxiety Inventory and Geriatric Depression Scale. RESULTS: Both conditions resulted in significant improvements over time on all diagnostic, symptom and wellbeing measures. Significant group × time interaction effects emerged at post-treatment only for diagnostic severity of the primary disorder, mean severity of all anxiety disorders, mood disorders, and all disorders, and recovery rates on primary disorder. CONCLUSION: Group CBT produced faster and sustained improvements in anxiety and depression on diagnostic severity and recovery rates compared to an active control in older adults.
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Trastornos de Ansiedad/terapia , Ansiedad/terapia , Terapia Cognitivo-Conductual/métodos , Depresión/terapia , Trastorno Depresivo/terapia , Psicoterapia de Grupo/métodos , Anciano , Ansiedad/epidemiología , Trastornos de Ansiedad/epidemiología , Comorbilidad , Depresión/epidemiología , Trastorno Depresivo/epidemiología , Femenino , Humanos , Vida Independiente , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND: Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach. METHOD: Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data. RESULTS: A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29-0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit-risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration. CONCLUSIONS: Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.
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Trastorno Depresivo Mayor/terapia , Internet , Evaluación de Resultado en la Atención de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto , Autocuidado/efectos adversos , Humanos , Autocuidado/métodosRESUMEN
Ovine pregnancy toxaemia is a metabolic disorder affecting sheep in their last 6 weeks of pregnancy as a result of their inability to maintain adequate energy homoeostasis. Different alternative treatments are available with variable results. The aim of this research was to evaluate a peroxisome proliferator-activated receptor alpha (PPARα) stimulant as an alternative to treat clinical pregnancy toxaemia. Thirty-three adult sheep, with known gestation date and carrying a single foetus, were fasted from day 130 of gestation until animals showed clinical disease. From that moment onwards, sheep were treated during 6 days with three different therapeutic alternatives: 10 mg/kg of 2-methyl-2-phenoxy-propionic acid; 10 mg/kg of 2-methyl-2-phenoxy-propionic acid + 100 mL of propylene glycol oral; or 100 mL of propylene glycol oral. Glycaemia and serum ß-hydroxybutyrate (BHOB) were determined daily. Liver biopsies were taken at day 130 of gestation, at the beginning and end of treatments and at 5 days postpartum, evaluating the extent and degree of the steatosis lesion. Even though in sheep treated with 2-methyl-2-phenoxy-propionic acid, serum concentrations of glucose and BHOB recovered more slowly, we conclude that 2-methyl-2-phenoxy-propionic acid alone or combined with propylene glycol can be used as an alternative to effectively treat fatty liver, and therefore pregnancy toxaemia.
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Ácidos Fíbricos/uso terapéutico , PPAR alfa/agonistas , Preeclampsia/veterinaria , Propilenglicol/uso terapéutico , Enfermedades de las Ovejas/tratamiento farmacológico , Ácido 3-Hidroxibutírico/sangre , Administración Oral , Animales , Glucemia/análisis , Femenino , Ácidos Fíbricos/administración & dosificación , Preeclampsia/tratamiento farmacológico , Embarazo , Propilenglicol/administración & dosificación , OvinosRESUMEN
BACKGROUND: Ovine pregnancy toxaemia is a common metabolic disorder of ewes due to increased foetal energy requirements in late pregnancy. This pathology is a metabolic condition characterized by hypoglycaemia and hyperketonaemia resulting in the inability of the animal to maintain an adequate energy balance. The response to treatment is effective, if it is started in the early stages of the disease, when irreversible neurological injuries have not yet been established. The aim was to evaluate three therapeutic alternatives to effectively reverse the disease process in its early stages. For this, thirty adult Corriedale ewes, pregnant with a single lamb, were randomly separated in three groups of ten animals each, at day 130 of gestation. From that day onwards, ewes were locked up for forage fasting until glycaemia reached clinical values defining sub-clinical pregnancy toxaemia (1.59 ± 0.24 mmol/L). After fasting, ewes grazed and received a treatment for 4 days: 50 ml i.v. infusions of hypertonic glucose and 20 UI insulin/ewe/day s.c. or 100 ml/sheep/12 h of glycerol together with propylene glycol oral solution or fed with pasture supplemented with two daily intakes 300 g/sheep of cracked corn. Glycaemia and ß-hydroxybutyrate were determined in all the animals from the beginning of fasting until the completion of the treatment. RESULTS: Fasting caused a decline in blood glucose in the 3 groups. This decline continued until fasting was withdrawn and treatment began. Thereafter blood glucose increased in all three groups, although in the group supplemented with glycerol and propylene glycol it started to increase significantly after 12 h. The values of ß-hydroxybutyrate decreased in the 3 groups at the start of treatment, and this decline was more pronounced earlier on and in the group supplemented with glycerol and propylene glycol. We found no significant differences between all experimental groups. No animal showed clinical signs of pregnancy toxaemia throughout the research. CONCLUSIONS: The three treatments administered to sheep affected by sub-clinical pregnancy toxaemia were able to restore normal concentration of glucose and ß-hydroxybutyrate in blood, although per os administration of 100 ml/sheep/12 h of glycerol with propylene glycol, was the most successful treatment, normalizing the aforementioned biochemical parameters in a shorter time.
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INTRODUCTION: Obstructive sleep apnea has been associated with higher cancer incidence and mortality. Increased melanoma aggressivity was reported in obstructive sleep apnea patients. Mice exposed to intermittent hypoxia (IH) mimicking sleep apnea show enhanced melanoma growth. Markers of melanoma progression have not been investigated in this model. OBJECTIVE: The present study examined whether IH affects markers of melanoma tumor progression. METHODS: Mice were exposed to isocapnic IH to a nadir of 8% oxygen fraction for 14 days. One million B16F10 melanoma cells were injected subcutaneously. Immunohistochemistry staining for Ki-67, PCNA, S100-beta, HMB-45, Melan-A, TGF-beta, Caspase-1, and HIF-1alpha were quantified using Photoshop. RESULTS: Percentage of positive area stained was higher in IH than sham IH group for Caspase-1, Ki-67, PCNA, and Melan-A. The greater expression of several markers of tumor aggressiveness, including markers of ribosomal RNA transcription (Ki-67) and of DNA synthesis (PCNA), in mice exposed to isocapnic IH than in controls provide molecular evidence for a apnea-cancer relationship. CONCLUSIONS: These findings have potential repercussions in the understanding of differences in clinical course of tumors in obstructive sleep apnea patients. Further investigation is necessary to confirm mechanisms of these descriptive results.
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Melanoma/etiología , Apnea Obstructiva del Sueño/complicaciones , Animales , Biomarcadores de Tumor/biosíntesis , Modelos Animales de Enfermedad , Progresión de la Enfermedad , Regulación Neoplásica de la Expresión Génica , Hipoxia/complicaciones , Masculino , Melanoma/genética , Melanoma/metabolismo , Melanoma/patología , Ratones , Ratones Endogámicos C57BLRESUMEN
The behavior of the mitochondrial inner membrane multiple conductance channel (MCC) which has a peak conductance of 1-1.5 nS has been examined in rat heart mitochondria. MCC can display several unique characteristics: (a) prolonged open and closed times on the order of seconds to minutes, (b) a voltage dependence in which MCC opens (negative potential) or closes (positive potential) generally in steps, (c) a response to inhibitors such as amiodarone in steps corresponding at least approximately to those in (b), (d) a 'free-running mode' in which the current level rapidly fluctuates between a minimum of nine conductance levels but with a preferred occupation of the 0.5-0.7 nS levels, and (e) very large transitions (1-1.5 nS) resolved at 4 kHz bandwidth as single events with variable mean open time.
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Membranas Intracelulares/fisiología , Mitocondrias Cardíacas/fisiología , Animales , Conductividad Eléctrica , Técnicas In Vitro , Potenciales de la Membrana , Mitocondrias Cardíacas/ultraestructura , Ratas , Ratas EndogámicasRESUMEN
The effect of amphiphilic cationic drugs on the channel activity of the mitochondrial inner membrane was examined with patch-clamp techniques. The therapeutic drugs amiodarone, propranolol and quinine reduced the probability of being open for the multiconductance channel (MCC) activity (levels from 30 pS to over 1 nS). While amiodarone decreased the probability of being open for the voltage dependent approximately 100 pS channel, it increased the conductance 42 +/- 20% (mean +/- SD, n = 6) with no significant change in mean open time. Similar results were obtained with propranolol. These data indicate that the approximately 100 pS channel is distinct from MCC activity.
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Amiodarona/farmacología , Canales Iónicos/efectos de los fármacos , Mitocondrias Hepáticas/efectos de los fármacos , Propranolol/farmacología , Quinina/farmacología , Animales , Conductividad Eléctrica/efectos de los fármacos , Membranas Intracelulares/efectos de los fármacos , Membranas Intracelulares/metabolismo , Potenciales de la Membrana/efectos de los fármacos , Mitocondrias Hepáticas/metabolismo , Ratas , Ratas EndogámicasRESUMEN
The technique with a wing microcatheter system and the pathologic aspects of 11 cerebral arteriovenous malformations (AVMs) surgically resected after embolization with polylene threads are reported. Embolization was performed once in eight patients and twice in three patients. Resected AVMs were submitted both to routine hematoxylineosin examination and to immunohistochemical workup in order to detect the type of immunologic response to thread emboli. In nine cases, 50% or more of the nidus was obliterated by the embolization. After embolization two patients developed reversible neurologic deficits. Pathologic specimens of resected AVMs demonstrated no vascular necrosis; however, a moderate inflammatory response could be seen, characterized by the presence of both mononuclear cells and foreign-body giant cells, associated with the absence of polymorphonuclear infiltrates. A granulomatous fibrotic process was identified that was present from the first month after embolization. Immunohistochemistry indicated that the immunologic response to thread emboli was cell-mediated, not humoral. Embolization with the wing microcatheter with the use of polylene threads proved to be a safe and efficient system of embolization, as a preoperative procedure. Polylene threads are a nontoxic and biocompatible material that can be used as an embolic agent for brain AVMs.
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Embolización Terapéutica/métodos , Malformaciones Arteriovenosas Intracraneales/terapia , Polienos , Cuidados Preoperatorios , Suturas , Adulto , Niño , Embolización Terapéutica/instrumentación , Femenino , Humanos , Malformaciones Arteriovenosas Intracraneales/patología , Malformaciones Arteriovenosas Intracraneales/cirugía , Masculino , Persona de Mediana Edad , Periodo PosoperatorioRESUMEN
Five cases of posttraumatic carotid-cavernous fistula are reported. The fistulas were occluded by intravascular detachable balloons, as described by Serbinenko and later modified by Debrun. The good results obtained in three of these patients illustrate the value of this procedure, as it allows a direct obliteration of the fistula with preservation of the internal carotid blood flow.
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Fístula Arteriovenosa/cirugía , Enfermedades de las Arterias Carótidas/cirugía , Seno Cavernoso/cirugía , Adolescente , Adulto , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/etiología , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/cirugía , Cateterismo/instrumentación , Cateterismo/métodos , Seno Cavernoso/diagnóstico por imagen , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Heridas y Lesiones/complicacionesRESUMEN
Massive hemoptysis and/or recurrent expectoration of measurable amounts of blood are common complications of chronic bronchopulmonary infections in cystic fibrosis (CF). When conservative treatment fails to control bleeding, surgery or bronchial artery embolization (BAE) is frequently considered. We present our experience and long-term follow up of BAE in 14 CF patients (age range 15-39 years) with massive (6 subjects) and/or recurrent (8 subjects) hemoptysis not responsive to medical treatment. Seven had chronic hypercapnic respiratory failure. After angiographic evaluation, polyvinyl alcohol particles (Ivalon) were injected to embolize obviously enlarged bronchial arteries. Seventeen procedures were performed in 14 patients and 36 bronchial arteries were embolized. All the patients stopped bleeding immediately upon BAE. Most of the patients had postembolization fever, dysphagia, and transient chest pain which were managed symptomatically. After a median follow-up period of 10.5 months (range 0.5-38 months), no recurrence of hemoptysis was observed in 8 patients who are still alive. In 3 patients hemoptysis recurred and they underwent reembolization after 3, 22, and 25 months, respectively. Three subjects died of respiratory failure within 5 months from BAE. Presently, 50% of patients studied had a > or = 1 year interval free of major hemoptysis after the first BAE. Our experience indicates that massive and/or recurrent hemoptysis in CF patients can be safety and effectively managed by BAE if the procedure is performed by a skilled practitioner. The procedure was well tolerated and resulted in prolonged and satisfactory bleeding control in most patients.
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Arterias Bronquiales/diagnóstico por imagen , Fibrosis Quística/complicaciones , Embolización Terapéutica , Hemoptisis/etiología , Adolescente , Adulto , Angiografía , Femenino , Hemoptisis/terapia , Humanos , Masculino , Radiografía TorácicaRESUMEN
Brachyspira (Serpulina) hyodysenteriae was isolated from 10 of 11 pigs with clinically suspected swine dysentery in six herds in northern Italy. All strains were successfully isolated in the selective blood agar modified medium with spectinomycin and rifampin (BAM-SR) currently used in our laboratory to isolate B. (S.) pilosicoli of human origin, after pre-treatment of intestinal material with spectinomycin and rifampin in foetal calf serum. Isolates had phenotypic characteristics typical of B. (S.) hyodysenteriae.
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Brachyspira hyodysenteriae/aislamiento & purificación , Disentería/veterinaria , Infecciones por Spirochaetales/veterinaria , Enfermedades de los Porcinos/microbiología , Animales , Medios de Cultivo , Disentería/microbiología , Italia , Fenotipo , Rifampin , Espectinomicina , Infecciones por Spirochaetales/microbiología , PorcinosRESUMEN
Head injuries are a common cause of death and permanent disability, particularly in the first decades of life. The high mortality and morbidity associated with head trauma is due mostly to the severity of the injury itself but also in part to the possible events that could aggravate the primary brain damage. This also occurs in patients with an initially mild head trauma. This article reviews imaging procedures, complications of head trauma, and the order of diagnostic evaluation.
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Lesiones Encefálicas/diagnóstico por imagen , Fracturas Craneales/diagnóstico por imagen , Conmoción Encefálica/diagnóstico por imagen , Edema Encefálico/diagnóstico por imagen , Lesiones Encefálicas/complicaciones , Angiografía Cerebral , Hemorragia Cerebral/diagnóstico por imagen , Infarto Cerebral/diagnóstico por imagen , Encefalocele/diagnóstico por imagen , Estudios de Seguimiento , Hematoma Epidural Craneal/diagnóstico por imagen , Hematoma Subdural/diagnóstico por imagen , Humanos , Hidrocefalia/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Spontaneous arterio-venous fistulae of the vertebral artery are rare. These lesions mainly affect the upper cervical area, and are usually asymptomatic, or may present as small, often pulsatile, cervical masses with vascular murmurs. The authors report on two cases in which the presumptive diagnosis, suggested by venous digital subtraction angiography, was then confirmed by selective angiography. In both cases an intravascular approach with detachable balloons and particulate substances was carried out, with good anatomical and functional results. Problems related to diagnosis, pathophysiology of symptoms, indications for treatment and embolization techniques are discussed.
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Fístula Arteriovenosa/diagnóstico por imagen , Cateterismo , Angiografía Cerebral/métodos , Arteria Vertebral , Adulto , Fístula Arteriovenosa/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intensificación de Imagen Radiográfica , Técnica de SustracciónRESUMEN
BACKGROUND: The main techniques and results in stereotactic radiosurgical treatment of endocranial AVM's are described and compared. The authors also report their preliminary experience in the treatment of 6 consecutive pediatric patients with intracerebral vascular malformations using gamma knife (GK) radiosurgery. METHODS: The various stereotactic radiosurgery methods currently used (charged-particle beam, modified linear accelerator, and GK) are described. At the Department of Neurosurgery in Verona, from February 1993 to February 1996, stereotactic GK radiosurgery was performed on 721 patients, including 20 of pediatric age (3%). Of the 78 AVMs, 7 (9%) were diagnosed in children. One patient was lost at follow-up. Among the remaining 6 children, there were 3 males and 3 females with a mean age of 12.3 years (range, 5-16 years). Treatment general anesthesia was needed only in 1 case. The AVM volume was always less than 10 cc. After completion of the procedure, children were discharged from the hospital the following day. RESULTS: The follow-up period ranged from 4 months to 29 months (median 18.8 months). The angiographic confirmed total obliteration is used as the end point of an AVM treated radiosurgically, and usually requires 2 to 3 years. All the patients are alive; four of the treated children are neurologically normal and one patient has clinically improved to a normal neurological status. The sixth patient has fixed neurological deficits that existed prior to treatment. Among the three cases with a follow-up period of over 2 years, complete obliteration has been angiographically confirmed in 2 patients and subtotal in 1 patient. In the three remaining patients with follow-up periods less than 2 years, serial MR images suggest subtotal obliteration in 2 cases and no significant change in one patient who had undergone treatment within the current year. To date, neither persistent GK radiosurgery-related complications nor bleeding following stereotactic radiosurgery has been described. CONCLUSIONS: The review of literature and our preliminary results suggest that also in children, as in adults, the use of stereotactically delivered irradiation represents a safe and effective technique obtaining complete obliteration of AVMs previously considered surgically inaccessible due to their location and poor response to resection and/or embolization.
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Malformaciones Arteriovenosas Intracraneales/cirugía , Radiocirugia , Adolescente , Adulto , Angiografía Cerebral , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Masculino , Aceleradores de Partículas , Radiocirugia/instrumentación , Radiocirugia/métodos , Estudios RetrospectivosRESUMEN
Our study group consisted of 29 patients who underwent endovascular treatment for the presence of pial AVMs. The patients were treated with various embolization methods including "-free flow" embolization (2 cases); embolization with suture threads (2 mm long micro-emboli: 17 cases) and embolization with acrylic glue (10 cases). There were significant angio-architectural and AVM location differences between the pediatric and the adult patient groups. In pediatric patients, the more frequent AVMs were of the mono or few-pedunculated type, then simple direct fistulas and high-flow fistulous-plexiform AVMs and giant infra-tentorial or deep-seated malformations. In mono or few-pedunculated AVMs, the elected treatment was acrylic glue followed by radio-surgery achieving definitive cure in 3 cases. In direct AVFs and elevated flow AVMs, embolization with suture and acrylic glue offered definitive results. Treatment for infra-tentorial and deep-seated AVMs presented the greatest difficulty in pediatric patients. In two of them, embolization with glue enabled radiosurgery (giant cerebellar AVMs). Our experience did not confirm that current endovascular techniques provide definitive treatment in extensive, deep-seated AVMs. Each treatment, in children more so than in adults, requires a risk/benefit evaluation of the method taking into account the natural history data.
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Embolización Terapéutica , Malformaciones Arteriovenosas Intracraneales/terapia , Piamadre , Adhesivos , Adolescente , Adulto , Hemorragia Cerebral/etiología , Niño , Femenino , Humanos , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/cirugía , Masculino , Radiografía , Estudios Retrospectivos , Suturas , Resultado del TratamientoRESUMEN
BACKGROUND AND PURPOSE: Filter cerebral protection during carotid stenting has been proposed as a new tool to reduce brain embolism. Angiographic findings (filter patency), pathological analysis of the collected materials inside the filters and coagulation parameters were analyzed to identify potential down sides in the use of these protection devices. METHODS: 29 consecutive endovascular treatments with filter cerebral protection in 27 patients affected by symptomatic internal carotid stenosis>70% were considered. Angiographic findings, activated clotting times and histopathologic specimens were recorded and correlated. RESULTS: Satisfactory dilatation of the stenosis was always achieved with a complication rate of 3% (1 transient neurological deficit). During the procedure, 9 filters (31%) appeared occluded, with temporary flow impairment. Histopathologic examination demonstrated material inside the filters in 86% of cases but this material was fibrin alone in 38% and plaque debris in 48%. Significant statistical correlation (p=0.009) was found between low activated clotting time and occlusion of the filter. CONCLUSION: Distal protection filters can collect plaque fragments occurring during carotid stenting. Significant proportion of the debris found in the filters consisted of thrombotic material. Precise monitoring of heparin anticoagulation is recommended to prevent filter occlusion.
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Angioplastia de Balón/instrumentación , Arteria Carótida Interna , Estenosis Carotídea/terapia , Angiografía Cerebral , Filtración/instrumentación , Embolia Intracraneal/prevención & control , Stents , Anciano , Anciano de 80 o más Años , Arteria Carótida Interna/diagnóstico por imagen , Femenino , Fibrina/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: Nearly 2.350 dairy farms (and 137.000 milk cows) are located in the province of Reggio Emilia, Italy, to produce the famous Parmigiano-Reggiano" cheese. Feeding is hay-based both in the cold season and (together with grazing) in the warm season. This requires a large production of hay and frequent handling by the farmers. Hay is packed in large cylindrical bales, "round bales" (nearly 2.41 m3), or, rarely, in traditional small prisms-shaped bales (about 0.15 m3), only used on small farms. We estimated there were 6.000-9.000 the workers exposed to hay dust. The risks for the farmer's health due to the hay dust exposure are well known; in particular Farmer's Lung disease (FL) is rather frequent in this Region (1.5%-3.0% among people exposed). We studied hay and air pollution by Saccharopolyspora Rectivirgula (SR) in relation to these two different hay-packing techniques (hay dried in the open air) both in flat and in hilly areas. METHODS: On 56 cattle-farms, hay and air samples were collected and analyzed using a six-stage Andersen sampler and a sedimentation chamber (SC) for hay samples with plastic Petri dishes containing culture medium. RESULTS: Round bales were richer in SR spores than the small prism-shaped bales (n = 37, mean = 6.20 logn ufc/m3 in SC, ds: 3.87 vs n = 15, mean = 2.40 logn ufc/m3 in SC; ds: 4.16) and they seem to produce higher air pollution (n = 30, mean = 5.30 logn ufc/m3; ds: 3.71 vs n = 15, mean = 2.32 logn ufc/m3; ds: 2.99). In hilly areas the pollution produced by round bales (in hay and air) was higher than in flat areas. On the contrary hay from small bales produced in hilly areas was poorest in SR spores. CONCLUSIONS: An heavy exposure to actinomycetes spores, therefore, comes from "round bales" hay handling, especially when the bales are produced in mountain areas. New drying systems, probably, can reduce this risk and raise hay quality.