Understanding vaccination hesitation among health professionals: a systematic review of qualitative studies.

OBJECTIVES: In terms of vaccination, people trust healthcare professionals (HCPs) more than any other source of information. They are the cornerstone of vaccination as they can move undecided populations not only towards vaccination but also towards non-vaccination. The aim of this systematic review was to explore the knowledge, beliefs, attitudes, and barriers associated with own vaccination and patient recommendation in HCPs. STUDY DESIGN: This study incorporated a systematic review. METHODS: A systematic review of studies published from January 1, 2000, to June 1, 2020, was conducted by searching PubMed and EMBASE electronic databases. Qualitative studies reporting outcomes related to knowledge, attitudes, or barriers related to vaccination/recommendation by healthcare personnel were included. The guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. RESULTS: From a total of 2916 studies identified, 36 articles met the inclusion criteria. Some of the factors cited by the HCP that may contribute to vaccine hesitancy were (a) concerns regarding safety or efficacy of vaccines (23 articles); (b) time constraints (21 articles); (c) lack of knowledge about the vaccination/vaccine (19 articles); (d) costs (13 articles); (e) distrust of pharmaceutical industry (8 articles); and (f) considering oneself insusceptible (7 articles), stock shortage (7 articles), lack of personnel (5 articles), and feelings of unnecessary vaccination (5 articles). CONCLUSIONS: Our review suggests that interventions to combat vaccine hesitancy should increase HCP education on vaccine efficacy and safety, as well as intervene on health system factors such as cost and time per visit. In this way, we could tackle the problem of vaccine hesitancy, which seriously threatens global public health.

Trends in celecoxib and etoricoxib prescribing following removal of prior authorization requirement in Spain.

WHAT IS KNOWN AND OBJECTIVE: Previous studies indicate that the implementation of a prior authorization requirement for coxibs was followed by a sharp decline in their use. There are no studies showing what happens if coxib prior authorization is removed. The objective of this study is to assess the trend in the use of coxibs marketed in Spain, following removal of their respective prior authorization requirements in November 2006 for celecoxib and February 2007 for etoricoxib. METHODS: We calculated the monthly number of defined daily doses per thousand inhabitants per day (DDD/TID) of coxibs dispensed in a health area of Spain from mid-2005 to December 2007. Data were analysed both graphically and by means of a segmented regression model. RESULTS AND DISCUSSION: At the start of the study period, use of coxibs showed no growth. At the date when prior authorization of celecoxib was removed (November 2006), however, DDD/TID of the coxib whose prior authorization had not been removed - namely etoricoxib - remained unchanged, whereas consumption of celecoxib increased significantly (by the end of the study period, celecoxib use displayed a relative increase of 615% in terms of the DDD/TID prescribed before the removal of its prior authorization requirement). Similarly, etoricoxib use remained unchanged until its prior authorization was removed (February 2007), from which time DDD/TID of etoricoxib also underwent a considerable increase (by the end of the study period, etoricoxib use displayed a relative increase of 793% in terms of the DDD/TID prescribed before the removal of its prior authorization). Segmented regression analysis showed a sharp, statistically significant rise and change in slope in both celecoxib and etoricoxib use immediately after removal of their respective prior authorizations. WHAT IS NEW AND CONCLUSION: Use of celecoxib and etoricoxib rose sharply after removal of their respective prior authorizations.

Health related quality of life in patients with Cohn´s disease in remission.

BACKGROUND: Crohn's disease (CD) affects Health Related Quality of Life (HRQoL) especially in patients with clinical activity but their impact over the disease during periods of remission has not been sufficiently studied. OBJECTIVE: To evaluate HRQoL in CD patients in remission and to identify socio-demographic and clinical factors related. METHODS: We included patients with CD in remission for at least 6 months, defined as a CDAI < 150 and a CRP < 5 mg/L. Socio-demographic and clinical parameters were recorded. HRQoL was evaluated with Short Form 36 Questionnaire (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ). Results were analyzed using multiple regressions with a confidence interval of 95%. RESULTS: Nine two patients (X = 37 +- 11.4 years, 52.2% men) were consecutively included. Two patients failed to fill correctly the questionnaire and were excluded. Scores on the SF-36 were lower than in the general population of similar age and sex. The most affected dimension in the SF-36 was General Health (47.98 +- 19.58) and the IBDQ Systemic Symptoms (5.15 +- 1.27). Age, colonic location and previous surgery was related with worse HRQoL, while higher educational status, more time since diagnosis, steroid-resistance and inflammatory behavior, was associated with better HRQoL. CONCLUSIONS: Despite being in remission, CD patients had affected their HRQoL, so we must continue working to achieve improvement in HRQL of these patients during these periods of the disease.

Reasons for medication non-initiation: A qualitative exploration of the patients' perspective.

BACKGROUND: Non-initiation occurs when the doctor prescribes a new pharmacological treatment to a patient who does not fill the prescription. Non-initiation prevalence estimates range between 6% and 28% in Primary Care (PC) and it is associated with poorer clinical outcomes, more sick-leave days and higher costs. To date, the reasons for non-initiation have not been explored using a qualitative framework. OBJECTIVE: The aim of the present study was to identify reasons for medication non-initiation among PC patients with distinct treatment profiles (acute, chronic symptomatic and asymptomatic, and mental disorders). METHODS: An exploratory, explanatory qualitative study based on Grounded Theory. We conducted individual semi-structured interviews with 30 PC patients. A constant comparative method of analysis was performed. RESULTS: The results were similar for all therapeutic groups. The decision to initiate treatment is multifactorial. Users make a risk-benefit assessment which is influenced by their beliefs about the pathology and the medication, their emotional reaction, health literacy and cultural factors. The patients' context and relationship with the health system influence decision-making. CONCLUSIONS: The decision to initiate a treatment is strongly influenced by factors that health professionals can discuss with patients. Health professionals should explore patients' beliefs about benefits and risks to help them make informed decisions and promote shared decision-making. General practitioners should ensure that patients understand the benefits and risks of disease and treatment, while explaining alternative treatments, encouraging patients to ask questions and supporting their treatment decisions.

Psychological impact of Crohn's disease on patients in remission: anxiety and depression risks.

BACKGROUND: the role of anxiety and depression in CD patients in remission has been poorly investigated. OBJECTIVE: the aim of the study was to evaluate the frequency of anxiety and depression symptoms in CD patients in remission, and potential factors influencing the development of these symptoms. METHODS: CD patients older than 18 years in remission for at least 6 months before study entry were included. CD remission was defined as a Crohn s Disease Activity Index (CDAI) < 150 points together with C-reactive protein < 5 mg/L. A demographic questionnaire was filled in, and all patients were clinically classified. The therapy maintaining remission was also recorded. A Hospital Anxiety and Depression scale (HAD) was administered to all patients. Results are shown as OR and 95% CI, and analyzed by logistic regression. RESULTS: 92 consecutive patients were included (48 male, mean age 37 years, range from 18 to 71 years). One patient failed to correctly fill in the questionnaire. Anxiety and depression symptoms were present in 36 (39%) and 22 (24%) patients, respectively. Infliximab therapy was the only factor associated with anxiety (OR = 3.11; 95% CI: 1.03-9.43; p < 0.05). In contrast, the presence of depressive symptoms is less frequent in patients under infliximab therapy (OR = 0.16; 95% CI: 0.02-0.97; p < 0.05). CONCLUSIONS: despite clinical remission, an important number of CD patients present with anxiety or depressive symptoms. Infliximab therapy in CD patients is associated to more anxiety but fewer depressive symptoms. CD patients in remission would probably benefit from psychological support.

Effect of short-term exposure to air pollution and pollen on medical emergency calls: a case-crossover study in Spain.

BACKGROUND: A symmetric case-crossover design was used to analyse the short-term relationship between air pollution, pollen and emergency calls to medical services. METHODS: This study covered patients who made medical emergency calls in the City of Vigo (Spain) during the period 1996-1999. Morbidity data were obtained from the records of the 061 Medical Emergency Control Center, in its capacity as the body officially coordinating all medical emergencies by telephone. Air pollution data were furnished by the Vigo Municipal Air Pollution Surveillance Grid. Pollen levels were provided by the staff of the Spanish Aerobiology Network in Vigo. RESULTS: A rise of 10 microg/m(3) in ambient particulate levels led to the risk of medical emergency calls requesting attention increasing by: (i) 1.97% [95% confidence interval (95% CI): 1.83-2.11%] for circulatory causes on the same day; (ii) 1.95% (95% CI: 1.76-2.14%) for respiratory causes at 2 days and (iii) 1.34% (95% CI: 1.23-1.45%) for combined circulatory and respiratory causes on the same day. A number of pollens displayed a statistically significant relationship with emergency calls. No interaction was in evidence between pollens and air pollutants. CONCLUSIONS: While elevations in particulate air pollution increase medical emergency calls because of cardiac or respiratory causes or both combined, elevations in pollen levels increase medical emergency calls because of respiratory causes.

Antioxidant vitamins and risk of lung cancer.

Tobacco use is the leading risk factor for lung cancer, yet in addition to smoking habit, diet may also play a role in the disease's appearance. While there are reports to indicate that antioxidant vitamins and carotenoids may decrease the risk of lung cancer, results to date have been somewhat ambiguous. This review aimed to describe the results yielded by different studies, which have addressed antioxidant vitamin intake and lung cancer, and to indicate the mechanisms whereby these nutrients might be exercising their activity. Antioxidant vitamins were observed to have no clear protective effect, though there was some evidence pointing to a protective role for vitamins C and E. Vitamin A, in contrast, evinced no clear effect. Insofar as provitamin A carotenoids were concerned, lutein/zeaxanthin, lycopene and alpha-carotene displayed a certain protective trend, yet beta-carotene exhibited no protective effect whatsoever; and indeed, there was speculation as to whether it might even be pernicious in smokers. Beta-criptoxanthin, on the other hand, showed a more consistent protective effect. The study highlighted the need to conduct further research on smokers and non-smokers alike, and in particular, to investigate the effect, if any, on lung cancer of carotenoids or vitamins when ingested in differing dosages.

Molecular diversity and genetic relationships in Secale.

The objective of this study was to quantify the molecular diversity and to determine the genetic relationships among Secale spp. and among cultivars of Secale cereale using RAPDs, ISSRs and sequence analysis of six exons of ScMATE1 gene. Thirteen ryes (cultivated and wild) were genotyped using 21 RAPD and 16 ISSR primers. A total of 435 markers (242 RAPDs and 193 ISSRs) were obtained, with 293 being polymorphic (146 RAPDs and 147 ISSRs). Two RAPD and nine ISSR primers generated more than 80% of polymorphism. The ISSR markers were more polymorphic and informative than RAPDs. Further, 69% of the ISSR primers selected achieved at least 70% of DNA polymorphism. The study of six exons of the ScMATE1 gene also demonstrated a high genetic variability that subsists in Secale genus. One difference observed in exon 1 sequences from S. vavilovii seems to be correlated with Al sensitivity in this species. The genetic relationships obtained using RAPDs, ISSRs and exons of ScMATE1 gene were similar. S. ancestrale, S. kuprijanovii and S. cereale were grouped in the same cluster and S. segetale was in another cluster. S. vavilovii showed evidences of not being clearly an isolate species and having great intraspecific differences.

Association of Isozymes with a Reciprocal Translocation in Cultivated Rye (SECALE CEREALE L.).

In rye (Secale cereale L. cv. "Ailés") the progeny of a cross between a structural heterozygote for a reciprocal translocation (involving the 1R chromosome) and a homozygote for the standard chromosome arrangement were analyzed for the electrophoretic patterns of eight different leaf isozymes and also for their meiotic configuration at metaphase I.--The Got-3 and Mdh-2b loci are linked to each other and also to the reciprocal translocation. The Mdh-2b locus is located in the interstitial segment of the 3Rq chromosome arm, with an estimated distance of 8 cM to the breakpoint. Therefore, the reciprocal translocation involves the 1R and 3R chromosomes.--Also, the Mdh-1 and 6-Pgd-2 loci are linked (16 +/- 3 cM) and have been located on the 2Rq arm. Finally, the Per-3 and Per-4 loci are located on the 2Rp chromosome arm at an estimated distance of 26 +/- 4 cM.

Effect of the administration schedule on the therapeutic efficacy of oral pancreatic enzyme supplements in patients with exocrine pancreatic insufficiency: a randomized, three-way crossover study.

BACKGROUND: Oral pancreatic enzyme supplements should be properly administered in order to ensure an adequate gastric mixing with the food and simultaneous gastric emptying with the chyme. AIM: To evaluate, in a prospective, randomized, open, comparative, three-way, crossover study, the effect of the administration schedule on the efficacy of oral pancreatic enzymes for the treatment of exocrine pancreatic insufficiency. METHODS: Twenty-four consecutive chronic pancreatitis patients with maldigestion secondary to exocrine pancreatic insufficiency were treated with 40 000 U lipase in the form of capsules containing enteric-coated mini-microspheres. Capsules were taken just before meals (schedule A), just after meals (schedule B) or distributed along with meals (schedule C) for three consecutive 1-week crossover periods in a randomized order. Fat digestion before and during the three treatment periods was evaluated by an optimized mixed (13)C-triglyceride breath test. RESULTS: Before therapy, the (13)CO(2) recovery in the breath test was 23.8 +/- 15.8% (normal >58.0%). During therapy, the (13)CO(2) recovery tended to be higher when capsules were taken along with meals ((13)CO(2) recovery 61.4 +/- 21.4%) or just after meals ((13)CO(2) recovery 60.6 +/- 21.8%) than when taken just before meals ((13)CO(2) recovery 53.9 +/- 20.3%). The percentage of patients who normalized fat digestion under therapy was 50, 54 and 63% with schedules A, B and C respectively. CONCLUSIONS: The efficacy of pancreatic enzyme supplements for the treatment of exocrine pancreatic insufficiency may be optimized by administration during or after meals.

The role of two superoxide dismutase mRNAs in rye aluminium tolerance.

Aluminium (Al) is the main factor that limits crop production in acidic soils. There is evidence that antioxidant enzymes such as superoxide dismutase (SOD) play a key role against Al-induced oxidative stress in several plant species. Rye is one of the most Al-tolerant cereals and exudes both citrate and malate from the roots in response to Al. The role of SOD against Al-induced oxidative stress has not been studied in rye. Al accumulation, lipid peroxidation, H2O2 production and cell death were significantly higher in sensitive than in tolerant rye cultivars. Also, we characterised two genes for rye SOD: ScCu/ZnSOD and ScMnSOD. These genes were located on the chromosome arms of 2RS and 3RL, respectively, and their corresponding hypothetical proteins were putatively classified as cytosolic and mitochondrial, respectively. The phylogenetic relationships indicate that the two rye genes are orthologous to the corresponding genes of other Poaceae species. In addition, we studied Al-induced changes in the expression profiles of mRNAs from ScCu/ZnSOD and ScMnSOD in the roots and leaves of tolerant Petkus and sensitive Riodeva rye. These genes are mainly expressed in roots in both ryes, their repression being induced by Al. The tolerant cultivar has more of both mRNAs than the sensitive line, indicating that they are probably involved in Al tolerance.

On the consequences of aluminium stress in rye: repression of two mitochondrial malate dehydrogenase mRNAs.

Plants have developed several external and internal aluminium (Al) tolerance mechanisms. The external mechanism best characterised is the exudation of organic acids induced by Al. Rye (Secale cereale L.), one of the most Al-tolerant cereal crops, secretes both citrate and malate from its roots in response to Al. However, the role of malate dehydrogenase (MDH) genes in Al-induced stress has not been studied in rye. We have isolated the ScMDH1 and ScMDH2 genes, encoding two different mitochondrial MDH isozymes, in three Al-tolerant rye cultivars (Ailés, Imperial and Petkus) and one sensitive inbred rye line (Riodeva). These genes, which have seven exons and six introns, were located on the 1R (ScMDH1) and 3RL (ScMDH2) chromosomes. Exon 1 of ScMDH1 and exon 7 of ScMDH2 were the most variable among the different ryes. The hypothetical proteins encoded by these genes were classified as putative mitochondrial MDH isoforms. The phylogenetic relationships obtained using both cDNA and protein sequences indicated that the ScMDH1 and ScMDH2 proteins are orthologous to mitochondrial MDH1 and MDH2 proteins of different Poaceae species. The expression studies of the ScMDH1 and ScMDH2 genes indicate that it is more intense in roots than in leaves. Moreover, the amount of their corresponding mRNAs in roots from plants treated and not treated with Al was higher in the tolerant cultivar Petkus than in the sensitive inbred line Riodeva. In addition, ScMDH1 and ScMDH2 mRNA levels decreased in response to Al stress (repressive behaviour) in the roots of both the tolerant Petkus and the sensitive line Riodeva.

Is the Mnr locus of Triticeae species the same as the Ndh and Dia loci?

The menadione reductase (MNR), the nicotinamide adenine dinucleotide dehydrogenase (NDH) and diaphorase (DIA) isozymes were studied in the allohexaploid Triticum aestivum cv "Chinese Spring" and in five diploid Triticeae species. The Mnr1, Ndh3and Dia1 loci were located on the chromosome arms 3AL, 3BL and 3DL of T. aestivum, respectively. These loci were also located on the 3H chromosome of Hordeum vulgare cv "Betzes", the 3L chromosome of Aegilops longissima and the 6RL chromosome arm of Secale cereale cv "Imperial". The chromosomal location results together with the segregation studies support a tetrameric behaviour of the MNR1, NDH3 and DIA1 isozymes. The Ndh1 and Dia3 loci were located on homoeologous group 4 showing a monomeric behaviour. The chromosomal locations and linkage data of the Mnr, Ndh and Dia loci suggest that Mnr1=Ndh3=Dia1; Ndh1=Dia3 and Ndh2=Dia2.

Diet and lung cancer: a new approach.

Lung cancer is one of major public health problems facing the world today, owing to the high incidence of the disease and its poor prognosis. Although the principal cause of lung cancer is tobacco use, smokers find it extremely difficult to quit the habit. Hence, there is a need to take action targeted at other risk factors for this disease. One such factor is diet, which is known to be able to raise or lower the risk of lung cancer. This paper seeks to complement other reviews in the field and to shed more light both on the influence that dietary factors may have upon the occurrence of this neoplasm and on the causes of this possible effect.

Dose-response relationship between tobacco and lung cancer: new findings.

The purpose of this work is to model the relationship between smoking-related variables and the risk of lung cancer by using parametric and non-parametric models. A hospital-based case-control study was conducted to ascertain the influence of smoking on risk of lung cancer. We used parametric logistic regression with a series of categorized independent variables and non-parametric logistic regression models. Such models allow for variables to be treated as continuous, since they avoid arbitrariness in the selection of cut-offs and furnish information on the dose-risk relationship. The results point to the possible existence of a saturation effect for a lifetime tobacco consumption of around 25 000-30 000 packets. Duration of habit and years of abstinence show a linear relationship marked by opposite, though similar, slopes, which would seem to indicate that for every year of smoking, risk rises by an amount (8.00%, 95% confidence interval (CI) 5.94-10.06) equal to the decline in risk for every year of abstinence (6.98%, 95% CI 2.53-11.84). Lastly, a lower age of smoking initiation appears to have an influence, although non-significant, on the appearance of the disease. The risk of lung cancer due to duration of the habit would seem to be proportional to years of abstinence, and there could be a saturation effect with respect to lifetime tobacco consumption.

Comparing meta-analysis and ecological-longitudinal analysis in time-series studies. A case study of the effects of air pollution on mortality in three Spanish cities.

STUDY OBJECTIVE: The objective of this paper is to introduce a different approach, called the ecological-longitudinal, to carrying out pooled analysis in time series ecological studies. Because it gives a larger number of data points and, hence, increases the statistical power of the analysis, this approach, unlike conventional ones, allows the complementation of aspects such as accommodation of random effect models, of lags, of interaction between pollutants and between pollutants and meteorological variables, that are hardly implemented in conventional approaches. DESIGN: The approach is illustrated by providing quantitative estimates of the short-term effects of air pollution on mortality in three Spanish cities, Barcelona, Valencia and Vigo, for the period 1992-1994. Because the dependent variable was a count, a Poisson generalised linear model was first specified. Several modelling issues are worth mentioning. Firstly, because the relations between mortality and explanatory variables were non-linear, cubic splines were used for covariate control, leading to a generalised additive model, GAM. Secondly, the effects of the predictors on the response were allowed to occur with some lag. Thirdly, the residual autocorrelation, because of imperfect control, was controlled for by means of an autoregressive Poisson GAM. Finally, the longitudinal design demanded the consideration of the existence of individual heterogeneity, requiring the consideration of mixed models. MAIN RESULTS: The estimates of the relative risks obtained from the individual analyses varied across cities, particularly those associated with sulphur dioxide. The highest relative risks corresponded to black smoke in Valencia. These estimates were higher than those obtained from the ecological-longitudinal analysis. Relative risks estimated from this latter analysis were practically identical across cities, 1.00638 (95% confidence intervals 1.0002, 1.0011) for a black smoke increase of 10 microg/m(3) and 1.00415 (95% CI 1.0001, 1.0007) for a increase of 10 microg/m(3) of sulphur dioxide. Because the statistical power is higher than in the individual analysis more interactions were statistically significant, especially those among air pollutants and meteorological variables. CONCLUSIONS: Air pollutant levels were related to mortality in the three cities of the study, Barcelona, Valencia and Vigo. These results were consistent with similar studies in other cities, with other multicentric studies and coherent with both, previous individual, for each city, and multicentric studies for all three cities.

Aggregation behaviour in Panstrongylus megistus and Triatoma infestans: inter and intraspecific responses.

We tested the aggregation response to inter and intraspecific chemical signals in Panstrongylus megistus and Triatoma infestans. As previously described for T. infestans, larvae of P. megistus significantly aggregated on papers impregnated with their own excrement and on papers marked with cuticular substances deposited on surfaces on which these insects had walked. T. infestans bugs also aggregated on papers impregnated by faeces or by cuticular substances of P. megistus, and P. megistus aggregated on papers contaminated by faeces or by cuticular substances of T. infestans. The response of P. megistus to its cuticular substances was significantly stronger than that to its faeces. The non-specificity of the two signals is discussed in the context of the ecological relationship between both species.

GSTM1 and GSTT1 polymorphisms, tobacco and risk of lung cancer: a case-control study from Galicia, Spain.

BACKGROUND: Only 15% of heavy smokers go on to develop lung cancer, indicating the existence of individual predisposition. PATIENTS AND METHODS: Using a case-control study, we ascertained whether there were differences between cases and controls in the frequency of GSTM1 and GSTT1 gene polymorphisms, and whether their effect might be linked to smoking habit. RESULTS: While a risk of lung cancer of 1.7 (1.0-3.0) was observed for GSTM1 gene deficiency, there appeared to be no such association for absence of the GSTT1 gene. The interaction observed with tobacco use indicated an excess risk of 24.5% (IC 95%-59.8-109.0) for the GSTM1 gene, with no such interaction in evidence for the GSTT1 gene. The highest risk for a combination of the different haplotypes was for subjects with the GSTT1 gene present and the GSTM1 gene deleted, with an Odds Ratio of 2.19 (1.18-4.07). CONCLUSION: The absence of the GSTM1 gene is, while that of the GSTT1 gene is seemingly not, implicated in susceptibility to lung cancer.

Colocutaneous fistula relating to the migration of a biliary stent.

The endoscopic placement of endoprostheses to decompress biliary obstruction is a commonly used treatment for malignant biliary diseases and is also used in the treatment of benign biliary strictures. Complications of endoprosthesis placement have been described and include the migration of the stent. We present a case of a colonic-cutaneous fistula secondary to the migration of a plastic biliary stent with colonic perforation.

High mutability in rye (Secale cereale L.).

Analysis of the rye cultivar Ailés of several descents derived from crosses between plants carrying specific genotypes and/or chromosome constitutions resulted in the detection of high chromosome (2.05 x 10(-2)) and gene (9.3 x 10(-3)) mutation frequencies. The existence of a transposon system responsible for this instability is suggested.