Exploring the Influence of Social Class and Sex on Self-Reported Health: Insights from a Representative Population-Based Study.

This study investigates the intricate interplay between social class, sex, and self-reported health (SRH) using data from the European Health Survey of Spain 2020 (EESE2020). Employing a cross-sectional design and a representative sample of 22,072 individuals, the analysis explores the persistence of disparities after adjusting for covariates, focusing on health-related variables. The study employs logistic regression models and directed acyclic graphs (DAGs) to delineate the direct effects of social class and sex on SRH, identifying a minimum adjustment set to control for confounding variables. Results reveal a gradient effect of social class on SRH, emphasizing the enduring impact of socioeconomic factors. Sex-based disparities in SRH diminish after considering additional health-related variables, highlighting the importance of a holistic approach. DAGs serve as transparent tools in disentangling complex relationships, guiding the identification of essential covariates. The study concludes that addressing health inequalities requires comprehensive strategies considering both individual health behaviours and socio-economic contexts. While recognizing limitations, such as the cross-sectional design, the findings contribute to a nuanced understanding of health disparities, informing evidence-based interventions and policies for a more equitable healthcare system.

Effect of a Nutritional Intervention on the Intestinal Microbiota of Vertically HIV-Infected Children: The Pediabiota Study.

AIMS: The gut microbiota exerts a critical influence in the immune system. The gut microbiota of human virus immunodeficiency (HIV)-infected children remains barely explored. We aimed to characterize the fecal microbiota in vertically HIV-infected children and to explore the effects of its modulation with a symbiotic nutritional intervention. METHODS: a pilot, double blind, randomized placebo-controlled study including HIV-infected children who were randomized to receive a nutritional supplementation including prebiotics and probiotics or placebo for four weeks. HIV-uninfected siblings were recruited as controls. The V3-V4 region of the 16S rRNA gene was sequenced in fecal samples. RESULTS: 22 HIV-infected children on antiretroviral therapy (ART) and with viral load (VL) <50/mL completed the follow-up period. Mean age was 11.4 ± 3.4 years, eight (32%) were male. Their microbiota showed reduced alpha diversity compared to controls and distinct beta diversity at the genus level (Adonis p = 0.042). Patients showed decreased abundance of commensals Faecalibacterium and an increase in Prevotella, Akkermansia and Escherichia. The nutritional intervention shaped the microbiota towards the control group, without a clear directionality. CONCLUSIONS: Vertical HIV infection is characterized by changes in gut microbiota structure, distinct at the compositional level from the findings reported in adults. A short nutritional intervention attenuated bacterial dysbiosis, without clear changes at the community level. SUMMARY: In a group of 24 vertically HIV-infected children, in comparison to 11 uninfected controls, intestinal dysbiosis was observed despite effective ART. Although not fully effective to restore the microbiota, a short intervention with pre/probiotics attenuated bacterial dysbiosis.

Effects of allergen exposure on methacholine and AMP-induced air trapping in pollen-sensitive subjects.

BACKGROUND: The effect of pro-inflammatory stimuli on bronchoconstrictor-induced air trapping has not been studied. OBJECTIVE: To determine the effect of natural allergen exposure, a pro-inflammatory stimulus, on methacholine- and adenosine 5'-monophospate (AMP)-induced air trapping. METHODS: Airway responsiveness to methacholine and AMP before and during the pollen season was obtained in 25 subjects with pollen allergy and in 10 healthy controls. The response was expressed by the sensitivity (PC20 value) and by the slope and intercept of the FVC values recorded at each step of the challenge against the corresponding FEV1 values. RESULTS: The slope and intercept FVC versus FEV1 values for both methacholine and AMP were significantly higher in subjects with pollen allergy than in healthy controls. In the group with pollen allergy, both methacholine and AMP PC20 values decreased significantly during the pollen season. However, the mean (95% CI) slope FVC versus FEV1 values for methacholine were 1.00 (0.84-1.16) before the pollen season and 0.99 (0.86-1.12, P = 0.90) during the pollen season. Similar results were obtained with AMP. CONCLUSIONS: Although the air trapping induced by both methacholine and AMP is significantly greater in subjects with pollen allergy than in healthy controls, natural allergen exposure is associated with a selective increase in airway sensitivity without concomitant changes in bronchoconstrictor-induced air trapping. These findings suggest that the information provided by the bronchoconstrictor-induced change in FEV1 and FVC is not equivalent and may be complementary.

Maximal degree of airway narrowing induced by methacholine and adenosine monophosphate: relationship with the decrease in forced vital capacity.

BACKGROUND: Changes in forced vital capacity (FVC) may represent an indirect method for the detection of plateau in response to inhaled bronchoconstrictor agents. OBJECTIVE: To determine the relationship between the level of plateau obtained with either methacholine or adenosine monophosphate (AMP) and the decrease in FVC induced by each bronchoconstrictor agent. METHODS: Airway responsiveness to high concentrations of methacholine and AMP was determined in patients with intermittent asthma (n = 41) or allergic rhinitis (n = 26). Furthermore, allergen-induced changes in the response to each bronchoconstrictor agent were investigated in 18 pollen-sensitive patients. Concentration-response curves were characterized by the slope of the FVC values recorded at each step of the challenge against the corresponding forced expiratory volume in 1 second (FEV1) values and, if possible, by the level of plateau. RESULTS: The slope FVC vs FEV1 was similar in patients with plateau and in those without plateau. In patients with pollen allergy, the mean (95% confidence interval) for the level of plateau detected with methacholine increased from 16.8% (11.8%-22.0%) before the pollen season to 21.7% (14.8%-28.6%, P = .008) during the pollen season, whereas pollen-induced changes in the slope FVC vs FEV1 were not significant. Similar results were obtained with AMP. CONCLUSIONS: In patients with allergic rhinitis or intermittent asthma, methacholine or AMP-induced changes in FVC are not significantly related to the presence or level of plateau. Furthermore, these 2 constituents of the concentration-response curve can be modified independently by a proinflammatory stimulus. These results suggest that the bronchoconstrictor-induced change in FVC cannot be used as a surrogate estimation of the level of plateau.

Infarto talámico bilateral y cognición en paciente con enfermedad de Hodgkin / Bilateral thalamic infarction and cognition in patient with Hodgkin's disease

La afectación del sistema nervioso central en la enfermedad de Hodgkin (HDG) es excepcional. Los pacientes con lesiones malignas tienen mayor riesgo de infarto cerebral. Se presentó un paciente con antecedente de enfermedad de HDG quien presentó episodios súbitos de deterioro del nivel de conciencia y que en el período de recuperación mostró severas alteraciones en sus funciones psíquicas superiores con trastornos groseros de la memoria de fijación y evocación, desorientación témporo-espacial, acalculia, perseveraciones, conducta inadecuada y agresividad. Se determinó, mediante estudios imagenológicos, tomografía axial computarizada y resonancia magnética nuclear, el diagnóstico de infarto talámico bilateral. Se concluyó que las lesiones del tálamo que se acompañan de alteraciones de las funciones psíquicas superiores de carácter demencial son comúnmente bilaterales y que es importante diagnosticar estas complicaciones porque la mayoría son tratables. Se recomendó realizar estudios neuropsicológicos periódicos para precisar si existe recuperación evolutiva de los trastornos cognitivos y conductuales o concluir su diagnóstico como una demencia vascular talámica

Infarto talámico bilateral y cognición en paciente con enfermedad de Hodgkin / Bilateral thalamic infarction and cognition in patient with Hodgkin's disease

La afectación del sistema nervioso central en la enfermedad de Hodgkin (HDG) es excepcional. Los pacientes con lesiones malignas tienen mayor riesgo de infarto cerebral. Se presentó un paciente con antecedente de enfermedad de HDG quien presentó episodios súbitos de deterioro del nivel de conciencia y que en el período de recuperación mostró severas alteraciones en sus funciones psíquicas superiores con trastornos groseros de la memoria de fijación y evocación, desorientación témporo-espacial, acalculia, perseveraciones, conducta inadecuada y agresividad. Se determinó, mediante estudios imagenológicos, tomografía axial computarizada y resonancia magnética nuclear, el diagnóstico de infarto talámico bilateral. Se concluyó que las lesiones del tálamo que se acompañan de alteraciones de las funciones psíquicas superiores de carácter demencial son comúnmente bilaterales y que es importante diagnosticar estas complicaciones porque la mayoría son tratables. Se recomendó realizar estudios neuropsicológicos periódicos para precisar si existe recuperación evolutiva de los trastornos cognitivos y conductuales o concluir su diagnóstico como una demencia vascular talámica(AU)

Soporte nutricional durante el tratamiento con radiaciones ionizantes en pacientes con tumores de cabeza y cuello en estadios avanzados / Nutritional supplement during the treatment with ionizing radiations in patients with head and neck tumors in advanced stages

La desnutrición en el paciente con cáncer avanzado favorece la inmunosupresión e implica un bajo índice de Karnofsky, pobre tolerancia y respuesta a los tratamientos oncoespecíficos, ya sea con intención curativa o paliativa, alta susceptibilidad a las infecciones y, por tanto, disminuye la calidad de vida. Los pacientes con tumores localizados en cabeza y cuello en etapas avanzadas (III-IV), constituyen uno de los grupos de alto riesgo de malnutrición por la reducción de ingresos de nutrientes, la anorexia, alteraciones del mecanismo de la deglución, obstrucción mecánica de las vías digestivas superiores, entre otras. Numerosos estudios demuestran la conveniencia del soporte nutricional en estos pacientes durante el tratamiento oncoespecífico. Se realizó un estudio prospectivo que incluyó 15 pacientes con neoplasias localizadas en cabeza y cuello en etapas avanzadas, clínicamente con signos de malnutrición, para evaluar el aporte calórico-energético adicional; a todos se les administró un soporte nutricional oral (Adn-22 %) durante el tratamiento radiante para evaluar la posibilidad de mejoría en cuanto a la tolerancia y respuesta al tratamiento. De los 15 casos estudiados, 13 presentaron complicaciones al tratamiento, pero en su mayoría de ligera intensidad, sin afectar de forma significativa el tiempo de duración y la dosis total de tratamiento, con respuesta favorable en relación con el tumor.

Malnutrition in the patient with advanced cancer favors immunosuppresion and implies a low Karnofsky index, poor tolerance and response to the oncospecific curative or palliative treatments, high susceptibility to infections and, as a result, a decline of the quality of life. Patients with head and neck tumors in advanced stages (III-IV) are one of the groups of high risk for malnutrition due to the reduction of the intake of nutrients, anorexia, alterations of the deglution mechanism, and mechanical obstruction of the upper digestive tract, among other causes.Numerous studies show the convenience of the nutritional supplement in these patients during the oncospecific treatment. A prospective study that included 15 patients with head and neck neoplasias in advanced stages, and with clinical signs of malnutrition, was conducted in order to evaluate the necessary calorie-energy supplement. All of them were administered an oral nutritional supplement (Adn-22 %) during the radiation treatment to assess the possibility of improving their tolerance and response to the treatment. Of the 15 studied cases, 13 presented complications in connection with the treatment, but most them were mild, and they did not affect in a significant way the time of duration and the total dose of treatment. There was a favorable response in relation to the tumor.

Soporte nutricional durante el tratamiento con radiaciones ionizantes en pacientes con tumores de cabeza y cuello en estadios avanzados / Nutritional supplement during the treatment with ionizing radiations in patients with head and neck tumors in advanced stages

La desnutrición en el paciente con cáncer avanzado favorece la inmunosupresión e implica un bajo índice de Karnofsky, pobre tolerancia y respuesta a los tratamientos oncoespecíficos, ya sea con intención curativa o paliativa, alta susceptibilidad a las infecciones y, por tanto, disminuye la calidad de vida. Los pacientes con tumores localizados en cabeza y cuello en etapas avanzadas (III-IV), constituyen uno de los grupos de alto riesgo de malnutrición por la reducción de ingresos de nutrientes, la anorexia, alteraciones del mecanismo de la deglución, obstrucción mecánica de las vías digestivas superiores, entre otras. Numerosos estudios demuestran la conveniencia del soporte nutricional en estos pacientes durante el tratamiento oncoespecífico. Se realizó un estudio prospectivo que incluyó 15 pacientes con neoplasias localizadas en cabeza y cuello en etapas avanzadas, clínicamente con signos de malnutrición, para evaluar el aporte calórico-energético adicional; a todos se les administró un soporte nutricional oral (Adn-22 por ciento) durante el tratamiento radiante para evaluar la posibilidad de mejoría en cuanto a la tolerancia y respuesta al tratamiento. De los 15 casos estudiados, 13 presentaron complicaciones al tratamiento, pero en su mayoría de ligera intensidad, sin afectar de forma significativa el tiempo de duración y la dosis total de tratamiento, con respuesta favorable en relación con el tumor(AU)

Modifications of airway responsiveness to adenosine 5'-monophosphate and exhaled nitric oxide concentrations after the pollen season in subjects with pollen-induced rhinitis.

STUDY OBJECTIVE: s: To determine the effect of cessation of exposure to pollen on airway responsiveness to adenosine 5'-monophosphate (AMP) in subjects with pollen-induced rhinitis, and to explore the relationship between changes in airway responsiveness and changes in exhaled nitric oxide (ENO) levels. STUDY DESIGN: Subjects were studied during the pollen season and out of season. SETTING: Specialist allergy unit in a university hospital. PATIENTS: Fourteen subjects without asthma with pollen-induced rhinitis who showed bronchoconstriction in response to methacholine and AMP during the pollen season and 10 healthy nonatopic control subjects. MEASUREMENTS AND RESULTS: In subjects with pollen-induced rhinitis, ENO concentrations, provocative concentration of agonist causing a 20% fall in FEV(1) (PC(20)) methacholine, and PC(20) AMP were determined during the pollen season and out of season. Healthy control subjects were studied during the pollen season. In subjects with allergic rhinitis, PC(20) AMP increased from a geometric mean of 79.4 mg/mL (95% confidence interval [CI], 31.6 to 199.5 mg/mL) during the pollen season to 316.2 mg/mL (95% CI, 158.5 to 400.0 mg/mL) out of season (p = 0.004). The ENO concentrations decreased from 63.1 parts per billion (ppb) [95% CI, 50.1 to 79.4 ppb] during the pollen season to 30.2 ppb (95% CI, 23.4 to 38.0 ppb) out of season (p < 0.001). The ENO concentrations out of pollen season were still significantly increased in subjects with pollen-induced rhinitis when compared with healthy control subjects. There was no relationship between individual changes in ENO levels and changes in either PC(20) methacholine or PC(20) AMP. CONCLUSIONS: In pollen-sensitive subjects with allergic rhinitis, the cessation of exposure to pollen is associated with a significant reduction of airway responsiveness to inhaled AMP. However, no association was found between allergen-induced changes in ENO values and in airway responsiveness to either direct or indirect bronchoconstrictors. These findings suggest that modifications in ENO and in airway responsiveness are the consequence of different alterations induced by allergen exposure on the lower airways.