Sustainable behavior begins with sustainable attitudes: Data to assess the relationships between demographics, concerns about transport-related pollution, and willingness for action.

This Data in Brief (DiB) article addresses the relationships among individuals' transport habits, perceptions, and attitudes regarding transport-related pollution, as well as their willingness to act for environmental change. There are presented descriptive statistics, basic comparisons, and bivariate correlations among the core variables of the study. Additionally, the attached dataset appends information from a nationwide sample of 1,250 citizens in the Dominican Republic, with sex, age and habitat distribution proportional to the national census. The research database contains the full set of questions and responses to the research questionnaire, which is also attached to the supplementary files along with its codebook, making it possible to conduct further data explorations for research-related, divulgation, and educational purposes. For more information about the root study, it is advisable to read the paper "Who wants to change their transport habits to help reduce air pollution? A nationwide study in the Caribbean", published in Journal of Transport & Health [1].

Lifestyle changes and mental health during the COVID-19 pandemic: A repeated, cross-sectional web survey.

BACKGROUND: This study aimed to compare self-reported changes on lifestyle behaviors during two phases of the COVID-19 pandemic in Spain, and to evaluate clinical and sociodemographic factors associated with lifestyles. METHODS: Two cross-sectional web surveys were conducted during lockdown (April 15-May 15, 2020) and seven months later (November 16-December 16, 2020). Lifestyle behaviors were self-reported by a multidimensional scale (SMILE-C). Two separate samples of respondents were analyzed. A multivariate regression model was performed to evaluate the association of SMILE-C scores with demographic and clinical variables. RESULTS: The sample comprised, 3412 participants from the first survey (S1) and in the S1 and 3635 from the second (S2). SMILE-C score decreased across surveys (p < 0.001). The rates of positive screenings for depression and anxiety were similar between the surveys, whereas those for alcohol abuse decreased (p < 0.001). Most participants in S2 reported that their lifestyle had not changed compared to those before the pandemic. Variables independently associated with an unhealthier lifestyle were working as an essential worker, lower educational level, previous mental disease, worse self-rated health, totally/moderate changes on diet, sleep or social support, as well as positive screenings for alcohol abuse, anxiety and depression. LIMITATIONS: The cross-sectional design and recruitment by non-probabilistic methods limit inferring causality and the external validity of the results. CONCLUSIONS: Overall lifestyle worsened seven months after the lockdown in Spain. Several demographic and clinical factors were associated with lifestyle scores. The contribution of common mental disorders to unhealthier lifestyles should be considered in order to prevent the negative impact of the pandemic.

Lifestyle in Undergraduate Students and Demographically Matched Controls during the COVID-19 Pandemic in Spain.

Few studies have used a multidimensional approach to describe lifestyle changes among undergraduate students during the COVID-19 pandemic or have included controls. This study aimed to evaluate lifestyle behaviors and mental health of undergraduate students and compare them with an age and sex-matched control group. A cross-sectional web survey using snowball sampling was conducted several months after the beginning of COVID-19 pandemic in Spain. A sample of 221 students was recruited. The main outcome was the total SMILE-C score. Students showed a better SMILE-C score than controls (79.8 + 8.1 vs. 77.2 + 8.3; p < 0.001), although these differences disappeared after controlling for covariates. While groups did not differ in the screenings of depression and alcohol abuse, students reported lower rates of anxiety (28.5% vs. 37.1%; p = 0.042). A lower number of cohabitants, poorer self-perceived health and positive screening for depression and anxiety, or for depression only were independently associated (p < 0.05) with unhealthier lifestyles in both groups. History of mental illness and financial difficulties were predictors of unhealthier lifestyles for students, whereas totally/moderate changes in substance abuse and stress management (p < 0.05) were predictors for the members of the control group. Several months after the pandemic, undergraduate students and other young adults had similar lifestyles.

Compliance, practices, and attitudes towards VTIs (Vehicle Technical Inspections) in Spain: What prevents Spanish drivers from checking up their cars?

OBJECTIVE: Mechanical conditions of vehicles may play a determinant role in driving safety, the reason why vehicle periodical technical inspections (VTIs) are mandatory in many countries. However, the high number of drivers sanctioned for not complying with this regulation is surprisingly high, and there is not much evidence on what kind(s) of motives may explain this concerning panorama. This study aimed to identify the aspects that modulate the relationship between complying (or not) with VTI's standards in a nationwide sample of Spanish drivers. The study design also addressed the drivers' awareness regarding different risky behaviors while driving, depending on their sex and their crash record. METHODS: 1,100 Spanish drivers completed a survey on the aforementioned issues. An analysis of variance (ANOVA) with Bonferroni post-hoc adjustment was conducted to assess significant differences (p<0.05) in the study variables. RESULTS: Most of the surveyed drivers (99.18%) reported that they always comply with VTI's requirements. The main reasons to comply were related to compliance with traffic regulation and fear of penalties, while the reasons attributed to its incompliance are, instead, stated as involuntary. CONCLUSION: The findings of this study support the idea that more actions are needed to increase drivers' awareness of the relevance of VTIs for road safety, as well as warning them about the dangers of neglecting vehicle checking beyond merely punishing measures. For this reason and given the greater prevalence of the issue among younger segments of the driving population, it is suggested that more emphasis on the matter could be made during novice driver's training.

Could Road Safety Education (RSE) Help Parents Protect Children? Examining Their Driving Crashes with Children on Board.

Recent evidence suggests that driving behavior and traffic safety outcomes of parents may be influenced by the extent to which they receive information and education on road safety, as well as the fact of driving with their children on board, which may increase their risk perception. However, there are no studies specifically addressing the case of crashes suffered while driving with children. Hence, this study aimed to describe the relationship between road safety education-related variables and parents' traffic safety outcomes while driving with children on board. For this cross-sectional study, data was retrieved from a sample composed of 165 Spanish parents-all of them licensed drivers-with a mean age of 45.3 years. Through binary logistic regression (logit) analysis, it was found that factors such as gender, having received road safety education (RSE), and having been sanctioned for the performance of risky driving behavior contribute to modulating the likelihood of suffering crashes while driving with children on board. Gender differences showed a riskier status for male parents. In this study, a set of risk factors explaining the involvement in traffic crashes when driving with children as passengers was identified among parents: gender, traffic sanctions, valuation, and exposure to road safety campaigns. Also, substantial limitations in the self-reported degree of received RSE were found, especially considering that risky driving behavior and traffic crash rates with children on board still have a high prevalence among parents.

Are Latin American cycling commuters "at risk"? A comparative study on cycling patterns, behaviors, and crashes with non-commuter cyclists.

INTRODUCTION: As part of the transformation of urban transportation dynamics, commuter cycling has acquired a high relevance as an alternative mode of transport in different countries, and Latin America seems to be one of the main focus of this worldwide "revolution". However, the high rates of crashes and injuries suffered by commuters have become a relevant issue in the field of road safety, especially in emerging regions with low cycling tradition, where social and infrastructural gaps may endanger the cyclists' safety. OBJECTIVES: This study had two objectives. First, to compare key safe cycling-related variables between cycling commuters and non-commuters; and second, to differentially asses the effect of individual and cycling-related variables on their self-reported crash rates. METHOD: For this cross-sectional research, the data provided by 577 Latin American urban cyclists from three countries (Argentina, Colombia and Mexico) with a mean age of 32.7 years was used. They answered a questionnaire on cycling habits, risk perception, rule knowledge, cycling behaviors and riding crashes. RESULTS: The outcomes of this study showed that, despite having a higher risk perception, cycling commuters perform deliberate risky cycling behaviors (traffic violations) more frequently, and they suffer more crashes; cycling commuters report higher rates of psychological distress, and a lower degree of rule knowledge and protective behaviors than non-commuters. Furthermore, structural similarities and differences in the explanation of cycling crashes were found across commuters and non-commuters. CONCLUSION: The results of this study suggest that non-commuters, whose purposes for cycling are more aimed at leisure and occasional trips, perform less risky behaviors but suffer more cycling distractions, whereas commuters are comparatively more exposed to behavioral-based safety risks, and suffer more frequent crashes. Since recent evidence forecasts that urban cycling will keep growing in Latin American cities, it is necessary to implement policies and educational/training improvements that may enhance the safety and health of cyclists in these countries.

Behavioral Health at School: Do Three Competences in Road Safety Education Impact the Protective Road Behaviors of Spanish Children?

Background: Education in road safety (also known as Road Safety Education-RSE) constitutes, nowadays, an emergent approach for improving present and future road behaviors, aiming at taking action against the current, and concerning, state-of-affairs of traffic crashes, through a behavioral perspective. In the case of children, and despite their overrepresentation in traffic injury figures, RSE-based strategies for behavioral health in transportation remain a "new" approach, whose impact still needs to be empirically tested. Objective: The aim of this study is to assess the impact of three key road safety skills of the Positive Attitudes, Risk perception and Knowledge of norms (PARK) model, addressed in RSE-based interventions, on the safe road behavior of Spanish children. Methods: For this cross-sectional study, a representative sample of 1930 (50.4% males and 49.6% females) Spanish children attending primary school, with a mean age of 10.1 (SD = 1.6) years, was gathered from 70 educational centers across all Spanish regions, through a national study on RSE and road safety. Results: Road safety skills show a positive relationship with children's self-reported safe behaviors on the road. However, the knowledge of traffic norms alone does not predict safe behaviors: it needs to be combined with risk perception and positive attitudes towards road safety. Furthermore, the degree of exposure to previous RSE interventions was shown to have an effect on the score obtained by children in each road safety skill; on the other hand, road misbehaviors observed in parents and peers had a negative impact on them. Conclusion: The outcomes of this study suggest that education in road safety is still a key process for the acquisition of safe habits, patterns and behaviors among young road users.

Job stress and emotional exhaustion at work in Spanish workers: Does unhealthy work affect the decision to drive?

OBJECTIVES: The purpose of this study was to assess the relationships among the following elements: unhealthy work indicators (job stress and emotional exhaustion at work), the decision to drive (or not), and driving crashes suffered by Spanish workers. METHODS: For this cross-sectional study, a full sample of 1,200 Spanish drivers (44% women and 56% men) was used, their mean age being 42.8 years. They answered a questionnaire divided into three sections: demographic and driving-related data; burnout, job stress, and life stress; and self-reported road behaviors and driving safety indicators. RESULTS: Overall, 41.6% of drivers reported emotional exhaustion at work. Furthermore, 80.2% of the participants showing substantial signs of job stress or exhaustion had experienced one or more important stressful life events during the previous year. Job stress was associated with the number of driving crashes suffered along the last 3 years. Also, and especially in situations where drivers admit not feeling well enough to drive, job stress and emotional exhaustion seem to be independent from the decision to drive, and from perceiving these variables as potential impairers of driving performance. CONCLUSIONS: First of all, this study showed a high prevalence of job stress and emotional exhaustion symptoms experienced at work by Spanish workers. Moreover, significant relationships were found among self-rated driving performance, workplace stress and burnout indicators, which suggests that job stress and emotional exhaustion levels may, indeed, impair driving performance, but they do not influence the decision to drive or not. In other words, even when they are significantly affected by job stress or emotional exhaustion at work, most Spanish drivers still drive.

Importance of Social- and Health-Related Problems: Do Spaniards Give Them the Significance They Actually Deserve?

Social and health problems imply an impact on society. The main objective of this study is to provide an overview of how Spanish people perceive cancer, terrorism, cardiovascular diseases, crime, AIDS, drugs, and traffic accidents, finding out whether they assess the importance of these issues in correspondence with their actual severity. The study used a full sample of 1206 Spaniards (51.6% females and 48.4% males) who responded to a computer-assisted telephone interviewing (CATI) survey on the significance of these social and health-related problems, assessed through a zero to ten Likert scale. The perceived severity of the problems was considered taking into account the official data of deaths reported by governmental institutions. For the comparison of mean values, the One-way Analysis of Variance (ANOVA) test was used. Results show high average values for all the problems. The most concerning elements are cancer (M = 9.28 ± 1.24) and terrorism (M = 9.22 ± 1.47). Cardiovascular diseases have the lowest scores (M = 8.29 ± 1.64). There is a good adjustment between real and subjective perception, but some issues are either underestimated or overestimated. Women assessed all of them as more important than men, and people over 65 gave all the issues more value than younger people. It is important that Spaniards understand the objective severity of these issues, thus allowing for more interventions by governments, education, and mass media.

Docencia en grado y posgrado en Medicina de Urgencias y Emergencias en las facultades de medicina españolas / Undergraduate and post-graduate teaching of Emergency Medicine and Emergencies in Spanish medical schools

INTRODUCCIÓN: Analizar la situación actual y las características de la docencia en Medicina de Urgencias y Emergencias (MUE) en el grado y posgrado en las facultades de medicina españolas. MÉTODO: Análisis descriptivo de los planes de estudio de grado y posgrado de las 42 facultades de medicina españolas, identificando en los planes de estudio de sus páginas web las asignaturas con la denominación «Medicina de Urgencias-Emergencias» o «Medicina de Urgencias». RESULTADOS: De las 42 facultades de medicina, 38 (90,4%) presentan en sus planes de estudio asignaturas con denominación MUE. De las 38 facultades, 3 (2,4%) tienen MUE como materia obligatoria única no prácticas, 21 (50%) facultades tienen MUE como materia obligatoria no prácticas compartida con otras materias, 26 (61,9%) facultades tiene MUE como materia obligatoria en el rotario clínico o de práctica clínicas y 13 (31%) facultades tienen MUE como materia optativa. En 11 (26,2%) imparten un título de posgrado como máster o experto relacionado con la MUE. De las 11 facultades, 2 imparten dos o más títulos y las 9 restantes solo uno. Solo en 2 facultades el título del máster es oficial; las 9 restantes ofertan su formación con título propio. CONCLUSIONES: La enseñanza-aprendizaje de la MUE es incluida en los planes de estudio de las facultades de medicina españolas, de carácter obligatorio, optativo o de práctica clínica

INTRODUCTION: To analyse the situation and characteristics of medical education in Emergency Medicine (EM) in undergraduates and post-graduates in Spanish medical schools. METHODS: Data were collected and analysed from 42 Spanish schools of medicine. A search was conducted on each school of medicine's website curricula, identifying subjects under the name "emergency medicine" or "urgent medicine". RESULTS: Of the 42 schools of medicine, 38 (90.4%) present EM in their plans of study subjects. Of these 38 schools, 3 (2.4%) have EM as a single non-practical, compulsory subject, 21 (50%) schools have EM as a non-practical compulsory subject shared with other subjects, 26 (61.9%) schools have EM as a compulsory subject in the clinical practice, and 13 (31%) schools have EM as optional subject. Eleven schools (26.2%) had a postgraduate certificates related to emergency medicine, with two of them having 2 or more certificates, and 9 with only one. Only 2 had official certificates and the others were non-official certificates. CONCLUSIONS: This study clearly shows that teaching in emergency medicine is included in the undergraduate curricula in most Spanish medical schools as mandatory, optional, or in clinical rotation, however in postgraduate education, its implantation is low

The observation period after clinical brain death diagnosis according to ancillary tests: differences between supratentorial and infratentorial brain injury.

OBJECTIVE: To determine the optimal observation period (OBP) in adults with a clinical diagnosis of brain death (BD) using electroencephalography (EEG) or computerized tomography angiography (CTA). METHODS: We conducted a retrospective observational analysis of adult patients with a diagnosis of BD from January 2000 to February 2017. The optimal OBP was defined as the minimum time interval from the first complete clinical neurological examination (CNE) that ensures that neither a second CNE nor any ancillary test (AT) performed after this period would fail to confirm BD. RESULTS: The study sample included 447 patients. In the supratentorial group, the first AT confirmed BD in 389 cases (98%), but in 8 (2%) cases the complementary test was incongruent. In this group, 8 of 245 patients in whom the first AT was carried out within the first 2 h after a complete CNE had a non-confirmatory test of BD versus none of 152 in whom the first AT was delayed more than 2 h (3.0% vs 0.0%; p = 0.026). In the infratentorial group, we found a higher probability of obtaining a first non-confirmatory AT of BD (34% vs 2%; p = 0.0001) and an OBP greater than 32.5 h was necessary to confirm a BD diagnosis. CONCLUSIONS: We found important differences in the confirmation of BD diagnosis between primary supratentorial and infratentorial lesion, and identified an optimal OBP of 2 h in patients with supratentorial lesions. By contrast, in primary posterior fossa/infratentorial lesions, the determination of an optimal OPB remains less accurate and hence more challenging.

Effect of Road Safety Education on Road Risky Behaviors of Spanish Children and Adolescents: Findings from a National Study.

BACKGROUND: Road Safety Education (RSE) is widely known as a reliable determinant of the future results for what concerns health and welfare and as an undisputable factor which contributes to the social behavior of individuals and to their mid- and long-term road safety outcomes. However, its development has been relatively scarce in most countries, a fact which has contributed to letting matters as delicate as traffic crashes, largely explained by road misbehaviors, continue to be a prevalent problem, thus affecting the health of the community. OBJECTIVE: The aim of this study was to describe the relationship between demographic and RSE-related variables and the self-reported road risky behavior of Spanish students. METHODS: For this cross-sectional study, a representative sample of 4062 (51.5% males and 48.5% females) participants attending primary (47.5%), secondary (40.7%), and high school (11.7%) was gathered through a national survey on RSE and road behaviors. RESULTS: A set of significant associations between demographic factors, RSE variables, and self-reported road behaviors was found. Furthermore, Structural Equation Modelling (SEM) allowed us to establish that age and observed misbehaviors (positively), and attitudes towards road safety and risk perception (negatively), have a direct link with the road risky behavior of children and young people. The knowledge of traffic rules was not a significant predictor of road behavior. CONCLUSIONS: The results of this study show that, together with demographic factors such as age, RSE-related variables have an effect on the road behavior of children and young people. They also suggest the need for strengthening actions to be implemented in road safety (Road Safety Education) at scholar and community levels.

Distraction of cyclists: how does it influence their risky behaviors and traffic crashes?

BACKGROUND: Undisputedly, traffic crashes constitute a public health concern whose impact and importance have been increasing during the past few decades. Specifically, road safety data have systematically shown how cyclists are highly vulnerable to suffering traffic crashes and severe injuries derived from them. Furthermore, although the empirical evidence is still very limited in this regard, in addition to other human factors involved in cycling crashes, distractions while cycling appear to be a major contributor to the road risk of cyclists. OBJECTIVES: The main objectives of this study were, first, to explore the prevalence and trends of cycling distractions within an international sample of bike users, and second, to determine the influence of such distractions on road crashes suffered by cyclists, simultaneously considering the explanatory role of risky behaviors (errors and traffic violations) as potentially mediating variables between cycling distractions and traffic crashes. METHODS: For this cross-sectional study, we analyzed the data obtained from 1,064 cyclists-61.2% male and 38.8% female-from 20 different countries, who answered an on-line questionnaire on cycling-related features, habits, behaviors and accidents. RESULTS: The prevalence of different cycling distractions oscillated between 34.7% and 83.6%. The most common distractions were those related to the behavior of other users, physical elements of the road, weather conditions and phone calls. Age trends and differences were also found, thus establishing a positive association between age and distractibility during cycling. Furthermore, the effect of distractions on traffic crashes of cyclists was significant when tested together with age, risk perception and risky behaviors on the road. CONCLUSION: The results of this study support the hypotheses that distractions have a major prevalence among bike users, and that they play a significant role in the prediction of the traffic crash rates of cyclists, through the mediation of risky behaviors.

Work stress and health problems of professional drivers: a hazardous formula for their safety outcomes.

BACKGROUND: Several empirical studies have shown that professional drivers are a vulnerable occupational group, usually exposed to environmental stressors and adverse work conditions. Furthermore, recent studies have associated work-related stress with negative job performances and adverse health outcomes within this occupational group, including cardiovascular diseases and unsafe vehicle operation. OBJECTIVE: The aim of this study was to describe the working conditions and the health status of this occupational group, and to evaluate the association between the Demand-Control model of job stress and their self-reported health and safety outcomes. METHODS: A pooled sample of 3,665 Colombian professional drivers was drawn from five different studies. The Job Content Questionnaire and the General Health Questionnaire were used to measure work stress and self-reported mental health, respectively. Additionally, professional drivers self-reported health problems (hypertension, dyslipidemia, diabetes and overweight) and health-related risky behaviors (smoking and sedentary behavior). RESULTS: Regarding the Job Demands-Control (JDC) model, it was found that approximately a third part of Colombian professional drivers suffer from high job strain (29.1%). Correlational and multivariate analyses suggest that de JDC model of stress is associated with the professional drivers' mental health, traffic accidents and fines, but not with other physical and behavioral health-related outcomes, which are highly prevalent among this occupational group, such as hypertension, dyslipidemia, diabetes, overweight, smoking and sedentary behavior. CONCLUSION: The results of this study suggest that (a) stressful working conditions are associated with health and lifestyle-related outcomes among professional drivers, and (b) that evidence-based interventions are needed in order to reduce hazardous working conditions, job stress rates and their negative impact on the health of this occupational group.

Driving under the influence of alcohol: frequency, reasons, perceived risk and punishment.

BACKGROUND: The aim of this study was to gain information useful to improve traffic safety, concerning the following aspects for DUI (Driving Under the Influence): frequency, reasons, perceived risk, drivers' knowledge of the related penalties, perceived likelihood of being punished, drivers' perception of the harshness of punitive measures and drivers' perception of the probability of behavioral change after punishment for DUI. METHODS: A sample of 1100 Spanish drivers, 678 men and 422 women aged from 14 to 65 years old, took part in a telephone survey using a questionnaire to gather sociodemographic and psychosocial information about drivers, as well as information on enforcement, clustered in five related categories: "Knowledge and perception of traffic norms"; "Opinions on sanctions"; "Opinions on policing"; "Opinions on laws" (in general and on traffic); and "Assessment of the effectiveness of various punitive measures". RESULTS: Results showed around 60% of respondents believe that driving under the influence of alcohol is maximum risk behavior. Nevertheless, 90.2% of the sample said they never or almost never drove under the influence of alcohol. In this case, the main reasons were to avoid accidents (28.3%) as opposed to avoiding sanctions (10.4%). On the contrary, the remaining 9.7% acknowledged they had driven after consuming alcohol. It is noted that the main reasons for doing so were "not having another way to return home" (24.5%) and alcohol consumption being associated with meals (17.3%). Another important finding is that the risk perception of traffic accident as a result of DUI is influenced by variables such as sex and age. With regard to the type of sanctions, 90% think that DUI is punishable by a fine, 96.4% that it may result in temporary or permanent suspension of driving license, and 70% that it can be punished with imprisonment. CONCLUSIONS: Knowing how alcohol consumption impairs safe driving and skills, being aware of the associated risks, knowing the traffic regulations concerning DUI, and penalizing it strongly are not enough. Additional efforts are needed to better manage a problem with such important social and practical consequences.

Psychotropic drugs and driving: prevalence and types.

BACKGROUND: Some psychotropic medications (e.g., benzodiazepines, sedative antidepressants, etc.) may impair cognitive and psychomotor functions and, therefore, endanger traffic safety (Ravera, Br J Clin Pharmacol, 72(3):505-513, 2011). They affect detection, registration, and information processing, problem solving, and decision-making processes, and they also affect emotional and social aspects. The objective of this research was to clarify three closely related issues that are significant for traffic safety: the prevalence of psychotropic drugs on driving, the most frequently used psychotropic drugs to treat depression, anxiety, insomnia, or any tranquilizers (whether it is a medical prescription or self-medication), and finally, provide a further understanding of the socio-demographic and psycho-social characteristics of drivers related to the psychotropic drugs consumption in Spain. METHODS: A sample of 1,200 Spanish drivers ranging from 18 to 64 years was used, 666 men and 534 women were asked to answer a questionnaire composed by a set of questions structured in different sections. The only selection criteria were to be in possession of any type of driving license for vehicles other than motorcycles and drive frequently. RESULTS: The results showed that 15% of the participants were consuming psychotropic drugs to treat depressive disorders, anxiety disorders, insomnia, or tranquilizers; 13.5% were using drugs to treat one of these disorders; while 1.5% used them for several of these disorders. A 2.5% of drivers were using medicines to treat depression, 2.6% to treat anxiety, and 3.7% to treat insomnia. The 8.3% of those drivers who were not using any drugs to treat these three disorders were occasionally using some type of tranquilizers. Benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) were the most used type of medicines among drivers. Benzodiazepines were the most used medicines to treat anxiety, while SSRIs were the most used to treat depression, 56.5% and 43.5%, respectively. CONCLUSIONS: Measures can be developed to reduce traffic accidents caused by the effects of these drugs; however, this will only be possible once the drivers and the use of these drugs are understood. Health care professionals and patients should be properly informed about the potential effects of some psychotropic medications on driving abilities considering individual and group differences.

A multiplex real-time PCR assay for identification of Pneumocystis jirovecii, Histoplasma capsulatum, and Cryptococcus neoformans/Cryptococcus gattii in samples from AIDS patients with opportunistic pneumonia.

A molecular diagnostic technique based on real-time PCR was developed for the simultaneous detection of three of the most frequent causative agents of fungal opportunistic pneumonia in AIDS patients: Pneumocystis jirovecii, Histoplasma capsulatum, and Cryptococcus neoformans/Cryptococcus gattii. This technique was tested in cultured strains and in clinical samples from HIV-positive patients. The methodology used involved species-specific molecular beacon probes targeted to the internal transcribed spacer regions of the rDNA. An internal control was also included in each assay. The multiplex real-time PCR assay was tested in 24 clinical strains and 43 clinical samples from AIDS patients with proven fungal infection. The technique developed showed high reproducibility (r(2) of >0.98) and specificity (100%). For H. capsulatum and Cryptococcus spp., the detection limits of the method were 20 and 2 fg of genomic DNA/20 µl reaction mixture, respectively, while for P. jirovecii the detection limit was 2.92 log10 copies/20 µl reaction mixture. The sensitivity in vitro was 100% for clinical strains and 90.7% for clinical samples. The assay was positive for 92.5% of the patients. For one of the patients with proven histoplasmosis, P. jirovecii was also detected in a bronchoalveolar lavage sample. No PCR inhibition was detected. This multiplex real-time PCR technique is fast, sensitive, and specific and may have clinical applications.

Non confirmatory electroencephalography in patients meeting clinical criteria for brain death: scenario and impact on organ donation.

OBJECTIVE: To describe the causes and outcome of adult patients with preserved electroencephalographic activity despite clinical findings suggesting brain death (BD), and its impact on organ donation. METHODS: Retrospective study of the clinical and electroencephalography (EEG) data of all adult patients admitted to our hospital between January 2001 and December 2011 in whom a comprehensive clinical diagnosis of BD was reached following absence of brainstem reflexes and confirmatory apnea tests, were obtained. All patients with clinical findings suggesting BD and an EEG showing brain activity were selected for the analysis. We calculated the brain death interval (BDI) as the time between the first complete clinical examination and confirmatory ancillary test, or the time between the first and second complete clinical examination for BD, in order to analyze the impact on family consent for organ donation. RESULTS: A complete clinical examination and EEG were diagnostic in 289 patients. In 279 (96.5%), the first EEG showed electrocerebral inactivity corroborating the clinical findings of BD. The mean BDI in this group was 4.2 ± 5.8h (median; 1.8[1.0-3.5]). This value was significantly lower than in the group in which only two full clinical evaluations were performed (p<0.0001). In 10 out 289 (3.5%), the first EEG showed at least some brain activity. The mean BDI in this group was 27.2 ± 13.8h (median; 22.9 [19.1-31.2]). In two cases, a third EEG was necessary before obtaining electrocerebral inactivity. A BDI>6h, was positively associated with a family refusal for organ donation (p=0.02). CONCLUSIONS: The rate of EEGs with electrocerebral activity despite clinical findings suggesting BD was only 3.5%. It occurred most frequently with severe brainstem damage. Although in this small percentage of patients, BD diagnosis was notably delayed, in the great majority of cases the use of EEG shortened the BDI. In our series, a BD diagnosis delay >6h negatively affected consent for organ donation. SIGNIFICANCE: The use of EEG can decrease the time interval for brain death diagnosis.