Environmental health knowledge and competences in Basque health workers. A comparison of different professional profiles.

Environmental exposures are responsible for a quarter of morbidity and mortality rates globally. Primary care professionals work in a privileged position to detect and intervene on environmental health matters. Nevertheless, due to lack of specific training, international literature shows that primary care health professionals have limited skills to deal with those. The objectives of this study were to assess the levels of environmental health (EH) knowledge and competence of a sample of 446 health professionals and students in the Basque Country and explore the presence that EH has on their daily practice. Only a very small proportion of participants had received training and took environmental clinical history regularly. Participants were confident to deal, and actually dealt, with tobacco, pollen and sun exposures but less able to address topics like biomarkers, pesticides and endocrine disruptors. Finally, and in accordance to previous works, we found moderate levels of EH knowledge and skills in our sample, and observed that nurses and nursing students reported higher EH skills than other professional profiles but scored lower in knowledge. Despite the manifold impacts of environmental exposures on health, interventions to strengthen health professionals' EH competence are required.

Redox Status in Retinitis Pigmentosa.

Retinitis pigmentosa (RP) is the most common form of inherited retinal dystrophy characterized by the progressive loss of vision. It is a rare disease. Despite being a genetic disease, its progression is influenced by oxidative damage and chemokines and cytokines released by the activated immune cells (e.g., macrophages or microglia). The role of oxidative stress is very important in the retina. Rods are the main consumers of oxygen (O2), so they are constantly exposed to oxidative stress and lipid peroxidation. According to the oxidative hypothesis, after rod death in the early stages of the disease, O2 would accumulate in large quantities in the retina, producing hyperoxia and favoring the accumulation of reactive oxygen species and reactive nitrogen species that would cause oxidative damage to lipids, proteins, and DNA, exacerbating the process of retinal degeneration. Evidence shows alterations in the antioxidant-oxidant state in patients and in animal models of RP. In recent years, therapeutic approaches aimed at reducing oxidative stress have emerged as useful therapies to slow down the progression of RP. We focus this review on oxidative stress and its relationship with the progression of RP.

Revisión de los cuestionarios utilizados para la detección del consumo de alcohol durante el embarazo y la Hoja Verde / Review of the questionnaires used to detect alcohol consumption during pregnancy and the Green Page

El consumo de alcohol en el embarazo es la causa del trastorno del espectro alcohólico fetal (TEAF). La información aportada por las mujeres en edad fértil o embarazadas es el estándar para la detección temprana del consumo de alcohol. La Hoja Verde (HV) es una herramienta de cribado de salud medioambiental que incluye el registro de la ingesta de alcohol durante el embarazo y/o lactancia. El objetivo del presente trabajo es revisar las características de los distintos cuestionarios de detección del consumo de alcohol durante la gestación y de la HV, así como hacer una comparación entre ellos. Revisión de la literatura científica publicada en los últimos 10 años de los artículos indexados en Medline. Estrategia de búsqueda combinada con los descriptores MeSH: ‘pregnancy, alcohol drinking, surveys and/or questionnaires’. AUDIT, AUDIT-C y SUPR-P se realizan mayoritariamente autoadministrados y no requieren entrenamiento. SUPR-P y 4P´s Plus están validados en embarazadas. Otros detectan cantidad y frecuencia, requieren entrenamiento previo y se realizan cara a cara: TLFB, RD, ACOG antepartum record y la HV. ACOG antepartum record y la HV son específicos para embarazadas. La HV detecta el consumo de alcohol al inicio del embarazo tanto en la gestante como en su pareja con un enfoque holístico y global de la salud medioambiental. Un cuidadoso registro de la ingesta de alcohol de forma presencial, con profesionales entrenados y con un enfoque holístico y global de la salud medioambiental durante el embarazo ayudaría a mejorar la prevención y cribado de embarazos en riesgo de TEAF. (AU)

Alcohol consumption during pregnancy is a leading cause of fetal alcohol spectrum disorder (FASD). Maternal reporting in childbearing women or pregnant women is the standard for the early detection of alcohol consumption. The Green Page (GP) is a screening questionnaire of environmental health which includes the alcohol intake record during pregnancy and/or lactation period. The aim of this paper is to review the features of the different questionnaires for the detection of alcohol consumption during the gestation period and the GP, as well as to make a comparison between them. Review of the scientific literature published over the last 10 years of indexed articles in Medline. Combined searching strategy with MeSH descriptors: ‘pregnancy, alcohol drinking, surveys and/or questionnaires. AUDIT, AUDIT-C and SURP-P are mainly self-administered and do not require training. SURP-P and 4P´s are validated in pregnant women. Others detect quantity and frequency of exposure, need specific training and are administered face to face: TLFB, RD, ACOG antepartum record and the GP. ACOG antepartum record and GP are specific for pregnant population. GP detects alcohol consumption at the beginning of pregnancy in both women and their partner on a holistic and global environmental health approach. A careful face-to-face recording of alcohol exposure with trained staff, with an integrative and global environmental health focus throughout pregnancy, may help improve prevention and screening of pregnancy at risk for FASD. (AU)

Reproductive outcomes following recurrent first-trimester miscarriage: a retrospective cohort study.

STUDY QUESTION: What are the subsequent reproductive outcomes (livebirths, miscarriages or other adverse pregnancy outcomes or no further pregnancy) of women with recurrent miscarriage (RM) attending a dedicated clinic? SUMMARY ANSWER: Of women with RM, 77% had a subsequent pregnancy, and among these pregnancies, the livebirth rate was 63%. WHAT IS KNOWN ALREADY: RM affects ∼1-3% of women of reproductive age. RM has known associations with advanced maternal age, obesity, diabetes, inherited thrombophilias, thyroid dysfunction, endometriosis and parental balanced translocations. However, ∼ 50% of women or couples will be left without an explanation for their pregnancy loss, even after completing investigations. RM is also associated with secondary infertility and adverse pregnancy outcomes including preterm birth and perinatal death. STUDY DESIGN SIZE DURATION: We undertook a retrospective cohort study to identify subsequent pregnancy outcomes in women with RM, defined as three consecutive first-trimester miscarriages. Women attending the RM clinic at a tertiary university hospital in the Republic of Ireland over 12 years (2008-2020) with a confirmed diagnosis of primary or secondary first-trimester RM were eligible for inclusion. In total, 923 charts were identified for review against the eligibility criteria. PARTICIPANTS/MATERIALS SETTING METHODS: Women with non-consecutive first-trimester miscarriages or ectopic pregnancy were excluded. Epidemiological and clinical information regarding medical history, investigation and management was gathered from paper and electronic medical records. Data were analysed using SPSS (Version 27). Associations between maternal characteristics and outcomes were explored using the χ2 test, with significance set at P < 0.05. Multinomial regression analysis was performed using a stepwise approach. MAIN RESULTS AND THE ROLE OF CHANCE: There were 748 women who were included; 332 (44%) had primary RM and 416 (56%) had secondary RM. The median age was 36 years (range 19-47). Foetal aneuploidy was the most common investigative finding (15%; n = 111/748); 60% had unexplained RM. In addition to supportive care, most women were prescribed aspirin (96%) and folic acid (75%). Of the 748 women, 573 had a subsequent pregnancy (77%) and 359 (48% of all women; 63% of pregnancies) had a livebirth, while 208 had a further pregnancy loss (28% of all women; 36% of pregnancies) and 6 were still pregnant at the end of the study. Women aged 35-39 years were more likely to have a livebirth than no further pregnancy (relative risk ratio (RRR): 2.29 (95% CI: 1.51-5.30)). Women aged 30-34 years were more likely to have a livebirth (RRR: 3.74 (95% CI: 1.80-7.79)) or a miscarriage (RRR: 2.32 (95% CI: 1.07-4.96)) than no further pregnancy. Smokers were less likely to have a livebirth (RRR: 0.37 (95% CI: 0.20-0.69)) or a miscarriage (RRR: 0.45 (95% CI: 0.22-0.90)) than no further pregnancy. Couples with an abnormal parental karyotype were less likely to have a miscarriage than no further pregnancy (RRR: 0.09 (95% CI: 0.01-0.79)). Including successive pregnancies conceived over the study period, the overall livebirth rate was 63% (n = 466/742), but this was reduced to 44% in women aged ≥40 years and 54% in women with infertility. LIMITATIONS REASONS FOR CAUTION: This work covers 13 years; however, those included in the later years have a shorter follow-up time. Although electronic health records have improved data availability, data collection in this cohort remains hampered by the absence of a formal booking visit for women presenting with miscarriage and a national miscarriage database or register. WIDER IMPLICATIONS OF THE FINDINGS: Our findings are largely reassuring as most women with RM and hoping to conceive achieved a livebirth. In addition to older age, smoking and parental balanced translocations were associated with a reduced likelihood of further pregnancy. No investigation or treatment was associated with pregnancy outcome, reiterating the importance of the supportive aspects of care for women and their partners after RM and counselling regarding individual risk factors. This contributes to the limited international data on the investigative findings and treatment of women with RM. The high rate of prescribed medications merits greater scrutiny, in conjunction with other pregnancy outcomes, and reiterates the need for a national guideline on RM. STUDY FUNDING/COMPETING INTERESTS: L.A.L. is a PhD scholar funded through the Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork. M.H. and C.F. are Postdoctoral Researchers on a project funded by the Health Research Board Ireland [ILP-HSR-2019-011] and led by K.O.D., titled: 'Study of the impact of dedicated recurrent miscarriage clinics in the Republic of Ireland'. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The authors have no conflicts of interests to declare. TRIAL REGISTRATION NUMBER: N/A.

Healthcare professionals and students' knowledge on termination of pregnancy legislation and clinical practice: A systematic review.

BACKGROUND: Legal and safe termination of pregnancy (TOP) has long been recognised as an important public health issue internationally. Healthcare professionals (HCPs) and students have a key role within TOP services, and it is crucial that they have sufficient understanding of laws, guidelines and clinical practice to facilitate safe and effective care. The current systematic review aims to study the level of knowledge of both HCPs and students on TOP legislation, methods and procedures and potential associated complications. METHODS: PubMed, Embase, Scopus and EBSCOhost were searched for peer-reviewed studies published until July 2020. After initial selection, 239 articles were screened in full and 31 studies (qualitative and quantitative) were included. A narrative review and synthesis of the findings was completed. MAIN FINDINGS: Poor knowledge on TOP legislation and clinical practice was reported for HCPs and students. The main issues identified included limited awareness of specific circumstances for legal TOP and poor understanding of methods and medical regimens recommended. Overall, education/training, experience in provision of TOP and receiving reminders of legislation were the main factors associated with increased levels of knowledge. CONCLUSION: HCPs must be fully aware of the clinical practice and circumstances in which TOP is legal in their country/region so adequate provision of this service is ensured. This study highlighted the importance of involving and promoting participation of HCPs and students in the provision of TOP services. A clear need and desire for staff education and training on TOP was shown. Adequate training allows preparation of current and future HCPs to provide respectful and compassionate care.

Review of the questionnaries used to detect alcohol consumption during pregnancy and the Green Page. / Revisión de los cuestionarios utilizados para la detección del consumo de alcohol durante el embarazo y la Hoja Verde.

Alcohol consumption during pregnancy is a leading cause of fetal alcohol spectrum disorder (FASD). Maternal reporting in childbearing women or pregnant women is the standard for the early detection of alcohol consumption. The Green Page (GP) is a screening questionnaire of environmental health which includes the alcohol intake record during pregnancy and/or lactation period. The aim of this paper is to review the features of the different questionnaires for the detection of alcohol consumption during the gestation period and the GP, as well as to make a comparison between them. Review of the scientific literature published over the last 10 years of indexed articles in Medline. Combined searching strategy with MeSH descriptors: 'pregnancy, alcohol drinking, surveys and/or questionnaires. AUDIT, AUDIT-C and SURP-P are mainly self-administered and do not require training. SURP-P and 4P´s are validated in pregnant women. Others detect quantity and frequency of exposure, need specific training and are administered face to face: TLFB, RD, ACOG antepartum record and the GP. ACOG antepartum record and GP are specific for pregnant population. GP detects alcohol consumption at the beginning of pregnancy in both women and their partner on a holistic and global environmental health approach. A careful face-to-face recording of alcohol exposure with trained staff, with an integrative and global environmental health focus throughout pregnancy, may help improve prevention and screening of pregnancy at risk for FASD.

El consumo de alcohol en el embarazo es la causa del trastorno del espectro alcohólico fetal (TEAF). La información aportada por las mujeres en edad fértil o embarazadas es el estándar para la detección temprana del consumo de alcohol. La Hoja Verde (HV) es una herramienta de cribado de salud medioambiental que incluye el registro de la ingesta de alcohol durante el embarazo y/o lactancia. El objetivo del presente trabajo es revisar las características de los distintos cuestionarios de detección del consumo de alcohol durante la gestación y de la HV, así como hacer una comparación entre ellos. Revisión de la literatura científica publicada en los últimos 10 años de los artículos indexados en Medline. Estrategia de búsqueda combinada con los descriptores MeSH: 'pregnancy, alcohol drinking, surveys and/or questionnaires'. AUDIT, AUDIT-C y SUPR-P se realizan mayoritariamente autoadministrados y no requieren entrenamiento. SUPR-P y 4P´s Plus están validados en embarazadas. Otros detectan cantidad y frecuencia, requieren entrenamiento previo y se realizan cara a cara: TLFB, RD, ACOG antepartum record y la HV. ACOG antepartum record y la HV son específicos para embarazadas. La HV detecta el consumo de alcohol al inicio del embarazo tanto en la gestante como en su pareja con un enfoque holístico y global de la salud medioambiental. Un cuidadoso registro de la ingesta de alcohol de forma presencial, con profesionales entrenados y con un enfoque holístico y global de la salud medioambiental durante el embarazo ayudaría a mejorar la prevención y cribado de embarazos en riesgo de TEAF.

Es la hora de la pediatría planetaria / It is time for planetary pediatrics

No disponible

Community Risk Factors in the COVID-19 Incidence and Mortality in Catalonia (Spain). A Population-Based Study.

The heterogenous distribution of both COVID-19 incidence and mortality in Catalonia (Spain) during the firsts moths of the pandemic suggests that differences in baseline risk factors across regions might play a relevant role in modulating the outcome of the pandemic. This paper investigates the associations between both COVID-19 incidence and mortality and air pollutant concentration levels, and screens the potential effect of the type of agri-food industry and the overall land use and cover (LULC) at area level. We used a main model with demographic, socioeconomic and comorbidity covariates highlighted in previous research as important predictors. This allowed us to take a glimpse of the independent effect of the explanatory variables when controlled for the main model covariates. Our findings are aligned with previous research showing that the baseline features of the regions in terms of general health status, pollutant concentration levels (here NO2 and PM10), type of agri-food industry, and type of land use and land cover have modulated the impact of COVID-19 at a regional scale. This study is among the first to explore the associations between COVID-19 and the type of agri-food industry and LULC data using a population-based approach. The results of this paper might serve as the basis to develop new research hypotheses using a more comprehensive approach, highlighting the inequalities of regions in terms of risk factors and their response to COVID-19, as well as fostering public policies towards more resilient and safer environments.

[Occupational exposures, diet and storing: Recommendations to reduce environmental pollutants in breastfeeding]. / Exposiciones laborales, dieta y envasado: recomendaciones para reducir los contaminantes medioambientales en la lactancia materna.

The pollution of the planet also reaches the breastfeeding ecosystem, one of the most intimate and inviolable that links us as an animal species to the rest of mammals. Nursing mothers may be concerned about whether the quality of their milk will be adequate for their baby and whether environmental pollutants through work, diet, and storing may adversely affect their child. Breast milk is a source of exposure to environmental pollutants, and at the same time it counteracts much of the effects of these exposures. An approach based on the principles of reality and precaution of environmental health to avoid, reduce or eliminate the production and use of harmful chemicals during pregnancy and lactation would improve the human and planetary health for the offspring.

Nen de 2 anys amb febre exantemàtica després d'un viatge / No disponible

No disponible

Social distancing at health care centers early in the pandemic helps to protect population from COVID-19.

The impact of COVID-19 outbreak has been unequal across Spanish regions. The epidemic wave has been smoother in the Region of Murcia (RM) (6 deaths/100,000 residents). Physical distance from health centers from day 0 is an additional social distancing measure that confers an advantageous starting position in the fight against COVID-19. Late healthcare distancing measures are not as powerful as the early ones.

How Should Forests Be Characterized in Regard to Human Health? Evidence from Existing Literature.

The potential of forests as a source of health has been addressed by the scientific community and is now being considered in national forest strategies, management plans and policies. Studies identifying the mechanisms by which forest characteristics may induce these effects on human health are nevertheless scarce. This systematic review of literature on forests and human health with real-life human exposure was conducted to assess the extent to which forests have been studied and described in detail and the extent to which relationships between forest variables and health effects have been reported. The analysis underlines the lack of forest descriptions in 19.35% of the 62 studies selected for review as well as the high heterogeneity of forest variables' description. Patterns among the articles could not be identified correlating the broader forest variable (forest type) and the most studied health variables identified (blood pressure, pulse rate or/and cortisol levels). These findings, together with previous ex situ researches, suggest the need to ameliorate and incorporate more accurate descriptions of forest variables within human health studies to provide data for forest management and the potential use of these habitats for preventive medicine and clinical practice guidelines.

Salut mediambiental pediàtrica a Catalunya: un camí d'oportunitats / No disponible

No disponible

Derivaciones para la realización de ecografías en pediatría de atención primaria: utilidad de una guía de indicaciones clínicas / Referral for ultrasound imaging in primary care pediatrics: Usefulness of a guideline for clinical indications

Introducción: La ecografía es una prueba complementaria que debe realizarse bajo una clara indicación clínica. En caso contrario, supone un aumento de la carga asistencial y puede generar falsas expectativas en los padres de los pacientes pediátricos. En pediatría carecemos de momento de catálogos de indicaciones para la ecografía. Material y métodos: Estudio prospectivo observacional de 3 años de duración, en el que se recogieron de manera sistemática las ecografías y las respectivas hojas de derivación realizadas por un equipo pediátrico de ámbito comarcal durante el primer año. Transcurrido ese tiempo se analizaron las indicaciones y la utilidad de estas pruebas con respecto al planteamiento clínico propuesto. Posteriormente se formó a los pediatras de la zona sobre el uso racional de la ecografía como herramienta diagnóstica, entregando una guía de pruebas indicadas y otras dudosas. Se compararon los 2 años siguientes con el primero en cuanto a la variación en el número relativo de indicaciones de bajo valor diagnóstico. Resultados: En los 2 años posteriores a la formación de los pediatras se observó una disminución mantenida y estadísticamente significativa (p <0,01) de las ecografías con bajo valor diagnóstico. En el mismo tiempo se observó un aumento del número total de las ecografías. Conclusiones: La introducción de un catálogo de indicaciones y su difusión mediante la formación de los pediatras solicitantes pueden optimizar el empleo de la ecografía clínica

Introduction: Ultrasound imaging is an examination that must be performed following a clear clinical indication. Otherwise it causes an increase of the work load and can generate false expectations in the parents. In pediatrics, there is a lack of guidelines for ultrasound indications. Materials and methods: Observational prospective study over 3 years. The ultrasounds images and the respective referral documents sent by primary care pediatricians at a county level were systematically collected during the first year. After that period the indications and the usefulness of the ultrasound imaging with respect to the proposed clinical indication were analyzed. Subsequently the pediatricians of the area were trained on the rationale of ultrasound usefulness as a diagnostic tool by means of a guideline of adequate and uncertain indications. The following two years were compared with the first one in terms of variation in the relative number of indications of low diagnostic value. Results: In the two years following the training of the primary care pediatricians, a sustained and statistically significant decrease (p <0.01) in ultrasound referrals with a low diagnostic value was observed. At the same time an increase in the total number of ultrasounds was observed. Conclusions: The introduction of a guideline of indications for ultrasound imaging and their dissemination to and training of the primary care pediatricians can help optimize the use of clinical ultrasound imaging

Bifidobacterium pseudocatenulatum CECT 7765 Ameliorates Neuroendocrine Alterations Associated with an Exaggerated Stress Response and Anhedonia in Obese Mice.

Obesity, besides being a problem of metabolic dysfunction, constitutes a risk factor for psychological disorders. Experimental models of diet-induced obesity have revealed that obese animals are prone to anxious and depressive-like behaviors. The present study aimed to evaluate whether Bifidobacterium pseudocatenulatum CECT 7765 could reverse the neurobehavioral consequences of obesity in a high-fat diet (HFD) fed mouse model via regulation of the gut-brain axis. Adult male wild-type C57BL-6 mice were fed a standard diet or HFD, supplemented with either placebo or the bifidobacterial strain for 13 weeks. Behavioral tests were performed, and immune and neuroendocrine parameters were analyzed including leptin and corticosterone and their receptors, Toll-like receptor 2 (TLR2) and neurotransmitters. We found that obese mice showed anhedonia (p < 0.050) indicative of a depressive-like behavior and an exaggerated hypothalamic-pituitary axis (HPA)-mediated stress response to acute physical (p < 0.001) and social stress (p < 0.050), but these alterations were ameliorated by B. pseudocatenulatum CECT 7765 (p < 0.050). These behavioral effects were parallel to reductions of the obesity-associated hyperleptinemia (p < 0.001) and restoration of leptin signaling (p < 0.050), along with fat mass loss (p < 0.010). B. pseudocatenulatum CECT 7765 administration also led to restoration of the obesity-induced reductions in adrenaline in the hypothalamus (p < 0.010), involved in the hypothalamic control of energy balance. Furthermore, the bifidobacterial strain reduced the obesity-induced upregulation of TLR2 protein or gene expression in the intestine (p < 0.010) and the hippocampus (p < 0.050) and restored the alterations of 5-HT levels in the hippocampus (p < 0.050), which could contribute to attenuating the obesity-associated depressive-like behavior (p < 0.050). In summary, the results indicate that B. pseudocatenulatum CECT 7765 could play a role in depressive behavior comorbid with obesity via regulation of endocrine and immune mediators of the gut-brain axis.

Bifidobacterium CECT 7765 modulates early stress-induced immune, neuroendocrine and behavioral alterations in mice.

Emerging evidence suggests that there is a window of opportunity within the early developmental period, when microbiota-based interventions could play a major role in modulating the gut-brain axis and, thereby, in preventing mood disorders. This study aims at evaluating the effects and mode of action of Bifidobacterium pseudocatenulatum CECT 7765 in a murine model of chronic stress induced by maternal separation (MS). C57Bl/6J male breast-fed pups were divided into four groups, which were subjected or not to MS and supplemented with placebo or B. pseudocatenulatum CECT7765 until postnatal period (P) 21 and followed-up until P41. Behavioral tests were performed and neuroendocrine parameters were analyzed including corticosterone, cytokine/chemokine concentrations and neurotransmitters. Microbiota was also analyzed in stools by 16S rRNA gene sequencing. B. pseudocatenulatum CECT 7765 administration attenuated some aspects of the excessive MS-induced stress response of the hypothalamic-pituitary-adrenal (HPA) axis, particularly corticosterone production at baseline and in response to subsequent acute stress in adulthood. B. pseudocatenulatum CECT 7765 also down-regulated MS-induced intestinal inflammation (reducing interferon gamma [IFN-γ]) and intestinal hypercatecholaminergic activity (reducing dopamine [DA] and adrenaline [A] concentrations) at P21. These effects have a long-term impact on the central nervous system (CNS) of adult mice since MS mice fed B. pseudocatenulatum CECT 7765 showed lower anxiety levels than placebo-fed MS mice, as well as normal neurotransmitter levels in the hypothalamus. The anti-inflammatory effect of B. pseudocatenulatum CECT 7765 seemed to be related to an improvement in glucocorticoid sensitivity in mesenteric lymph node immunocompetent cells at P21. The administration of B. pseudocatenulatum CECT 7765 to MS animals also reversed intestinal dysbiosis affecting the proportions of ten Operational Taxonomic Units (OTUs) at P21, which could partly explain the restoration of immune, neuroendocrine and behavioral alterations caused by stress in early and later life. In summary, we show that B. pseudocatenulatum CECT 7765 is able to beneficially modulate the consequences of chronic stress on the HPA response produced by MS during infancy with long-lasting effects in adulthood, via modulation of the intestinal neurotransmitter and cytokine network with short and long-term consequences in brain biochemistry and behavior.

Síndrome de fatiga crónica en adolescentes / Chronic fatigue syndrome in adolescents

No disponible

Hemangioma hemosiderótico en diana / Targetoid hemosiderotic hemangioma

No disponible