Comparison of sediment bioavailable methods to assess the potential risk of metal(loid)s for river ecosystems.

A heavily impacted river basin (Caudal River, NW Spain) by Hg and Cu mining activities, abandoned decades ago, was used to evaluate the environmental quality of their river sediments. The obtained results compared with reference values established by the US EPA and the Canadian Council of Ministers of the Environment for river sediments, have shown that the main elements of environmental concern are arsenic (As), mercury (Hg) and, to a lesser extent, copper (Cu), which reach concentrations up to 1080, 80 and 54 mg kg-1, respectively. To understand the role that river sediments play in terms of risk to ecosystem health, a comparison has been made between the total content of metal(oid)s in the sediments and the bioavailable contents of the same elements in pore water, passive DGT (Diffusive Gradients in Thin films) samplers and the sediment extractant using acetic acid. A good correlation between the As and Cu contents in the DGTs and the pore water was found, resulting in a transfer from the pore water to the DGT of at least 47 % of the Cu and more than 75 % of the As when the concentrations were low, with a deployment time of 4 days. When As and Cu concentrations were higher, their transfer was not so high (above 23.6 % for As and 19.3 % for Cu). The transfer of Hg from the pore water to the DGT was practically nil and does not seem to depend on the content of this metal. The fraction extracted with acetic acid, conventionally accepted as bioavailable, was clearly lower than that captured by DGTs for As and Cu (≤5 % and ≤8.5 % of the total amount, respectively), while it was similar for Hg (0.2 %).

Results of the implementation of the DP-TRANSFERS project in Catalonia: A translational method to improve diabetes screening and prevention in primary care.

INTRODUCTION: DP-TRANSFERS is a translational lifestyle intervention project, which follows a previous protocol described in the DE-PLAN-CAT study. OBJECTIVE: Analyze the feasibility of reproducing the intensive intervention and estimating the effect of translation in real conditions of clinical practice in primary care. METHODOLOGY: Implementation of the face-to-face group intervention adjusted to 2 years. After screening, the intervention consisted of a basic module and a continuity module. Stratifying by clusters (health centers), a representative sample (centers, professionals and participants) was evaluated (FINDRISC > 11 and/or prediabetes) from 2016 to 2020. The effect of the intervention on the incidence of diabetes was analyzed. RESULTS: The intervention, feasible in 95 of 123 centers, involved 343 of 647 professionals. Of 2381 subjects screened, 1713 participated in the basic module, with 1186 participants completing the first year and 776 completing the second. 121 participants (7.06%) were diagnosed with diabetes: 77 (4.49%) during the first year; 44 (2.57%) during the second. The bivariate analysis showed that those subjects in whom diabetes affected differed in: previous glycemic status, A1c, HDL-cholesterol, FINDRISC score and adherence to the Mediterranean diet, and in the differences between the beginning and end of the study of: body weight, BMI and abdominal circumference. CONCLUSIONS: The intensive intervention substantially reduced (23.6%) the incidence of diabetes compared to that previously estimated in standardized intervention. The following acted as protective factors: a better glycemic status, lower baseline risk, elevated HDL-cholesterol, or achieving a reduction in weight or abdominal circumference during the study.

Delaying progression to type 2 diabetes among high-risk Spanish individuals is feasible in real-life primary healthcare settings using intensive lifestyle intervention.

AIMS/HYPOTHESIS: To assess the feasibility and effectiveness of an active real-life primary care lifestyle intervention in preventing type 2 diabetes within a high-risk Mediterranean population. METHODS: A prospective cohort study was performed in the setting of Spanish primary care. White-European individuals without diabetes aged 45-75 years (n = 2,054) were screened using the Finnish Diabetes Risk Score (FINDRISC) and a subsequent 2 h OGTT. Where feasible, high-risk individuals who were identified were allocated sequentially to standard care, a group-based or an individual level intervention (intensive reinforced DE-PLAN [Diabetes in Europe-Prevention using Lifestyle, Physical Activity and Nutritional] intervention). The primary outcome was the development of diabetes according to WHO criteria. Analyses after 4-year follow-up were performed based on the intention-to-treat principle with comparison of standard care and the combined intervention groups. RESULTS: The standard care (n = 219) and intensive intervention (n = 333) groups were comparable in age (62.0/62.2 years), sex (64.4/68.2% women), BMI (31.3/31.2 kg/m(2)), FINDRISC score (16.2/15.8 points), fasting (5.3/5.2 mmol/l), 2 h plasma glucose (7.1/6.9 mmol/l) and self-reported interest to make lifestyle changes at baseline. Diabetes was diagnosed in 124 individuals: 63 (28.8%) in the standard care group and 61 (18.3%) in the intensive intervention group. During a 4.2-year median follow-up, the incidences of diabetes were 7.2 and 4.6 cases per 100 person-years, respectively (36.5% relative risk reduction, p < 0.005). The number of participants needed to be treated by intensive intervention for 4 years to reduce one case of diabetes was 9.5. CONCLUSIONS/INTERPRETATION: Intensive lifestyle intervention is feasible in a primary care setting and substantially reduces diabetes incidence among high-risk individuals. CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov NCT01519505. FUNDING: Commission of the European Communities, Institute of Health Carlos III, Spanish Ministry of Health and Department of Health, Generalitat de Catalunya.

Shifting from glucose diagnostic criteria to the new HbA(1c) criteria would have a profound impact on prevalence of diabetes among a high-risk Spanish population.

AIM: To investigate changes in the prevalence of diabetes and pre-diabetes by shifting from 2-h plasma glucose and/or fasting plasma glucose diagnostic criteria to the proposed new HbA(1c) -based criteria when applied to a Mediterranean population detected to have a high risk of Type 2 diabetes. METHODS: Individuals without diabetes aged 45-75 years (n = 2287) were screened using the Finnish Diabetes Risk Score questionnaire, a 2-h oral glucose tolerance test plus HbA(1c) test. Prevalence and degree of diagnostic overlap between three sets of criteria (2-h plasma glucose, fasting plasma glucose and HbA(1c) ) and three diagnostic categories (normal, pre-diabetes and diabetes) were calculated. RESULTS: Defining diabetes by a single HbA(1c) measurement resulted in a dramatic decrease in prevalence (1.3%), particularly in comparison with diabetes defined by 2-h plasma glucose (8.6%), but was also significant with regard to fasting plasma glucose (2.8%). A total of 201 screened subjects (8.8%) were classified as having diabetes and 1023 (44.7%) as having pre-diabetes based on at least one of these criteria; among these, the presence of all three criteria simultaneously classified only 21 and 110 individuals respectively, about ten percent of each group. The single overlap index between subjects diagnosed as having diabetes by 2-h plasma glucose/fasting plasma glucose vs. HbA(1c) was 13.9/28%. Similarly, the single overlap index regarding pre-diabetes was 19.2/27.1%. CONCLUSIONS: A shift from the glucose-based diagnosis to the HbA(1c) -based diagnosis for diabetes will reduce diabetes prevalence with a low overall or single degree of overlap between diagnostic categories in this high-risk Spanish population.

Effect of different glycerol treatments on frozen-thawed dog sperm longevity and acrosomal integrity.

Four different concentrations of glycerol in a Tris-fructose-citric acid extender for frozen dog semen and the effects of adding glycerol at 37 degrees C or 4 degrees C to the extender were studied by monitoring the post-thaw sperm longevity and acrosomal integrity during incubation at 39 degrees C. In the first part of this study, ejaculates from 13 dogs were pooled and divided into 4 aliquots, which were centrifuged and the sperm pellets rediluted with a Tris-fructose-citric acid extender containing 2, 4, 6 and 8% (v/v) glycerol, respectively. Progressive motility by subjective estimation, live:dead spermatozoa ratio using eosin-nigrosin staining, and acrosomal integrity using phase contrast microscopy were evaluated before processing and at 0, 0.5, 1, 2 and 4 hours post-thawing incubating the semen samples in the dark at 39 degrees C. The experiment was performed using seven replicates and it was found that sperm motility and acrosomal integrity were superior following the use of 8% glycerol in the extender. In Experiment 2, 13 ejaculates from the same dogs used in the first experiment were pooled and divided into 3 aliquots, and an 8% glycerol diluent was added at 37 degrees C and 4 degrees C after 1 h of cooling or at 4 degrees C after 2 h of cooling, respectively. After freezing and thawing the same parameters as studied in the first experiment were assessed. The experiment was performed in 7 replicates, and no difference was found between treatments.

Lifestyle interventions for diabetes mellitus type 2 prevention.

BACKGROUND AND AIMS: Transferring the results from clinical trials on type 2 diabetes prevention is the objective of the Diabetes in Europe-Prevention using Lifestyle, Physical Activity and Nutritional intervention (DE-PLAN) project in Catalonia, whose cost-effectiveness analysis is now presented. PATIENTS AND METHODS: A prospective cohort study was performed in primary care involving individuals without diagnosed diabetes aged 45-75 years (n=2054) screened using the questionnaire Finnish Diabetes Risk Score (FINDRISC) and a subsequent oral glucose tolerance test. Where feasible, high-risk individuals who were identified (n=552) were allocated sequentially to standard care (n=219), a group-based (n=230) or an individual-level (n=103) intensive (structured programme of six hours using specific teaching techniques) lifestyle intervention (n=333). The primary outcome was the development of diabetes (WHO). We evaluated the cost of resources used with comparison of standard care and the intervention groups in terms of effectiveness and quality of life (15D questionnaire). RESULTS: After 4.2-year median follow-up, the cumulative incidences were 18.3% (14.3-22.9%) in the intensive intervention group and 28.8% (22.9-35.3%) in the standard care group (36.5% relative-risk-reduction). The corresponding 4-year HR was 0.64 (0.47-0.87; P<.004). The incremental cost induced by intensive intervention compared with the standard was 106€ per participant in the individual level and 10€ in the group-based intervention representing 746€ and 108€ per averted case of diabetes, respectively. The estimated incremental cost-utility ratio was 3243€ per quality-adjusted life-years gained. CONCLUSION: The intensive lifestyle intervention delayed the development of diabetes and was efficient in economic analysis.

[Recommendations for the management of influenza in pediatrics (2009-2010).] / Recomendaciones sobre el tratamiento de la gripe en Pediatría (2009-2010).

Specific action plans from various institutions, governments and scientific societies have been identified and implemented to combat the A H1N1 2009 influenza virus pandemic. This document sets out the recommendations of the Spanish Association of Pediatrics for the management of influenza in children for influenza season 2009-2010. The risk factors for influenza A H1N1 2009 in pediatric patients, the clinical course, severity and complications are similar to seasonal influenza. In most cases, the diagnosis of influenza will be based on clinical suspicion, without viral subtype differentiation. In a patient with influenza virus infection, the criteria for referral and hospital admission will be based broadly on the signs of clinical severity or complications, regardless of the causative virus. Children with influenza but with no signs of clinical severity or complications do not require antiviral treatment. Physical measures of hygiene and isolation are essential to reduce the transmissibility of the disease. The influenza vaccines in infancy, for both seasonal influenza and for influenza A H1N1 2009, should be directed primarily at patients with risk factors.

[Renal venous thrombosis treatment in the newborn (author's transl)]. / Tratamiento de la trombosis venosa renal del recién nacido.

Based on the experience of 61 cases, the recommended treatment for R.V.T. in newborns and infants is described. A historical review of its management is made. Therapeutic evolution and exposition of conservative therapy, founded on the following points: Close control of the hydrosaline disorder, early peritoneal dialysis and heparinization is given. Eventually thrombectomy can be advisable when the thrombous invades the inferior vena cava. A decreasing incidence of R.V.T., after a good prophilaxis and an evident improvement of the survival of children with R.V.T. is confirmed.

[Renal venous thrombosis in infants of diabetic mothers (author's transl)]. / Trombósis venosa renal en hijos de madre diabética.

Six cases of renal venous thrombosis in infants of diabetic mothers, out of a series of 61 infants under two months old affected of R.V.T. (9.8%), are reported. The clinical, metabolic and histopathological features of these cases are discussed, as well as the different etiological theories that exist in the literature. An etiopathogenic hypothesis that maintains a similarity with the theory that explains the origin of R.V.T. in classical cases, is suggested. Prophilactic attitudes in order to prevent R.V.T. by a control of diabetes in the pregnant and close control of the newborn in the 10 first days of life, are pointed out.

Coste-efectividad de la intervención sobre el estilo de vida para prevenir la diabetes tipo 2 / Lifestyle interventions for diabetes mellitus type 2 prevention

Antecedentes y objetivos: Trasladar los resultados de los ensayos clínicos sobre prevención de la diabetes mellitus tipo 2 (DM2) es el objetivo del proyecto Diabetes in Europe-Prevention using Lifestyle, Physical Activity and Nutritional intervention (DE-PLAN) en Cataluña. En este trabajo se presenta un análisis de coste-efectividad de varias intervenciones para prevenir la DM2. Pacientes y métodos: Estudio prospectivo de cohortes en el ámbito de la atención primaria. Participaron 2.054 sujetos de 45-75 años sin DM2 diagnosticada (n=2.054), que rellenaron el cuestionario Finnish Diabetes Risk Score (FINDRISC) y una sobrecarga oral con glucosa. Cuando fue factible, los participantes con riesgo de DM2 (n=552) se asignaron consecutivamente a una intervención estandarizada (n=219) o bien a una intervención intensiva (programa estructurado de 6h usando técnicas didácticas específicas) sobre el estilo de vida (n=333): de forma grupal (n=230) o bien individual (n=103). El indicador primario de efectividad fue la incidencia de DM2 (criterios de la OMS), comparando los costes de recursos utilizados en cada grupo según efectividad y calidad de vida (cuestionario 15D). Resultados: Tras 4,2 años de mediana, la incidencia acumulada de DM2 fue del 18,3% (rango: 14,3-22,9%) en intervención intensiva y 28,8% (22,9-35,3%) en estandarizada (36,5% reducción-riesgo-relativo), con un HR=0,64 (0,47-0,87; p<0,004). El incremento del coste generado por la intervención intensiva respecto a la estandarizada fue de 106 Euros por participante en la modalidad individual y 10 Euros en la grupal, representando 746 y 108 Euros por caso evitado de diabetes, respectivamente. La intervención intensiva comportó un sobrecoste de 3.243 Euros por año de vida ganado, ajustado por calidad. Conclusión: La intervención intensiva sobre el estilo de vida demoró el desarrollo de diabetes y fue eficiente en términos económicos (AU)

Background and aims: Transferring the results from clinical trials on type 2 diabetes prevention is the objective of the Diabetes in Europe-Prevention using Lifestyle, Physical Activity and Nutritional intervention (DE-PLAN) project in Catalonia, whose cost-effectiveness analysis is now presented. Patients and methods: A prospective cohort study was performed in primary care involving individuals without diagnosed diabetes aged 45-75 years (n=2054) screened using the questionnaire Finnish Diabetes Risk Score (FINDRISC) and a subsequent oral glucose tolerance test. Where feasible, high-risk individuals who were identified (n=552) were allocated sequentially to standard care (n=219), a group-based (n=230) or an individual-level (n=103) intensive (structured programme of six hours using specific teaching techniques) lifestyle intervention (n=333). The primary outcome was the development of diabetes (WHO). We evaluated the cost of resources used with comparison of standard care and the intervention groups in terms of effectiveness and quality of life (15D questionnaire). Results: After 4.2-year median follow-up, the cumulative incidences were 18.3% (14.3-22.9%) in the intensive intervention group and 28.8% (22.9-35.3%) in the standard care group (36.5% relative-risk-reduction). The corresponding 4-year HR was 0.64 (0.47-0.87; P<.004). The incremental cost induced by intensive intervention compared with the standard was 106 Euros per participant in the individual level and 10 Euros in the group-based intervention representing 746 Euros and 108 Euros per averted case of diabetes, respectively. The estimated incremental cost-utility ratio was 3243Euros per quality-adjusted life-years gained. Conclusion: The intensive lifestyle intervention delayed the development of diabetes and was efficient in economic analysis (AU)

Recomendaciones sobre el tratamiento de la gripe en Pediatría (2009–2010) / Recommendations for the management of influenza in pediatrics (2009–2010)

Ante la actual situación de pandemia de gripe causada por el virus A H1N1 2009, se han definido planes de actuación específicos desde distintas instituciones, administraciones y sociedades científicas. En este documento se definen las recomendaciones de la Asociación Española de Pediatría para el tratamiento de la gripe en la infancia para la estación gripal 2009–2010. Para la gripe A H1N1 2009, los factores de riesgo en edad pediátrica, el curso clínico, la gravedad y las complicaciones son similares a los de la gripe estacional. Además, el diagnóstico de gripe será, en la gran mayoría de los casos, por sospecha clínica sin diferenciación del subtipo viral. Ante un paciente con gripe, los criterios de derivación e ingreso hospitalario se basarán globalmente en la presencia de signos de gravedad clínica o de complicaciones, independientemente del virus causante. Los niños con gripe sin signos de gravedad ni complicaciones no requieren tratamiento con antivirales. Las medidas físicas de higiene y el aislamiento son fundamentales para reducir la transmisibilidad de la enfermedad. La vacunación antigripal en la infancia, tanto para gripe estacional como para gripe A H1N1 2009, debe dirigirse de forma prioritaria a los pacientes con factores de riesgo (AU)

Specific action plans from various institutions, governments and scientific societies have been identified and implemented to combat the A H1N1 2009 influenza virus pandemic. This document sets out the recommendations of the Spanish Association of Pediatrics for the management of influenza in children for influenza season 2009–2010. The risk factors for influenza A H1N1 2009 in pediatric patients, the clinical course, severity and complications are similar to seasonal influenza. In most cases, the diagnosis of influenza will be based on clinical suspicion, without viral subtype differentiation. In a patient with influenza virus infection, the criteria for referral and hospital admission will be based broadly on the signs of clinical severity or complications, regardless of the causative virus. Children with influenza but with no signs of clinical severity or complications do not require antiviral treatment. Physical measures of hygiene and isolation are essential to reduce the transmissibility of the disease. The influenza vaccines in infancy, for both seasonal influenza and for influenza A H1N1 2009, should be directed primarily at patients with risk factors (AU)