The role of parental smoking on adolescent smoking and its social patterning: a cross-sectional survey in six European cities.

Background: Several studies have observed socio-economic (SE) inequalities in smoking among adolescents, but its causes are not fully understood. This study investigates the association between parental and adolescent smoking, and whether this association is socially patterned. Methods: We used data from a survey administered in 2013 to students aged 14-17 years old of six European cities (n = 10 526). Using multilevel mixed-effects logistic regression, we modelled the probability of being a daily smoker as a function of parental smoking and SE status. We tested whether the smoking association differed across social strata. Results: The prevalence of parental smoking was higher in low SE status adolescents. Boys and girls were more likely to smoke if they have a father [boys: adjusted odds ratio (AOR) = 1.90, 95% CI = 1.47-2.46; girls: AOR = 1.42, 95% CI = 1.09-1.86] and mother (boys: AOR = 1.77, 95% CI = 1.35-2.31; girls: AOR = 3.36, 95% CI = 2.56-4.40) who smoked. Among boys, the odds of smoking when having a smoking parent were higher in lower SE classes. However, this was not statistically significant, nor was it observed among girls. Conclusions: Adolescents are more likely to smoke when their father and mother smoke. Although the susceptibility to parental smoking was similar across social classes, SE differences in parental smoking contribute to the transmission of SE inequalities in smoking.

Effectiveness of the pharmacological therapy to prevent post ERCP acute pancreatitis: a network meta-analysis.

OBJECTIVE: To determine the effectiveness of the different pharmacological agents in preventing post-ERCP acute pancreatitis. METHODS: We included clinical trials of pharmacological interventions for prophylaxis of acute post-ERCP pancreatitis. The event evaluated was acute pancreatitis. We conducted a search strategy in MEDLINE (OVID), EMBASE, and Cochrane Central Register of Controlled Trials from inception to nowadays. We reported the information in terms of relative risks (RR) with a 95% confidence interval. We assessed the heterogeneity using the I2 test. RESULTS: We included 84 studies for analysis (30,463 patients). The mean age was 59.3 years (SD ± 7.01). Heterogeneity between studies was low (I2 = 34.4%) with no inconsistencies (p = 0.2567). Post ERCP pancreatitis was less in prophylaxis with NSAIDs (RR 0.65 95% CI [0.52 to 0.80]), aggressive hydration with Lactate Ringer (RR 0.32 95% CI [0.12-0.86]), NSAIDs + isosorbide dinitrate (RR 0.28 95% CI [0.11-0.71]) and somatostatin and analogues (RR 0.54 [0.43 to 0.68]) compared with placebo. CONCLUSIONS: NSAIDs, the Combination of NSAIDs + isosorbide dinitrate, somatostatin and analogues, and aggressive hydration with lactate ringer are pharmacological strategies that can prevent post-ERCP pancreatitis when compared to placebo. More clinical trials are required to determine the effectiveness of these drugs.

Academic performance, emotional intelligence, and academic burnout: A cross-sectional study of a mediational effect in nursing students.

BACKGROUND: Course failure arises as the ultimate result of students' declining academic performance in the face of high course demands. It can eventually lead to dropout and academic dissatisfaction. Emotional intelligence may play an essential role in decreasing the emotional effects of stress, such as academic burnout in nursing students. However, emotional intelligence is conceptualized multidimensionally, and each of its attributes may have a different impact on burnout reduction. OBJECTIVE: To explore the dimensions of emotional intelligence that may mediate the association between academic performance (course failure) and academic burnout in nursing students. DESIGN: The design was cross-sectional, with survey-based data collection. SETTINGS: Educational setting, undergraduate nursing students at a private university in Metropolitan Lima, Peru. PARTICIPANTS: 154 students (77.3 % female) with a mean age of 25.9 years. METHODS: A multiple mediation strategy was used, using the Wong-Law Emotional Intelligence Scale. Four emotional intelligence attributes (self-emotional appraisal, others' emotional appraisal, use of emotion, and regulation of emotion) were evaluated in the relationship of failed courses (dichotomous variable: yes/no) and academic burnout (single item based on physical and emotional exhaustion). The structural equation modeling framework was used. RESULTS: Course failure (academic performance) positively affects academic burnout. Regulation of emotion is the only dimension of emotional intelligence mediating between course failure and academic burnout. The proportion of the mediating effect was 0.315, while the rest was around zero. Statistically significant gender differences were detected concerning burnout, with men scoring moderately higher than women. CONCLUSIONS: The results indicate that the regulation of emotion may have a relevant role in reducing burnout compared to other emotional intelligence attributes. These regulatory skills are important for developing health care and positive patient relationships. Interventions focused on the regulatory characteristics of emotions and distinguishing different attributes of emotional intelligence while exploring its mediating effect should be strengthened. These implications are linked to the growing call to include EI in university education.

Acetazolamide-induced bilateral choroidal effusion following insertion of a phakic implantable collamer lens.

PURPOSE: To present the case of a 28-year-old man with acetazolamide-induced bilateral choroidal effusion after uneventful surgery of the second eye in delayed sequential bilateral insertion of an implantable collamer lens for hyperopia. METHODS: Case report. RESULTS: Surgery of the left eye was uneventful, and the implantable collamer lens was implanted 3 weeks later in the right eye. Twenty-four hours after surgery, the patient presented with bilateral shallow anterior chamber, vault 0, and myopic shift (-8 diopters) in both eyes. B-scan ultrasound showed choroidal thickening in both eyes, which was consistent with choroidal effusion syndrome. A causal relationship was suspected with oral acetazolamide, which had been prescribed after surgery. When the drug was stopped, the condition improved slowly and resolved completely within 5 days. CONCLUSIONS: Choroidal effusion should be included in the differential diagnosis of shallow anterior chamber after implantation of an implantable collamer lens.

Efficient production of a polyhydroxyalkanoate by Azotobacter vinelandii OP using apple residues as promising feedstock.

Fruit residues are attractive substrates for the production of bacterial polyhydroxyalkanoates due to the high contents of fermentable sugars and the fast, simple, and efficient pretreatment methods required. In this study, apple residues, mainly apple peel, were used as the sole carbon source in cultures of the bacterium Azotobacter vinelandii OP to produce poly-3-hydroxybutyrate (P3HB). Conversion from the residue to total sugars was highly effective, achieving conversions of up to 65.4 % w w-1 when using 1 % v v-1 sulfuric acid and 58.3 % w w-1 in the absence of acid (only water). The cultures were evaluated at the shake-flask scale and in 3-L bioreactors using a defined medium under nitrogen starvation conditions. The results showed the production of up to 3.94 g L-1 P3HB in a bioreactor, reaching an accumulation of 67.3 % w w-1 when using apple residues. For the PHB obtained from the cultures with apple residues, a melting point of 179.99 °C and a maximum degradation temperature of 274.64 °C were calculated. A P3HB production strategy is shown using easily hydrolysable fruit residues to achieve production yields comparable to those obtained with pure sugars under similar cultivation conditions.

Amniotic Membrane Transplantation in the Management of Corneal Ulceration Following Infectious Keratitis.

PURPOSE: To report on the outcomes of amniotic membrane transplantation (AMT) for corneal ulceration following infectious keratitis. METHOD: In this retrospective cohort study of 654 patients with culture-proven infectious keratitis from 8 hospitals in Galicia (Spain), a total of 43 eyes of 43 patients (6.6%) underwent AMT for postinfectious corneal ulceration. The indications for AMT were sterile persistent epithelial defects, severe corneal thinning or perforation. RESULTS: AMT was successful in 62.8% of cases, with 37.2% requiring an additional surgery. Median time to healing was 40.0 days (IQR 24.2-101.7 days) and final BCVA was lower than baseline (p = 0.001). Ulcers were large (>3 mm) in 55.8% of cases. Previous herpetic keratitis and topical steroid use were more common in patients who received AMT (p < 0.001). 49 microorganisms (43 bacteria and 6 fungi) were isolated. CONCLUSIONS: AMT is a therapeutic option for complications following infectious keratitis, which present with a sterile persistent epithelial defect, significant corneal thinning or perforation.

Diversity and toxicity of the planktonic diatom genus Pseudo-nitzschia from coastal and offshore waters of the Southeast Pacific, including Pseudo-nitzschia dampieri sp. nov.

To expand knowledge of Pseudo-nitzschia species in the Southeast Pacific, we isolated specimens from coastal waters of central Chile (36°S-30°S), the Gulf of Corcovado, and the oceanic Robinson Crusoe Island (700 km offshore) and grew them into monoclonal strains. A total of 123 Pseudo-nitzschia strains were identified to 11 species based on sequencing of the ITS region of the nuclear rDNA and on ultrastructural and morphometric analyses of the frustule in selected representatives of each clade: P. australis, P. bucculenta, P. cf. chiniana, P. cf. decipiens, P. fraudulenta, P. hasleana, P. multistriata, P. plurisecta, P. cf. sabit, the new species P. dampieri sp. nov., and one undescribed species. Partial 18S and 28S rDNA sequences, including the hypervariable V4 and D1-D3 regions used for barcoding, were gathered from representative strains of each species to facilitate future metabarcoding studies. Results showed different levels of genetic, and at times ultrastructural, diversity among the above-mentioned entities, suggesting morphological variants (P. bucculenta), rapidly radiating complexes with ill-defined species boundaries (P. cf. decipiens and P. cf. sabit), and the presence of new species (P. dampieri sp. nov., Pseudo-nitzschia sp. 1, and probably P. cf. chiniana). Domoic acid (DA) was detected in 18 out of 82 strains tested, including those of P. australis, P. plurisecta, and P. multistriata. Toxicity varied among species mostly corresponding to expectations from previous reports, with the prominent exception of P. fraudulenta; DA was not detected in any of its 10 strains tested. In conclusion, a high diversity of Pseudo-nitzschia exists in Chilean waters, particularly offshore.

Intracameral phenylephrine 1.5% for prophylaxis against intraoperative floppy iris syndrome: prospective, randomized fellow eye study.

PURPOSE: To evaluate the efficacy of intracameral phenylephrine (IPH) administered as prophylaxis against intraoperative floppy iris syndrome (IFIS) and to analyze the ability of IPH to reverse IFIS. DESIGN: Prospective, multicenter, randomized, comparative case series of fellow eyes. PARTICIPANTS: Forty-two patients receiving tamsulosin who underwent cataract surgery between January and April 2011. METHODS: Phacoemulsification was performed by 2 experienced surgeons at 2 surgical sites (Complexo Hospitalario Universitario Orense and Complexo Hospitalario Universitario A Coruña). One eye of each patient was randomized to receive 0.6 ml of nonpreserved bisulfite-free IPH 1.5% (group 1) or balanced saline solution (group 2) at the start of surgery. If significant miosis or iris prolapse occurred, IPH was injected during phacoemulsification in group 2. No changes were performed in the surgeon's standard fluidic parameters or viscoelastic preferences. Routine topical mydriatics were instilled before surgery. Intraoperative iris billowing and prolapse and pupil size were recorded and videotaped. Surgical complications; adverse events; pre- and postoperative pulse rate and blood pressure; and final best-corrected visual acuity (BCVA), intraocular pressure (IOP), and endothelial cell count (ECC) were recorded. MAIN OUTCOME MEASURES: Incidence of IFIS and change in pupil size after IPH administration in those eyes of group 2 requiring IPH because of significant miosis or iris prolapse. RESULTS: Signs of IFIS were observed in 88.09% of eyes in group 2. No signs of IFS were noted in group 1 (P < 0.001). Significant miosis, iris prolapse, or both occurred in 54.76% of eyes in group 2, although the condition was successfully reverted with IPH, with a significant increase in pupil size after IPH administration (from 4.77±0.88 mm to 6.68±0.93 mm; P=0.000). No intraoperative complications occurred. No significant differences in ECC, BCVA, or IOP were detected between IPH-treated and nontreated eyes. Blood pressure/pulse rate did not differ significantly from preoperative values in IPH-treated cases. CONCLUSIONS: Intracameral phenylephrine is a highly efficient measure for prophylaxis against IFIS. Moreover, the drug can reverse IFIS, restoring iris rigidity and causing the pupil to return to its preoperative size.

Decentralization Can Improve Equity, but Can It Be Sustained?

A major theoretical issue about health system reform involving decentralization has been whether it promotes equity of health system funding. An article by the principal author and others in 2003 showed that, under certain conditions and policies, decentralization improved the equity of allocation of financial resources to different income levels of municipalities in Colombia and Chile. Another recurring issue has been whether reforms can be sustained over time. In a follow-up study in 2015, we found that the equity of national allocations was sustained even though the allocation rules for intergovernmental transfers and insurance funding sources had changed, as long as per capita allocation rules were retained. Nevertheless, the wealthier municipalities in Chile were able to increase their own source funding contributing to a larger gap between wealthy and poor municipalities, suggesting that in order to assure continued equity some compensation for these funds be included in intergovernmental transfer rules or that local source funding be restricted by national policy. These reforms may be more likely to be sustained if they become embedded in existing financial systems and if they receive support of status quo constituencies.

Porphyromonas gingivalis-Helicobacter pylori co-incubation enhances Porphyromonas gingivalis virulence and increases migration of infected human oral keratinocytes.

Background: Porphyromonas gingivalis is part of the subgingival biofilm and a keystone species in the development of periodontitis. Interactions between P.gingivalis and other bacteria in biofilms have been shown to affect bacterial virulence. Helicobacter pylori also inhabits the subgingival biofilm, but the consequences of interactions there with P.gingivalis remain unknown. Here, we investigated how the pre-incubation of P.gingivalis with H.pylori affects P.gingivalis virulence. Methods: We assayed P.gingivalis internalization by oral keratinocytes (OKs), hemagglutination and biofilm formation to identify alterations in virulence after pre-incubation with H. pylori. Also, we evaluated viability and migration of OKs infected with P. gingivalis, as well as the role of toll-like receptor 4 (TLR4).   In addition, we quantified the mRNA of genes associated with P.gingivalis virulence. Results: Pre-incubation of P.gingivalis with H.pylori enhanced P.gingivalis biofilm formation, bacterial internalization into OKs and hemagglutination. Infection with pre-incubated P.gingivalis increased OK migration in a manner dependent on the O-antigen and linked to  increased expression of the gingipain RgpB. Also, OK TLR4 participates in these events, because upon TLR4 knock-down, pre-incubated P.gingivalis no longer stimulated OK migration. Discussion: We provide here for the first time insight to the consequences of direct interaction between P.gingivalis and H.pylori. In doing so, we shed light on the mechanism by which H. pylori presence in the oral cavity increases the severity or progression of periodontitis.

Gender differences in the use of coping strategies to reduce food insecurity in Colombia.

This study explores the gender differences in the use of coping strategies to reduce food insecurity in Colombian urban and rural households. Data was collected from the Colombian National Survey of Nutritional Status (ENSIN 2015), and analyzed using ordinal logistic regression models, logistic models, and simultaneous equation models. Results show that rural households have a higher prevalence of food insecurity than their urban counterparts. After adjusting for household characteristics - e.g., head of household schooling level -, urban households were more likely to present severe and moderate food insecurity, whereas rural households were more likely to experience mild food insecurity. This result was explained by self-consumption and certain coping strategies, such as selling seeds from the next harvest or animals, implemented by rural households. Even though female-headed households present on average higher levels of food insecurity than male-headed ones, because they are more likely to use coping strategies, especially in rural areas, they can reduce and even cancel out this gap. Hence, female heads are more successful in mitigating food insecurity.

Optimal Allocation of Chemotherapy Schemes for Metastatic Colon Cancer in Colombia.

OBJECTIVES: This study aims to determine the optimal proportion for different chemotherapy schemes in patients with metastatic colorectal cancer who have undergone surgical resection in Colombia. METHODS: A linear programming model was used to quantify the optimal proportion of the chemotherapy schemes that maximize quality-adjusted life-years (QALYs). The model was evaluated in 6 different scenarios using parametric and dynamic optimization with different budget restriction constraints. The results were compared to the current mixture of schemes used in our country. RESULTS: The results show that 63%, 37%, and 0.8% of the population should receive the FOLFOXIRI scheme (fluorouracil + leucovorin + oxaliplatin + irinotecan), FOLFIRI (irinotecan + leucovorin + fluorouracil), and FOLFIRI plus cetuximab, respectively. With these proportions, 8734 QALYs and universal coverage of the population are obtained. In an optimistic scenario (high QALYs, low costs, and budget of $40 million), the entire population should receive the FOLFIRI scheme. A pessimistic scenario (low QALYs, high costs, and budget of $15 million) would benefit only 46% of the population with the fluorouracil plus leucovorin scheme. In the other 3 scenarios with higher budget constraints, 52%, 69%, and 86% of the population should receive FOLFIRI, respectively. Dynamic optimization revealed that FOLFIRI and FOLFOX (oxaliplatin + leucovorin + fluorouracil) schemes are more likely to generate higher QALYs with lower costs and a limited budget. CONCLUSIONS: The current use of chemotherapy schemes is not optimal. An increasing proportion of FOLFIRI, FOLFOX, and FOLFOXIRI should be used more often as schemes to treat metastatic colorectal cancer in Colombia.

Infectious keratitis in 204 586 LASIK procedures.

PURPOSE: To investigate the incidence, culture results, risk factors, and visual outcomes of infectious keratitis after LASIK, and examine treatment strategies. DESIGN: Retrospective study. PARTICIPANTS: We included 107 613 patients who underwent LASIK at Clínica Baviera (Instituto Oftalmológico Europeo, Spain) from September 2002 to May 2008. METHODS: The medical records of post-LASIK patients (204 586 eyes) were reviewed to identify cases of infectious keratitis. Incidence, risk factors, clinical course, days to diagnosis, medical and surgical treatment, and final visual outcomes were recorded. MAIN OUTCOME MEASURES: Incidence of post-LASIK infectious keratitis, culture results, response to treatment, and visual outcome. RESULTS: Post-LASIK infectious keratitis was diagnosed in 72 eyes from 63 patients. Onset of infection was early (within 7 days after surgery) in 62.5% of cases. Cultures were positive in 21 of 54 cases in which samples were taken. The most frequently isolated microorganism was Staphylococcus epidermidis (9 cases). Immediate flap lifting and irrigation with antibiotics was performed in 54 eyes; late flap lifting was subsequently required in 10 out of 18 cases initially treated with topical antibiotics alone. One case required flap amputation owing to flap necrosis. Final best spectacle-corrected visual acuity (BSCVA) was >or=20/20 in 38 cases (52.7%) and >or=20/40 in 67 cases (93.05%); final BSCVA was <20/40 in 5 cases (6.94%). CONCLUSIONS: The incidence of post-LASIK infectious keratitis was 0.035% per procedure. Infectious keratitis after LASIK is a potentially vision-threatening complication. The appearance of infections in asymptomatic patients highlights the need for a proper schedule of follow-up appointments. Prompt and aggressive management of this LASIK complication with early flap lifting, scraping, culture, and irrigation with antibiotics is strongly recommended. Proper management can result in preserving useful vision. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

[Costs of an Aedes aegypti vector control program in municipalities in Colombia: a case study in Girón and Guadalajara de Buga, 2016]. / Costos de un programa de control del vector Aedes aegypti en municipios de Colombia: el caso de Girón y Guadalajara de Buga, 2016.

The aim of this study was to measure the costs of vector-borne disease control programs at the local level in Colombia (2016). A cost analysis was performed for this purpose from the policymaker's perspective in the municipalities (counties) of Girón and Guadalajara de Buga, specifically for the Aedes aegypti control program, the principal mosquito vector of dengue, Zika, and chikungunya. The analysis involved the quantification of all the costs required for each of the prevention and control strategies in vector-borne diseases. The costs were classified as operating and capital costs, and for purposes of comparison the costs were also calculated per case and per capita. The programs' total estimated costs were USD 146,651 in Girón and USD 97,936 in Guadalajara de Buga. Per capita cost was USD 0.88 in Girón and USD 0.99 in Guadalajara de Buga. In general, the predominant cost strategies were chemical spraying of adult mosquitos, accounting for 26% of the total costs in Girón and 47% in Guadalajara de Buga, with personnel representing 40% of the total costs for this strategy in Girón and 66% of the operating costs in Guadalajara de Buga.

El objetivo de este estudio fue cuantificar los costos de los programas de control de enfermedades transmitidas por vectores a nivel local en Colombia (2016). Para ello, fue realizado un análisis de costos desde la perspectiva del hacedor de política en los municipios de Girón y Guadalajara de Buga, específicamente para el programa de control del Aedes aegypti, principal vector trasmisor del dengue, Zika y chikungunya. Este análisis implicó la cuantificación de todos los costos requeridos para cada una de las estrategias de prevención y control de enfermedades transmitidas por vectores. Los costos fueron clasificados en recurrentes y de capital, además, con fines comparativos se obtuvo el costo por caso y a nivel per cápita. El costo total estimado de los programas fue de USD 146.651 en el municipio de Girón y USD 97.936 en el municipio de Guadalajara de Buga; a nivel per cápita el costo fue de USD 0,88 en Girón y en Guadalajara de Buga fue de USD 0,99. En general, las estrategias predominantes en costos fueron el control químico de vectores adultos, con un 26% del total de los costos en Girón y un 47% en Guadalajara de Buga, esta fue intensiva en costos recurrentes, con un costo de personal 40% del total de costos para esta estrategia en Girón y un 66% de costos operacionales en Guadalajara de Buga.

O objetivo deste estudo foi quantificar os custos dos programas de controle de doenças transmitidas por vetores ao nível local na Colômbia em (2016). Para isso, foi realizada uma análise de custos desde a perspectiva do criador de políticas nos municípios de Girón e Guadalajara de Buga, especificamente para o programa de controle do Aedes aegypti, principal vector transmissor da dengue, Zika e chikungunya. Esta análise implicou a quantificação de todos os custos requeridos para cada uma das estratégias de prevenção e controle de doenças transmitidas por vetores. Os custos foram classificados em recorrentes e do capital, ademais, para fins comparativos foi obtido o custo por caso e nível per capita. O custo total estimado dos programas foi de USD 146.651 no Município de Girón e USD 97.936 no Município de Guadalajara de Buga; ao nível per capita o custo foi de USD 0,88 em Girón e em Guadalajara de Buga foi de USD 0,99. Em geral, as estratégias predominantes em custos foram o controle químico de vetores adultos, com um 26% do total dos custos em Girón e um 47% em Guadalajara de Buga, essa foi intensiva em custos recorrentes, com um custo de pessoal de um 40% do total de custos para esta estratégia em Girón e um 66% de custos operacionais em Guadalajara de Buga.

Manifestaciones Orales y COVID-19 en Adultos. Resumen de Revisiones Sistemáticas

El objetivo de este resumen de revisiones sistemáticas fue describir los efectos del COVID-19 sobre la cavidad oral en pacientes adultos. Se realizó una búsqueda electrónica en las bases de datos; Medline a través de PubMed, Scopus y Springer con la estrategia de búsqueda: "COVID-19 OR SARS- CoV-2 AND oral cavity AND oral manifestations". Se encontraron 312 escritos y se analizaron tres revisiones sistemáticas. El COVID-19 mostró estar vinculado con la prevalencia de trastornos del gusto OR: 7,54 (IC 95 % = 5,24 - 10,86, I2 = 93 %, p < 0,001) y Xerostomía 0,43 (0.36, 0.50, I2 = 71 %, p < 0.001) con alta certeza sobre la evidencia, mientras que las lesiones orales generales 0.33 (0.11, 0.60, I2 = 99 %, p < 0.001), lesiones aftosas 0.10 (0.01, 0.24, I2 = 98 %, p < 0.0001) y gravedad del cuadro clínico 1.63 (1.33, 1.99, I2 = 69 %, p < 0.0001) reportan un bajo nivel de certeza, por tanto se puede concluir una vinculación entre la presencia del COVID-19 y el desarrollo de trastornos del gusto y xerostomía. No obstante, se requieren de más revisiones sistemáticas con meta análisis que permitan la toma de decisiones clínicas en torno a otros tipos de manifestaciones orales.

The objective of this summary of systematic reviews was to describe the effects of COVID-19 on the oral cavity in adult patients. An electronic search of the databases was performed; Medline through PubMed, Scopus and Springer with the search strategy: "COVID-19 OR SARS-CoV-2 AND oral cavity AND oral manifestations". 312 writings were found and three systematic reviews were analyzed. COVID-19 was shown to be associated with the prevalence of taste disorders OR: 7.54 (95 % CI = 5.24 - 10.86, I2 = 93 %, p < 0.001) and Xerostomia 0.43 (0.36, 0.50, I2 = 71 %, p < 0.001) with high certainty about the evidence, while general oral lesions 0.33 (0.11, 0.60, I2 = 99 %, p < 0.001), aphthous lesions 0.10 (0.01, 0.24 , I2 = 98 %, p < 0.0001) and severity of the clinical picture 1.63 (1.33, 1.99, I2 = 69 %, p < 0.0001) report a low level of certainty, therefore a link between the presence of COVID- 19 and the development of taste disorders and xerostomia However, more systematic reviews with meta-analyses are required to allow clinical decision-making regarding other types of oral manifestations.

Social network and inequalities in smoking amongst school-aged adolescents in six European countries.

OBJECTIVES: Smoking contributes to socio-economic health inequalities; but it is unclear how smoking inequalities emerge at a young age. So far, little attention has been paid to the role of friendship ties. We hypothesised that the combination of peer exposure and friendship social homophily may contribute to socio-economic inequalities in smoking at school. METHODS: In 2013, a social network survey was carried out in 50 schools in six medium-size European cities (Namur, Tampere, Hanover, Latina, Amersfoort, and Coimbra). Adolescents in grades corresponding to the 14-to-16 age group were recruited (n = 11.015, participation rate = 79.4 %). We modelled adolescents' smoking behaviour as a function of socio-economic background, and analysed the mediating role of social homophily and peer exposure. RESULTS: Lower socio-economic groups were more likely to smoke and were more frequently exposed to smoking by their close and distant friends, compared with adolescents of higher SES. The smoking risk of the lowest socio-economic group decreased after controlling for friends smoking and social homophily. CONCLUSIONS: Smoking socio-economic inequalities amongst adolescents are driven by friendship networks.

A social network analysis of substance use among immigrant adolescents in six European cities.

BACKGROUND: Social integration and the health of adolescents with a migration background is a major concern in multicultural societies. The literature, however, has paid little attention to the wider determinants of their health behaviours, including the composition of their social networks. The aim of this study was to describe the composition of adolescents' social networks according to migration background, and to examine how social networks are associated with substance use. METHOD: In 2013, the SILNE study surveyed 11,015 secondary-school adolescents in 50 schools in six European cities in Belgium, Finland, Germany, Italy, the Netherlands, and Portugal, using a social network design. Each adolescent nominated up to five of their best and closest friends. Migration status was defined as first-generation migrants, second-generation migrants, and speaking another language at home. We computed two groups of network structural positions, the centrality of individual adolescents in networks, and the homophily of their social ties regarding migration (same-migration). Multilevel logistic regression was used to model the association between network structural position and smoking, alcohol use, and cannabis use. RESULTS: Compared with non-migrant adolescents, adolescents with migration backgrounds had similar relationship patterns. But almost half their social ties were with same-migration-background adolescents; non-migrants had few social ties to migrants. For adolescents with a migration background, a higher proportion of social ties with non-migrants was associated with increased use of cannabis (OR = 1.07, p = 0.03) and alcohol (OR = 1.08, p < 0.01), but not with increased smoking (p = 0.60). Popular migrant adolescents were at less risk of smoking, alcohol use, and cannabis use than popular non-migrant adolescents. CONCLUSION: Homophily of social ties by migration background is noticeable in European schools. The tendency of migrant adolescents to have same-migration social ties may isolate them from non-migrant adolescents, but also reduces their risky health behaviours, in particular cannabis and alcohol use.

Intracorneal inlay complicated by intrastromal epithelial opacification.

OBJECTIVE: To report epithelial perilenticular opacity as a new complication of intracorneal inlay implantation for the correction of hyperopia. DESIGN: Prospective observational case series. PARTICIPANTS: Eleven eyes of 7 patients underwent intracorneal inlay implantation for the correction of hyperopia. METHODS: Intracorneal inlays were implanted onto the stromal bed by using a microkeratome cut to create an inferior hinged corneal flap. MAIN OUTCOME MEASURES: Postoperative complication occurrence of intracorneal perilenticular opacity, microbiological laboratory analysis, histopathological analysis, and confocal microscopy study. RESULTS: Of 11 implanted eyes, 5 showed diffuse perilenticular opacity of varying intensity that was unresponsive to steroid use following intracorneal inlay implantation. All patients had moderate to severe loss of best-corrected visual acuity. The inlays showed deposits at the edge and on the surface. Confocal microscopy in all eyes produced images compatible with the confocal morphologic features of epithelial cells. Explantation of inlays was performed in 5 eyes. The histopathologic study showed the presence of epithelial cells, and microbiological analysis and cultures were negative for bacteria, fungi, and mycobacteria. CONCLUSION: Epithelial perilenticular opacity is a new and serious complication in patients with intracorneal inlay implantation for the correction of hyperopia.