Pharmaceuticals and personal care products in Tunisian hospital wastewater: occurrence and environmental risk.

Despite concerns about the potential risk associated with the environmental occurrence of pharmaceuticals and personal care products (PPCPs), few studies address the emissions of hospitals to aquatic compartments. We examined within a 3-month sampling period the occurrence and environmental risk of PPCPs in seven Tunisian hospital wastewaters. From personal care products, UV filters, main metabolites, and benzotriazoles were quantified, with benzophenone 3 (oxybenzone, BP3) and benzotriazole (BZT) the most frequently found (71%) at median concentrations in the range 2.43 ± 0.87 ngL-1-64.05 ± 6.82 ngL-1 for BP3 and 51.67 ± 1.67 ngL-1-254 ± 9.9 ngL-1 for BZT. High concentrations were also found for 4-hydroxybenzophenone (4HB) (221 ± 6.22 ngL-1), one of the main metabolites of BP3. The antibiotics ofloxacin and trimethoprim, the anti-inflammatory acetaminophen, the antiepileptic carbamazepine, and the stimulant caffeine were present in all the wastewaters. The highest median concentration corresponded to acetaminophen, with 1240 ± 94 mgL-1 in Tunis Hospital, followed by ofloxacin with 78850 ± 39 µgL-1 in Sousse Hospital. For ecotoxicity assessment, acute toxicity was observed for Daphnia magna and Vibrio fischeri. The toxicity data were used in a hazard quotient (HQ) approach to evaluate the risk posed by the target PPCPs to aquatic organisms. The calculated HQs revealed that marbofloxacin (234 for V. fischeri), enrofloxacin (121 for D. magna), and BZT (82.2 for D. magna and 83.7 for V. fischeri) posed the highest risk, concluding that potential risk exists toward aquatic microorganisms. This study constitutes the first monitoring of UV filters in Tunisian hospital effluents and provides occurrence and toxicity data of PPCPs for reference in further surveys in the country.

Epidemiology and burden of dengue fever in the United States: a systematic review.

BACKGROUND: Dengue is currently a global concern. The range of dengue vectors is expanding with climate change, yet United States of America (USA) studies on dengue epidemiology and burden are limited. This systematic review sought to characterize the epidemiology and disease burden of dengue within the USA. METHODS: Studies evaluating travel-related and endemic dengue in US states and territories were identified and qualitatively summarized. Commentaries and studies on ex-US cases were excluded. MEDLINE, Embase, Cochrane Library, Latin American and Caribbean Center of Health Sciences Information, Centre for Reviews and Dissemination and Clinicaltrials.gov were searched through January 2022. RESULTS: 116 studies were included. In US states, dengue incidence was generally low, with spikes occurring in recent years in 2013-16 (0.17-0.31 cases/100,000) and peaking in 2019 (0.35 cases/100,000). Most cases (94%, n = 7895, 2010-21) were travel related. Dengue was more common in Puerto Rico (cumulative average: 200 cases/100,000, 1980-2015); in 2010-21, 99.9% of cases were locally acquired. There were <50 severe cases in US states (2010-17); fatal cases were even rarer. Severe cases in Puerto Rico peaked in 1998 (n = 173) and 2021 (n = 76). Besides lower income, risk factors in US states included having birds in residence, suggesting unspecified environmental characteristics favourable to dengue vectors. Commonly reported symptoms included fever, headache and rash; median disease duration was 3.5-11 days. Hospitalization rates increased following 2009 World Health Organization disease classification changes (pre-2009: 0-54%; post-2009: 14-75%); median length of stay was 2.7-8 days (Puerto Rico) and 2-3 days (US states). Hospitalization costs/case (2010 USD) were$14 350 (US states),$1764-$5497 (Puerto Rico) and$4207 (US Virgin Islands). In Puerto Rico, average days missed were 0.2-5.3 (work) and 2.5 (school). CONCLUSIONS: Though dengue risk is ongoing, treatments are limited, and dengue's economic burden is high. There is an urgent need for additional preventive and therapeutic interventions.

Pilot Study on Satisfaction in Children and Adolescents after a Comprehensive Educational Program on Healthy Habits.

Prospective research in the area of Education Sciences and Physical-Sports Education agree on the need to design and implement educational programs that promote emotional competencies (ECs), interpersonal competencies (ICs), an adequate level of healthy physical activity (NAFS) and a good adherence to the Mediterranean diet (ADM). The main objective of the study is to design an intervention program in intra- and interpersonal competencies together with nutritional education and corporality called "MotivACTION". The sample consisted of 80 primary schoolchildren aged 8 to 14 years (M = 12.70; SD = 2.76) (37 girls and 43 boys) from two schools in the Community of Madrid. An ad-hoc questionnaire was created to assess the participant's perception of the usefulness of the "MotivACTION" educational experience. The program "MotivACTION: Feed your SuperACTION" is designed and implemented based on the development of a workshop organized through the Universidad Europea de Madrid. As the main preliminary results of the pilot study, the schoolchildren who experienced the "MotivACTION" workshop showed high satisfaction with the educational program. They were able to create a healthy menu with the frog chef. They also felt better and happier at the end of it, and they enjoyed practicing physical activity moving to the rhythm of the music while doing mathematical calculations.

Study of an Anti-Doping Education Program in Spanish Sports Sciences Students.

Doping continues to be one of the biggest risks to the credibility of elite sports, and its practice remains widespread among athletes despite improved controls. Athletes' support personnel could be key to preventing doping behavior. In this sense, anti-doping education for this population appears as a possible strategy to reduce doping behaviors in elite sport, but these programs must be evaluated and designed based on scientific evidence. The aim of this research is to explore the impact of an anti-doping education program about substances perceived efficacy, ill-health short- and long-term effects, and the morality of doping substance use in Spanish sports sciences students. METHOD: A total of 145 students of Physical Activity and Sport Sciences (PASS) from different Spanish universities who took an online anti-doping educational course of the Spanish Anti-Doping Commission (CELAD) answered a questionnaire on their perceptions about doping before, after, and four months later. RESULTS: The results show that the course reduced students' ignorance about the effects of substances on performance and health and increased their moral judgment and feelings against doping. DISCUSSION: The results are in line with previous research that showed that the moral stance against doping can be improved through educational programs. CONCLUSION: Online educational interventions can be effective in reducing doping behavior, so their future implementation among ASP can be an effective strategy to reduce doping behavior.

Anti-Doping Knowledge of Students Undertaking Bachelor's Degrees in Sports Sciences in Spain.

In Spain, students pursuing a career in athletic training, physical education, or scientific evaluation of sports enroll in a bachelor's degree in sports sciences. This degree provides knowledge and skills in a broad array of sports settings and promotes research-based interdisciplinary knowledge. However, the student's syllabus rarely includes specific academic training on anti-doping regulations or doping prevention. The purpose of this study was to assess the anti-doping knowledge of the students undertaking a bachelor's degree in sports sciences in Spanish universities. One thousand two hundred and thirty-three bachelor students in sport science (907 males, 322 females, and 4 participants with non-binary sex) from 26 Spanish universities completed a validated questionnaire about general anti-doping knowledge. The questionnaire is an adapted version of the Play True Quiz of the World Anti-Doping Agency and contains 37 multiple-choice questions. The score obtained in the questionnaire was transformed into a 0−100-point scale. The questionnaire was distributed among students within each university by a faculty member and it was filled out online. Students obtained a score of 65.8 ± 10.10 points (range = 32−92 points). There was an effect of the course in the score obtained (p < 0.001). Students of the first course (63.6 ± 9.5 points) had lower scores than the remaining courses (p < 0.037) while the students of the fourth course obtained the highest scores (68.7 ± 9.5 points; p < 0.019). The students with an itinerary on sports performance were the respondents with the highest anti-doping knowledge (67.2 ± 10.2) points, followed by the students with an itinerary on health (66.7 ± 9.5 points). The knowledge of basic anti-doping rules and doping prevention strategies of the bachelor students in sports sciences in Spain was suboptimal. Increasing doping prevention information in the syllabus of the bachelor's degree in sports sciences is essential as these future professionals will directly work with populations at risk of doping.

Validación de la versión española de la Escala de Reflexión en futbolistas de élite jóvenes / Validation of the Spanish Version of the Reflection Scale for Young Elite Football Players / Validação da versão espanhola da Escada de Reflexão em futebolistas de elite jovens

Resumen Objetivo. Validar la versión española de la Escala de Reflexión del instrumento Reflective Learnning Continuum en futbolistas jóvenes de élite. Método. Estudio de validación. La versión original fue traducida y adaptada siguiendo el protocolo de la American Psychological Association. Una vez traducida, se administró a 478 jugadores jóvenes de élite junto con el Behavioural Regulation in Sport Questionnaire, con el objetivo de evaluar sus propiedades psicométricas; además, se llevaron a cabo el análisis de consistencia interna, el análisis factorial confirmatorio y el análisis de correlaciones bivariadas con variables teóricamente relacionadas. Resultados. En el análisis de contenido, la versión española de la Escala de Reflexión aplicada mostró evidencias en los aspectos cultural y lingüístico con la versión original. Además, el análisis factorial confirmatorio mostró un ajuste aceptable a los datos: χ²(df) = 28.61 (88), p < 0.001, RMSEA (90% CI) = 0.07 (0.06-0.08), CFI = 0.99, TLI = 0.99. Los análisis de consistencia interna, así como la relación con la motivación, apoyaron la versión validada. Conclusión. Los resultados proporcionan evidencia en favor de las propiedades psicométricas de la validación al español de la Escala de Reflexión.

Abstract Objective. To validate the Spanish version of the Reflection Scale from the instrument Reflective Learning Continuum for young elite football players. Method. Validation study. The original version was translated and adapted following the protocol of the American Psychological Association. Once translated, the version was administered to 478 young elite players together with the Behavioral Regulation in Sport Questionnaire, aiming to evaluate the psychometric properties. In addition, internal consistency analysis, confirmatory factor analysis and bivariate correlations analysis with theoretically related variables were carried out. Results. The Spanish version of the Reflection Scale shows cultural and linguistic evidence with its original version. Moreover, confirmatory factor analysis showed an acceptable fit to the data χ²(df)= 28.61 (88), p < 0.001, RMSEA (90% CI) = 0.07 (0.06-0.08), CFI = 0.99, TLI = 0.99. Also, the internal consistency analyses, as well as the relationship with motivation, support the validated version. Conclusion. The results provide evidence in favour of the psychometric properties of the Spanish validation of the Reflection Scale.

Resumo Escopo. Validar a versão espanhola da Escada de Reflexão do instrumento Reflective Learnning Continuum em futebolistas jovens de elite. Metodologia. Estudo de validação. A versão original foi traduzida e adaptada seguindo o protocolo da American Psycological Association. Uma vez traduzida, foi administrada a 478 jogadores jovens de elite junto com o Behavioural Regulation in Sport Qustionnaire, com o escopo de avaliar suas propriedades psicométricas; Além, foram realizadas analises de correlações bivariadas com variáveis teoricamente relacionadas. Resultados. Na análise de conteúdo, a versão espanhola da Escada de Reflexão aplicada mostrou evidencias nos aspectos cultural e linguístico com a versão original. Além, a análise fatorial confirmatória mostrou um ajuste aceitável para os dados: As análises de consistência interna, assim como a relação com a motivação, apoiaram a versão validada. Conclusão. Os resultados proporcionaram evidencia em favor das propriedades psicométricas da validação ao espanhol da Escada de Reflexão.

Efficiency of an intensive educational program for informal caregivers of hospitalized, dependent patients: cluster randomized trial.

BACKGROUND: Educational initiatives for informal caregivers have proved efficient at reducing some of their symptoms, consequence of their involvement in care giving. However, more progress must be made in terms of the design of more successful interventions. AIMS: Randomized clinical trial to test the efficiency of an Education Program for Primary Informal Caregivers of Hospitalized Dependent Patients in relation to their burden, mental and physical health, and care related knowledge. DESIGN: Cluster Randomized Trial. SAMPLE: 151 participants, primary caregivers of hospitalized, dependent patients, carried out from February 2009 to March 2010. They were assigned at random to two groups: one received an intensive educational program (n = 78), and the other just a generic speech (n = 73). The degree of burden of caregivers was recorded (Zarit Test), as well as their physical and mental health (SF12) and their knowledge of caregiving, before, immediately, after and one and a half months after the intervention. These analyses were carried out according to the Generalized Estimated Equations Method, in order to assess any possible improvements. RESULTS: Participants´ burden did not improve, as measured by Zarit Test (p = 0,338), nor did their physical (p = 0,917) or mental health (p = 0,345). However there was an improvement in their hygiene caregiving (p = 0,001) and mobility care giving (p = 0,001). CONCLUSIONS: Caregivers found useful the education program, providing them with an informal support group. Interventions need to be longer and more customized as well as adapted to specific demands. There is a lack of validated questionnaires to assess improvements in care knowledge. There is a need to develop programs that contemplate continuity of care from primary to specialized caregiving. TRIAL REGISTRATION: Cluster randomized trial: ESCPD2010.

Cancer en el adolescente a proposito de nuestra experiencia (224 pacientes) / Cancer in adolescents our experience with 224 patients

El cáncer es una enfermedad de rara ocurrencia en pediatría y adolescencia (10-19 años). Casi el 70 % de las neoplasias ocurren en pacientes menores de 5 años. Presentamos nuestra experiencia sobre 224 pacientes adolescentes con una enfermedad neoplásica no hematológica. El 61 % correspondieron al sexo masculino. La incidencia relativa de las neoplasias fue: tumores del sistema nerviosos central 30,5 %, sarcomas de partes blandas 22,7 %, tumores de hueso 18,1 %, tumores germinales 11,8 %, carcinomas 6,3 %, nefroblastoma 2,9 % y neuroblastoma 0,9 %.Comparando dos periodos diferentes (1984-89 y 1990-99) la sobrevida libre de enfermedad (SLE) a 48 meses fue de 39,4 % (45/114) y 81,8 % (90/110), respectivamente mientras que 49 % y 35,5 % presentaron secuelas, respectivamente. La adaptación social posterior a la curación orgánica de la enfermedad mostró que solo 4/135 pacientes (2,9 %) están en la Universidad; el grupo mas numerosos correspondió a aquellos con instrucción primaria incompleta (42,2 % versus 33 %). El 37 % y 53,3 % respectivamente, trabajan (intermitentemente) y el 13,3 % y el 15,5 % han formado pareja. De estos últimos 20 pacientes, el 35 % tiene 10 hijos; 6 son mujeres y 3 tenían tumores pelvianos, dos de ellas de ovario (tumores germinales)

Cancer en el adolescente a proposito de nuestra experiencia (224 pacientes) / Cancer in adolescents our experience with 224 patients

El cáncer es una enfermedad de rara ocurrencia en pediatría y adolescencia (10-19 años). Casi el 70 % de las neoplasias ocurren en pacientes menores de 5 años. Presentamos nuestra experiencia sobre 224 pacientes adolescentes con una enfermedad neoplásica no hematológica. El 61 % correspondieron al sexo masculino. La incidencia relativa de las neoplasias fue: tumores del sistema nerviosos central 30,5 %, sarcomas de partes blandas 22,7 %, tumores de hueso 18,1 %, tumores germinales 11,8 %, carcinomas 6,3 %, nefroblastoma 2,9 % y neuroblastoma 0,9 %.Comparando dos periodos diferentes (1984-89 y 1990-99) la sobrevida libre de enfermedad (SLE) a 48 meses fue de 39,4 % (45/114) y 81,8 % (90/110), respectivamente mientras que 49 % y 35,5 % presentaron secuelas, respectivamente. La adaptación social posterior a la curación orgánica de la enfermedad mostró que solo 4/135 pacientes (2,9 %) están en la Universidad; el grupo mas numerosos correspondió a aquellos con instrucción primaria incompleta (42,2 % versus 33 %). El 37 % y 53,3 % respectivamente, trabajan (intermitentemente) y el 13,3 % y el 15,5 % han formado pareja. De estos últimos 20 pacientes, el 35 % tiene 10 hijos; 6 son mujeres y 3 tenían tumores pelvianos, dos de ellas de ovario (tumores germinales).

Prevalence and management of Schneiderian membrane perforations during sinus-lift procedures.

This clinical study was undertaken to evaluate the prevalence of surgical complications of the sinus graft procedure and to set a protocol to repair sinus membrane perforations intraoperatively using a variety of techniques and materials. From January 2000 to May 2005, 338 patients were studied, on whom 474 sinus floor augmentation procedures were performed, and a total of 1166 dental implants were simultaneously placed. A total of 104 perforations of the sinus membrane were observed (19 were bilateral). In group number 1, sinus membrane perforations of <5 mm were observed in 56 sinus augmentation procedures (53.85%), 44 were treated using a resorbable collagen membrane and 12 were sutured with a resorbable material. In group number 2, 28 sinus membranes had a perforation size between 5 and 10 mm (26.92%) and were treated using lamellar bone combined with a resorbable membrane. Group number 3 consisted of 20 sinus membrane perforations>10 mm (19.23%), 10 were covered with lamellar bone combined with a buccal fat pad flap, six were treated with a mandibular block graft and four perforations were treated with only a lamellar bone sheet. Two-hundred and seventy-eight implants were placed under repaired membrane perforations and 247 implants survived. Interestingly enough, all the 25 implants that failed to integrate were placed under perforated and reconstructed membranes during the sinus lift procedure. Based on the results of this study, the survival rates of implants placed under reconstructed membranes correlate inversely with the size of the perforations.

Minimally invasive tibial bone harvesting under intravenous sedation.

PURPOSE: Collecting high amounts of autogenous bone often results in considerable donor site morbidity. The hypothesis evaluated with this prospective study is that a modified approach for tibial bone harvesting using a minimally invasive access under local anesthesia plus sedation in an office setting compares favorably in terms of amount of bone harvested, morbidity, and patient satisfaction with more aggressive approaches previously reported. PATIENTS AND METHODS: Thirty-eight patients (18 women, 10 men) were treated using this method and followed prospectively. A medial approach to the proximal tibia was performed in all cases. A 10 mm incision gives access to an 8 mm manual trephine, which creates a bony window. Cancellous bone is released from the proximal compartment and a bone filter connected to suction allows fast removal of bone particles. Amount of bone harvested (compressed and non-compressed), surgical time, and complications were recorded. RESULTS: Mean surgical time was 14 minutes (range, 9 to 20 minutes). Volume of compressed cancellous bone ranged between 18 and 30 cc (mean, 28 cc). CONCLUSION: Tibial bone harvesting through a medial minimally invasive approach with a bone filter yields satisfactory results in terms of bone volume, surgical time, and patient satisfaction.