Understanding vaccination hesitation among health professionals: a systematic review of qualitative studies.

OBJECTIVES: In terms of vaccination, people trust healthcare professionals (HCPs) more than any other source of information. They are the cornerstone of vaccination as they can move undecided populations not only towards vaccination but also towards non-vaccination. The aim of this systematic review was to explore the knowledge, beliefs, attitudes, and barriers associated with own vaccination and patient recommendation in HCPs. STUDY DESIGN: This study incorporated a systematic review. METHODS: A systematic review of studies published from January 1, 2000, to June 1, 2020, was conducted by searching PubMed and EMBASE electronic databases. Qualitative studies reporting outcomes related to knowledge, attitudes, or barriers related to vaccination/recommendation by healthcare personnel were included. The guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. RESULTS: From a total of 2916 studies identified, 36 articles met the inclusion criteria. Some of the factors cited by the HCP that may contribute to vaccine hesitancy were (a) concerns regarding safety or efficacy of vaccines (23 articles); (b) time constraints (21 articles); (c) lack of knowledge about the vaccination/vaccine (19 articles); (d) costs (13 articles); (e) distrust of pharmaceutical industry (8 articles); and (f) considering oneself insusceptible (7 articles), stock shortage (7 articles), lack of personnel (5 articles), and feelings of unnecessary vaccination (5 articles). CONCLUSIONS: Our review suggests that interventions to combat vaccine hesitancy should increase HCP education on vaccine efficacy and safety, as well as intervene on health system factors such as cost and time per visit. In this way, we could tackle the problem of vaccine hesitancy, which seriously threatens global public health.

Reasons for medication non-initiation: A qualitative exploration of the patients' perspective.

BACKGROUND: Non-initiation occurs when the doctor prescribes a new pharmacological treatment to a patient who does not fill the prescription. Non-initiation prevalence estimates range between 6% and 28% in Primary Care (PC) and it is associated with poorer clinical outcomes, more sick-leave days and higher costs. To date, the reasons for non-initiation have not been explored using a qualitative framework. OBJECTIVE: The aim of the present study was to identify reasons for medication non-initiation among PC patients with distinct treatment profiles (acute, chronic symptomatic and asymptomatic, and mental disorders). METHODS: An exploratory, explanatory qualitative study based on Grounded Theory. We conducted individual semi-structured interviews with 30 PC patients. A constant comparative method of analysis was performed. RESULTS: The results were similar for all therapeutic groups. The decision to initiate treatment is multifactorial. Users make a risk-benefit assessment which is influenced by their beliefs about the pathology and the medication, their emotional reaction, health literacy and cultural factors. The patients' context and relationship with the health system influence decision-making. CONCLUSIONS: The decision to initiate a treatment is strongly influenced by factors that health professionals can discuss with patients. Health professionals should explore patients' beliefs about benefits and risks to help them make informed decisions and promote shared decision-making. General practitioners should ensure that patients understand the benefits and risks of disease and treatment, while explaining alternative treatments, encouraging patients to ask questions and supporting their treatment decisions.

Trends in celecoxib and etoricoxib prescribing following removal of prior authorization requirement in Spain.

WHAT IS KNOWN AND OBJECTIVE: Previous studies indicate that the implementation of a prior authorization requirement for coxibs was followed by a sharp decline in their use. There are no studies showing what happens if coxib prior authorization is removed. The objective of this study is to assess the trend in the use of coxibs marketed in Spain, following removal of their respective prior authorization requirements in November 2006 for celecoxib and February 2007 for etoricoxib. METHODS: We calculated the monthly number of defined daily doses per thousand inhabitants per day (DDD/TID) of coxibs dispensed in a health area of Spain from mid-2005 to December 2007. Data were analysed both graphically and by means of a segmented regression model. RESULTS AND DISCUSSION: At the start of the study period, use of coxibs showed no growth. At the date when prior authorization of celecoxib was removed (November 2006), however, DDD/TID of the coxib whose prior authorization had not been removed - namely etoricoxib - remained unchanged, whereas consumption of celecoxib increased significantly (by the end of the study period, celecoxib use displayed a relative increase of 615% in terms of the DDD/TID prescribed before the removal of its prior authorization requirement). Similarly, etoricoxib use remained unchanged until its prior authorization was removed (February 2007), from which time DDD/TID of etoricoxib also underwent a considerable increase (by the end of the study period, etoricoxib use displayed a relative increase of 793% in terms of the DDD/TID prescribed before the removal of its prior authorization). Segmented regression analysis showed a sharp, statistically significant rise and change in slope in both celecoxib and etoricoxib use immediately after removal of their respective prior authorizations. WHAT IS NEW AND CONCLUSION: Use of celecoxib and etoricoxib rose sharply after removal of their respective prior authorizations.

Molecular diversity and genetic relationships in Secale.

The objective of this study was to quantify the molecular diversity and to determine the genetic relationships among Secale spp. and among cultivars of Secale cereale using RAPDs, ISSRs and sequence analysis of six exons of ScMATE1 gene. Thirteen ryes (cultivated and wild) were genotyped using 21 RAPD and 16 ISSR primers. A total of 435 markers (242 RAPDs and 193 ISSRs) were obtained, with 293 being polymorphic (146 RAPDs and 147 ISSRs). Two RAPD and nine ISSR primers generated more than 80% of polymorphism. The ISSR markers were more polymorphic and informative than RAPDs. Further, 69% of the ISSR primers selected achieved at least 70% of DNA polymorphism. The study of six exons of the ScMATE1 gene also demonstrated a high genetic variability that subsists in Secale genus. One difference observed in exon 1 sequences from S. vavilovii seems to be correlated with Al sensitivity in this species. The genetic relationships obtained using RAPDs, ISSRs and exons of ScMATE1 gene were similar. S. ancestrale, S. kuprijanovii and S. cereale were grouped in the same cluster and S. segetale was in another cluster. S. vavilovii showed evidences of not being clearly an isolate species and having great intraspecific differences.

The role of two superoxide dismutase mRNAs in rye aluminium tolerance.

Aluminium (Al) is the main factor that limits crop production in acidic soils. There is evidence that antioxidant enzymes such as superoxide dismutase (SOD) play a key role against Al-induced oxidative stress in several plant species. Rye is one of the most Al-tolerant cereals and exudes both citrate and malate from the roots in response to Al. The role of SOD against Al-induced oxidative stress has not been studied in rye. Al accumulation, lipid peroxidation, H2O2 production and cell death were significantly higher in sensitive than in tolerant rye cultivars. Also, we characterised two genes for rye SOD: ScCu/ZnSOD and ScMnSOD. These genes were located on the chromosome arms of 2RS and 3RL, respectively, and their corresponding hypothetical proteins were putatively classified as cytosolic and mitochondrial, respectively. The phylogenetic relationships indicate that the two rye genes are orthologous to the corresponding genes of other Poaceae species. In addition, we studied Al-induced changes in the expression profiles of mRNAs from ScCu/ZnSOD and ScMnSOD in the roots and leaves of tolerant Petkus and sensitive Riodeva rye. These genes are mainly expressed in roots in both ryes, their repression being induced by Al. The tolerant cultivar has more of both mRNAs than the sensitive line, indicating that they are probably involved in Al tolerance.

On the consequences of aluminium stress in rye: repression of two mitochondrial malate dehydrogenase mRNAs.

Plants have developed several external and internal aluminium (Al) tolerance mechanisms. The external mechanism best characterised is the exudation of organic acids induced by Al. Rye (Secale cereale L.), one of the most Al-tolerant cereal crops, secretes both citrate and malate from its roots in response to Al. However, the role of malate dehydrogenase (MDH) genes in Al-induced stress has not been studied in rye. We have isolated the ScMDH1 and ScMDH2 genes, encoding two different mitochondrial MDH isozymes, in three Al-tolerant rye cultivars (Ailés, Imperial and Petkus) and one sensitive inbred rye line (Riodeva). These genes, which have seven exons and six introns, were located on the 1R (ScMDH1) and 3RL (ScMDH2) chromosomes. Exon 1 of ScMDH1 and exon 7 of ScMDH2 were the most variable among the different ryes. The hypothetical proteins encoded by these genes were classified as putative mitochondrial MDH isoforms. The phylogenetic relationships obtained using both cDNA and protein sequences indicated that the ScMDH1 and ScMDH2 proteins are orthologous to mitochondrial MDH1 and MDH2 proteins of different Poaceae species. The expression studies of the ScMDH1 and ScMDH2 genes indicate that it is more intense in roots than in leaves. Moreover, the amount of their corresponding mRNAs in roots from plants treated and not treated with Al was higher in the tolerant cultivar Petkus than in the sensitive inbred line Riodeva. In addition, ScMDH1 and ScMDH2 mRNA levels decreased in response to Al stress (repressive behaviour) in the roots of both the tolerant Petkus and the sensitive line Riodeva.

Valoración de la idoneidad de los criterios STOPP/START en el ámbito de atención primaria en España por el método RAND / Assessment of the appropriateness of STOPP/START criteria in primary health care in Spain by the RAND method

Introducción. Pretendemos valorar la idoneidad de los criterios STOPP/START para su utilización en el ámbito de atención primaria (AP) en España. Material y método. Estudio observacional transversal con metodología RAND a 2 rondas realizado en la Gerencia de AP de Vigo con 582.968 habitantes (24% ≥>= 65 años). El grupo de expertos fue constituido por la comisión de farmacia del área, con 12 miembros de diversas especialidades. En una primera ronda, se proporciona a la comisión bibliografía relevante y un cuestionario con los criterios STOPP/START para puntuar la idoneidad en AP con una escala Likert del 1-9 (mínimo, máximo). Cada criterio se clasifica en función de la mediana de las puntuaciones obtenidas y su grado de acuerdo. En una segunda ronda, los expertos debaten los criterios dudosos y las sugerencias aportadas. Resultados. La mayoría de los criterios se consideran apropiados, proponiendo una nueva versión AP2012 con las siguientes diferencias: eliminar START E2 «Bifosfonatos en pacientes que reciben corticoesteroides orales a dosis de mantenimiento»; eliminar START F3 «Antiagregantes plaquetarios en la diabetes mellitus si coexisten uno o más factores mayores de riesgo cardiovascular»; modificar STOPP A9, A15, A16, A17 y E5 y START A1 y A2, por referirse solo a la warfarina y se añade acenocumarol, habitual en nuestro medio, e introducir STOPP C6 «Uso de inhibidores de la bomba de protones (IBP) fuera de sus indicaciones autorizadas». Conclusiones. Los criterios STOPP/START son adecuados para su uso en el ámbito de AP pero es necesaria su adaptación y actualización periódica (AU)

Introduction: A new screenings tool called STOPP/START has been formulated to identify potentially inappropriate prescribing in older people. This study aimed to assess the appropriateness of STOPP/START criteria in primary health care (PHC) in Spain. Material and method: The RAND Appropriateness Method was used to obtain agreement on STOPP/START criteria with two rounds in Vigo PHC with 582.968 inhabitants (24% >=65 years). The pharmacotherapy committee of Vigo PHC area was identified as expert panel, with 12 members from different specialties. In the first round, the committee was provided with relevant literature and a questionnaire with STOPP/START criteria to rate their applicability in PHC with a 9-point Likert scale. Then, each of the criteria was classified according to the median scores and the degree of agreement. In the second round, the experts discussed the undecided criteria and suggestions. Results: Most of the criteria were appropriate. We present a new version with the following differences: to remove START E2 «Biphosphonates in patients taking maintenance oral corticosteroid therapy»; to remove START F3 «Antiplatelet therapy in diabetes mellitus with coexisting major cardiovascular risk factors»; to modify STOPP A9, A15, A16, A17 and E5; and START A1 and A2, adding acenocoumarol to all of them because acenocoumarol is the most used anticoagulant in our country and they only refer to warfarin, and to introduce STOPP C6: «Use of proton pump inhibitors without authorized indication». Conclusions: Criteria STOPP/START are suitable for use PHC but it is necessary to adapt and update them periodically (AU)

[Assessment of the appropriateness of STOPP/START criteria in primary health care in Spain by the RAND method]. / Valoración de la idoneidad de los criterios STOPP/START en el ámbito de atención primaria en España por el método RAND.

INTRODUCTION: A new screenings tool called STOPP/START has been formulated to identify potentially inappropriate prescribing in older people. This study aimed to assess the appropriateness of STOPP/START criteria in primary health care (PHC) in Spain. MATERIAL AND METHOD: The RAND Appropriateness Method was used to obtain agreement on STOPP/START criteria with two rounds in Vigo PHC with 582.968 inhabitants (24% ≥ 65 years). The pharmacotherapy committee of Vigo PHC area was identified as expert panel, with 12 members from different specialties. In the first round, the committee was provided with relevant literature and a questionnaire with STOPP/START criteria to rate their applicability in PHC with a 9-point Likert scale. Then, each of the criteria was classified according to the median scores and the degree of agreement. In the second round, the experts discussed the undecided criteria and suggestions. RESULTS: Most of the criteria were appropriate. We present a new version with the following differences: to remove START E2 «Biphosphonates in patients taking maintenance oral corticosteroid therapy¼; to remove START F3 «Antiplatelet therapy in diabetes mellitus with coexisting major cardiovascular risk factors¼; to modify STOPP A9, A15, A16, A17 and E5; and START A1 and A2, adding acenocoumarol to all of them because acenocoumarol is the most used anticoagulant in our country and they only refer to warfarin, and to introduce STOPP C6: «Use of proton pump inhibitors without authorized indication¼. CONCLUSIONS: Criteria STOPP/START are suitable for use PHC but it is necessary to adapt and update them periodically.

The role of antennae in the thermopreference and biting response of haematophagous bugs.

Insects sense thermal cues mainly through thermoreceptors located in the antenna. To analyse the impact of antennectomy on the thermal behaviour of the haematophagous bug Triatomainfestans, we studied the distribution of intact and antennectomised bugs in an experimental arena where a temperature gradient was established, as well as the biting response of insects with and without antennae to objects at the temperature of a potential host. Antennectomy did not abolish thermopreference, but modified the temperature at which the insects preferred to stay. In the arena, antennectomised insects chose to remain at a higher temperature (ca. 3°C higher in unfed bugs), and exhibited a larger dispersion around that preferred temperature, than intact bugs. In addition, ablated insects temporarily lost their ability to bite an object at the temperature of a potential host, but that ability was gradually recovered after the fifth day post-antennectomy. Results presented here show that thermoreceptors other than those located on the antennae can also guide thermal behaviours. We conclude that the function of antennal thermoreceptors can be taken over by other receptors located in different regions of the body. Those receptors have a different sensitivity and confer the insects with a different responsiveness.

Central nervous system demyelinating diseases and recombinant hepatitis B vaccination: a critical systematic review of scientific production.

The etiology of multiple sclerosis has not yet been fully described. A potential link between the recombinant hepatitis B vaccine and an increased risk of onset or exacerbation of multiple sclerosis emerged in the mid-1990s, leading to several spontaneous reports and studies investigating this association. We conducted a critical systematic review aimed at assessing whether hepatitis B vaccination increases the risk of onset or relapse of multiple sclerosis and other central nervous system demyelinating diseases. MEDLINE and EMBASE were used as data sources, and the search covered the period between 1981 and 2011. Twelve references met the inclusion criteria. No significant increased risk of onset or relapse of the diseases considered was associated with hepatitis B vaccination, except in one study. Most studies included in this review displayed methodological limitations and heterogeneity among them, which rendered it impossible to draw robust conclusions about the safety of hepatitis B vaccination in healthy subjects and patients with multiple sclerosis. Therefore, on the basis of current data there is no need to modify the vaccination recommendations; however, there is a need to improve the quality of observational studies with emphasis on certain considerations that are discussed in this review.

Health related quality of life in patients with Cohn´s disease in remission.

BACKGROUND: Crohn's disease (CD) affects Health Related Quality of Life (HRQoL) especially in patients with clinical activity but their impact over the disease during periods of remission has not been sufficiently studied. OBJECTIVE: To evaluate HRQoL in CD patients in remission and to identify socio-demographic and clinical factors related. METHODS: We included patients with CD in remission for at least 6 months, defined as a CDAI < 150 and a CRP < 5 mg/L. Socio-demographic and clinical parameters were recorded. HRQoL was evaluated with Short Form 36 Questionnaire (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ). Results were analyzed using multiple regressions with a confidence interval of 95%. RESULTS: Nine two patients (X = 37 +- 11.4 years, 52.2% men) were consecutively included. Two patients failed to fill correctly the questionnaire and were excluded. Scores on the SF-36 were lower than in the general population of similar age and sex. The most affected dimension in the SF-36 was General Health (47.98 +- 19.58) and the IBDQ Systemic Symptoms (5.15 +- 1.27). Age, colonic location and previous surgery was related with worse HRQoL, while higher educational status, more time since diagnosis, steroid-resistance and inflammatory behavior, was associated with better HRQoL. CONCLUSIONS: Despite being in remission, CD patients had affected their HRQoL, so we must continue working to achieve improvement in HRQL of these patients during these periods of the disease.

Calidad de vida en pacientes con enfermedad de Crohn en remisión / No disponible

Introducción: La enfermedad de Crohn (EC) afecta la Calidad de Vida Relacionada con la Salud (CVRS) en las fases de actividad pero el impacto de esta enfermedad en la CVRS durante los períodos de remisión no ha sido suficientemente estudiada. Objetivo: Evaluar la CVRS en pacientes con EC en remisión e identificar los factores sociodemográficos y clínicos relacionados. Métodos: Se incluyeron pacientes adultos con EC en remisión durante al menos 6 meses, definida con un CDAI < 150 y una PCR < 5 mg/l. Se recogieron datos sociodemográficos, clínicos y de CVRS con los cuestionarios Short Form 36 Questionnaire (SF-36) y The Inflammatory Bowel Disease Questionnaire (IBDQ). Los resultados fueron analizados mediante regresión múltiple con un intervalo de confianza del 95%. Resultados: Se incluyeron consecutivamente 92 pacientes (X – = 37 ± 11,4 años; 52,2% varones). 2 pacientes no cumplimentaron adecuadamente los cuestionarios. Las puntuaciones en el SF-36 fueron inferiores a las de la población general de similar edad y sexo. La dimensión más afectada en el SF-36 fue Salud General (47,98 ±19,58) y en el IBDQ Síntomas Sistémicos (5,15 ± 1,27). La mayor edad, la localización colónica y la cirugía previa se relacionaron con una peor CVRS, mientras que mayor nivel de estudios, mayor tiempo desde el diagnóstico, patrón inflamatorio y corticorresistencia se asociaron con una mejor CVRS. Conclusiones: A pesar de encontrarse en período de remisión los pacientes EC presentan afectada su CVRS, por lo que se debe continuar trabajando en la consecución de la mejora en la CVRS de estos enfermos durante esta fase de la enfermedad(AU)

Background: Crohn’s disease (CD) affects Health Related Quality of Life (HRQoL) especially in patients with clinical activity but their impact over the disease during periods of remission has not been sufficiently studied. Objective: To evaluate HRQoL in CD patients in remission and to identify socio-demographic and clinical factors related. Methods: We included patients with CD in remission for at least 6 months, defined as a CDAI < 150 and a CRP < 5 mg/L. Socio-demographic and clinical parameters were recorded. HRQoL was evaluated with Short Form 36 Questionnaire (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ). Results were analyzed using multiple regressions with a confidence interval of 95%. Results: Nine two patients (X – = 37 ± 11.4 years, 52.2% men) were consecutively included. Two patients failed to fill correctly the questionnaire and were excluded. Scores on the SF-36 were lower than in the general population of similar age and sex. The most affected dimension in the SF-36 was General Health (47.98 ± 19.58) and the IBDQ Systemic Symptoms (5.15 ± 1.27). Age, colonic location and previous surgery was related with worse HRQoL, while higher educational status, more time since diagnosis, steroid-resistance and inflammatory behavior, was associated with better HRQoL. Conclusions: Despite being in remission, CD patients had affected their HRQoL, so we must continue working to achieve improvement in HRQL of these patients during these periods of the disease(AU)

Psychological impact of Crohn's disease on patients in remission: anxiety and depression risks.

BACKGROUND: the role of anxiety and depression in CD patients in remission has been poorly investigated. OBJECTIVE: the aim of the study was to evaluate the frequency of anxiety and depression symptoms in CD patients in remission, and potential factors influencing the development of these symptoms. METHODS: CD patients older than 18 years in remission for at least 6 months before study entry were included. CD remission was defined as a Crohn s Disease Activity Index (CDAI) < 150 points together with C-reactive protein < 5 mg/L. A demographic questionnaire was filled in, and all patients were clinically classified. The therapy maintaining remission was also recorded. A Hospital Anxiety and Depression scale (HAD) was administered to all patients. Results are shown as OR and 95% CI, and analyzed by logistic regression. RESULTS: 92 consecutive patients were included (48 male, mean age 37 years, range from 18 to 71 years). One patient failed to correctly fill in the questionnaire. Anxiety and depression symptoms were present in 36 (39%) and 22 (24%) patients, respectively. Infliximab therapy was the only factor associated with anxiety (OR = 3.11; 95% CI: 1.03-9.43; p < 0.05). In contrast, the presence of depressive symptoms is less frequent in patients under infliximab therapy (OR = 0.16; 95% CI: 0.02-0.97; p < 0.05). CONCLUSIONS: despite clinical remission, an important number of CD patients present with anxiety or depressive symptoms. Infliximab therapy in CD patients is associated to more anxiety but fewer depressive symptoms. CD patients in remission would probably benefit from psychological support.

Impacto psicológico de la enfermedad de Crohn en pacientes en remisión: riesgo de ansiedad y depresión / Psychological impact of Crohn's disease on patients in remission: anxiety and depression risks

Introducción: el papel de la ansiedad y depresión en pacientes con enfermedad de Crohn (EC) en remisión es incierto. Objetivo: evaluar la frecuencia de ansiedad y depresión en pacientes con EC en remisión y potenciales factores que pueden influir en el desarrollo de esos síntomas. Métodos: se incluyeron pacientes con EC mayores de 18 años, que estuviesen en remisión durante al menos 6 meses. La remisión se definió como un CDAI < 150 junto con una PCR < 5 mg/l. Se recogieron datos sociodemográficos y los pacientes fueron estratificados clínicamente y se evaluó el tratamiento empleado para el mantenimiento de la remisión. Los síntomas ansiosos y depresivos se evaluaron a través de la Hospital Anxiety and Depression Scale (HAD). Los resultados fueron analizados mediante regresión logística y se muestran como Odds ratio con un intervalo de confianza del 95%. Resultados: se incluyeron 92 pacientes (48 hombres, edad media 37, rango 18 a 71 años). Un paciente no completó correctamente el cuestionario. Se encontraron síntomas ansiosos y depresivos en 36 (39%) y 22 (24%) pacientes respectivamente. El tratamiento con infliximab de mantenimiento fue el único factor asociado con ansiedad (OR = 3,11; 95% IC: 1,03-9,43; p < 0,05). Por el contrario, la presencia de síntomas depresivos es menos frecuente en pacientes en tratamiento de mantenimiento con infliximab (OR = 0,16; 95% IC: 0,02-0,97; p < 0,05). Conclusiones: a pesar de estar en remisión clínica, un importante número de pacientes con EC presentas síntomas ansiosos o depresivos. El tratamiento con infliximab parece asociarse con más ansiedad pero menos síntomas depresivos. Probablemente algunos de estos pacientes serían susceptibles de tratamiento psicológico(AU)

Background: the role of anxiety and depression in CD patients in remission has been poorly investigated. Objective: the aim of the study was to evaluate the frequency of anxiety and depression symptoms in CD patients in remission, and potential factors influencing the development of these symptoms. Methods: CD patients older than 18 years in remission for at least 6 months before study entry were included. CD remission was defined as a Crohn's disease Activity Index (CDAI) < 150 points together with C-reactive protein < 5 mg/L. A demographic questionnaire was filled in, and all patients were clinically classified. The therapy maintaining remission was also recorded. A Hospital Anxiety and Depression scale (HAD) was administered to all patients. Results are shown as OR and 95% CI, and analyzed by logistic regression. Results: 92 consecutive patients were included (48 male, mean age 37 years, range from 18 to 71 years). One patient failed to correctly fill in the questionnaire. Anxiety and depression symptoms were present in 36 (39%) and 22 (24%) patients, respectively. Infliximab therapy was the only factor associated with anxiety (OR = 3.11; 95% CI: 1.03-9.43; p < 0.05). In contrast, the presence of depressive symptoms is less frequent in patients under infliximab therapy (OR = 0.16; 95% CI: 0.02-0.97; p < 0.05). Conclusions: despite clinical remission, an important number of CD patients present with anxiety or depressive symptoms. Infliximab therapy in CD patients is associated to more anxiety but fewer depressive symptoms. CD patients in remission would probably benefit from psychological support(AU)

Effect of short-term exposure to air pollution and pollen on medical emergency calls: a case-crossover study in Spain.

BACKGROUND: A symmetric case-crossover design was used to analyse the short-term relationship between air pollution, pollen and emergency calls to medical services. METHODS: This study covered patients who made medical emergency calls in the City of Vigo (Spain) during the period 1996-1999. Morbidity data were obtained from the records of the 061 Medical Emergency Control Center, in its capacity as the body officially coordinating all medical emergencies by telephone. Air pollution data were furnished by the Vigo Municipal Air Pollution Surveillance Grid. Pollen levels were provided by the staff of the Spanish Aerobiology Network in Vigo. RESULTS: A rise of 10 microg/m(3) in ambient particulate levels led to the risk of medical emergency calls requesting attention increasing by: (i) 1.97% [95% confidence interval (95% CI): 1.83-2.11%] for circulatory causes on the same day; (ii) 1.95% (95% CI: 1.76-2.14%) for respiratory causes at 2 days and (iii) 1.34% (95% CI: 1.23-1.45%) for combined circulatory and respiratory causes on the same day. A number of pollens displayed a statistically significant relationship with emergency calls. No interaction was in evidence between pollens and air pollutants. CONCLUSIONS: While elevations in particulate air pollution increase medical emergency calls because of cardiac or respiratory causes or both combined, elevations in pollen levels increase medical emergency calls because of respiratory causes.

Daily rhythm of aggregation in the haematophagous bug Triatoma infestans (Heteroptera: Reduviidae).

Triatomine bugs show a temporal modulation of many activities. Here, we analyse the daily modulation of the aggregation behaviour of Triatoma infestans larvae and its chronobiological basis. In the laboratory, groups of six bugs were released over an experimental arena during six consecutive days, where their aggregation behaviour was quantified every hour. When submitted to a 12/12 h photoperiod (L/D), the larvae of T. infestans exhibited a cyclic pattern of aggregation with a 24 h period, evincing the existence of a daily rhythm of aggregation in this species. Bugs exhibited the maximum aggregation tendency at the end of the scotophase (7:00 h), moment in which they naturally search for refuges. The minimum aggregation (i.e. maximal dispersion) was observed during the last part of the photophase and beginning of the scotophase (15:00 to 1:00 h). This cyclic pattern disappeared when constant conditions of illumination (L/L) or darkness (D/D) were imposed to the bugs, suggesting the absence of an endogenous circadian control of this behaviour. Insects submitted to L/L and D/D photoperiods presented lower global levels of aggregation than those submitted to L/D conditions. The lack of an endogenous control and the relevance of light cycles as a synchronization signal are discussed as the temporal modulation of this behaviour might play an important role in the nocturnal habits of this species.

Daily rhythm of aggregation in the haematophagous bug Triatoma infestans (Heteroptera: Reduviidae)

Triatomine bugs show a temporal modulation of many activities. Here, we analyse the daily modulation of the aggregation behaviour of Triatoma infestans larvae and its chronobiological basis. In the laboratory, groups of six bugs were released over an experimental arena during six consecutive days, where their aggregation behaviour was quantified every hour. When submitted to a 12/12 h photoperiod (L/D), the larvae of T. infestans exhibited a cyclic pattern of aggregation with a 24 h period, evincing the existence of a daily rhythm of aggregation in this species. Bugs exhibited the maximum aggregation tendency at the end of the scotophase (7:00 h), moment in which they naturally search for refuges. The minimum aggregation (i.e. maximal dispersion) was observed during the last part of the photophase and beginning of the scotophase (15:00 to 1:00 h). This cyclic pattern disappeared when constant conditions of illumination (L/L) or darkness (D/D) were imposed to the bugs, suggesting the absence of an endogenous circadian control of this behaviour. Insects submitted to L/L and D/D photoperiods presented lower global levels of aggregation than those submitted to L/D conditions. The lack of an endogenous control and the relevance of light cycles as a synchronization signal are discussed as the temporal modulation of this behaviour might play an important role in the nocturnal habits of this species.

Factors underlying residential radon concentration: results from Galicia, Spain.

Radon causes lung cancer when inhaled for prolonged periods of time. A range of factors influence residential radon concentration and this study therefore sought to ascertain which dwelling-related factors exert an influence on radon levels. A cross-sectional study was conducted from 2001 to 2003 which analyzed 983 homes of as many subjects randomly selected from the 1991 census. Sampling was carried out by district and stratified by population density to ensure that more detectors were placed in the most heavily populated areas. Radon concentration and different dwelling characteristics were measured in each of the homes selected. Bivariate and multivariate analyses were performed to ascertain which factors influenced radon concentration. The geometric mean of radon concentration was 69.5 Bq/m3, and 21.3% of homes had concentrations above 148 Bq/m3. Factors shown to influence radon concentration in the bivariate analysis were: age of dwelling; interior building material; exterior building material; and storey on which the detector was placed. Explanatory variables in the multivariate analysis were: age of dwelling; number of storeys; distance off floor; and interior building material. The model was significant, but the variability explained was around 10%. These results highlight the fact that the study area is an area of high radon emission and that factors other than those directly related with the characteristics of the dwelling also influence radon concentration.

Antioxidant vitamins and risk of lung cancer.

Tobacco use is the leading risk factor for lung cancer, yet in addition to smoking habit, diet may also play a role in the disease's appearance. While there are reports to indicate that antioxidant vitamins and carotenoids may decrease the risk of lung cancer, results to date have been somewhat ambiguous. This review aimed to describe the results yielded by different studies, which have addressed antioxidant vitamin intake and lung cancer, and to indicate the mechanisms whereby these nutrients might be exercising their activity. Antioxidant vitamins were observed to have no clear protective effect, though there was some evidence pointing to a protective role for vitamins C and E. Vitamin A, in contrast, evinced no clear effect. Insofar as provitamin A carotenoids were concerned, lutein/zeaxanthin, lycopene and alpha-carotene displayed a certain protective trend, yet beta-carotene exhibited no protective effect whatsoever; and indeed, there was speculation as to whether it might even be pernicious in smokers. Beta-criptoxanthin, on the other hand, showed a more consistent protective effect. The study highlighted the need to conduct further research on smokers and non-smokers alike, and in particular, to investigate the effect, if any, on lung cancer of carotenoids or vitamins when ingested in differing dosages.