Psychosocial interventions reduce cortisol in breast cancer patients: systematic review and meta-analysis.

Introduction: Cancer initiation, progression and recurrence are intricate mechanisms that depend on various components: genetic, psychophysiological, or environmental. Exposure to chronic stress includes fear of recurrence that can affect biological processes that regulate immune and endocrine systems, increase cancer risk, and influence the survival rate. Previous studies show that psychological interventions might influence the level of cortisol that has been extensively used as a biomarker for measuring hypothalamic-pituitary-adrenal axis functioning and body's immunity response. This meta-analysis aimed to provide a quantitative scrutiny of the effect of certain types of psychosocial interventions on cortisol as a neuroendocrine biomarker in saliva or blood and might predict breast cancer (BC) progression. Methods: A literature search was performed in the following databases: PubMed, The Cohrane Library, Scopus, WOS, PsychInfo, Google Scholar, Ovid Science Direct. After methodical selection of originally generated 2.021 studies, the search yielded eight articles that met inclusion criteria. All these studies explored effects of psychosocial interventions that measured cortisol in total of 366 participants with BC, stages 0-IV, in randomized control trial or quasi experimental study design setting. We applied random effects model to conduct meta-analyses on the parameters of salivary and plasma cortisol and used PRISMA Guidelines as validated methodology of investigation to report the results. Results: Eight studies selected for meta-analysis have shown the reduction of cortisol level due to applied psychosocial intervention. The random effects model showed that interventions produced large effect sizes in reductions of cortisol in blood (Cohen's d = -1.82, 95% Confidence Interval (CI): -3.03, -0.60) and slightly less in saliva (d = -1.73, 95%CI: -2.68, -0.78) with an overall effect of d = -1.76 (95%CI: -2.46, -1.07). Conclusion: Our study concluded that certain types of psychosocial interventions reduce cortisol (indicator of chronic stress) in patients with BC. Application of specific psychosocial support as adjuvant non-invasive therapy for affected females with BC at all phases of treatment could contribute to more cost-effective health care.

Effect of Long-Term Use of Alcohol-Containing Handwashing Gels on the Biofilm-Forming Capacity of Staphylococcus epidermidis.

The spread of coronavirus disease 2019 (COVID-19) has promoted the use of hand sanitizers among the general population as recommended by health authorities. Alcohols, which are used in many hand sanitizers, have been shown to promotes the formation of biofilms by certain bacteria and to increase bacterial resistance to disinfection. We investigated the effect of continued use of alcohol-based gel hand sanitizer on biofilm formation by the Staphylococcus epidermidis resident strain isolated from the hands of health science students. Hand microbes were counted before and after handwashing, and the ability to produce biofilms was investigated. We found that 179 (84.8%) strains of S. epidermidis isolated from hands had the ability to form biofilm (biofilm-positive strains) in an alcohol-free culture medium. Furthermore, the presence of alcohol in the culture medium induced biofilm formation in 13 (40.6%) of the biofilm-negative strains and increased biofilm production in 111 (76.6%) strains, which were classified as low-grade biofilm-producing. Based on our findings, there is no clear evidence that the continued use of alcohol-based gels results in the selection of strains with the capacity to form biofilms. However, other disinfectant formulations that are more commonly used in clinical settings, such as alcohol-based hand-rub solutions, should be tested for their long-term effects.

Alzheimer's Disease, Mild Cognitive Impairment and Mediterranean Diet. A Systematic Review and Dose-Response Meta-Analysis.

Alzheimer's Disease (AD) is a pathology with increasing prevalence in the context of a more long-lived society and it is the first cause of dementia in western countries. It is important to investigate factors that can be protective and may influence its development, in order to act on them trying to reduce AD incidence and its progression. The aim of this study was to conduct a systematic review and meta-analysis to determine the effects of a higher adherence to Mediterranean diet (MD) on Mild Cognitive Impairment (MCI) and AD. A literature search in PubMed, The Cochrane Library Plus and Scopus was conducted, selecting articles that analyzed associations between MD adherence and AD biomarkers (Volumetry assessed by MRI and betamiloide and Tau deposits by PET); cognitive performance in patients at risk or presenting MCI and AD; and incidence or progression from MCI to AD. Out of the 589 studies screened, 22 studies met eligibility criteria for the systematic review and qualitative synthesis. Finally, 11 studies were included in the meta-analysis (12,458 participants). Higher adherence to MD was associated with a significantly lower risk of MCI (RR = 0.91, 95%CI = 0.85-0.97) and lower risk of AD (RR = 0.89, 95% CI = 0.84-0.93). Our results enhance the importance of taking health-promoting lifestyle measures like following Mediterranean dietary patterns in order to reduce AD risk.

Prevalence of Chronic Diseases among International Travelers Seeking Pretravel Medical Advice in 2018 at Malaga, Spain.

Travelers with preexisting diseases or chronic conditions may be more susceptible to travel-related health risks. They may, therefore, require more attention from specialist travel medicine providers. Our objective was to examine a group of international travelers in Malaga, Spain, quantify the proportion of travelers suffering from chronic conditions, and understand the characteristics of this group. A representative sample of travelers requesting pretravel medical advice at one travel clinic were asked about their preexisting chronic conditions and any immunosuppression. Additional demographic variables were used in an analysis of bivariate correlations. We used a binary logistic regression analysis to identify relationships between independent variables (age, gender, type of trip, travel duration, and destination) and the presence or absence of chronic conditions in travelers. Of the sample of 1,196 travelers, 258 (21.6%) reported having preexisting chronic conditions and 72 (6%) had two or more chronic conditions. Twenty-four of the travelers with chronic conditions (9%) were immunocompromised because of the disease or treatment. The two most common chronic conditions were cardiovascular disease and chronic respiratory conditions (36.8% and 17.1%, respectively). The chronic condition increased by 6.7% for every year of increased age. Travelers with chronic conditions are older, travel mainly to visit friends and relatives, and take shorter trips. More than half of travelers visiting (55.8%) needed more attention from the travel medicine practitioner because of their preexisting chronic conditions, age, or type of travel. Surveillance data based on the population of people traveling would be helpful to provide better advice to travelers.

Trends in the travelers' demand for pre-travel medical advice at a Spanish International Vaccination Center between 2000 and 2017.

Crises and disasters affect the numbers of people traveling either for tourism or other reasons. Many studies have been published on the effects of such events on travel, especially on tourism, and based on the arrivals or departures of travelers to or from countries. Our aim was to assess the influence of these events on the demand for pre-travel medical consultation in an International Vaccination Centre (IVC). Data on 94683 international travelers who visited 113529 international destinations attended at the IVC of Malaga (Spain) during 2000-2017 were studied. A descriptive and time series analyses was conducted. The demand to IVC was 3.47 times higher in 2017 than in 2000. The increase has not been the same for all destinations: Travel to South-East Asia and Western Pacific World Health Organization (WHO) regions has multiplied by 10, while in the same period, Africa WHO region has declined from 36% to 20% of total demand. Thailand, India and Brazil were the countries with the highest demand (21% of all pre-travel consultations). We found out three periods, concurrent with some socioeconomic or health events, in which the number of travellers attend decline with respect to the previous years, or the growth was very slow. Growth in the demand for pre-travel medical advice in parallel with a foreseeable increase in the number of travelers is expected. Pre-travel medical services must be adapted to this increase. This study of the trend of demand for pre-travel medical information should new related problems to travel to be identified and quantified, and should assist improvement of policies and programs aimed at care of travelers.

Carbapenem resistance in Acinetobacter baumannii is associated with enhanced survival on hospital fabrics.

The success of Acinetobacter baumannii as an emerging organism is probably linked to its high resistance to adverse environmental conditions. This study was conducted to analyze the association between some factors that may favor the dissemination of A. baumannii clinical isolates. A total of 47 clinical strains of A. baumannii were evaluated to carbapenem, the ability to produce biofilm, the susceptibility to some antiseptics, and the survival time on cotton fabrics. Most of the isolates were resistant to carbapenem (72.3%), produced biofilm (83%), and survived more than 7 (51%) days on fabrics. A significant association between decreased susceptibility to antiseptics containing chlorhexidine or triclosan and carbapenem resistance and survival on fabrics could be observed. The resistance to carbapenem was significantly associated with survival on fabric, but not with the ability to form biofilm. The survival of the isolates on fabric was not associated with the ability to produce biofilms. Characteristics, such as resistance to antibiotics, ability to form biofilm, and survival on dry surfaces, probably contribute to the proliferation of this organism when selected in the hospital environment and can partly explain its success as responsible for nosocomial infection.

The Maritime Declaration of Health (MDH) as a tool to detect maritime traffic-related health risks: analysis of MDH forms submitted to Spanish ports, October 2014 to March 2015.

The international maritime traffic of people and goods has often contributed to the spread of pathogens affecting public health. The Maritime Declaration of Health (MDH), according to the International Health Regulations (IHR) (2005), is a document containing data related to the state of health on board a ship during passage and on arrival at port. It is a useful tool for early detection of public health risks. The main objective of our study was to evaluate compliance with the model provided in the IHR, focusing on the format and degree of completion of MDH forms received at Spanish ports. We reviewed the content of 802 MDH forms submitted to nine Spanish ports between October 2014 and March 2015. Study results show that 22% of MDH forms presented did not comply with the recommended model and 39% were incomplete. The proportion of cargo ships with correct and complete MDH forms was lower than passenger ships; thus, the nine health questions were answered less frequently by cargo ships than passenger ships (63% vs 90%, p value < 0.001). The appropriate demand and usage of MDH forms by competent authorities should improve the quality of the document as a tool and improve risk assessment.

Fluorescence assay for evaluating microbicidal activity of hand antiseptics.

We developed a fluorescent ß-d-glucuronidase activity (BGA)-based assay for detecting and quantifying Escherichia coli in samples to assess the biocide efficacy of hand antiseptics. The fluorescence level is proportional to the number of viable E. coli organisms present. We compared our assay results to those of the E. coli plate count method specified by the European standard for testing hygienic hand rub disinfectant products (EN1500). The plate count method requires excessive handling and materials and is not valid if the number of organisms per plate is too low or high for counting in many of the samples. We optimized the fluorescent assay based on the cleavage of 4-methylumbelliferyl-ß-d-glucuronide by adding 4-nitrophenyl-ß-d-glucuronide, a nonfluorogenic BGA substrate, to induce glucuronidase activity and reduce assay time. Furthermore, our method can be automated and eliminates the need for multiple dilutions. Fluorescence was temporally monitored, and the time required to reach a specific value of fluorescence was correlated with the initial number of viable E. coli organisms on the samples. There was a positive correlation (P < 0.05) with a high correlation coefficient (R(2) = 0.82) between the E. coli counts by plate count and fluorescence methods. Reported effects in fluorescent BGA were compared to the EN1500 plate count method with five hand disinfectants. We found our method more advantageous, because it was as sensitive as the EN1500 method, requires less time to complete, and is less expensive and less laborious than conventional plating techniques.

Persistence of nosocomial bacteria on 2 biocidal fabrics based on silver under conditions of high relative humidity.

BACKGROUND: The survival of pathogenic microorganism on fabrics in the health care environment has a important role in nosocomial infections. The use of biocidal fabrics and surfaces could reduce the prevalence of the microorganisms in the hospital environment. METHODS: In this study, the persistence of nosocomial bacteria on 2 fabrics containing biocidal fibers (BF) in the long term following desiccation and subsequent storage was examined at 40% and 90% relative humidity (RH). RESULTS: Very few strains survived more than 7 days at 40% RH on fabrics containing 67% BF, and only strains of Acinetobacter baumanii and Pseudomonas aeruginosa survived on fabric containing 100% BF. None of the strains tested survived 14 days on the 2 fabrics, 67% or 100% BF, under these environmental conditions. In contrast, at higher RH (∼90%), most of the strains tested showed prolonged survival on both fabrics, and all strains of Klebsiella pneumoniae, Enterobacter aerogenes, and A baumannii survived for more than 14 days; however, in a Petri dish, most of the microorganisms tested showed a higher survival even at 28 days. The gram-positive cocci and A baumannii were the most persistent bacteria on the Petri dish. CONCLUSIONS: This study emphasizes the effect of RH on the survival of nosocomial bacteria on 2 commercially available fabrics containing biocide. Evidence of the clinical efficacy of these BF-containing fabrics is lacking.

Commercializing diarrhea vaccines for travelers.

Continued growth in international travel and forecasts for a great increase in the number of people who travel from industrialized to emerging and developing countries make it necessary to develop and improve the capacity to provide health protection to travelers. Measures available to prevent some diseases include a currently limited number of marketed vaccines which represent extremely useful tools to protect travelers. Travelers very often experience diarrheal and gastrointestinal diseases for which some vaccines are available. Use of these vaccines should be evaluated based on traveler and travel destination and characteristics. Vaccines available include those against cholera, typhoid fever, hepatitis A, hepatitis E (only available in China), and rotavirus. The aim of this review is to provide an updated summary about each of the abovementioned vaccines that may be useful for making decisions regarding their use and assessing their indications in recommendations for travelers.

Effectiveness of the WC/rBS oral cholera vaccine in the prevention of traveler's diarrhea: a prospective cohort study.

OBJECTIVE: Traveler's diarrhea (TD) is the most frequent disease among people from industrialized countries who travel to less developed ones, especially sub-Saharan Africa, Southern Asia and South America. The most common bacteria causing TD is enterotoxigenic Escherichia coli (ETEC). The WC/rBS cholera vaccine (Dukoral) has been shown to induce cross-protection against ETEC by means of the B subunit of the cholera toxin. The aim of the study was to evaluate the effectiveness of the WC/rBS cholera vaccine in preventing TD. METHODS: Between May 1 and September 30 (2007), people seeking pre-travel advice in ten Spanish international vaccination centers were included in a prospective cohort study of travelers to cholera risk countries. The incidence rates of TD were adjusted for variables whose frequencies were statistically different (entry point 0.10) between the vaccinated and non-vaccinated cohorts. FINDINGS: The vaccinated cohort (n = 544 travelers) included people vaccinated with the WC/rBS cholera vaccine, and the non-vaccinated cohort (n = 530 travelers) by people not vaccinated. The cumulative incidence rate of TD was 1.69 in vaccinated and 2.14 in non-vaccinated subjects. The adjusted relative risk of TD in vaccinated travelers was 0.72 (95% CI: 0.58-0.88) and the adjusted vaccination effectiveness was 28% (95% CI: 12-42). CONCLUSIONS: The WC/rBS cholera vaccine prevents TD in 2 out of 7 travelers (preventive fraction: 28%). The number needed to vaccinate (NNV) to prevent 1 case of TD is 10.

Vaccination strategies to combat an infectious globe: oral cholera vaccines.

Cholera is a substantial health burden in many countries in Africa and Asia, where it is endemic. It is as well responsible for ongoing epidemics in sub-Saharan Africa which are becoming greater in terms of frequency, extension, and duration. Given the availability of two oral cholera vaccines and the new data on their efficacy, field effectiveness, feasibility, and acceptance in cholera-affected populations and in travelers, these vaccines should be used in endemic areas, in travelers for these areas and should be considered in areas at risk for outbreaks. The two vaccines currently available in worldwide are: (1) The killed oral vaccine (Dukoral, licensed by SBL-Sweden to Crucell-Holland) is recommended since 1999 by WHO and consists of a mixture of four preparations of heat or formalin killed whole cell Vibrio cholera O1 (Inaba and Ogaba serotypes, and classical and El Tor biotypes) that are then added with purified recombinant cholera toxin (CT) B subunit. Because CT cross-reacts with Escherichia coli LT the vaccine also provides short-term protection against ETEC (enterotoxigenic E. coli) which is of added benefit for travelers. It is available in more than 60 countries. (2) A bivalent O1 and O139 whole cell oral vaccine without CT B subunit (Shanchol) has been lately developed in Vietnam (licensed by VaBiotech-Viet Nam to Shantha Biotechnics-India. It is available in India and Indonesia. A structured search of papers in PubMed and reports on cholera vaccines by WHO and CDC, as well as critical reading and synthesis of the information was accomplished. Inclusion criteria were defined according to reports quality and relevance.

Effectiveness and economic analysis of the whole cell/recombinant B subunit (WC/rbs) inactivated oral cholera vaccine in the prevention of traveller's diarrhoea.

BACKGROUND: Nowadays there is a debate about the indication of the oral whole-cell/recombinant B-subunit cholera vaccine (WC/rBS) in traveller's diarrhoea. However, a cost-benefit analysis based on real data has not been published. METHODS: A cost-effectiveness and cost-benefit study of the oral cholera vaccine (WC/rBS), Dukoral for the prevention of traveller's diarrhoea (TD) was performed in subjects travelling to cholera risk areas. The effectiveness of WC/rBS vaccine in the prevention of TD was analyzed in 362 travellers attending two International Vaccination Centres in Spain between May and September 2005. RESULTS: The overall vaccine efficacy against TD was 42,6%. Direct healthcare-related costs as well as indirect costs (lost vacation days) subsequent to the disease were considered. Preventive vaccination against TD resulted in a mean saving of 79.26 euro per traveller. CONCLUSION: According to the cost-benefit analysis performed, the recommendation for WC/rBS vaccination in subjects travelling to zones at risk of TD is beneficial for the traveller, regardless of trip duration and visited continent.

Fluorescent assay based on resazurin for detection of activity of disinfectants against bacterial biofilm.

A new, quick method, using the resazurin dye test as a bacterial respiration indicator, has been developed to assay the antibacterial activity of various substances used as disinfectants against bacterial biofilm growth on clinical devices. Resazurin was used to measure the presence of active biofilm bacteria, after adding disinfectant, in relation to a standard curve generated from inocula in suspension of the same organism used to grow the biofilm. The biofilm was quantified indirectly by measuring the fluorescent, water-soluble resorufin product produced when resazurin is reduced by reactions associated with respiration. Four products used as disinfectants and the biofilm growth of five bacterial species on carriers made of materials commonly found in clinical devices were studied. Under test conditions, chlorhexidine, NaOCl, ethanol, and Perasafe at concentrations of 0.2, 0.01, 350, and 0.16 mg/ml, respectively, all produced 5-log reductions in biofilm cell numbers on the three different carriers. The redox-driven test depends on bacterial catabolism, for which reason resazurin reduction produces an analytic signal of the bacterial activity in whole cells, and therefore could be used for determining disinfectant efficacy in an assay based on the metabolic activity of microorganisms grown as biofilm or in suspension.

La continuidad interepisodios en atención primaria de salud : Propuesta de un indicador / Interepisodic continuity in primary health care : Proposal for an indicator

El objetivo del trabajo fue valorar la calidad de los registros incluidos en la historia personal y elaborar un indicador de continuidad interepisodios basado en la información de esos registros. El estudio fue descriptivo. En su diseño y análisis participaron especialistas de salud pública del Departamento de Medicina Preventiva de la Universidad de Granada, España, y en el trabajo de campo, especialistas de medicina familiar y comunitaria del Centro de Salud Zaidín-Sur de Granada, lugar donde se llevó a cabo la investigación entre abril y diciembre de 1989. Para efectuar el estudio, se analizaron 1 581 historias personales. El registro mejor cumplimentado fue el de los antecedentes personales (37 porciento de las historias personales evaluadas) y las historias mejor complimentadas, las pediátricas, las de las mujeres y las de las personas que participaron en programas organizados por el centro de salud. El grado de cumplimentación de los registros fue bajo. Según el indicador elaborado, solo el 16 porciento de las historias del Centro contienen información suficiente que permita la continuidad asistencial. Se recomienda crear sistemas de registros de datos sencillos y educar a los médicos de atención primaria en la recogida de datos esenciales

La continuidad interepisodios en atención primaria de salud: Propuesta de un indicador / Interepisodic continuity in primary health care: Proposal for an indicator

El objetivo del trabajo fue valorar la calidad de los registros incluidos en la historia personal y elaborar un indicador de continuidad interepisodios basado en la informacion de esos registros. El estudio fue descriptivo. En su diseno y analisis participaron especialistas de salud pública del Departamento de Medicina Preventiva de la Universidad de Granada, Espana, y en el trabajo de campo, especialistas de medicina familiar y comunitaria del Centro de Salud Zaidin-Sur de Granada, lugar donde se llevo a cabo la investigación entre abril y diciembre de 1989. Para efectuar el estudio, se analizaron 1 581 historias personales. El registro mejor cumplimentado fue el de los antecedentes personales (37 porciento de las historias personales evaluadas) y las historias mejor complimentadas, las pediatricas, las de las mujeres y las de las personas que participaron en programas organizados por el centro de salud. El grado de cumplimentacion de los registros fue bajo. Segun el indicador elaborado, solo el 16 porciento de las historias del Centro contienen informacion suficiente que permita la continuidad asistencial. Se recomienda crear sistemas de registros de datos sencillos y educar a los medicos de atención primaria en la recogida de datos esenciales

La continuidad interepisodios en atención primaria de salud : Propuesta de un indicador / Interepisodic continuity in primary health care : Proposal for an indicator

El objetivo del trabajo fue valorar la calidad de los registros incluidos en la historia personal y elaborar un indicador de continuidad interepisodios basado en la información de esos registros. El estudio fue descriptivo. En su diseño y análisis participaron especialistas de salud pública del Departamento de Medicina Preventiva de la Universidad de Granada, España, y en el trabajo de campo, especialistas de medicina familiar y comunitaria del Centro de Salud Zaidín-Sur de Granada, lugar donde se llevó a cabo la investigación entre abril y diciembre de 1989. Para efectuar el estudio, se analizaron 1 581 historias personales. El registro mejor cumplimentado fue el de los antecedentes personales (37 porciento de las historias personales evaluadas) y las historias mejor complimentadas, las pediátricas, las de las mujeres y las de las personas que participaron en programas organizados por el centro de salud. El grado de cumplimentación de los registros fue bajo. Según el indicador elaborado, solo el 16 porciento de las historias del Centro contienen información suficiente que permita la continuidad asistencial. Se recomienda crear sistemas de registros de datos sencillos y educar a los médicos de atención primaria en la recogida de datos esenciales