bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in consumption of sugar and sweeteners in two neighbor countries: Lithuania and Poland
Authors: Austys D , Stukas R , Dobrovolskij V , Arlauskas R
Published: October 2020

Background

In connection with attempts to reduce consumption of added sugar, consumption of non-nutritive (or low caloric) sweeteners (NNS) is likely to increse in many countries. In addition to variety of NNS, limited evidence on public health effects related to NNS exist. Thus, it remains important to monitor consumption of added sugar and sweeteners in our societies. As Lithuania and Poland are neighbor countries with similar culture and nutritional habits, the objective of this study was to compare consumption of sweeteners among adults in Lithuania and Poland.

Methods

A representative sample of Lithuanian population of adults aged 18 to 75 years was formed. A total number of 1008 residents from Lithuania participated. Distribution of them by answers about consumption of added sugar and sweeteners was assessed with respect to results of the survey conducted in central part of Poland where a group of 2000 adult respondents was investigated.

Results

Majority of respondents in both countries declared consumption of added sugar: 79.3% and 87.4% of Lithuanian and Polish respondents, respectively (p-value less than 0.05). Apart from sugar, majority of the respondents in Lithuania declared consumption of honey or fructose (respectively, 78.1% and 43.4%), consumption of other sweeteners such as saccharin, stevia, corn syrup, aspartame and sucralose were less prevalent (respectively, 30.9%, 18.2%, 9.5%, 9.0%, 3.4%). In Poland, 41.8% of respondents declared consumption of products containing stevia. Distribution of Poles by answers to the question which sweetener they used most often was 26.6%, 23.6%, 15.6%, 12.3% for stevia, xylitol, aspartame and fructose, respectively. Honey, acesulfame K, thaumatin and other substances were used by a lower percentage of Polish respondents.

Conclusions

Despite cultural similarities consumption of added sugar and sweeteners among adults differed significantly in two neighbor counties: Lithuania and Poland.

Key messages

In comparison to Lithuania, consumption of added sugar, xylitol and natural non-nutritive but intense sweetener stevia was more prevalent in Poland. In comparison to Poland, consumption of added sugar was less prevalent, but non-intense and high in calories sweeteners were more prevalent in Lithuania.
Socio-economically deprived families’ routes to family-based addiction prevention services
Authors: Pfister A , Wyss S , Koschmieder N
Published: October 2020

Background

Families living in poor socio-economic circumstances, already confronted with social and health inequalities, are often not reached by family-based addiction prevention programmes. Besides quantitative models and health literacy approaches, qualitative research is lacking that could shed light on the exact circumstances and processes that lead to hindered addiction prevention service uptake by these families. Drawing on the concept of 'candidacy', we aimed to reconstruct how socio-economically deprived parents and their (pre-)adolescent children in German-speaking Switzerland identify their candidacy for family-based addiction prevention services.

Methods

Following grounded theory, we collected and analysed data in an iterative-cyclical manner using theoretical sampling and theoretical coding techniques. Sixteen families with children aged 10-14 years were interviewed in depth (parent/s and one child separately). All but one family lived below the at-risk-of poverty threshold.

Results

Families' modes of recognising and handling problems in everyday life were found to be core phenomena that structure the process towards (non-)identification of candidacy for family-based addiction prevention services. Further, thematic relevance of addiction prevention, past experience with offers, integration in systems of assistance (social welfare, etc.), strategies to protect the family, and parents' search movements for support were important for families' identification of candidacy.

Conclusions

Socio-economically deprived families are not a homogeneous group. They differ in modes of problem construction and handling in everyday life; this differently opens up or closes routes to family-based addiction prevention services. Policy and practice should build on a bundle of diverse strategies for outreach to these vulnerable families.

Key messages

Our qualitative study adds scientific knowledge to a better understanding of socio-economically deprived families’ complex routes to family-based addiction prevention services. Results provide evidence that policy and practice should build on a bundle of diverse strategies to reach these vulnerable families. Equity in access to services can thus be improved.
Impact of ferric carboxymaltose in patient blood management in Portuguese hospitals
Authors: Lucas J , Sousa P , Sequeira R , Isoppo C , Quinaz Romana G , Carvalho D , Fernandes A Campos
Published: October 2020

Background

The use of transfusions leads to excessive blood consumption, implying risks such as infections and immunological reactions, so it should be used only when strictly necessary. Patient Blood Management (PBM) aims to minimize the use of allogeneic blood and improve clinical outcomes, with better cost-effectiveness, using three essential points: improving hematopoiesis, minimize blood loss in and optimize the hemoglobin reserves of each patient. The aim of this work is to assess the preoperative haemoglobin optimization using ferric carboxymaltose as part of PBM implementation, in elective orthopaedic, cardiac and colorectal surgery in Portuguese hospitals.

Methods

This is an observational study materialized in a retrospective and multicenter cohort with data collection from medical records. The population and sample will be patients over 18 years from elective orthopaedic, cardiac and colorectal surgeries, treated according with local standards before PBM implementation were assigned to the pre-PBM cohort and patients after PBM implementation with ferric carboxymaltose to preoperative haemoglobin optimization to the PBM cohort. The criteria for selecting hospitals will be the implementation of PBM during the study period.

Expected Results

Based on a previous review, it is expected that the results of the use of ferric carboxymaltose to correct iron deficiency anaemia for preoperative haemoglobin optimization will contribute positively to reducing the number of transfusions, the length of hospital stays and will have a direct impact on economic results.

Conclusions

The use of ferric carboxymaltose and other ferric compounds, as part of PBM program, has demonstrated a positive impact on patients' outcomes (morbility and mortality), adverse events and on economic results. This study might show that clinical guidelines and programs like PBM are a major contribution not just for hemovigilance and blood safety but also for patient safety and health quality.

Key messages

This work is focused on Portuguese hospitals and aims to assess the impact of ferric carboxymaltose and its benefit on PBM strategy. Specially this study intends to conduct the assessment on health outcomes and costs.
Age-appropriate healthy living - research examples from German and Italy
Authors: Mairhofer S , Teti A
Published: October 2020

Housing and social participation have a significant influence on the quality of life and independence of elderly people. The importance of the living situation increases with age, because spend more time in the immediate living environment. Age-appropriate housing and life situations are therefore a prerequisite for reducing social and health inequalities in older life. Two research projects in the field of healthy ageing will be presented and some of the joint results will be discussed.

The project HOME Housing Opportunities & Mobility in the Elderly (North Germany) examines willingness to move in favor of age-appropriate living environments versus Aging in Place. The majority of the respondents were stayers. Age, gender, education and income are predictors for the willingness to move. In data analisis movers show a lower health-related quality of life than stayers.

As a second project a participative research project with elderly people, the 'young old', in South Tyrol (North Italy) will be presented. Elderly people are often associated with need for help, which does not correspond to the current diversity, especially for the 'young old'. The research results show the necessity of sensitization for health promotion and health (in)equity and the importance of professional community work for healthy ageing. Participatory research with elderly people seems to be a promising approach to ensure sustainability, to increase the quality of research and to stimulate transformation in science, politics, practice and the population.

Key messages

Housing and social participation have a significant influence on healthy aging. Health promotion with the young old in rural areas should become more attention.
Tuberous Sclerosis: a disease systematically monitored by the Rare Diseases Registries in Spain
Authors: Cavero Carbonell C , De La Natividad Palomares M , Botella P , Zurriaga O , Guardiola Vilarroig S
Published: October 2020

Background

Tuberous Sclerosis (TS) is a rare genetic disease that causes hamartomas and neuropsychiatric disorders.

Objective

to determine the prevalence and its evolution in the Valencian Region in the period 2010-2017.

Methods

Through the information sources used by the Rare Disease Population-based Registry of the Valencian Region, possible cases of TS were identified with codes 759.5 (International Classification of Diseases -ICD- 9th Revision Clinical Modification version) and Q85.1 (ICD10th Revision, ICD10th Spanish version and ICD10th British Paediatric Association version). Prevalence and mortality rates per year were obtained (by the direct method, using the European Standard Population 2013) and a descriptive analysis of the sociodemographic variables of the confirmed cases was performed.

Results

158 possible cases of TS were obtained, which 139 were confirmed (54.7% women and 45.3% men). The lowest prevalence was in the year 2010 with 16.0/1,000,000 (95%CI: 12.7-20.0) and the highest in 2017 with 26.5/1,000,000 (95%CI: 22.0-31.7), identifying an increasing trend along the period. Prevalence in women was higher than in men throughout the period, being in the year 2017 in women (30.3/1,000,000 (95%CI: 23.5-38.4)) and in men (22.7/1,000,000 (95%CI: 17.0-30.0)).The province with the highest prevalence was Castellón (in the north), 34.8/1,000,000 (95%CI: 20.9-55.0) in the year 2017. The median age at diagnosis was 7.2 years. The mortality rate over the period was 0.4/1,000,000 (95%CI: 0.2-0.7), being higher in men (0.5/1,000,000 (95%CI: 0.2-1.0)) than in women (0.3/1,000,000 (95%CI: 0.1-0.7)).

Conclusions

The prevalence obtained is lower than that estimated by Orphanet, the rare diseases reference portal, (100-500/1,000,000), being in this study the first time it is identified in the Valencian Region. The increasing trend in prevalence may be due to the low mortality of TS and it is being chronic, as well as a good healthcare management of the disease.

Key messages

The Tuberous Sclerosis is one of the 20 rare diseases systematically monitored by the Rare Disease IPopulation-based Registry of the Valencian Region and in the Spanish Rare Disease Registry. The obtained prevalence and mortality could be used to increase the knowledge of the Tuberous Sclerosis and as a basis for health programs and research.
Adequacy of hospitals in Rome to an unconventional event (CBRNe): TTX simulation and HTA
Authors: Rosiello F , Desideri E , Vinci A , Zelinotti L
Published: October 2020

Background

Rome hosts thousands of sensible targets. Healthcare reaction has been guaranteed by 6 advanced Emergency Departments (EDs) and 7 basic ones. Everyday Rome hosts 6 millions of people/die, ± 2 million in particular occasions. About National Stockpile Antidotes (SNA), Rome hosts 3 warehouses. In case of events, stockpiles are activated with a long-time call; then stockpiles are charged in delivering trucks.

Methods

Study analyzes PEIMAF (State of emergency plans for massive influx of injures) of advanced EDs in Rome and their adequacy in a possible CBRNe attack. Hypothesis of C/N attack on Saint Peter's Square during Angelus on Wednesday (at 12.00 AM) or E attack in Trastevere on Saturday (at 9.00 PM). Analysis of activation of SNA and travel times between SNA warehouse and EDs. Comparison with French EDs during Paris attacks.

Results

EDs are chronically undermanned in ordinary conditions already, and would have issues in hosting a very large number of critical patients all at once. Some hospitals do not inform their workers about PEIMAF or they do not consider CBRNe emergencies in their PEIMAF, and even if it has been considered, hardly any simulation/exercitation is ever performed. Moreover, news of the CBRNe attack may not reach immediately the healthcare personal already at work in EDs; this is extremely problematic since they could be at major risk of contamination in case of CBRNe attacks. Furthermore, without a standardize protocol active in the whole city, no cross-hospital organization can be performed.

Conclusions

All data point towards the weakness and fragmentation of actual organizative system. Time of activation and charging are crucials for first aid efficacy and efficiency; a smart call system can reduce the activation time of SNA. A better organization of SNA in major Rome hospitals can reduce delivering time and help save more lives.

Key messages

Basing on our experience, we can say that all the resilience health strategies, especially when connected to terrorist/CBRNe events, should be managed by the National Government. the capability to face up these kind of events should be up to time-dependent networks, especially considering those hospitals with medium-high intensity healthcare.
Countering COVID-19: A European survey on acceptability of and commitment to preventive measures
Authors: Sabat I , Elsem Varghese N , Neuman-Böhme S , Pita Barros P , Brouwer W , van Exel J , Schreyögg J , Stargardt T
Published: October 2020

To understand the public sentiment toward the measures used by policymakers for COVID-19 containment, a survey among representative samples of the population in seven European countries was carried out in the first two weeks of April 2020. The study addressed people's support for containment policies, worries about COVID-19 consequences, and trust in sources of information. Citizens were overall satisfied with their government's response to the pandemic; however, the extent of approval differed across countries and policy measures. A north-south divide in public opinion was noticeable across the European states. It was particularly pronounced for intrusive policy measures, such as mobile data use for movement tracking, economic concerns, and trust in the information from the national government. Considerable differences in people's attitudes were noticed within countries, especially across individual regions and age groups. The findings suggest that the epidemic acts as a stressor, causing health and economic anxieties even in households that were not directly affected by the virus. At the same time, the burden of stress was unequally distributed across regions and age groups. Based on the data collected, we draw lessons from the containment stage and identify several insights that can facilitate the design of lockdown exit strategies and future containment policies so that a high level of compliance can be expected.

Key messages

Citizens were overall satisfied with their government's response to the COVID-19 outbreak. A north-south pattern in public opinion was observed across the European states.
Support to academic education in view of the consolidation of the universal health system in Brazil
Authors: Ribeiro Bizuti M , Eneida de Almeida M , Roberto Barbato P , Savi Geremia D , Inácio Andrioli A , Rossetto M
Published: October 2020

The Federal University of Fronteira Sul (UFFS) is the first higher-level institution in Brazil to emerge from the processes of social and political participation of social movements and networks of civil associations. Its objective is to ensure access to higher education for the entire population of the region named Fronteira Sul, historically excluded, in order to contribute to the resolution of local and regional problems. Its public and popular character is structural, with a historical aspect of a struggle of more than forty years of various social movements for the federal university, in defense of society and its ideas: democracy, equality, respect for diversity, citizenship, right to free public education, sustainability and social justice. The center of political action at UFFS is in direction of universal human rights, equality and the reduction of social inequality, being one of the structuring axes, the strengthening of Policies and Practices for the Promotion of Public Health, since society has presented its demands guided by the concerns with health care in the region. CEBES is a national entity created in 1976, whose historical mission is the struggle for the democratization of society and the defense of social rights, in particular the universal right to health. As a supraparty plural space, it brings together activists, leaders, researchers, teachers, professionals and students, together with other entities in the fight for health. It was responsible for founding the Brazilian Sanitary Reform Movement, by producing and disseminating information, knowledge and critical analyzes aimed at strengthening subjects through the expansion of critical thinking and health awareness, essential elements for political practice and action. The Chapecó nucleus was created to contribute to academic education in the health field by respecting the founding principles of social justice that are in the Federal Constitution of 1988, universality, equity and integrality.

Key messages

Present the Chapecó nucleus created to contribute to academic education in the health field, while respecting the founding principles of social justice and democracy. To present UFFS as an important institution for universal human rights and its commitment to the reduction of social inequality in the strengthening of Public Health Promotion Policies and Practices.
Prevalence of burnout among operating room professionals in the district of Sousse
Authors: Aouicha W , Tlili M A , Sahli J , Hlaoui A , Chniti A , Chelbi S , Said Latiri H , Ajmi T , Ben Rejeb M , Mallouli M
Published: October 2020

Background

The Operating Room (OR) is a complex, stressful and potentially dangerous environment. In fact, the professionals practicing in these units suffer from a continuous exposure to multiple stressors that can, eventually, lead to a state of Burnout. The aim of this study was to estimate the prevalence of burnout in the OR and to determine the possible associated factors with this syndrome.

Methods

This is a cross-sectional study that was carried out among surgeons and paramedical staff in twelve ORs in the teaching hospitals in Sousse, Tunisia, using an auto-administred questionnaire. It was spread over a 4-month period; from January 1st to April 30th 2018. Data was entered and analyzed using SPSS 20.0. Also, all confidentiality and anonymity measures were respected.

Results

A total of 225 OR professionals participated with a response rate of 76.8%. The medical profession was represented by 46 surgeons and the female gender, overall, was predominant and accounted for 60.9% of the participants. Our study showed that the prevalence of burnout was very high (82.6%). Actually, more than half of our population (65.3%) had a high level of emotional exhaustion, 34.2% had a high level of depersonalization and 40.4% represented a high level of low self efficacy. In fact, several factors have been found to promote the occurrence of the burnout syndrome. Indeed, there was a link between burnout and dissatisfaction of work conditions (P = 0.001), high workload (P = 0.001) and altered relationship with the hierarchical superiors (P = 10-6).

Conclusions

In light of these results, the burnout syndrome is a reality in the ORs. It represents a public health problem whose consequences do not only affect the health of caregivers but, also, the quality of care provided. Thus, it is essential to plan awareness-raising and prevention actions to combat this phenomenon.

Key messages

A high prevalence of Burnout was recorded among operating rooms professionals. Dissatisfaction and an altered relationship with superiors were found to be associated with the occurrence of Burnout.
Both soap and ozone more effective and better tolerated than alcohol hand disinfection?
Authors: Breidablik H , Johannessen L , Andersen J , Lysebo D , Skare Å , Kleiven O T
Published: October 2020

Background

Preventing the transfer of virulent microorganisms is an essential part of infection control programs and clinical practice. Hand disinfection using alcohol from dispensers has become a standard practice worldwide; however, consequent skin irritation is frequently reported. Thus, alternative methods for hand sanitization are needed.

Objectives

We used a modified European Standard procedure (EN 1500:2013) with the aim of comparing the efficiency of alcohol, ozonated water and soap for eradicating transient Escherichia coli from artificially contaminated hands.

Methods

We applied a crossover design for testing alcohol and ozone (20 participants/product; 40 participants in total). The participants were mostly nursing students. We have merged the results from two separate crossover studies with altogether 35 participants, and also included 20 non-crossover participants for soap washing.

Results

Both ozonated tap water and soap & water were more effective than alcohol disinfection; and washing hands with soap the most effective. In some participants, disinfection with alcohol seemed to fail at eradicating transient E. coli from the hands, particularly from one side. The pre-test CFU/mL values were ≥30,000 in 52 of 55 participants. After disinfection of both the hands with 85% alcohol, 0.8 ppm ozonated tap water and soap & water, the mean/median (range) values were 2330/300 (14,000), 538/250 (3450) and 98/50 (450), respectively. The majority of the participants (66%) stated that they would prefer using ozonated tap water if the disinfection effect was the same as that of other agents.

Conclusions

We hypothesize that hand disinfection with alcohol is more difficult, and that the flow rate of water may play a pivotal role in eradicating microorganisms in addition to the choice of disinfectant. Ozonated tap water had no adverse effects on the skin and was preferred by most participants.

Key messages

Ozonized water as hand disinfection. Alcohol hand disinfection problems.
Risk assessment in hematology ward renovation, a FMEA example in a tertiary hospital in Italy
Authors: Battaglini A , Orsi A , Icardi G , Vyshka S , Casabona F , Orengo G
Published: October 2020

Background

Hospital construction and renovation works cause derangement, increasing mistake rate in healthcare workers and resulting in dust contamination and dispersal of fungal spores that could improve morbidity and mortality in severely immune suppressed patients. The necessary renovation of hematology ward at IRCCS Policlinico San Martino in Genoa, scheduled for February 2020 required a risk assessment to avoid logistical, organizational and clinical problems. Two possible scenarios were proposed: (1) displacement of patients in another building previously used as hematological unit or (2) department split in 2 sections to carry out renovation works in different periods. Risk management of the choice relies on failure mode and effects analysis (FMEA) method, a proactive tool based on risk priority number (RPN) that ranks failure modes in terms of occurrence, severity and detection. Aim of this work is to analyze and compare the two scenarios; a team of experts in Public health with specific skills in risk management and hospital governance used FMEA to single out failure modes and to compute RPN.

Methods

Thirteen failure modes were combined together in four major possible risks: (a) lengthening waiting times and delay haematopoietic stem cell transplant procedures, (b) exposure to airborne contamination, (c) cross contamination and water contamination, (d) wrong behaviors. RPN was computed for each failure mode.

Results

Relevant failure modes were: reduction of bedsides in both scenarios (7 bedsides lost in first scenario RPN1 540 vs 9 bedsides lost in second scenario RPN2 630), less air exchange/hour in the first scenario (4/h RPN1 500 vs 6/h RPN2 400) balanced by closeness to the work site in the second scenario(RPN2 500). First scenario total RPN was 2430, second scenario was 3250.

Conclusions

Using FMEA, we assessed the different risks profile of two scenarios. Although some residual risks persisted, the first scenario shows a lower risk profile for all major risks.

Key messages

Risk assessment is a key element to better understand hospital problems and improve environmental health in healthcare setting FMEA represents a useful tool to guide hospital manager in difficult choices concerning severely immune suppressed patients.
The emerging issue of cognitive disorders and dementia among migrants
Authors: Canevelli M , Lacorte E , Cova I , Cascini S , Bargagli A M , Giusti A , Pomati S , Pantoni L , Vanacore N
Published: October 2020

Background

Due to population aging, people with a migration background are (and will be) increasingly exposed to the burden of chronic, age-related diseases. Specifically, the occurrence of dementia and cognitive disorders in this population of individuals can assume special clinical and public health relevance. The ImmiDem project (GR-2016-02364975) is aimed at characterizing the emerging phenomenon of cognitive disorders in migrants in Italy.

Methods

The number of dementia and mild cognitive impairment (MCI) cases among migrants living in the extended European Union was calculated by applying the age- and gender-specific prevalence rates of these conditions to the population data of international migrants provided by Eurostat. A pilot survey was addressed to a representative sample of Italian centers for cognitive disorders and dementia (CCDDs) with the aim of collecting information on the number of migrants attending these services, the adopted diagnostic, and the possible barriers and resources in the provision of care.

Results

Nearly 700,000 cases of dementia and 680,000 cases of MCI can be estimated in the migrant population living in Europe in 2018. Nevertheless, the number of migrants referred to the surveyed CCDDs was very low and was considered as stable over the last 5 years. Most of CCDDs reported the possibility of contacting cultural mediators and/or interpreters, while only a few reported the availability and regular use of translated and/or cross-cultural cognitive assessment tools.

Conclusions

The data produced by the ImmiDem project allow a preliminary characterization of the emerging phenomenon of cognitive disturbances in the migrant population. The survey will be extended to all Italian dementia services (CDCD, day centers, residential structures). Activities aimed at identifying and promoting dedicated care pathways or good practices will also be conducted.

Key messages

The clinical and epidemiological characterization of cognitive disorders occurring in migrants represent an emerging public health matter for Western countries. The onset of dementia in migrants can result in important clinical-diagnostic and healthcare complexities.
Early risk factors of obesity in 5-year-old boys and girls in Finland
Authors: Laitinen U , Lehtinen-Jacks S , Lundqvist A
Published: October 2020

Background

Several potential early-life risk factors for childhood overweight and obesity have been identified. Yet results regarding early risk factors and obesity (BMI-for-age ≥30 kg/m2) at pre-school age are mixed and boys and girls have rarely been studied separately. Our aim was to study whether pre- and perinatal factors predict obesity in 5-year-old boys and girls.

Methods

National register data was used to identify children born in Finland between 2007 and 2014 with data available on pre- and perinatal factors as well as on height and weight at 5 years of age (n = 131,818). Multivariable logistic regression models were used to analyze sex-specific associations between pre- and perinatal factors (e.g. maternal age, parity, pre-pregnancy BMI, smoking, diabetes, delivery method, gestational-age-adjusted birth weight) and offspring obesity.

Results

Five percent of boys (n = 3,551) and 3% of girls (n = 1,949) had obesity. Adjusted for potential confounders, the strongest predictor of subsequent obesity at 5 years of age was severe maternal obesity (BMI ≥35 kg/m2) (boys: OR 6.5, 95% CI 5.8-7.4; girls: OR 7.5, 95% CI 6.4-8.8) followed by maternal obesity (BMI 30.0-34.9 kg/m²) (boys: OR 3.9, 95% CI 3.5-4.4; girls: OR 5.5, 95% CI 4.8-6.2) and maternal overweight (BMI 25.0-29.9 kg/m²) (boys: OR 2.3, 95% CI 2.1-2.5; girls: OR 2.6, 95% CI 2.3-3.0). Other factors associated with child obesity were maternal smoking during pregnancy (boys: OR 1.8, 95% CI 1.6-1.9; girls: OR 2.0, 95% CI 1.8-2.2) and being born large for gestational age (boys: OR 1.9, 95% CI 1.6-2.2; girls: OR 2.1, 95% CI 1.8-2.6).

Conclusions

These findings indicate that childhood obesity may partly originate before conception, gestation and birth. As prevention of obesity may be economically and socially more sustainable than treatment of its consequences, emphasis should be put on early interventions. Particular attention should be paid on preventing maternal overweight and obesity.

Key messages

Maternal obesity was the strongest predictor of child obesity at 5 years of age. Investing in maternal health from as early as before conception may help prevent offspring obesity.
Lactational exposure to phthalate monoesters among breastfed infants in Italy
Authors: Arletti M , Maione D , Fioretti E , Panciroli G , Predieri G , Pinetti D , Bargellini A , Facchinetti F , Fantuzzi G , Righi E
Published: October 2020

Background

Phthalates are chemicals widely used as additives in plastics, cosmetics and medical devices. Due to their endocrine disrupting action and ubiquitous environmental presence, the detection of their levels in breast milk is a crucial public health issue. However, up to date limited information exists on lactational exposure to phthalates in Italy. We aimed to determine the levels of 6 phthalate monoesters in breast milk of women living in Modena (Italy), to investigate the potential sources of exposure and to calculate the Estimated Daily Intake (EDI) for breastfed infants.

Methods

In this cross-sectional study 201 women (19-45 years) living in Modena (Northern Italy) provided a sample of breast milk (30-40 days postpartum) and filled in a questionnaire on personal data and on potential sources of exposure to phthalates. Samples were analyzed by triple Quad LC/MS Mass Spectrometry. Phthalates levels were used to calculate newborns' EDIs that were compared with the Tolerable Daily Intake (TDI) set up by the European Food Safety Authority (EFSA).

Results

Monoethyl phthalate (MEP) and monoisononyl phthalate (MiNP) were detected in most samples, respectively, in 173 (86%; mean: 14.50±80.88; range: 0.03-674 μg/l) and 160 samples (80%; mean: 1.41±2.48; range: 0.04-18.40 μg/l). Levels appeared higher in women more frequently consuming food and beverages preserved in plastic containers or using cosmetics, although differences were not significant. The EDI levels for MEP (mean: 2.08±11.39 µg/kg BW/day) and MiNP (mean: 0.20±0.33 µg/kg BW/day) appeared below the TDI values set up by EFSA.

Conclusions

Although the widespread diffusion of phthalate monoesters in breast milk, their levels resulted lower than those reported in other studies and the EFSA recommended values. Thus, the use of breast milk, a unique nourishment for infants, should not be discouraged.

Key messages

Monitoring phthalates’ levels in breast milk is crucial to check breastfed infants’ exposure and to prevent potential health risks associated with this exposure. It’s essential to adopt effective public health interventions to reduce phthalates dissemination in environment and food and consequently the maternal and infant exposure to these contaminants.
From the roots to the stem: unveiling pear root colonization and infection pathways by Erwinia amylovora
Authors: Santander Ricardo D , Català-Senent José F , Figàs-Segura Àngela , Biosca Elena G
Published: October 2020

Fire blight caused by Erwinia amylovora affects pome fruit worldwide, generating serious economic losses. Despite the abundant literature on E. amylovora infection mechanisms of aerial plant organs, root infection routes remain virtually unexplored. Assessing these infection pathways is necessary for a full understanding of the pathogen's ecology. Using the pathosystem Pyrus communis–E. amylovora and different experimental approaches including a green fluorescent protein transformant (GFP1) and epifluorescence microscopy (EFM) and laser confocal scanning microscopy (LCSM), we demonstrated the pathogen's ability to infect, colonize and invade pear roots and cause characteristic fire blight symptoms both in the aerial part and in the root system. Plant infections after soil irrigation with E. amylovora-contaminated water were favored by root damage, which agreed with EFM and LCSM observations. E. amylovora GFP1 cells formed aggregates/biofilms on root surfaces and invaded the cortex through wounds and sites of lateral root emergence. Sugars, sugar-alcohols and amino acids typically secreted by roots, favored the in vitro biofilm development by E. amylovora. Migration of E. amylovora cells to aerial tissues mainly occurred after xylem penetration. Overall, our findings revealed, for the first time, common root infection patterns between E. amylovora and well-known soil borne plant pathogens and endophytes.
An ideal spacing is required for the control of Class II CRP-dependent promoters by the status of CRP K100
Authors: Écija-Conesa Ana , Gallego-Jara Julia , Lozano Terol Gema , Browning Douglas F , Busby Steve J W , Wolfe Alan J , Cánovas Díaz Manuel , de Diego Puente Teresa
Published: October 2020

Transcription activation by the Escherichia coli CRP at Class II promoters is dependent on direct interactions between RNA polymerase and CRP, therefore the spatial proximity between both proteins plays a significant role in the ability of CRP to activate transcription. Using both in vivo and in vitro techniques, here we demonstrate that the CRP K100 positive charge, adjacent to AR2, is required for full promoter activity when CRP is optimally positioned. Accordingly, K100 mediated activation is very position-dependent and our data confirm that the largest impact of the K100 status on transcription activation occurs when the spacing between the CRP binding site and the A2 of the −10 element is 22 bp. From the results of this study and the progress in the understanding about open complex DNA scrunching, we propose that CRP-dependent promoters should now be numbered by the distance from the center of the DNA site for CRP and the most highly conserved base at position 2 of the −10 hexamer in bacterial promoters.
Lanthanide rarity in natural waters: implications for microbial C1 metabolism
Authors: Glass Jennifer B , Cowan Elizabeth T , Johannesson Karen H
Published: October 2020

Research in the last decade has illuminated the important role that lanthanides play in microbial carbon metabolism, particularly methylotrophy. Environmental omics studies have revealed that lanthoenzymes are dominant in some environments, and laboratory studies have shown that lanthoenzymes are favored over their calcium-containing counterparts even when calcium is far more abundant. Lanthanide elements are common in rocks but occur at exceedingly low levels in most natural waters (picomolar to nanomolar range) with the exception of volcanic hot springs, which can reach micromolar concentrations. Calcium is orders of magnitude higher in abundance than lanthanide elements across natural settings. Bacteria that use lanthanides for growth on simple carbon compounds (e.g. methanol and ethanol) grow optimally at micromolar concentrations. It is highly likely that bacteria in the environment have evolved specialized lanthanide sequestration and high-affinity uptake systems to overcome lanthanide deprivation. Indeed, we identified genes in soil metagenomes encoding the lanthanide-binding protein lanmodulin, which may be important for cellular differentiation between calcium and lanthanides. More research is needed on microbial adaptations to lanthanide scarcity.
Assistant Nurses’ Positioned Accounts for Prioritizations in Residential Care for Older People
Authors: Lundin Anette , Bülow Pia H , Stier Jonas
Published: October 2020

Background and Objectives

Swedish eldercare is strained by an increased administrative workload, which draws time away from individual care of and interaction with older people. This study explores how eldercare staff, working closely with residents in Swedish special housing (nursing homes), make accounts for how they prioritize work tasks.

Research Design and Methods

Openly structured, thematic interviews were conducted with 12 permanently employed, female assistant nurses, including a group interview with 3 of them. Positioned accounts (small stories) concerning prioritizations due to insufficient resources were analyzed, using Bamberg’s three-level positioning analysis.

Results

The analysis shows that the staff take a favorable position toward the older people by distinguishing between care and “the other things.” They also justify prioritizations at odds with their care values. The assistant nurses present themselves as doing the best they can in organizationally restricted situations. Organizational demands limit the space for care, giving rise to an idealization of “icing on the cake.” Morale is complex in residential care. A narration of “the torn carer” was found as a co-constructed storyline explaining why the staff did not perform eldercare consistent their care values.

Discussion and Implications

When ideals and practice differ, interaction in the peer group becomes important in order to maintain a positive professional identity. “The torn carer” is a way for the staff to escape blame for not living up to care values, but it also victimizes them. Staff could be empowered by a working environment characterized by a reflective practice.
Priority-setting and the Right to Health: Synergies and Tensions on the Path to Universal Health Coverage
Authors: Wang Daniel Wei Liang
Published: October 2020

There is a growing consensus that fair priority-setting and the right to health contribute to achieving universal health coverage. The right to health creates legal entitlements to receive care and fair priority-setting promotes efficient and just health systems. However, there can be tension between them, particularly when the right to health is judicially protected. This article analyses three approaches to understanding this tension: the first minimises the conflicts between them to emphasise their synergies; the second admits the tension and considers it positive as rights create and protect substantive entitlements against priority-setting decisions; the third also recognises that this tension exists, but sees these substantive entitlements as obstacles for fair priority-setting. Building on the analysis of these approaches, this article argues that the involvement of courts in allocative decisions can be more comprehensively evaluated by assessing whether they promote or impair fair priority-setting rather than by focusing on the direct beneficiaries of judicial decisions. If this argument is correct, then courts using the right to health to create and enforce substantive entitlements to health treatments becomes very questionable.
Using Quasispecies Patterns of Hepatitis B Virus to Predict Hepatocellular Carcinoma With Deep Sequencing and Machine Learning
Authors: Chen Shipeng , Zhang Zihan , Wang Ying , Fang Meng , Zhou Jun , Li Ya , Dai Erhei , Feng Zhaolei , Wang Hao , Yang Zaixing , Li Yongwei , Huang Xianzhang , Jia Jian’an , Li Shuang , Huang Chenjun , Tong Lin , Xiao Xiao , He Yutong , Duan Yong , Zhu Shanfeng , Gao Chunfang
Published: October 2020

Background

Hepatitis B virus (HBV) infection is one of the main leading causes of hepatocellular carcinoma (HCC) worldwide. However, it remains uncertain how the reverse-transcriptase (rt) gene contributes to HCC progression.

Methods

We enrolled a total of 307 patients with chronic hepatitis B (CHB) and 237 with HBV-related HCC from 13 medical centers. Sequence features comprised multidimensional attributes of rt nucleic acid and rt/s amino acid sequences. Machine-learning models were used to establish HCC predictive algorithms. Model performances were tested in the training and independent validation cohorts using receiver operating characteristic curves and calibration plots.

Results

A random forest (RF) model based on combined metrics (10 features) demonstrated the best predictive performances in both cross and independent validation (AUC, 0.96; accuracy, 0.90), irrespective of HBV genotypes and sequencing depth. Moreover, HCC risk scores for individuals obtained from the RF model (AUC, 0.966; 95% confidence interval, .922–.989) outperformed α-fetoprotein (0.713; .632–.784) in distinguishing between patients with HCC and those with CHB.

Conclusions

Our study provides evidence for the first time that HBV rt sequences contain vital HBV quasispecies features in predicting HCC. Integrating deep sequencing with feature extraction and machine-learning models benefits the longitudinal surveillance of CHB and HCC risk assessment.
Post-Transcriptional Mechanisms Respond Rapidly to Ecologically Relevant Thermal Fluctuations During Temperature-Dependent Sex Determination
Authors: Bock Samantha L , Hale Matthew D , Leri Faith M , Wilkinson Philip M , Rainwater Thomas R , Parrott Benjamin B
Published: October 2020

Synopsis

An organism’s ability to integrate transient environmental cues experienced during development into molecular and physiological responses forms the basis for adaptive shifts in phenotypic trajectories. During temperature-dependent sex determination (TSD), thermal cues during discrete periods in development coordinate molecular changes that ultimately dictate sexual fate and contribute to patterns of inter- and intra-sexual variation. How these mechanisms interface with dynamic thermal environments in nature remain largely unknown. By deploying thermal loggers in wild nests of the American alligator (Alligator mississippiensis) over two consecutive breeding seasons, we observed that 80% of nests exhibit both male- and female-promoting thermal cues during the thermosensitive period, and of these nests, all exhibited both male- and female-promoting temperatures within the span of a single day. These observations raise a critical question—how are opposing environmental cues integrated into sexually dimorphic transcriptional programs across short temporal scales? To address this question, alligator embryos were exposed to fluctuating temperatures based on nest thermal profiles and sampled over the course of a daily thermal fluctuation. We examined the expression dynamics of upstream genes in the temperature-sensing pathway and find that post-transcriptional alternative splicing and transcript abundance of epigenetic modifier genes JARID2 and KDM6B respond rapidly to thermal fluctuations while transcriptional changes of downstream effector genes, SOX9 and DMRT1, occur on a delayed timescale. Our findings reveal how the basic mechanisms of TSD operate in an ecologically relevant context. We present a hypothetical hierarchical model based on our findings as well as previous studies, in which temperature-sensitive alternative splicing incrementally influences the epigenetic landscape to affect the transcriptional activity of key sex-determining genes.
Music as an Emancipatory Pedagogical Tool in International Relations Classes in the Global South
Authors: de Oliveira Vinícius Tavares , Silveira Mariana Balau , Bittencourt Rodrigues Lopes Rafael
Published: October 2020

The purpose of this paper is to present considerations about the use of music as a critical and radical pedagogy in an International Relations class in the Global South. How can music help students understand the processes of marginalization, resistance, and struggle? Can it be understood as a tool to be used in the classroom to transcend traditional and marginalizing pedagogies? The contribution of our proposal derives from the possibility of a symbiosis between the teaching of critical, decolonial, and postcolonial perspectives and the language used to communicate these concepts and ideas to a young audience with different backgrounds. In this sense, we bring perceptions of the engagement with music as a pedagogical tool in an undergraduate course entitled “Decolonizing International Relations: epistemic violence and emancipation in Global South.” By playing songs, not only the learning process became deeper and more meaningful to students, but it also opened margins to a dialogical interaction. We share our experience hoping to contribute to a meaningful debate among scholars, inspiring teachers to engage with decolonial/critical pedagogies.
Effect of RecA inactivation on quinolone susceptibility and the evolution of resistance in clinical isolates of Escherichia coli
Authors: Machuca J , Recacha E , Gallego-Mesa B , Diaz-Diaz S , Rojas-Granado G , García-Duque A , Docobo-Pérez F , Blázquez J , Rodríguez-Rojas A , Pascual A , Rodríguez-Martínez J M
Published: October 2020

Background

SOS response suppression (by RecA inactivation) has been postulated as a therapeutic strategy for potentiating antimicrobials against Enterobacterales.

Objectives

To evaluate the impact of RecA inactivation on the reversion and evolution of quinolone resistance using a collection of Escherichia coli clinical isolates.

Methods

Twenty-three E. coli clinical isolates, including isolates belonging to the high-risk clone ST131, were included. SOS response was suppressed by recA inactivation. Susceptibility to fluoroquinolones was determined by broth microdilution, growth curves and killing curves. Evolution of quinolone resistance was evaluated by mutant frequency and mutant prevention concentration (MPC).

Results

RecA inactivation resulted in 2–16-fold reductions in fluoroquinolone MICs and modified EUCAST clinical category for several isolates, including ST131 clone isolates. Growth curves and time–kill curves showed a clear disadvantage (up to 10 log10 cfu/mL after 24 h) for survival in strains with an inactivated SOS system. For recA-deficient mutants, MPC values decreased 4–8-fold, with values below the maximum serum concentration of ciprofloxacin. RecA inactivation led to a decrease in mutant frequency (≥103-fold) compared with isolates with unmodified SOS responses at ciprofloxacin concentrations of 4×MIC and 1 mg/L. These effects were also observed in ST131 clone isolates.

Conclusions

While RecA inactivation does not reverse existing resistance, it is a promising strategy for increasing the effectiveness of fluoroquinolones against susceptible clinical isolates, including high-risk clone isolates.