Do healthy doctors deliver better messages of health promotion to their patients?: Data from the SUN cohort study

Background Healthy lifestyle adherence is associated with lower chronic disease morbidity/mortality. The role of doctors, as counselors and role models, is essential. Among physicians participating in a prospective cohort, we investigated the behavioral counseling on diet and lifestyle provided to their patients in association with their own personal behaviors. Methods We assessed 890 doctors aged ≤65 years participating in the ‘Seguimiento Universidad de Navarra’ (SUN) cohort, who replied to an online questionnaire regarding their practices on behavioral counseling and drug prescription to their patients. Data were combined with previous baseline information on their personal healthy habits. Results Among doctors, 31% reported <10 min per visit; 73% counseled 60–100% of their patients on smoking cessation, 58% on physical activity, 54% on weight control, 51% on healthy nutrition, 44% on alcohol avoidance/reduction and 28% recommended alcohol moderate consumption. The percentage of doctors that counseled 100% of their patients about lifestyle was 43% for smoking cessation, 15% for exercise and 13% for weight control and nutrition. Better doctor’s adherence to the Mediterranean dietary pattern was associated with more frequent and longer nutrition counseling. Higher practice of physical activity was associated with longer time on counseling about exercise to their patients. Among doctors both current and former smoking were inversely associated with the frequency and duration of their smoking cessation/avoidance counseling practices. Conclusions Personal behavioral changes among doctors and better training of medical doctors on a personal healthy diet and lifestyle are likely to contribute to improve the behavioral counseling given to patients

Survey of potential toxic exposure in patients with systemic sclerosinin rescle registry. A preliminary study

Background Systemic sclerosis (SSc) is a systemic autoimmune disease with extremely heterogeneous clinical features and unknown etiology, although numerous studies suggest a relationship with environmental and occupational factors. So far there is little information on whether toxic substances can play a relevant role in its phenotypic expression (1). Objectives To analyze in a cohort of patients with SSc the proportion of patients exposed to toxic and their correlation with epidemiologic, clinical and serological data. Methods A survey was conducted aimed at the knowledge of the working life of patients from six centers belonging to the Spanish Scleroderma Registry (RESCLE), categorizing them in six groups: no potential exposure to toxic substances, potential exposure to silica, to hydrocarbons, to organic solvents, to mixed toxics (silica and/or hydrocarbons and/or organic solvents) and to another toxics. In all patients 87 epidemiological, clinical and analytical variables included in the registry were analyzed, carrying out a comparative study between groups. Results 225 SSc patients were selected. Of these, 81 patients (36%) had worked in professions with potential risk of toxic exposure, 64 women out of the 227 included (28%) and 17 men out of the 28 included (60%). The toxic agent most frequently involved was silica in 29 patients (35.8%), followed by hydrocarbons in 21 (25.9%), mixture of toxic substances in 21 other patients (25.9%), organic solvents in 4 patients (4.9%) and other toxic in 6 cases (7.4%). Toxic exposure was associated with a lower risk of being female (OR 0.15, p <0.001), having been exposed to tobacco (OR 0.4, p 0.037) and digital ulcers (OR 0.43, p 0.016) and with a greater likelihood of hepatic involvement (OR 3.63, p 0.021), musculoskeletal involvement (OR 2.13, p 0.017) and the slow capillary pattern of Maricq (OR 1.8, p 0.063). Analyzing the exposure groups separately, patients exposed to silica had a lower probability of Raynaud?s phenomenon (OR 0.25, p 0.005) and a higher probability of diagnosis at older ages (OR: 1.04, p 0.005), presence of Topoisomerase I antibody (OR 3.71, p 0.023) and slow capillary pattern of Maricq (OR 4.15, p 0.008). Patients exposed to hydrocarbons had an increased risk of liver involvement (OR 5.34, p 0.029). Conclusion In our cohort of 225 patients with SSc, 60% of male patients and 28% of women worked in a profession with a potential risk of toxic exposure. In this preliminary study, important differences were observed in the probability of a different phenotypic expression of the SSc according to the history of occupational exposure to toxins. Studies with a larger number of patients are needed to establish these associations in a solid way

Off-label use of rituximab for systemic lupus erythematosus in Europe

Objectives: Rituximab (RTX) is a biological treatment used off-label in patients with systemic lupus erythematosus (SLE). This survey aimed to investigate the off-label use of RTX in Europe and compare the characteristics of patients receiving RTX with those receiving conventional therapy. Methods: Data on patients with SLE receiving RTX were taken from the International Registry for Biologics in SLE retrospective registry and complemented with data on patients with SLE treated with conventional therapy. For nationwide estimates of RTX use in patients with SLE, investigators were asked to provide data through case report forms (CRFs). Countries for which no data were submitted through CRFs, published literature and/or personal communication were used, and for European countries where no data were available, estimates were made on the assumption of similarities with neighbouring countries. Results: The estimated off-label use of RTX in Europe was 0.5%-1.5% of all patients with SLE. In comparison with patients with SLE on conventional therapy, patients treated with RTX had longer disease duration, higher disease activity and were more often treated with immunosuppressives. The most frequent organ manifestations for which either RTX or conventional therapy was initiated were lupus nephritis followed by musculoskeletal and haematological. The reason for treatment was, besides disease control, corticosteroid-sparing for patients treated with conventional therapy. Conclusions: RTX use for SLE in Europe is restrictive and appears to be used as a last resort in patients for whom other reasonable options have been exhausted

Impact of commercial strain use on saccharomyces cerevisiae population structure and dynamics in pinot noir vineyards and spontaneous fermentations of a canadian Winery

Wine is produced by one of two methods: inoculated fermentation, where a commerciallyproduced, single Saccharomyces cerevisiae (S. cerevisiae) yeast strain is used; or the traditional spontaneous fermentation, where yeast present on grape and winery surfaces carry out the fermentative process. Spontaneous fermentations are characterized by a diverse succession of yeast, ending with one or multiple strains of S. cerevisiae dominating the fermentation. In wineries using both fermentation methods, commercial strains may dominate spontaneous fermentations. We elucidate the impact of the winery environment and commercial strain use on S. cerevisiae population structure in spontaneous fermentations over two vintages by comparing S. cerevisiae populations in aseptically fermented grapes from a Canadian Pinot Noir vineyard to S. cerevisiae populations in winery-conducted fermentations of grapes from the same vineyard. We also characterize the vineyard-associated S. cerevisiae populations in two other geographically separate Pinot Noir vineyards farmed by the same winery. Winery fermentations were not dominated by commercial strains, but by a diverse number of strains with genotypes similar to commercial strains, suggesting that a population of S. cerevisiae derived from commercial strains is resident in the winery. Commercial and commercial-related yeast were also identified in the three vineyards examined, although at a lower frequency. There is low genetic differentiation and S. cerevisiae population structure between vineyards and between the vineyard and winery that persisted over both vintages, indicating commercial yeast are a driver of S. cerevisiae population structure. We also have evidence of distinct and persistent populations of winery and vineyard-associated S. cerevisiae populations unrelated to commercial strains. This study is the first to characterize S. cerevisiae populations in Canadian vineyards