Asma en los centros escolares e impacto de una intervención educativa en los profesores

163 p.Estudio observacional, transversal y descriptivo en el que se ha evaluado el grado de conocimientos que sobre asma tienen los profesores(n=743), sus creencias y actitudes, fuentes de información y los recursos disponibles en 17 centros escolares. En un estudio antes-después, con grupo control, se ha estudiado la modificación de esos conocimientos tras la realización de una intervención educativa. Se ha podido observar que, en muchas ocasiones, los profesores desconocen la existencia de alumnos con asma en sus clases. Además, el nivel de comunicación entre los profesores y las familias acerca de los problemas de asma de los alumnos es bajo. Se ha constatado un bajo nivel de conocimientos que sobre asma tienen los docentes, sobre todo en algunos puntos concretos. Reconocen esa deficiente formación siendo muy positiva su actitud en el sentido de desear mejorarla. Tras implementar una acción educativa, el nivel de conocimientos aumenta significativamente y, aunque disminuye algo con el paso del tiempo, se mantiene elevado a los tres meses. Se destaca que algunos aspectos del conocimiento, aunque mejoran con la intervención educativa, son todavía limitados

Advances in methods for determining fecundity: application of the new methods to some marine fishes

Estimation of individual egg production (realized fecundity) is a key step either to understand the stock and recruit relationship or to carry out fisheries-independent assessment of spawning stock biomass using egg production methods. Many fish are highly fecund and their ovaries may weigh over a kilogram; therefore the work time can be consuming and require large quantities of toxic fixative. Recently it has been shown for Atlantic cod (Gadus morhua) that image analysis can automate fecundity determination using a power equation that links follicles per gram ovary to the mean vitellogenic follicular diameter (the autodiametric method). In this article we demonstrate the precision of the autodiametric method applied to a range of species with different spawning strategies during maturation and spawning. A new method using a solid displacement pipette to remove quantitative fecundity samples (25, 50, 100, and 200 milligram [mg]) is evaluated, as are the underlying assumptions to effectively fix and subsample the ovary. Finally, we demonstrate the interpretation of dispersed formaldehyde-fixed ovarian samples (whole mounts) to assess the presence of atretic and postovulatory follicles to replace labor intensive histology. These results can be used to estimate down regulation (production of atretic follicles) of fecundity during maturation

Streptococcus pneumoniae , an unusual cause of early- onset neonatal sepsis and necrotizing pneumonia

Key Clinical Message Vertically transmitted sepsis due to Streptococcus pneumoniae has a low incidence, and vaginal colonization among pregnant women is exceptional. Necrotizing pneumonia is uncommon in immunocompetent term neonates, and the prognosis is uncertain. At present, systematic screening does not seem warranted in pregnant women. Therefore, aggressive treatment of neonates remains the best treatment

Advances in methods for determining fecundity: application of the new methods to some marine fishes

17 pages, 9 figures, 6 tables.Estimation of individual egg production (realized fecundity) is a key step either to understand the stock and recruit relationship or to carry out fisheries-independent assessment of spawning stock biomass using egg production methods. Many f ish are highly fecund and their ovaries may weigh over a kilogram; therefore the work time can be consuming and require large quantities of toxic fixative. Recently it has been shown for Atlantic cod (Gadus morhua) that image analysis can automate fecundity determination using a power equation that links follicles per gram ovary to the mean vitellogenic follicular diameter (the autodiametric method). In this article we demonstrate the precision of the autodiametric method applied to a range of species with different spawning strategies during maturation and spawning. A new method using a solid displacement pipette to remove quantitative fecundity samples (25, 50, 100, and 200 milligram [mg]) is evaluated, as are the underlying assumptions to effectively fix and subsample the ovary. Finally, we demonstrate the interpretation of dispersed formaldehyde-fixed ovarian samples (whole mounts) to assess the presence of atretic and postovulatory follicles to replace labor intensive histology. These results can be used to estimate down regulation (production of atretic follicles) of fecundity during maturation.T his study was jointly funded under Eu ropean Union Frame Work V Q5RS -2002 - 01825 and the Institutes in England (Department of the Environment, Food, and Rural Affairs), Norway (Institute of Marine Research), and Spain (Consejo Superior de Investigaciones Científ icas, and A ZTI Tecnalia (publication number 424))Peer reviewe

Performance of QuantiFERON-TB Gold Plus assays in children and adolescents at risk of tuberculosis: a cross-sectional multicentre study

Introduction: The QuantiFERON-TB Gold Plus (QFT-Plus) assay, which features two antigen-stimulated tubes (TB1 and TB2) instead of a single tube used in previous-generation interferon-gamma release assays (IGRAs), was launched in 2016. Despite this, data regarding the assay’s performance in the paediatric setting remain scarce. This study aimed to determine the performance of QFT-Plus in a large cohort of children and adolescents at risk of tuberculosis (TB) in a low-burden setting. Methods: Cross-sectional, multicentre study at healthcare institutions participating in the Spanish Paediatric TB Research Network, including patients <18 years who had a QFT-Plus performed between September 2016 and June 2020. Results: Of 1726 patients (52.8% male, median age: 8.4 years), 260 (15.1%) underwent testing during contact tracing, 288 (16.7%) on clinical/radiological suspicion of tuberculosis disease (TBD), 649 (37.6%) during new-entrant migrant screening and 529 (30.6%) prior to initiation of immunosuppressive treatment. Overall, the sensitivity of QFT-Plus for TBD (n=189) and for latent tuberculosis infection (LTBI, n=195) was 83.6% and 68.2%, respectively. The agreement between QFT-Plus TB1 and TB2 antigen tubes was excellent (98.9%, κ=0.961). Only five (2.5%) patients with TBD had discordance between TB1 and TB2 results (TB1+/TB2−, n=2; TB1−/TB2+, n=3). Indeterminate assay results (n=54, 3.1%) were associated with young age, lymphopenia and elevated C reactive protein concentrations. Conclusions: Our non-comparative study indicates that QFT-Plus does not have greater sensitivity than previous-generation IGRAs in children in both TBD and LTBI. In TBD, the addition of the second antigen tube, TB2, does not enhance the assay’s performance substantially

Technical mitigation measures for sharks and rays in fisheries for tuna and tuna-like species: turning possibility into reality

Tuna fisheries have been identified as one of the major threats to populations of other marine vertebrates, including sea turtles, sharks, seabirds and marine mammals. The development of technical mitigation measures (MM) in fisheries is part of the code of conduct for responsible fisheries. An in-depth analysis of the available literature regarding bycatch mitigation in tuna fisheries with special reference to elasmobranchs was undertaken. Studies highlighting promising MMs were reviewed for four tuna fisheries (longline, purse seine, driftnets and gillnet, and rod and line – including recreational fisheries). The advantages and disadvantages of different MMs are discussed and assessed based on current scientific knowledge. Current management measures for sharks and rays in tuna Regional Fishery Management Organizations (t-RFMOs) are presented. A review of relevant studies examining at-vessel and postrelease mortality of elasmobranch bycatch is provided. This review aims to help fisheries managers identify pragmatic solutions to reduce mortality on pelagic elasmobranchs (and other higher vertebrates) whilst minimizing impacts on catches of target tuna species. Recent research efforts have identified several effective MMs that, if endorsed by t-RFMOs, could reduce elasmobranchs mortality rate in international tropical purse seine tuna fisheries. In the case of longline fisheries, the number of operational effective MMs is very limited. Fisheries deploying driftnets in pelagic ecosystems are suspected to have a high elasmobranchs bycatch and their discard survival is uncertain, but no effective MMs have been field validated for these fisheries. The precautionary bans of such gear by the EU and by some t-RFMOs seem therefore appropriate. Recreational tuna fisheries should be accompanied by science-based support to reduce potential negative impacts on shark populations. Priorities for research and management are identified and discussed.S

The upper-airway microbiome as a biomarker of asthma exacerbations despite inhaled corticosteroid treatment.

BACKGROUND: The response to inhaled corticosteroids (ICS) in asthma is affected by the interplay of several factors. Among these, the role of the upper-airway microbiome has been scarcely investigated. We aimed to evaluate the association between the salivary, pharyngeal, and nasal microbiome with asthma exacerbations despite receipt of ICS. METHODS: Samples from 250 asthma patients from the Genomics and Metagenomics of Asthma Severity (GEMAS) study treated with ICS were analyzed. Control/case subjects were defined by the absence/presence of asthma exacerbations in the past 6 months despite being treated with ICS. The bacterial microbiota was profiled by sequencing the V3-V4 region of the 16S rRNA gene. Differences between groups were assessed by PERMANOVA and regression models adjusted for potential confounders. Afalse discovery rate (FDR) of 5% was used to correct for multiple comparisons. Classification models of asthma exacerbations despite ICS treatment were built with machine learning approaches based on clinical, genetic, and microbiome data. RESULTS: In nasal and saliva samples, case subjects had lower bacterial diversity (Richness, Shannon, and Faith indices) than control subjects (.007≤ P≤ .037). Asthma exacerbations accounted for 8% to 9% of the interindividual variation of the salivary and nasal microbiomes (.003≤ P≤ .046). Three, 4, and 11 bacterial genera from the salivary, pharyngeal, and nasal microbiomes were differentially abundant between groups (4.09*10-12≤ FDR≤ 0.047). Integrating clinical, genetic, and microbiome data showed good discrimination for the development of asthma exacerbations despite receipt of ICS (AUCtraining: 0.82 and AUCvalidation: 0.77). CONCLUSION: The diversity and composition of the upper-airway microbiome are associated with asthma exacerbations despite ICS treatment. The salivary microbiome has a potential application as a biomarker of asthma exacerbations despite receipt of ICS

Spatio-temporal assessment of the European hake (Merluccius merluccius) recruits in the northern Iberian Peninsula

The protection of fish nurseries has been recognized as a useful tool to efficiently manage fisheries given that protected areas enhance the recruitment of target species. To identify and locate potential nursery areas, a solid understanding of species-environment relationships and their spatio-temporal dynamics is needed. Within this context, in this study we assess where European hake (Merluccius merluccius) recruits persistently aggregate in the northern continental shelf of the Iberian Peninsula. Hake recruit data collected during scientific trawl surveys between 2005 and 2016 were analyzed using Bayesian hurdle hierarchical spatio-temporal models, considering the environmental variables bathymetry, sea bottom temperature and salinity. Additionally, three different spatio-temporal structures (i.e., persistent, progressive, or opportunistic) were compared to assess the temporal persistence of nurseries over time. Among all the environmental variables analyzed, bathymetry was the most important. The preferential habitat of recruits was found to be within a bathymetric range of 120–200 m. Our findings clearly show that there is a temporally persistent main nursery located along the continental shelf of the Artabrian gulf (off La Coruña) in addition to several areas with high aggregations of hake recruits but with strong inter-annual variability. We argue that the analytical framework applied in this study allowed us to identify European hake nurseries in the northern continental shelf of the Iberian Peninsula, as well as their spatio-temporal fluctuations throughout the study period (2005–2016), and to assess which environmental factors, among bathymetry, sea bottom temperature and salinity, influence the occurrence and abundance of recruits in the study area. Results of our models also produce a new abundance index that could be useful for improving traditional stock assessment models.En prens

Asthma education for school staff.

BACKGROUND: Teachers and school staff should be competent in managing asthma in schools. Demonstrated low levels of asthma knowledge mean that staff may not know how best to protect a child with asthma in their care, or may fail to take appropriate action in the event of a serious attack. Education about asthma could help to improve this knowledge and lead to better asthma outcomes for children. OBJECTIVES: To assess the effectiveness and safety of asthma education programmes for school staff, and to identify content and attributes underpinning them. SEARCH METHODS: We conducted the most recent searches on 29 November 2016. SELECTION CRITERIA: We included randomised controlled trials comparing an intervention to educate school staff about asthma versus a control group. We included studies reported as full text, those published as abstract only and unpublished data. DATA COLLECTION AND ANALYSIS: At least two review authors screened the searches, extracted outcome data and intervention characteristics from included studies and assessed risk of bias. Primary outcomes for the quantitative synthesis were emergency department (ED) or hospital visits, mortality and asthma control; we graded the main results and presented evidence in a 'Summary of findings' table. We planned a qualitative synthesis of intervention characteristics, but study authors were unable to provide the necessary information.We analysed dichotomous data as odds ratios, and continuous data as mean differences or standardised mean differences, all with a random-effects model. We assessed clinical, methodological and statistical heterogeneity when performing meta-analyses, and we narratively described skewed data. MAIN RESULTS: Five cluster-RCTs of 111 schools met the review eligibility criteria. Investigators measured outcomes in participating staff and often in children or parents, most often at between 1 and 12 months.All interventions were educational programmes but duration, content and delivery varied; some involved elements of training for pupils or primary care providers. We noted risk of selection, performance, detection and attrition biases, although to a differing extent across studies and outcomes.Quanitative and qualitative analyses were limited. Only one study reported visits to the ED or hospital and provided data that were too skewed for analysis. No studies reported any deaths or adverse events. Studies did not report asthma control consistently, but results showed no difference between groups on the paediatric asthma quality of life questionnaire (mean difference (MD) 0.14, 95% confidence interval (CI) -0.03 to 0.31; 1005 participants; we downgraded the quality of evidence to low for risk of bias and indirectness). Data for symptom days, night-time awakenings, restricted activities of daily living and school absences were skewed or could not be analysed; some mean scores were better in the trained group, but most differences between groups were small and did not persist to 24 months.Schools that received asthma education were more adherent to asthma policies, and staff were better prepared; more schools that had received staff asthma training had written asthma policies compared with control schools, more intervention schools showed improvement in measures taken to prevent or manage exercise-induced asthma attacks and more staff at intervention schools reported that they felt able to administer salbutamol via a spacer. However, the quality of the evidence was low; results show imbalances at baseline, and confidence in the evidence was limited by risk of bias and imprecision. Staff knowledge was higher in groups that had received asthma education, although results were inconsistent and difficult to interpret owing to differences between scales (low quality).Available information about the interventions was insufficient for review authors to conduct a meaningful qualitative synthesis of the content that led to a successful intervention, or of the resources required to replicate results accurately. AUTHORS' CONCLUSIONS: Asthma education for school staff increases asthma knowledge and preparedness, but studies vary and all available evidence is of low quality. Studies have not yet captured whether this improvement in knowledge has led to appreciable benefits over the short term or the longer term for the safety and health of children with asthma in school. Randomised evidence does not contribute to our knowledge of content or attributes of interventions that lead to the best outcomes, or of resources required for successful implementation.Complete reporting of the content and resources of educational interventions is essential for assessment of their effectiveness and feasibility for implementation. This applies to both randomised and non-randomised studies, although the latter may be better placed to observe important clinical outcomes such as exacerbations and mortality in the longer term