Personal inhalation exposure to manganese and other trace metals in an environmentally exposed population: bioaccessibility in size-segregated particulate matter samples

Exposure to environmental airborne manganese (Mn) can lead to neurotoxic disorders and cognitive deficits. The degree of exposure can be assessed by personal sampling of particulate matter (PM) or through biomarkers of exposure. The aim of this work was to characterise the personal exposure to airborne Mn and other trace metals by measuring their bioaccessibility in PM filters taken from personal samplers in an environmentally exposed adult population living in the vicinity of a ferromanganese alloy plant in Santander Bay (northern Spain). Concentrations of bioaccessible and non-bioaccessible Mn and other metals associated with coarse (PM10-2.5) and fine (PM2.5) modes were quantified from 24 h personal samplers in 130 participants divided into two groups according to their Mn exposure: highly (n = 65) and moderately (n = 65) exposed. Gastric fluid and artificial lysosomal fluid (ALF) were used in the bioaccessibility tests as surrogate agents for the body fluids that can come into contact with coarse and fine particles, respectively. The mean air Mn levels in PM10-2.5 and PM2.5 were 127.2 and 126.2 ng/m3, respectively, in the highly exposed group, and 18.6 and 31.7 ng/m3 in the moderately exposed group. The bioaccessibility (%) of Mn in gastric fluid and ALF was also found to be greater in the highly exposed group. The results indicate that people living near Mn alloy plants have an increased potential health risk for Mn exposure due to higher total air Mn concentrations and bioaccessibility.This work was funded by the Spanish Ministry of Science, Innovation and Universities through Project CTM 2017-82636-R. Bohdana Markiv also thanks the same Ministry for her PhD grant, PRE 2018-085152

Environmental exposure to manganese and health risk assessment from personal sampling near an industrial source of airborne manganese

Manganese (Mn), despite being a trace element necessary in small quantities for the correct functioning of the organism, at higher concentrations can induce health disorders, mainly in motor and cognitive functions, even at levels found in non-occupational environments. For this reason, US EPA guidelines define safe reference doses/concentrations (RfD/RfC) for health. In this study, the individualised health risk of exposure to Mn through different media (air, diet, soil) and routes of entry into the organism (inhalation, ingestion and dermal absorption) was assessed according to the procedure defined by the US EPA. Calculations related to Mn present in ambient air were made on the basis of data obtained from size-segregated particulate matter (PM) personal samplers carried by volunteers recruited in a cross-sectional study conducted in the Santander Bay (northern Spain), where an industrial source of airborne Mn is located. Individuals residing in the vicinity of the main Mn source (within 1.5 km) were found to have a hazard index (HI) higher than 1, indicating that there is a potential risk for these subjects to develop health alterations. Also, people living in Santander, the capital of the region, located 7-10 km from the Mn source, may have some risk (HI > 1) under some wind conditions (SW). In addition, a preliminary study of media and routes of entry into the body confirmed that inhalation of PM2.5-bound Mn is the most important route contributing to the overall non-carcinogenic health risk related to environmental Mn.This work was supported by the Spanish Ministry of Science and Innovation (Project CTM2017-82636-R, funded by MCIN/AEI/10.13039/501100011033 and “ERDF A way of making Europe”). Bohdana Markiv also thanks the MICIU for her predoctoral contract (PRE2018-085152, financed together by MCIN/AEI/10.13039/501100011033 and “ESF Investing in your future”)

Percepción del personal médico de atención primaria de salud acerca de sus funciones, formación y conocimientos en materia de salud laboral

ObjetivosEvaluar la percepción que el profesional médico de atención primaria de salud (PMAPS) tiene sobre sus funciones en prevención de riesgos laborales (PRL), así como sus conocimientos y habilidades en materia de salud laboral (SL).DiseñoEstudio descriptivo, transversal.EmplazamientoDepartamento de Salud 20 de la provincia de Alicante.ParticipantesTodos los PMAPS (n=104), con una participación del 80% (n=83).Mediciones principalesLos participantes autocumplimentaron un cuestionario específicamente desarrollado para el estudio. Se establecieron 16 cuestiones que abarcaban funciones en PRL y capacitación para desarrollarlas, así como cantidad y utilidad de formación recibidas en materia de SL.ResultadosEl PMAPS no percibe que tenga funciones en materia de PRL (mediana [Me], 2; rango intercuartílico [RI], 1-3). En mayor medida se consideró capacitado para identificar el origen laboral o no de una enfermedad atendida en su consulta (Me, 3; RI, 3-4). La formación en SL durante la licenciatura de medicina junto con la vía MIR se han identificado como las de menor cuantía (el 55,4 y el 60% de los entrevistados puntuaron en el valor 1 del cuestionario). EL PMAPS claramente ha considerado que una mayor formación en SL le ayudaría en su actividad diaria profesional; se obtuvieron puntuaciones de tipo alto (opciones de respuesta mayores o iguales a 4) en más del 70% de los entrevistados.ConclusionesEs necesario que se fomente la formación en SL para que el PMAPS se sienta parte integrante del personal sanitario con funciones en PRL y pueda adquirir los conocimientos y habilidades necesarios en materia de SL para su práctica médica habitual.ObjectivesTo evaluate the perception of primary health care medical staff (PHCMS) have on their functions in occupational risk prevention (ORP), as well as their knowledge and skills on the subject of occupational health (OH).DesignDescriptive cross-sectional study.SettingHealth Department 20 of Alicante province, Spain.ParticipantsAll PHCMS (N=104), with a participation of 80% (N=83).Primary MeasurementsThe participants self-completed a questionnaire specifically developed for the study. Sixteen questions were established and covered functions in ORP and skills for developing them, as well as the amount and usefulness of training received on the subject of OH.ResultsThe PHCMS did not perceive that they had functions as regards ORP (median [Me], 2; interquartile range [IR], 1-3). To a greater extent they considered themselves capable of identifying whether an illness seen in their clinic was of work origin or not (Me, 3; IR, 3-4).Training in OH as a medical student and in their medical internship (MIR) was identified as of minor importance (55.4% and 60%, respectively, of those surveyed scored a value of 1 in the questionnaire). The PHCMS obviously considered that better training in OH would help them in their daily professional activity. High scores were obtained for this (response options greater than or equal to 4) in more than 70% of the interviewees.ConclusionsTraining in OH must be encouraged so that PHCMS are seen to be health personnel with functions in ORP and are able to acquire the necessary knowledge and skills in OH for their routine medical practice

Estimating changes in air pollutant levels due to COVID-19 lockdown measures based on a business-as-usual prediction scenario using data mining models: A case-study for urban traffic sites in Spain

In response to the COVID-19 pandemic, governments declared severe restrictions throughout 2020, presenting an unprecedented scenario of reduced anthropogenic emissions of air pollutants derived mainly from traffic sources. To analyze the effect of these restrictions derived from COVID-19 pandemic on air quality levels, relative changes in NO, NO2, O3, PM10 and PM2.5 concentrations were calculated at urban traffic sites in the most populated Spanish cities over different periods with distinct restrictions in 2020. In addition to the changes calculated with respect to the observed air pollutant levels of previous years (2013-2019), relative changes were also calculated using predicted pollutant levels for the different periods over 2020 on a business-as-usual scenario using Multiple Linear Regression (MLR) models with meteorological and seasonal predictors. MLR models were selected among different data mining techniques (MLR, Random Forest (RF), K-Nearest Neighbors (KNN)), based on their higher performance and accuracy obtained from a leave-one-year-out cross-validation scheme using 2013-2019 data. A q-q mapping post-correction was also applied in all cases in order to improve the reliability of the predictions to reproduce the observed distributions and extreme events. This approach allows us to estimate the relative changes in the studied air pollutants only due to COVID-19 restrictions. The results obtained from this approach show a decreasing pattern for NOx, with the largest reduction in the lockdown period above -50%, whereas the increase observed for O3 contrasts with the NOx patterns with a maximum increase of 23.9%. The slight reduction in PM10 (-4.1%) and PM2.5 levels (-2.3%) during lockdown indicates a lower relationship with traffic sources. The developed methodology represents a simple but robust framework for exploratory analysis and intervention detection in air quality studies.This research was developed in the framework of the Project “Contaminación atmosférica y COVID-19: ¿Qué podemos aprender de esta pandemia?”, selected in the Extraordinary BBVA Foundation grant call for SARS-CoV-2 and COVID-19 research proposals, within the area of ecology and veterinary science

Prognostic value of plasma pentraxin 3 levels in patients with septic shock admitted to intensive care

Objective: To evaluate the usefulness of a new marker, pentraxin, as a prognostic marker in septic shock patients. Materials and methods: Single-centre prospective observational study that included all consecutive patients 18 years or older who were admitted to the intensive care unit (ICU) with septic shock. Serum levels of procalcitonin (PCT), C reactive protein (CRP) and pentraxin (PTX3) were measured on ICU admission. Results: Seventy-five septic shock patients were included in the study. The best predictors of inhospital mortality were the severity scores: SAPS II (AUC = 0.81), SOFA (AUC = 0.79) and APACHE II (AUC = 0.73). The ROC curve for PTX3 (ng/mL) yielded an AUC of 0.70, higher than the AUC for PCT (0.43) and CRP (0.48), but lower than lactate (0.79). Adding PTX3 to the logistic model increased the predictive capacity in relation to SAPS II, SOFA and APACHE II for in-hospital mortality (AUC 0.814, 0.795, and 0.741, respectively). In crude regression models, significant associations were found between in-hospital mortality and PTX3. This positive association increased after adjusting for age, sex and immunosuppression: adjusted OR T3 for PTX3 = 7.83, 95% CI 1.35?45.49, linear P trend = 0.024. Conclusion: Our results support the prognostic value of a single determination of plasma PTX3 as a predictor of hospital mortality in septic shock patients

Transcultural adaptation of the revised caregiving appraisal scale (RCAS) in the Spanish population

Aim To develop a transcultural adaptation of the Revised Caregiving Appraisal Scale among Spanish caregivers of dependent older people and to test the psychometric properties of the scale. Design Cross-sectional study. Methods The Revised Caregiving Appraisal Scale was transculturally adapted to the Spanish population following the methodology of direct and back translation. The Spanish version of the Revised Caregiving Appraisal Scale was administered to a total of 182 family caregivers of older dependent people. The study began in January 2016 and ended in December of the same year. The construct validity was studied by means of the scree plot and parallel analysis. The exploratory factorial analysis was carried out, and the correlation between factors was studied. To verify the reliability of the process, Cronbach's alpha and homogeneity were calculated by the corrected total item correlation. The validity of the convergent criterion was studied by means of the Pearson correlation coefficient, using the Zarit Caregiver Load Interview and the Family Satisfaction Scale as the gold standard. Results The construct validity revealed three factors: ?Subjective Burden? (15 items), ?Satisfaction? (7 items) and ?Competence? (3 items). The Cronbach alpha was .86 for ?Subjective Burden?, .74 for ?Satisfaction? and .74 for ?Competence?. The corrected total item correlation was greater than .25. The validity of the convergent criterion of the ?Subjective Burden? and ?Competence? factors with the ?Zarit Caregiver's Load Interview? presented a very high statistically significant correlation, unlike ?Satisfaction? which presented a low positive correlation with the ?Family Satisfaction Scale?. Conclusion The Spanish version of the Revised Caregiving Appraisal Scale is a valid and reliable scale according to the tests performed on a random sample of family caregivers of older dependent people in Spain. Impact This scale will enable the simultaneous assessment of negative (?Subjective Burden? and ?Competence?) and positive (?Satisfaction?) perceptions among family caregivers of older dependent people

Prevalence of Seasonal Influenza Vaccination in Chronic Obstructive Pulmonary Disease (COPD) Patients in the Balearic Islands (Spain) and Its Effect on COPD Exacerbations: A Population-Based Retrospective Cohort Study

To determine the prevalence of influenza vaccination in chronic obstructive pulmonary disease (COPD) patients and its effect on COPD exacerbations, we conducted a retrospective population-based cohort study analyzing real-life data. We included all registered COPD patients ?40 years old using respiratory medication during the study period (2012?2013). Influenza vaccination during the 2012/2013 campaign was the parameter studied. Moderate and severe exacerbations during 2013 were the dependent outcome variables. Logistic regression adjusting for age, gender, concomitant asthma diagnosis, COPD severity, smoking status, number of moderate and severe exacerbations the previous year, and comorbidities was performed, and 59.6% of the patients received seasonal influenza vaccination. The percentage of patients with exacerbations was higher among those vaccinated. Influenza vaccination had a statistically significantly negative (non-protective) crude effect favoring the risk of severe exacerbations: OR: 1.20 (95% CI; 1.05?1.37). This association diminished and lost statistical significance after adjustment: aOR: 0.93 (95% CI; 0.74?1.18). The protective effect in the analysis restricted to the epidemic period was not significant: aOR: 0.82 (95% CI; 0.58?1.16). We concluded that prevalence of influenza vaccination was suboptimal. In contrast with most of the available evidence, our results did not support a protective effect of influenza vaccination on the risk of admission for COPD exacerbation

Poorer cognitive function and environmental airborne Mn exposure determined by biomonitoring and personal environmental monitors in a healthy adult population

Background/aim: In the Santander Bay (Cantabria, northern Spain), a ferromanganese alloy plant is located. Our objective was to characterize the Mn personal exposure of adult healthy volunteers living in this highly Mn exposed region, and to determine its association with a poorer cognitive function. Methods: Cross-sectional study analyzing 130 consecutive participants. Cognitive function was assessed by Stroop Color Word, Verbal Fluency tests, Trail Making Test (TMT), Digit Span (WAIS III) and Rey Osterrieth Complex Figure (ROCF) tests and crude scores were standardized according to NEURONORMA norms. Exposure to Mn was assessed in terms of source distance, by Personal Environmental Monitors (PEMs) allowing the separation of fine (PM2.5) and coarse (PM10-2.5) particles (obtaining the bioaccessible fraction by in-vitro bioaccessibility tests), and by biomarkers (blood, hair and fingernails). Age, sex, study level and number of years of residence were predefined as confounding variables and adjusted Mean Differences (MDs) were obtained. Results: Statistically significant lower scores (negative MDs) in all test were observed when living near the industrial emission source, after adjusting for the predefined variables. Regarding PEMs results, statistically significant lower scores in all Stroop parts were obtained in participants with higher levels of Total Mn in All fractions (PM10). For Verbal Fluency tests, negative MDs were obtained for both bioaccessible fractions. Digit Span Backward scores were lower for those with higher levels in the bioaccessible coarse fraction, and negative MDs were also observed for the ROCF Delayed part and the non-bioaccessible fine fraction. As regards to Mn in fingernails, adjusted MDs of -1.60; 95%CI (-2.57 to -0.64) and -1.45; 95%CI (-2.29 to -0.61) for Digit Span Forward and Backward parts were observed. Conclusions: Our results support an association between poorer cognitive function and environmental airborne Mn exposure.This work was supported by the Spanish Ministry of Science, Innovation and Universities through the CTM2017-82636-R Project. This funding source was not involved in the study design; data collection, analysis, or interpretation; the writing of the article; or the decision to submit for publication

Clinical practice outcomes and differential results in maternal and neonatal morbidity among pregnant women in Spain who are candidates for a normal birth: a cross-sectional study

OBJECTIVE: To determine the percentage of pregnant women who are potential candidates for a normal birth in the region of Cantabria, Spain. Also, to compare the main clinical practice outcome indicators and the rates of maternal and neonatal morbidity among the group of candidate women versus non-candidates. DESIGN: A cross-sectional study. SETTING: A tertiary Hospital in Cantabria (Northern region of Spain). PARTICIPANTS: The study population comprised the total number of hospital births that took place between 1 January 2014 and 31 December 2014 (n=3315). RESULTS: Secondary registers were accessed to review the main indicators of care and the outcome of births. The ?2 test or the Student's t-test were used to compare both groups for the categorical and continuous variables, respectively. In total, 1863 births (56.20%) were candidates for applying the strategy of care for a normal birth. In 50.86% of these candidate births, an episiotomy was performed, compared with 60.96% in the group of non-candidates (p<0.001). Regarding caesarean sections, these were carried out in 19.32% of the candidate births, compared with 26.79% of non-candidate births (p<0.001). Furthermore, there were statistically significant differences between the groups according to the type of birth, the need for instrumental birthing methods, the existence of perineal tears, Apgar scores and the requirement for the infant to be admitted to the neonatal intensive care unit. CONCLUSIONS: Our results suggest a differential clinical practice, in line with the recommendations of the Clinical Practice Guidelines for Care of Normal Birth. Nonetheless, improvements are necessary regarding the care provided to women and infants, as the percentages of episiotomies and caesarean sections are still high when compared with current standards and compared with other reports

Biomonitoring and bioaccessibility of environmental airborne manganese in relation to motor function in a healthy adult population

Background/aim: Santander, the capital of Cantabria, Spain (172,000 inhabitants) is 7 km from an industrial emission source (IES) of Mn located in a 10,000 inhabitants town (Maliaño) (annual air Mn arithmetic mean = 231.8 ng/m3 ; reference WHO guideline = 150 ng/m3 ). Our objective was to compare the motor function of adult healthy volunteers living in both places. Methods: Cross-sectional study analyzing 130 consecutive participants. Exposure to Mn was assessed in terms of source distance from the IES, by Personal Environmental Monitors (PEMs) carried for 24 h by participants consisting of a portable impactor connected to a personal pump, and by biomarkers (blood, hair and fingernails). The impactor allowed the separation of fine (PM2.5) and coarse (PM10-2.5) particles and for each particle size in-vitro bioaccessibility tests with biologically active fluids were performed to separate the soluble (bio accessible) from the insoluble (non-bioaccessible) fraction. Mean Differences (MDs) adjusted for age, sex, and study level, were obtained for motor function tests results. Results: Regarding Grooved Pegboard, overall mean time to complete the test was 59.31 and 65.27 seconds (Standard Deviation = 10.11 and 11.69) for dominant and nondominant hands respectively. Statistically significant higher times (indicating worse function) were observed when living near the IES in both hands but MDs of only 1.22 and 2.05 seconds were obtained after adjusting for the predefined confounders (p = 0.373 and 0.221 respectively). Regarding Mn levels in their PEMs (in both bioaccessible and non-bioaccessible coarse&fine fractions) higher times were computed in participants with higher levels for the bioaccessible-fine fraction, with a MD that diminished but still yielded statistical significance after controlling for confounding: adjusted MD = 3.01 more seconds; 95%CI (0.44-5.38), p = 0.022. Poorer results were also observed for fingernails levels. Regarding Finger Tapping Test, no statistically significant differences were found with the exception of Mn fingernails levels. Conclusions: Our results suggest poorer motor function as assessed by Grooved Pegboard test in relation to "proximity to IES", "bioaccessible-fine fraction as determined by PEMs and "Mn fingernails levels". However, our findings were affected by confounding, and only the adjusted MD for the Mn bioaccessible-fine fraction remained of sufficient magnitude to maintain statistical significance.This work was supported by the Spanish Ministry of Science, Innovation and Universities through the CTM2017-82636-R Project. This funding source was not involved in the study design; data collection, analysis, or interpretation; the writing of the article; or the decision to submit for publication. Bohdana Markiv also thanks this Ministry for the PhD grant awarded, PRE2018-085152