Vigilância da qualidade microbiológica de água de consumo humano e de água destinada ao abastecimento público da província de Valência durante o período 2002-2010

This study focuses on assessing the microbiological quality of drinking water and of water intended for drinking in the province of Valencia (Spain) between 2002 and 2010. Variation was found regarding space, time and source requirements in samples that did not meet the standards of quality established by Royal Decree 140/2003 for the following: total coliforms (TC); faecal coliforms (FC); Escherichia coli (EC); aerobic bacteria at 22 ºC (AB 22 ºC); faecal streptococci (FS); enterococci (EN); sulphite-reducing clostridia (SC); and Clostridium perfringens (CP). The samples were stratified by those meeting the standards (“Compliance”) and those that did not (“Non-Compliance”), as well as by their relationship with the degree of chlorination.A total of 10057 water samples were examined from various sources: springs; surface waters; denitrifying plant waters; wells; and distribution networks. They were grouped into each of the 17 districts of the province of Valencia.The total number of samples that failed to meet the standards of quality, for each criterion, were as follows: 34.0 % for TC; 16.0 % FS-EN; 13.0 % for FC-EC; 5.6 % for SC-CP; and 15.5 % for AB 22 ºC. Regarding spatial variation in samples, the highest percentages of samples in the “Non-Compliance” group were found in the interior part of the province. For time variation, the highest percentages of “Non-Compliance” were for the years: 2002 - 2004, 2008 and 2009. Regarding source variation, origin of the samples with “Non- compliance” was highest for surface waters, followed by springs and wells.For all samples studied, 39.8 % were within the “Non-Compliance” group, of which 18.3 % came from sources that supply the population (distribution networks).Of the samples within the “Compliance” group, 61 % were chlorinated, which confirms that chlorine is a powerful disinfectant and that chlorination is an effective water disinfection treatment.El presente trabajo tiene como objetivo la evaluación de la calidad microbiológica de las muestras de agua analizadas en la provincia de Valencia durante el período 2002-2010. Se observó la variación espacial, temporal y por origen de las muestras que no cumplían los requisitos especificados en el RD 140/2003 para los coliformes totales (CT), coliformes fecales (CF), Escherichia coli (EC), aerobios a 22 ºC (AB 22 ºC), estreptococos fecales (EF), enterococos (EN), Clostridium sulfito reductores (CS), y Clostridium perfringens (CP), estratificando las muestras en aquellas que cumplían la normativa “Conformes” y las que no “No Conformes”, y su relación con el grado de cloración.Se estudian un total de 10057 muestras de agua procedentes de fuentes que no manan de la red, aguas superficiales, aguas provenientes de plantas desnitrificadoras, pozos y redes de distribución. Se han agrupado en las 17 comarcas de la provincia de Valencia.Del total de las muestras, no cumplían los requisitos de calidad para CT el 34,0 %, para EF-EN el 16,0 %, para AB 22 ºC el 15.5 % para CF-EC el 13,0 % y para CS-CP el 5,6 %. Los porcentajes más elevados de muestras “No Conformes” se observaron situados en la zona interior, y en los años 2002-2004, 2008 y 2009. Respecto a la distribución por origen, se observaron en aguas superficiales, seguidas de fuentes y pozos.Del total de muestras estudiadas, el 39,8 % eran “No Conformes”, y de estas un 18,3 % procedían de abastecimientos que proveen a la población (redes de distribución).El 61,0 % de las muestras “Conformes” estaban cloradas, lo que demuestra que el cloro sigue siendo un tratamiento efectivo de desinfección.Este trabalho tem como objetivo avaliar a qualidade microbiológica de amostras de água analisadas na província de Valência durante o período de 2002 a 2010. Observou-se a variação espacial, temporal e da origem das amostras que não cumprem os requisitos estabelecidos no RD 140/2003, para coliformes totais (CT), coliformes fecais (CF), Escherichia coli (EC), germes aeróbios a 22 ºC (AB 22 ºC), estreptococos fecais (EF), enterococos (EN), Clostridium sulfito (CS) e Clostridium perfringens (CP), estratificando as amostras que cumpriam os requisitos em “conformes” e as que não cumpriam em “não conformes” e a relação com o nível de cloro. Foi estudado um total de 10057 amostras de água de diversas origens: fontes, águas superficiais, centrais de desnitrificação, poços e rede de distribuição. Foram agrupadas nos 17 municípios de Valência.Do total das amostras, não cumpriam os requisitos de qualidade para CT (34 %), EF e EN (16 %), AB 22 ºC (15,5 %), CF e EC (13 %) e CS e CP (5,6 %). Quanto à variação espacial registaram-se as maiores percentagens de amostras “não conformes” na zona interior e nos anos 2002 a 2004, 2008 e 2009. No que diz respeito à distribuição por origens foram observadas maiores percentagens de amostras “não conformes” nas águas de superfície, seguido de nascentes e poços.Do total de amostras analisadas, 39,8 % estavam “não conforme”, sendo que 18,3 % destas eram da rede que abastece a população (rede de distribuição).61 % das amostras “conformes” estão cloradas, o que significa que o cloro ainda é um tratamento eficaz de desinfeção

Risk of infection and adverse outcomes among pregnant working women in selected occupational groups: A study in the Danish National Birth Cohort

<p>Abstract</p> <p>Background</p> <p>Exposure to infectious pathogens is a frequent occupational hazard for women who work with patients, children, animals or animal products. The purpose of the present study is to investigate if women working in occupations where exposure to infections agents is common have a high risk of infections and adverse pregnancy outcomes.</p> <p>Methods</p> <p>We used data from the Danish National Birth Cohort, a population-based cohort study and studied the risk of Infection and adverse outcomes in pregnant women working with patients, with children, with food products or with animals. The regression analysis were adjusted for the following covariates: maternal age, parity, history of miscarriage, socio-occupational status, pre-pregnancy body mass index, smoking habit, alcohol consumption.</p> <p>Results</p> <p>Pregnant women who worked with patients or children or food products had an excess risk of sick leave during pregnancy for more than three days. Most of negative reproductive outcomes were not increased in these occupations but the prevalence of congenital anomalies (CAs) was slightly higher in children of women who worked with patients. The prevalence of small for gestational age infants was higher among women who worked with food products. There was no association between occupation infections during pregnancy and the risk of reproductive failures in the exposed groups. However, the prevalence of CAs was slightly higher among children of women who suffered some infection during pregnancy but the numbers were small.</p> <p>Conclusion</p> <p>Despite preventive strategies, working in specific jobs during pregnancy may impose a higher risk of infections, and working in some of these occupations may impose a slightly higher risk of CAs in their offspring. Most other reproductive failures were not increased in these occupations.</p

Bladder cancer index: cross-cultural adaptation into Spanish and psychometric evaluation

BACKGROUND: The Bladder Cancer Index (BCI) is so far the only instrument applicable across all bladder cancer patients, independent of tumor infiltration or treatment applied. We developed a Spanish version of the BCI, and assessed its acceptability and metric properties. METHODS: For the adaptation into Spanish we used the forward and back-translation method, expert panels, and cognitive debriefing patient interviews. For the assessment of metric properties we used data from 197 bladder cancer patients from a multi-center prospective study. The Spanish BCI and the SF-36 Health Survey were self-administered before and 12 months after treatment. Reliability was estimated by Cronbach's alpha. Construct validity was assessed through the multi-trait multi-method matrix. The magnitude of change was quantified by effect sizes to assess responsiveness. RESULTS: Reliability coefficients ranged 0.75-0.97. The validity analysis confirmed moderate associations between the BCI function and bother subscales for urinary (r = 0.61) and bowel (r = 0.53) domains; conceptual independence among all BCI domains (r ≤ 0.3); and low correlation coefficients with the SF-36 scores, ranging 0.14-0.48. Among patients reporting global improvement at follow-up, pre-post treatment changes were statistically significant for the urinary domain and urinary bother subscale, with effect sizes of 0.38 and 0.53. CONCLUSIONS: The Spanish BCI is well accepted, reliable, valid, responsive, and similar in performance compared to the original instrument. These findings support its use, both in Spanish and international studies, as a valuable and comprehensive tool for assessing quality of life across a wide range of bladder cancer patients

Un examen actualizado de la percepción de las barreras para la implementación de la farmacogenómica y la utilidad de los pares fármaco/gen en América Latina y el Caribe

La farmacogenómica (PGx) se considera un campo emergente en los países en desarrollo. La investigación sobre PGx en la región de América Latina y el Caribe (ALC) sigue siendo escasa, con información limitada en algunas poblaciones. Por lo tanto, las extrapolaciones son complicadas, especialmente en poblaciones mixtas. En este trabajo, revisamos y analizamos el conocimiento farmacogenómico entre la comunidad científica y clínica de ALC y examinamos las barreras para la aplicación clínica. Realizamos una búsqueda de publicaciones y ensayos clínicos en este campo en todo el mundo y evaluamos la contribución de ALC. A continuación, realizamos una encuesta regional estructurada que evaluó una lista de 14 barreras potenciales para la aplicación clínica de biomarcadores en función de su importancia. Además, se analizó una lista emparejada de 54 genes/fármacos para determinar una asociación entre los biomarcadores y la respuesta a la medicina genómica. Esta encuesta se comparó con una encuesta anterior realizada en 2014 para evaluar el progreso en la región. Los resultados de la búsqueda indicaron que los países de América Latina y el Caribe han contribuido con el 3,44% del total de publicaciones y el 2,45% de los ensayos clínicos relacionados con PGx en todo el mundo hasta el momento. Un total de 106 profesionales de 17 países respondieron a la encuesta. Se identificaron seis grandes grupos de obstáculos. A pesar de los continuos esfuerzos de la región en la última década, la principal barrera para la implementación de PGx en ALC sigue siendo la misma, la "necesidad de directrices, procesos y protocolos para la aplicación clínica de la farmacogenética/farmacogenómica". Las cuestiones de coste-eficacia se consideran factores críticos en la región. Los puntos relacionados con la reticencia de los clínicos son actualmente menos relevantes. Según los resultados de la encuesta, los pares gen/fármaco mejor clasificados (96%-99%) y percibidos como importantes fueron CYP2D6/tamoxifeno, CYP3A5/tacrolimus, CYP2D6/opioides, DPYD/fluoropirimidinas, TMPT/tiopurinas, CYP2D6/antidepresivos tricíclicos, CYP2C19/antidepresivos tricíclicos, NUDT15/tiopurinas, CYP2B6/efavirenz y CYP2C19/clopidogrel. En conclusión, aunque la contribución global de los países de ALC sigue siendo baja en el campo del PGx, se ha observado una mejora relevante en la región. La percepción de la utilidad de las pruebas PGx en la comunidad biomédica ha cambiado drásticamente, aumentando la concienciación entre los médicos, lo que sugiere un futuro prometedor en las aplicaciones clínicas de PGx en ALC.Pharmacogenomics (PGx) is considered an emergent field in developing countries. Research on PGx in the Latin American and the Caribbean (LAC) region remains scarce, with limited information in some populations. Thus, extrapolations are complicated, especially in mixed populations. In this paper, we reviewed and analyzed pharmacogenomic knowledge among the LAC scientific and clinical community and examined barriers to clinical application. We performed a search for publications and clinical trials in the field worldwide and evaluated the contribution of LAC. Next, we conducted a regional structured survey that evaluated a list of 14 potential barriers to the clinical implementation of biomarkers based on their importance. In addition, a paired list of 54 genes/drugs was analyzed to determine an association between biomarkers and response to genomic medicine. This survey was compared to a previous survey performed in 2014 to assess progress in the region. The search results indicated that Latin American and Caribbean countries have contributed 3.44% of the total publications and 2.45% of the PGx-related clinical trials worldwide thus far. A total of 106 professionals from 17 countries answered the survey. Six major groups of barriers were identified. Despite the region’s continuous efforts in the last decade, the primary barrier to PGx implementation in LAC remains the same, the “need for guidelines, processes, and protocols for the clinical application of pharmacogenetics/pharmacogenomics”. Cost-effectiveness issues are considered critical factors in the region. Items related to the reluctance of clinicians are currently less relevant. Based on the survey results, the highest ranked (96%–99%) gene/drug pairs perceived as important were CYP2D6/tamoxifen, CYP3A5/tacrolimus, CYP2D6/opioids, DPYD/fluoropyrimidines, TMPT/thiopurines, CYP2D6/tricyclic antidepressants, CYP2C19/tricyclic antidepressants, NUDT15/thiopurines, CYP2B6/efavirenz, and CYP2C19/clopidogrel. In conclusion, although the global contribution of LAC countries remains low in the PGx field, a relevant improvement has been observed in the region. The perception of the usefulness of PGx tests in biomedical community has drastically changed, raising awareness among physicians, which suggests a promising future in the clinical applications of PGx in LAC

An Updated Examination of the Perception of Barriers for Pharmacogenomics Implementation and the Usefulness of Drug/Gene Pairs in Latin America and the Caribbean

Pharmacogenomics (PGx) is considered an emergent field in developing countries. Research on PGx in the Latin American and the Caribbean (LAC) region remains scarce, with limited information in some populations. Thus, extrapolations are complicated, especially in mixed populations. In this paper, we reviewed and analyzed pharmacogenomic knowledge among the LAC scientific and clinical community and examined barriers to clinical application. We performed a search for publications and clinical trials in the field worldwide and evaluated the contribution of LAC. Next, we conducted a regional structured survey that evaluated a list of 14 potential barriers to the clinical implementation of biomarkers based on their importance. In addition, a paired list of 54 genes/drugs was analyzed to determine an association between biomarkers and response to genomic medicine. This survey was compared to a previous survey performed in 2014 to assess progress in the region. The search results indicated that Latin American and Caribbean countries have contributed 3.44% of the total publications and 2.45% of the PGx-related clinical trials worldwide thus far. A total of 106 professionals from 17 countries answered the survey. Six major groups of barriers were identified. Despite the region’s continuous efforts in the last decade, the primary barrier to PGx implementation in LAC remains the same, the “need for guidelines, processes, and protocols for the clinical application of pharmacogenetics/pharmacogenomics”. Cost-effectiveness issues are considered critical factors in the region. Items related to the reluctance of clinicians are currently less relevant. Based on the survey results, the highest ranked (96%–99%) gene/drug pairs perceived as important were CYP2D6/tamoxifen, CYP3A5/tacrolimus, CYP2D6/opioids, DPYD/fluoropyrimidines, TMPT/thiopurines, CYP2D6/tricyclic antidepressants, CYP2C19/tricyclic antidepressants, NUDT15/thiopurines, CYP2B6/efavirenz, and CYP2C19/clopidogrel. In conclusion, although the global contribution of LAC countries remains low in the PGx field, a relevant improvement has been observed in the region. The perception of the usefulness of PGx tests in biomedical community has drastically changed, raising awareness among physicians, which suggests a promising future in the clinical applications of PGx in LAC

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Quality of life in patients with non-muscle-invasive bladder cancer: one-year results of a multicentre prospective cohort study

OBJECTIVE: Few studies describe the effect of non-muscle-invasive bladder cancer (NMIBC) on health-related quality of life (HRQL), although patients are mostly diagnosed at this stage of the disease. Taking into account this current evidence gap and the high incidence rates in Spain, we aimed to describe the evolution over time of HRQL in Spanish patients with NMIBC and to examine the clinical and treatment-related factors associated with HRQL change during the first year of management. METHODS AND MATERIALS: Observational multicenter prospective inception cohort study conducted in urology departments of 7 Spanish hospitals. A consecutive sample of 244 patients with anatomopathologically confirmed NMIBC, recruited from October 2010 to September 2011, was followed during the diagnostic process, and 6 and 12 months later. HRQL was assessed by generic and disease-specific instruments: the Short Form-36 (covering physical and mental health) and the Bladder Cancer Index, measuring urinary, bowel, and sexual domains (summary scores: 0-100). Bivariate analysis was performed and generalized estimating equation models were constructed to assess HRQL score change. RESULTS: Almost 52% of the patients were diagnosed at stage I, and 84% were men. The number of patients treated only with transurethral resection (TUR) was 144, and 82 also received intravesical therapy with bacillus Calmette-Guérin (BCG) or mitomycin C. Mental health was significantly worse than Short Form-36 reference norms at diagnosis (mean of 49.7 vs. 53.3, 95% CI: 52.5-54.2). Urinary domain improved significantly from diagnosis (85.2, 95% CI: 82.9-87.4) to 12-month evaluation (90.2, 95% CI: 87.7-92.8), whereas sexual domain showed deterioration from 56.4 (95% CI: 52.8-59.9) to 53.7 (95% CI: 50.0-57.4). Adjusted HRQL score changes from baseline to 12-month follow-up estimated with generalized estimating equation models showed improvement on the following parameters: urinary domain after TUR with or without intravesical therapy (+3.9, 95% CI: 0.1-7.7), bowel domain among patients treated with TUR and BCG (+7.0, 95% CI: 2.4-11.5), and sexual domain among those treated with TUR and mitomycin C (+13.1, 95% CI: 5.9-20.2). CONCLUSIONS: For the first time, a distinctive HRQL pattern of bladder cancer treatment benefits emerges for TUR alone, and in combination with BCG or mitomycin C, which deserves further research. Treatment differences cannot be interpreted in terms of efficacy but can be useful to generate hypotheses to test in future studies

Microbiological quality surveillance of drinking water and water intended for drinking in the province of Valencia (Spain) during the period 2002-2010

El presente trabajo tiene como objetivo la evaluación de la calidad microbiológica de las muestras de agua analizadas en la provincia de Valencia durante el período 2002-2010. Se observó la variación espacial, temporal y por origen de las muestras que no cumplían los requisitos especificados en el RD 140/2003 para los coliformes totales (CT), coliformes fecales (CF), Escherichia coli (EC), aerobios a 22 ºC (AB 22 ºC), estreptococos fecales (EF), enterococos (EN), Clostridium sulfito reductores (CS), y Clostridium perfringens (CP), estratificando las muestras en aquellas que cumplían la normativa “Conformes” y las que no “No Conformes”, y su relación con el grado de cloración.Se estudian un total de 10057 muestras de agua procedentes de fuentes que no manan de la red, aguas superficiales, aguas provenientes de plantas desnitrificadoras, pozos y redes de distribución. Se han agrupado en las 17 comarcas de la provincia de Valencia.Del total de las muestras, no cumplían los requisitos de calidad para CT el 34,0 %, para EF-EN el 16,0 %, para AB 22 ºC el 15.5 % para CF-EC el 13,0 % y para CS-CP el 5,6 %. Los porcentajes más elevados de muestras “No Conformes” se observaron situados en la zona interior, y en los años 2002-2004, 2008 y 2009. Respecto a la distribución por origen, se observaron en aguas superficiales, seguidas de fuentes y pozos.Del total de muestras estudiadas, el 39,8 % eran “No Conformes”, y de estas un 18,3 % procedían de abastecimientos que proveen a la población (redes de distribución).El 61,0 % de las muestras “Conformes” estaban cloradas, lo que demuestra que el cloro sigue siendo un tratamiento efectivo de desinfección.Este trabalho tem como objetivo avaliar a qualidade microbiológica de amostras de água analisadas na província de Valência durante o período de 2002 a 2010. Observou-se a variação espacial, temporal e da origem das amostras que não cumprem os requisitos estabelecidos no RD 140/2003, para coliformes totais (CT), coliformes fecais (CF), Escherichia coli (EC), germes aeróbios a 22 ºC (AB 22 ºC), estreptococos fecais (EF), enterococos (EN), Clostridium sulfito (CS) e Clostridium perfringens (CP), estratificando as amostras que cumpriam os requisitos em “conformes” e as que não cumpriam em “não conformes” e a relação com o nível de cloro. Foi estudado um total de 10057 amostras de água de diversas origens: fontes, águas superficiais, centrais de desnitrificação, poços e rede de distribuição. Foram agrupadas nos 17 municípios de Valência.Do total das amostras, não cumpriam os requisitos de qualidade para CT (34 %), EF e EN (16 %), AB 22 ºC (15,5 %), CF e EC (13 %) e CS e CP (5,6 %). Quanto à variação espacial registaram-se as maiores percentagens de amostras “não conformes” na zona interior e nos anos 2002 a 2004, 2008 e 2009. No que diz respeito à distribuição por origens foram observadas maiores percentagens de amostras “não conformes” nas águas de superfície, seguido de nascentes e poços.Do total de amostras analisadas, 39,8 % estavam “não conforme”, sendo que 18,3 % destas eram da rede que abastece a população (rede de distribuição).61 % das amostras “conformes” estão cloradas, o que significa que o cloro ainda é um tratamento eficaz de desinfeção.This study focuses on assessing the microbiological quality of drinking water and of water intended for drinking in the province of Valencia (Spain) between 2002 and 2010. Variation was found regarding space, time and source requirements in samples that did not meet the standards of quality established by Royal Decree 140/2003 for the following: total coliforms (TC); faecal coliforms (FC); Escherichia coli (EC); aerobic bacteria at 22 ºC (AB 22 ºC); faecal streptococci (FS); enterococci (EN); sulphite-reducing clostridia (SC); and Clostridium perfringens (CP). The samples were stratified by those meeting the standards (“Compliance”) and those that did not (“Non-Compliance”), as well as by their relationship with the degree of chlorination.A total of 10057 water samples were examined from various sources: springs; surface waters; denitrifying plant waters; wells; and distribution networks. They were grouped into each of the 17 districts of the province of Valencia.The total number of samples that failed to meet the standards of quality, for each criterion, were as follows: 34.0 % for TC; 16.0 % FS-EN; 13.0 % for FC-EC; 5.6 % for SC-CP; and 15.5 % for AB 22 ºC. Regarding spatial variation in samples, the highest percentages of samples in the “Non-Compliance” group were found in the interior part of the province. For time variation, the highest percentages of “Non-Compliance” were for the years: 2002 - 2004, 2008 and 2009. Regarding source variation, origin of the samples with “Non- compliance” was highest for surface waters, followed by springs and wells.For all samples studied, 39.8 % were within the “Non-Compliance” group, of which 18.3 % came from sources that supply the population (distribution networks).Of the samples within the “Compliance” group, 61 % were chlorinated, which confirms that chlorine is a powerful disinfectant and that chlorination is an effective water disinfection treatment