The Role of Chiggers as Human Pathogens

Trombiculid mites (Acari: Trombiculidae) are distributed worldwide ectoparasites of a wide range of vertebrates. More than 50 species are known to bite humans, and about 20 have medical importance. The larval stages (chiggers) of the genus Leptotrombidium are vectors of Orientia tsutsugamushi, causative agent of scrub typhus. This life-threatening disease is widely endemic in Asian Pacific regions where more than one billion people are at risk of acquiring the infection and around one million new cases are estimated to occur annually. In addition, although underreported and often misdiagnosed, trombiculiasis, defined as a dermatitis caused by the salivary secretion of biting chiggers, is present in America and Europe

Role of Birds in Dispersal of Etiologic Agents of Tick-borne Zoonoses, Spain, 2009

We amplified gene sequences from Anaplasma phagocytophilum, Borrelia garinii, B. valaisiana, B. turdi, Rickettsia monacensis, R. helvetica, R. sibirica sibirica, and Rickettsia spp. (including Candidatus Rickettsia vini) in ticks removed from birds in Spain. The findings support the role of passerine birds as possible dispersers of these tick-borne pathogens

Media competence evaluation depending on gender and educational qualifications

Este artículo tiene como objetivo averiguar si existen diferencias significativas en las dimensiones de competencia mediática: estética, lenguaje, ideología y valores, recepción y audiencia, producción y programación, y tecnología, entre los españoles en general y los riojanos en particular en función de la variable género y de la variable estratificada según nivel de estudios cursados por los encuestados. Para llevar a cabo dicho trabajo se ha elaborado y aplicado un cuestionario con fiabilidad y validez demostrada, dicho cuestionario ha sido consensuado por expertos de ámbito nacional e internacional en este campo de estudio. La muestra ha consistido en la gestión de más de 6.626 cuestionarios en el conjunto de España y de 516 cuestionarios en la Comunidad Autónoma de La Rioja. El trabajo se realizó alternando el sistema presencial y el on-line. Los resultados ponen de manifiesto que tanto en los ciudadanos de España como en los ciudadanos de la Comunidad Autónoma de La Rioja existen graves carencias respecto al grado de competencia en comunicación audiovisual, entendida como la capacidad para interpretar mensajes audiovisuales de manera reflexiva y crítica y para expresarse a través del lenguaje audiovisual con unos mínimos de corrección y de creatividad.This article aims to find out whether there are significant differences in the dimensions of media competence: aesthetics, language, ideology and values, reception and audience, production and programming, and technology, between Spanish citizens in general and Rioja citizens in particular depending on the gender variable and the stratified level of educational qualifications variable, with different values reflecting the qualifications of the citizens surveyed. In order to carry out this work a questionnaire with proven reliability and validity has been designed. Such a questionnaire has been agreed on by national and international experts on this field of study. The sample consists of more than 6626 questionnaires filled in by Spanish citizens from different regions and 516 questionnaires filled in by citizens of the La Rioja autonomous region of Spain. Both, face-to-face and online, methods have been used in this work. The results show that both the Spanish citizens and the citizens of the La Rioja autonomous region exhibit a marked lack of competence in audiovisual communication, understood as the ability to interpret audiovisual messages in a reflective and critical manner, and to express their ideas using the audiovisual language with a minimum degree of correctness and creativity

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

Association among presence of cancer pain, inadequate pain control, and psychotropic drug use

Introduction Pain is a common symptom in cancer patients, and its control and management are complex. Despite the high concomitant use of psychotropic drugs among such patients, the association among pain, inadequate pain control, and psychotropic drug use has not been fully determined. This study examined the prevalence of cancer pain and inadequate pain control and the association with psychotropic drug use. Materials and methods In this cross-sectional study, we investigated 402 medical records obtained by simple random sampling of oncology patients at a hospital in northern Spain from July 2012 to July 2014. Adjusted odds ratios (ORs) were estimated together with their 95% confidence intervals (95% CIs) by unconditional logistic regression for each type of psychotropic drug (anxiolytics, hypnotics, and antidepressants). Results The mean patient age was 61.17 (standard deviation ± 13.14) years; 57.5% were women, 42.5% men. Pain was present in 18.4% of patients and inadequate pain control in 54.2%. We found a statistically significant association between the presence of cancer pain and anxiolytic use (adjusted OR, 3.15; 95% CI, 1.49±6.68) and hypnotic use (adjusted OR, 5.19; 95% CI, 1.77±15.25). Inadequate pain control was associated to a greater extent with the use of those drugs: adjusted OR for anxiolytic use, 4.74 (95% CI, 1.91±11.80); adjusted OR for hypnotic use, 6.09 (95% CI, 1.74±21.32). By contrast, no association was found between pain and antidepressant use (adjusted OR, 0.99). Conclusion The presence of pain and (to a greater extent) poor pain control were associated with increased use of certain psychotropic drugs, such as anxiolytics and hypnotics. There appeared to be no association between pain and antidepressant use

Validación de escala de apoyo en duelo en atención de salud para población hispanoparlante

The death of a child, who is attended by professionals, can be conceived by them as a loss, sometimes resulting in a traumatic expe­rience. Social support becomes an important mediator of the grieving process, helping to relieve the stress and to cope better. Objec­tive: Translation and validation into Spanish of «Grief Support in Health Care Scale (GS­HCS)». Method: Through the translation and validation of cross-cultural equivalence of GS­HCS in its Spanish version: «Apoyo en Duelo en Atención de Salud (EADAS)», we procee­ded to auto-apply this instrument to 215 pro­fessionals working in oncology units and cri­tical pediatric care. With this data there was an internal analysis of the tendencies using Cronbach’s Alpha, Bootstrap Confidence In­tervals and an exploratory analysis was perfor­med to test the psychometric properties of the scale divided into three dimensions; recogni­tion of the relationship, recognition of the loss and incorporation of belief rituals, performing a comparison of means using the t test for independent samples. Results: The «Grief Sup­port in Health Care Scale» (GSHCS) obtained a validation and reliability with a coefficient Cronbach’s Alpha score of 0.81. By analyzing the variables, it was found that oncology unit professionals and both units women perceive themselves to be more socially supported in their mourning. Conclusion: The «Grief Sup­port in Health Care Scale» (GSHCS) is a valid and reliable instrument, which allows to iden­tify the perception of support in the mourning process. La muerte de un niño atendido por profe­sionales puede ser concebida por ellos como una pérdida, convirtiéndose en ocasiones en una experiencia traumática. El soporte social se transforma en un importante mediador del proceso de duelo, ayudando a aliviar el estrés y afrontarlo de mejor manera. Objetivo: Traduc­ción y validación al español del Grief Support in Health Care Scale (GSHCS). Método: Tras la traducción y validación de la equivalencia transcultural del GSHCS en su versión al es­pañol: Escala de Apoyo en Duelo en Atención de Salud (EADAS), se procedió a la auto apli­cación del instrumento en 215 profesionales que trabajan en unidades de oncología y de cuidados críticos pediátricos. Con los datos se realizó un análisis de consistencia interna, Alfa de Cronbach, intervalos de confianza de Boostrap y análisis exploratorio para testear las propiedades psicométricas de la escala di­vidida en tres dimensiones: reconocimiento de la relación, reconocimiento de la pérdida e incorporación de los rituales, realizándose una comparación de medias mediante la prueba de t para muestras independientes. Resultados: El EADAS obtuvo una validación y confiabilidad con un Coeficiente Alfa de Cronbach de 0,81. Al analizar las variables, se encontró que los profesionales de la unidad de oncología y las mujeres de ambas unidades se perciben más socialmente apoyados en sus duelos. Conclu­sión: El EADAS es un instrumento válido y con­fiable que permite identificar la percepción de soporte ante el duelo en profesionales de la salud

Living with a peripherally inserted central catheter: the perspective of cancer outpatients - a qualitative study

PURPOSE: The aim of this study was to describe the experience of using a peripherally inserted central catheter (PICC) in cancer sufferers receiving outpatient treatment. METHODS: A qualitative, phenomenological study was performed. Purposeful sampling methods were used. Data collection methods included semi-structured interviews and researcher field notes. Thematic analysis was used to analyze data. The study was conducted following the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS: Eighteen patients (61% women, mean age 58 years) participated. They spent a mean duration of 155 days with the line in place. Two themes were identified with different subgroups. The theme "Living with a PICC line," including the subthemes "Benefits" and "Disadvantages," displays how the implantation is experienced by patients in a dichotomous manner. This highlighted both the beneficial and negative aspects of the implantation. The second theme was "Adapting to life with the catheter" and comprised three subthemes: "Advantages," "Lifestyle modifications," and "Overall assessment of the peripherally inserted central catheter," which shows how patients gradually accept the catheter by adapting their lifestyle. CONCLUSIONS: Over time, most patients considered having a PICC line to be a positive experience that they would recommend to other patients, as they found that it did not alter their quality of life. These results can be applied in Oncology Units for developing specific protocols for patients

Impact of environmental airborne manganese exposure on cognitive and motor functions in adults: a systematic review and meta-analysis

Background/Objective: Whether environmental exposure to Manganese (Mn) in adults is associated with poorer results in cognitive and motor function is unclear. We aimed to determine these associations through a meta-analysis of published studies. Methods: A systematic review was conducted to identify epidemiological studies on a population _18 years old exposed to environmental airborne Mn, and in which results on specific tests to evaluate cognitive or motor functions were reported. We consulted Medline through PubMed, Web of Science and SCOPUS databases. We also performed a manual search within the list of bibliographic references of the retrieved studies and systematic reviews. To weight Mn effects, a random effects versus fixed effect model was chosen after studying the heterogeneity of each outcome. Results. Eighteen studies met the inclusion criteria. Among them, eleven studies reported data susceptible for meta-analysis through a pooled correlation or a standardized means difference (SMD) approach between exposed and non-exposed groups. Regarding cognitive function, the results of the studies showed heterogeneity among them (I2 = 76.49%, p < 0.001). The overall effect was a statistically significant negative correlation in the random effects model (pooled r = -0.165; 95%CI: -0.214 to -0.116; p < 0.001). For SMD, the results showed a lower heterogeneity with a negative SMD that did not reach statistical significance under the fixed effects model (SMD = -0.052; 95%CI -0.108 to 0.004; p = 0.068). Regarding motor function, heterogeneity (I2 = 75%) was also observed in the correlation approach with a pooled r (random effect model) = -0.150; 95%CI: -0.219 to -0.079; p < 0.001. Moderate heterogeneity was observed according to the SMD approach (I2 = 52.28%), with a pooled SMD = -0.136; 95%CI: -0.188 to-0.084; p < 0.001, indicating worse motor function in those exposed. Conclusions: Correlation approach results support a negative effect on cognitive and motor functions (the higher the Mn levels, the poorer the scores). Regarding the SMD approach, results also support a worse cognitive and motor functions in those exposed, although only for motor function statistical significance was obtained.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

Nasosinusal adenocarcinoma in Cantabria

RESUMEN: Objetivo: El adenocarcinoma nasosinusal (ADCNS) es una neoplasia infrecuente con una fuerte asociación a exposición ocupacional a polvo de madera que se encuentra recogida en el cuadro de enfermedades profesionales del RD 1299/2006. El propósito de este trabajo es conocer la incidencia, las características clínicas y su declaración como enfermedad profesional en la Comunidad de Cantabria. Material y Método: Estudio clínico-epidemiológico retrospectivo de los pacientes diagnosticados de ADCNS en la comunidad autónoma de Cantabria entre los años 1990-2014. Resultados: En el periodo de estudio se registraron 36 casos de ADCNS. Todos los casos fueron varones, con una mediana de edad de 69 años. La localización más frecuente fue el etmoides. Los síntomas principales que motivaron la consulta fueron la obstrucción nasal y epistaxis, con una mediana de tiempo hasta la primera consulta con el especialista de 6 meses. La supervivencia estimada a los 5 años fue del 52%; Intervalo de Confianza al 95% (IC): 36-68%. En 31 pacientes (86%) se objetivó historia laboral de ocupaciones relacionadas con la exposición a polvo de madera, siendo ebanistas y carpinteros las más frecuentes. Sin embargo, ningún caso se declaró como contingencia laboral, y en especial como enfermedad profesional tras la aprobación en 2006 de la normativa vigente. Conclusiones: Los síntomas clínicos como la obstrucción nasal o la epistaxis deben alertarnos en trabajadores que tengan el antecedente de haber trabajado con la madera. La mayoría de los adenocarcinomas son diagnosticados en estadios avanzados lo que empeora el pronóstico. Debe proporcionarse la formación y sensibilización adecuada sobre cáncer laboral en facultativos para una mejor notificación de la sospecha de un origen laboral.ABSTRACT: Objective: Nasosinusal adenocarcinoma (NSADC) is an infrequent neoplasm with a strong association to occupational exposure to wood dust that is listed in the RD 1299/ 2006 occupational disease list. The purpose of this work is to know the incidence, the clinical characteristics and its declaration as an occupational disease in the Autonomous Community of Cantabria of Spain. Material and Method: Retrospective clinical-epidemiological study of patients diagnosed with NSADC in the autonomous community of Cantabria between the years 1990-2014. Results: During the study period, 36 cases of ADCNS were recorded. All cases were male, with a median age of 69 years. The most frequent location was the ethmoid. The main symptoms that motivated the specialist visit were nasal obstruction and epistaxis, with a median time until the first specialist visit of 6 months. Estimated survival at 5 years was 52%; 95% confidence interval (IC): 36-68%. In 31 patients (86%) there was an occupational history of occupations related to exposure to wood dust, with cabinetmakers and carpenters being the most frequent. However, no case was declared as an occupational contingency, and especially not as an occupational disease after the approval in 2006 of the current regulations. Conclusions: Clinical symptoms such as nasal obstruction or epistaxis should alert us in workers who have a history of working with wood. Most adenocarcinomas are diagnosed in advanced stages which worsens the prognosis. Adequate training and awareness of occupational cancer should be provided to physicians for better reporting of suspected occupational origin