Incorporating Administrative Staff in Trans-Affirmative Care Training: A Cognitive-Behavioral Learning Approach

Administrative staff play an integral role in providing trans-affirmative health care. However, few trans-affirmative education and training interventions have been developed for non-medical health care staff. In this short report, we describe the development and piloting of a trans-affirmative care training intervention designed expressly for administrative staff. Based on our piloting, we put forth recommendations for the inclusion of administrative staff in trans-affirming education and training in health care systems. We hope to stimulate further development and evaluation of our approach, as well as changes in policies, so as to create more inclusive, trans-affirming health care systems.

Near real-time surveillance of the SARS-CoV-2 epidemic with incomplete data

Designing public health responses to outbreaks requires close monitoring of population-level health indicators in real-time. Thus, an accurate estimation of the epidemic curve is critical. We propose an approach to reconstruct epidemic curves in near real time. We apply this approach to characterize the early SARS-CoV-2 outbreak in two Spanish regions between March and April 2020. We address two data collection problems that affected the reliability of the available real-time epidemiological data, namely, the frequent missing information documenting when a patient first experienced symptoms, and the frequent retrospective revision of historical information (including right censoring). This is done by using a novel back-calculating procedure based on imputing patients' dates of symptom onset from reported cases, according to a dynamically-estimated "backward" reporting delay conditional distribution, and adjusting for right censoring using an existing package, NobBS , to estimate in real time (nowcast) cases by date of symptom onset. This process allows us to obtain an approximation of the time-varying reproduction number ( R t ) in real-time. At each step, we evaluate how different assumptions affect the recovered epidemiological events and compare the proposed approach to the alternative procedure of merely using curves of case counts, by report day, to characterize the time-evolution of the outbreak. Finally, we assess how these real-time estimates compare with subsequently documented epidemiological information that is considered more reliable and complete that became available later in time. Our approach may help improve accuracy, quantify uncertainty, and evaluate frequently unstated assumptions when recovering the epidemic curves from limited data obtained from public health surveillance systems in other locations.

Recent and historical pollution legacy in high altitude Lake Marboré (Central Pyrenees): A record of mining and smelting since pre-Roman times in the Iberian Peninsula

We have analyzed potential harmful trace elements (PHTE; Pb, Hg, Zn, As and Cu) on sediment cores retrieved from lake Marboré (LM) (2612 m a.s.l, 42°41'N; 0° 2'E). PHTE variability allowed us to reconstruct the timing and magnitude of trace metal pollutants fluxes over the last 3000 years in the Central Pyrenees. A statistical treatment of the dataset (PCA) enabled us to discern the depositional processes of PHTE, that reach the lake via direct atmospheric deposition. Indeed, the location of LM above the atmospheric boundary layer makes this lake an exceptional site to record the long-range transport of atmospheric pollutants in the free troposphere. Air masses back-trajectories analyses enabled us to understand the transport pathways of atmospheric pollutants while lead isotopic analyses contributed to evaluate the source areas of metal pollution in SW Europe during the Late Holocene. PHTE variability, shows a clear agreement with the main exploitation phases of metal resources in Southern Europe during the Pre-Industrial Period. We observed an abrupt lead enrichment from 20 to 375 yrs CE mostly associated to silver and lead mining and smelting practices in Southern Iberia during the Roman Empire. This geochemical data suggests that regional atmospheric metal pollution during the Roman times rivalled the Industrial Period. PHTE also increased during the High and Late Middle Ages (10-15^th centuries) associated to a reactivation of mining and metallurgy activities in high altitude Pyrenean mining sites during climate amelioration phases. Atmospheric mercury deposition in the Lake Marboré record mostly reflects global emissions, particularly from Almadén mines (central Spain) and slightly fluctuates during the last three millennia with a significant increase during the last five centuries. Our findings reveal a strong mining-related pollution legacy in alpine lakes and watersheds that needs to be considered in management plans for mountain ecosystems as global warming and human pressure effects may contribute to their future degradation.

First secondary case of Ebola outside Africa: epidemiological characteristics and contact monitoring, Spain, September to November 2014

On 6 October 2014, a case of Ebola virus disease (EVD) acquired outside Africa was detected in Madrid in a healthcare worker who had attended to a repatriated Spanish missionary and used proper personal protective equipment. The patient presented with fever <38.6 °C without other EVD-compatible symptoms in the days before diagnosis. No case of EVD was identified in the 232 contacts investigated. The experience has led to the modification of national protocols.

Accumulation of mercury in Typha domingensis under field conditions

Typha species is a common wetland plant used in the treatment of urban and industrial effluents. But, despite their widespread implementation, there are not many studies based on the behaviour of this plant growing in an areas affected by mercury. The present work investigates the ability of Typha domingensis to accumulate mercury under field conditions. The study area was along the Valdeazogues river which flows through the Almadén mining district (Ciudad Real, Spain) that is considered the largest mercury reservoir in the world. The mercury concentration in different plant fractions was measured as well as the available and total concentration in the bottom sediments. The results showed that the highest mercury concentrations were found in the belowground organs. T. domingensis had a high efficiency to accumulate mercury in their organs although available metal concentrations in the environment did not exceed 0.16 mg kg(-1). Bioaccumulation factors (BAF) ranged between 121 and 3168 in roots. Furthermore, significant correlations were found between mercury concentration in all plant organs and Hg in sediments (both total and available). These results demonstrated that T. domingensis could be used as a biomonitor as well as in phytoextraction technology in areas affected by mercury.

Impact of the lavender rhizosphere on the mercury uptake in field conditions

Lavender plants as well as their rhizosphere and bulk soil were sampled on a wide range of soils with different land use within the Almadén mercury mining district. The aim of this work is to evaluate the role of the rhizosphere on mercury behavior in soil-lavender plant system including chemometric analysis. The edaphic parameters that significantly differed between lavender rhizosphere and bulk soil were: total Hg; easily available Hg; electrical conductivity; organic matter; cation exchange capacity; soluble ions (Cl(-); SO(4)(2-); PO(4)(3-); NO(3)(-); Al(+); Mn(2+); Ca(2+) and Mg(2+)). The most important variable in the differentiation is electrical conductivity. Furthermore, both organic matter and Mn(2+) in rhizosphere soil seem to block Hg availability to plant. However, the presence of sulfates seems to favor it. Regarding other relationships, Hg seems to block Pb uptake by lavender plants and, on the other hand, the presence of Mn(2+) seems to favor it. Furthermore, Hg root uptake by lavender and its distribution throughout the plant have been studied. The more available Hg in rhizosphere soil, the more Hg is translocated to aerial part and less Hg is retained by root. In all cases, the Hg concentration in the root was higher than in the aerial part.

Potential cultivation of Hordeum vulgare L. in soils with high mercury background concentrations

Experimental work was carried out under close-to-real conditions to study mercury uptake by Hordeum vulgare L. cultivated in lysimeter experiments. The soil in the lysimeter experiment was obtained from a test plot located near Almadén (Spain) and had a mean mercury content of 22.9 mg kg(-1). A sequence of four crops was sown starting in autumn 2000 and repeated on a yearly basis until 2004. The first crop was grown in the field prior to the extraction of 5 one-cubic-meter lysimeters. The succeeding crops were sown in the lysimeter experiments at the CIEMAT Research Centre (Madrid, Spain). Samples of root and shoot were obtained during the four seasons. Concentrations of mercury at plant maturity in roots vary between I and 3 mg kg(-1) and in straw and grain the concentrations range from 72 to 480 microg kg(-1) and from 5 to 257 microg kg(-1), respectively. In order to assess the potential risk for human health and animal feed, an evaluation of the mercury content in the edible part of the crop has been carried out. According to legislation, there is no human health intoxication risk with a balanced consumption; otherwise, the forage use would have to be controlled.

Mercury content in vegetation and soils of the Almadén mining area (Spain)

The Almadén area is an exceptional case of mercury concentration in the world, where cinnabar is the predominant mineralised form. Mining activities have been carried out over the past two thousand years and once this activity is concluded, a restoration of the environment is necessary for the affected areas. That implies the selection, optimisation and application of the most appropriate techniques focused on the recovery of contaminated areas. Phytotechnology is one of the proposed techniques, which considers the use of plants due to the low environmental impact and their proved efficiency. In this framework, it is necessary to study the behaviour of mercury in the soil-plant system and to determine the mercury absorption capacity of the different Almadén plant species. Therefore, field and laboratory studies have been carried out to determine the easily available forms of mercury in ten test plots in the Almadén area and the resulting data is related to the mercury accumulation in different plant species of the studied territory. Special attention is given to the easily available forms of mercury in the analysed soils and used as the transfer factor for the Hg-availability index that relates the amount of mercury in a plant with the total amount of mercury in a soil and with the easily available forms. The result of this experimental work is selecting the plant species suitable to be used in a future implementation of phytotechnologies in this area.

The association of dietary folate, B6, and B12 with cardiovascular mortality in Spain: an ecological analysis

OBJECTIVES

This study assessed the association of dietary folate, vitamin B6, and vitamin B12 with cardiovascular mortality.

METHODS

Poisson regression analyses assessed coronary/cerebrovascular mortality rates via nutrient data obtained from the National Nutrition Survey, which recorded 7-day food intakes from a national sample of 21,155 households.

RESULTS

In regard to coronary mortality, male and female rate ratios (highest vs lowest quintile) were 0.83 (95% confidence interval [CI] = 0.77, 0.91) and 0.95 (95% CI = 0.86, 1.05), respectively, for folate and 0.74 (95% CI = 0.65, 0.84) and 0.86 (95% CI = 0.73, 0.99), respectively, for B12. Intake of folate and B6 (but not B12) was significantly associated with cerebrovascular mortality.

CONCLUSIONS

B vitamins are associated with cardiovascular mortality in the general population.

[Orthostatic hypotension in the aged and its association with antihypertensive treatment]

BACKGROUND

To assess the prevalence of orthostatic hypotension (OH) in an elderly population and to evaluate the influence of hypertension control and of the type of antihypertensive drug used.

METHODS

2,700 elderly patients (> 65 years) from the EPICARDIAN study were included. Blood pressure (BP) was measured twice with the patient seated and once again 1 to 3 minutes afterwards with the patient standing. Hypertension is defined as BP > or = 140/90 mmHg or if the patient received antihypertensive treatment. Orthostatic hypotension was defined as a fall of SBP > or = 20 mmHg and/or DBP > or = 10 mmHg 1 to 3 minutes after the postural change.

RESULTS

71.6% of the patients were classified as hypertensive and 57.1% were receiving pharmacological treatment. The overall prevalence of OH was 6.8% among hypertensive patients, 8.1% and 3.4% in normotensives patients (p < 0.05). No significant difference was found in the prevalence of OH between those receiving (7.7%) or not (8.6%) antihypertensive medication. No association was found either between the prevalence of OH and the type or number of antihypertensive drugs used. 17.6% of the patients reached hypertension optimal control (SBP < 140 and DBP < 90 mmHg), the prevalence of OH in these patients was 5.3%, among the uncontrolled the prevalence was 8.9% (p < 0.05). The adjusted OR was 1.91 (1.1-3.3) for the prevalence of OH in the uncontrolled patients versus the controlled.

CONCLUSIONS

The prevalence of OH in the elderly is not very high, being greater among hypertensive than normotensive patients. No association was found between the prevalence of OH and the number of drugs received. Reaching hypertension control reduces the prevalence of OH.

[Cerebrovascular mortality in Spain]

INTRODUCTION

Although the mortality due to cerebrovascular disease in Spain has been considerably reduced in the past twenty years, at all ages and in both sexes, it is still the second cause of death in men and first in women.

OBJECTIVE

To describe the mortality due to cerebrovascular disease in Spain.

MATERIAL AND METHODS

We analyse a time series over a period of 45 years (1951-1995) by age, sex, period of death (calendar year) and cohort of birth, the geographical distribution in the last five year period available (1991-1995), and compared with other industrial countries.

RESULTS

The mortality due to cerebrovascular disease in Spain has dropped over the past twenty years. This fall has accelerated over the past five years, mainly in the older age groups. Both effects, period and cohort, are seen in this drop. There is marked male predominance. The geographical distribution is in a north-south pattern. At an international level, mortality due to cerebrovascular disease in Spain is medium-low, although in some provinces it is high.

CONCLUSIONS

Efforts to reduce the incidence and severity of cerebrovascular disease are essential to reduce mortality. It is necessary to continue investigations as to the true impact of this group of disorders, incidence, gravity and mortality, and the distribution of cardiovascular risk factors in the whole population.

Time trends, cohort effect and spatial distribution of cerebrovascular disease mortality in Spain

STUDY OBJECTIVE

This study describes mortality due to cerebrovascular disease (CVD) in Spain, based on time-series analysis in the period 1951-1995 by age, sex, and cohort of birth; spatial distribution observed for the five-year period 1991 1995, and time-spatial analysis in the period 1992-1995 vs. 1988-1991. Special attention is paid to risk of medium aged population.

DESIGN

Longitudinal and cross-sectional observational study.

SETTING AND PARTICIPANTS

Spanish population. All mortality data used were taken from official statistics. Time trends and spatial distribution were analyzed using log-linear Poisson regression models.

MAIN RESULTS

CVD mortality declined over the last two decades of the study period (1974-1995) by an annual average of 4.16% (95% CI: 3.95-4.36) and 4.00% (95% CI: 3.77-4.24) in men and women, respectively. The downward trends were accelerated in last decade. An excess of male mortality was in evidence. For all age groups mortality declined with more recent cohorts, but the decline was less marked among ages 35 64. Spatial distribution of CVD mortality revealed a north-south pattern, but this is being difuminated by increasing rates in the lower risk provinces. Internationally, Spain ranks midway to low in terms of its overall CVD mortality.

CONCLUSIONS

Efforts to reduce CVD incidence and case fatality are the essential prerequisite for any long-term improvement in mortality. Accordingly, further research is called for into current disease morbidity and the risk factors to be targeted at a general population level, nationwide.