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Ribeiro AI, Triguero-Mas M, Jardim Santos C, Gómez-Nieto A, Cole H, Anguelovski I, Silva FM, Baró F. Exposure to nature and mental health outcomes during COVID-19 lockdown. A comparison between Portugal and Spain. Environ Int 2021; 154:106664. [PMID: 34082237 PMCID: PMC8162907 DOI: 10.1016/j.envint.2021.106664] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 03/22/2021] [Accepted: 05/22/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND To control the spread of the SARS-CoV-2 virus, countries around the world implemented lockdowns with varying intensities. Lockdowns, however, have been associated with a deterioration of mental health, including post-traumatic stress symptoms, anger and anxiety. Exposure to nature might reduce stress and provide relaxation opportunities. OBJECTIVE Firstly, we aimed to determine which sociodemographic, housing and lockdown-related characteristics were associated with changes in exposure to nature during the COVID-19 lockdown in Portugal and Spain. Secondly, we sought to estimate the associations of these changes with mental health, and test whether these associations differed according to sociodemographic characteristics and between the two countries, which experienced different restrictions and epidemiological situations. METHODS A cross-sectional study was conducted between March 27 and May 6, 2020, using an online questionnaire to measure changes in exposure to nature (including private green space and other greenery, views of nature from home and public natural spaces); sociodemographic, housing and lockdown-related characteristics; stress levels (visual stress scale); psychological distress (General Health Questionnaire - 12 items) and somatization (somatization scale). Adjusted regression models were fitted to estimate associations. RESULTS This study included 3157 participants (1638 from Portugal, 1519 from Spain). In Portugal, maintaining/increasing the use of public natural spaces during the lockdown was associated with lower levels of stress (adjusted beta -0.29; 95%CI -0.49, -0.08) and maintaining/increasing the frequency of viewing nature from home was associated with reduced psychological distress (0.27; -0.51, -0.03), somatization (-0.79; -1.39, -0.20), and stress levels (-0.48; -0.74, -0.23). In Spain, maintaining/increasing contact with private green space and greenery was associated with lower stress levels: for contact with indoor plants (-0.52; -0.96, -0.07) and for use of private community green spaces (-0.82; -1.61, -0.03). CONCLUSION Exposure to nature was associated with better mental health outcomes during lockdowns, but the natural features associated with improved mental health differed between the two countries. Nature should be incorporated into urban planning interventions and housing design and exposure to nature should be promoted during lockdowns.
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Affiliation(s)
- Ana Isabel Ribeiro
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal.
| | - Margarita Triguero-Mas
- Institute of Environmental Science and Technology (ICTA), Universitat Autònoma de Barcelona (UAB), Edifici Z (ICTA-ICP), Carrer de les Columnes s/n, Campus de la UAB, 08193 Cerdanyola del Vallès, Spain; Hospital del Mar Medical Research Institute (IMIM), Carrer Doctor Aiguader 88, 08003 Barcelona, Spain; Barcelona Lab for Urban Environmental Justice and Sustainability (BCNUEJ), Carrer Doctor Aiguader 88, 08003 Barcelona, Spain; Mariana Arcaya's research lab, Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Cláudia Jardim Santos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Rua das Taipas 135, 4050-600 Porto, Portugal
| | | | - Helen Cole
- Institute of Environmental Science and Technology (ICTA), Universitat Autònoma de Barcelona (UAB), Edifici Z (ICTA-ICP), Carrer de les Columnes s/n, Campus de la UAB, 08193 Cerdanyola del Vallès, Spain; Hospital del Mar Medical Research Institute (IMIM), Carrer Doctor Aiguader 88, 08003 Barcelona, Spain; Barcelona Lab for Urban Environmental Justice and Sustainability (BCNUEJ), Carrer Doctor Aiguader 88, 08003 Barcelona, Spain
| | - Isabelle Anguelovski
- Institute of Environmental Science and Technology (ICTA), Universitat Autònoma de Barcelona (UAB), Edifici Z (ICTA-ICP), Carrer de les Columnes s/n, Campus de la UAB, 08193 Cerdanyola del Vallès, Spain; Hospital del Mar Medical Research Institute (IMIM), Carrer Doctor Aiguader 88, 08003 Barcelona, Spain; Barcelona Lab for Urban Environmental Justice and Sustainability (BCNUEJ), Carrer Doctor Aiguader 88, 08003 Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Passeig Lluís Companys 23, Barcelona, Spain
| | - Filipa Martins Silva
- Departamento Pedopsiquiatria e Saúde Mental da Infância e da Adolescência do Centro Hospitalar e Universitário do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Francesc Baró
- Institute of Environmental Science and Technology (ICTA), Universitat Autònoma de Barcelona (UAB), Edifici Z (ICTA-ICP), Carrer de les Columnes s/n, Campus de la UAB, 08193 Cerdanyola del Vallès, Spain; Barcelona Lab for Urban Environmental Justice and Sustainability (BCNUEJ), Carrer Doctor Aiguader 88, 08003 Barcelona, Spain; Vrije Universiteit Brussel (VUB), Geography Department, Pleinlaan 2, B-1050 Brussels, Belgium; Vrije Universiteit Brussel (VUB), Sociology Department, Pleinlaan 2, B-1050 Brussels, Belgium
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García-Pajares F, Sánchez-Antolín G, Almohalla Alvárez C, Madrigal Rubiales B, Núñez-Rodríguez H, Sancho del Val L, Ruiz-Zorrilla R, Barrera A, Gómez-Nieto A, Peñas Herrero I, Vargas García A, Caro-Patón A. Cutaneous mucormycosis infection by Absidia in two consecutive liver transplant patients. Transplant Proc 2013; 44:1562-4. [PMID: 22841214 DOI: 10.1016/j.transproceed.2012.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mucormycosis, although an infrequent fungal infection, has a high mortality in patients undergoing orthotopic liver transplantation. We present two cases of cutaneous Absidia mucormycosis in two successive patients undergoing liver transplantation in our hospital. In our literature search, we encountered only one published case of Absidia infection in liver transplantation.
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Affiliation(s)
- F García-Pajares
- Liver Transplantation Unit, Hospital Universitario Río Hortega, Valladolid, Spain.
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Briongos-Figuero LS, Gómez-Traveso T, Bachiller-Luque P, Domínguez-Gil González M, Gómez-Nieto A, Palacios-Martín T, González-Sagrado M, Dueñas-Laita A, Pérez-Castrillón JL. Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. Int J Clin Pract 2012; 66:891-6. [PMID: 22897466 DOI: 10.1111/j.1742-1241.2012.02991.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIM Urinary tract infection (UTI) caused by resistant bacteria is becoming more prevalent. We investigate characteristics and associated risk factors for UTIs resulting from extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. METHODS Retrospective study of urinary tract isolates of ESBL-producing enterobacteria in adults (2009 and 2010). We included 400 patients and 103 controls (UTI caused by non-ESBL Escherichia coli). Clinical and demographic information was obtained from medical records. Comorbidity was evaluated using Charlson Index (CI). Strains were identified using VITEK 2 system. RESULTS A total of 400 isolates were obtained (93%E. coli and 7%Klebsiella spp). In 2009, 6% of cultures were ESBL-producing E. coli and 7% in 2010. 37% of patients were men and 81% were aged ≥60years. CI was 2.3±1.8 (high comorbidity: 42.8%). 41.5% of strains were susceptible to amoxicillin-clavulanate, 85.8% to fosfomycin and 15.5% to ciprofloxacin. The total number of ESBL E. coli positive urine cultures during hospital admission was 97 and, compared with 103 controls, risk factors for UTI caused by ESBL- E. coli strains in hospitalised patients were nursing home residence (p<0.001), diabetes (p=0.032), recurrent UTI (p=0.032) and high comorbidity (p=0.002). In addition, these infections were associated with more symptoms (p<0.001) and longer admission (p=0.004). CONCLUSIONS Urinary tract infection caused by ESBL are a serious problem and identifying risk factors facilitates early detection and improved prognosis. Male sex, hospitalisation, institutionalisation, diabetes, recurrent UTI and comorbidity were risk factors and were associated with more symptoms and longer hospital stay.
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