Assisted Reproductive Technology: Gaps in young adults’ perceptions and information from clinics

Background

Around 186 million individuals are facing infertility worldwide, with a huge impact on their wellbeing. Fertility care is considered a key element to promote reproductive health. This study aims to explore young adults’ knowledge, perceptions and concerns about infertility and Assisted Reproductive Technology (ART), and to contrast it with the information provided by ART clinics.

Methods

A multi-country qualitative study was conducted in Albania, Belgium, Slovenia, Spain, Italy, Kosovo, North Macedonia and Switzerland within the H2020 B2-INF project (Grant Agreement 872706). In 2021, 10-15 semi-structured interviews were conducted in each country with participants aged 18-30, childless and non-ART users. Additionally, 3-5 clinics’ websites in each country were explored. Data was collected in native languages and translated into English. A thematic analysis was carried out.

Results

In total, 98 interviews were conducted and 38 clinics’ websites were explored. Three themes emerged from the analysis of the interviews: 1. Parenthood and (in)fertility; 2. Young people's perception on ART; 3. Information and publicity of ART. Parenthood was described as a relationship beyond biological ties and infertility as a social taboo. Most participants perceived ART positively and would use it if needed, although knowledge on ART was low. Participants considered information on ART as scarce and suggested that government-led information campaigns should be launched to raise awareness on it. Concerning clinics, the websites provided information on infertility and exhaustive technical descriptions of ART techniques, although it may be difficult for the general population to understand. Data offered on success rates were unclear and heterogeneous.

Conclusions

Gaps in citizens’ expectations and needs and the information provided by ART clinics were identified. Awareness campaigns are needed to diminish social taboo on infertility and ART and to promote reproductive health.

Key messages

• Assisted Reproductive Technology is positively perceived by young adults, though their knowledge of it and infertility is low. Information campaigns are thus needed to raise awareness among the young.

• ART clinics have room for improvement in aligning the information provided on their websites with young people's perceptions and needs, and to show it in a more accessible and understandable way.

Implementation of recommendations in rheumatic and musculoskeletal diseases: considerations for development and uptake

A clinical guideline is a document with the aim of guiding decisions based on evidence regarding diagnosis, management and treatment in specific areas of healthcare. Specific to rheumatic and musculoskeletal diseases (RMDs), adherence to clinical guidelines recommendations impacts the outcomes of people with these diseases. However, currently, the implementation of recommendations is less than optimal in rheumatology.The WHO has described the implementation of evidence-based recommendations as one of the greatest challenges facing the global health community and has identified the importance of scaling up these recommendations. But closing the evidence-to-practice gap is often complex, time-consuming and difficult. In this context, the implementation science offers a framework to overcome this scenario.This article describes the principles of implementation science to facilitate and optimise the implementation of clinical recommendations in RMDs. Embedding implementation science methods and techniques into recommendation development and daily practice can help maximise the likelihood that implementation is successful in improving the quality of healthcare and healthcare services.

Effect of glyphosate on growth of four freshwater species of phytoplankton: a microplate bioassay

The acute toxicity of glyphosate herbicide was tested on the four species of freshwater phytoplankton, Scenedesmus acutus, Scenedesmus subspicatus, Chlorella vulgaris and Chlorella saccharophila. Herbicide concentrations eliciting a 50% growth reduction over 72 h (EC(50)) ranged from 24.5 to 41.7 mg L(-1), whilst a 10% growth inhibition is achieved by herbicide concentrations ranging from 1.6 to 3.0 mg L(-1), difficult to find neither in paddy fields (it is not used in rice) nor in the lake of the Albufera Natural Park. Chorella species are less sensitive to the herbicide than Scenedesmus species. It can be concluded that glyphosate has a low potential risk for the tested organisms.

Municipal distribution of breast cancer mortality among women in Spain

Background

Spain has one of the lowest rates of breast cancer in Europe, though estimated incidence has risen substantially in recent decades. Some years ago, the Spanish Cancer Mortality Atlas showed Spain as having a heterogeneous distribution of breast cancer mortality at a provincial level. This paper describes the municipal distribution of breast cancer mortality in Spain and its relationship with socio-economic indicators.

Methods

Breast cancer mortality was modelled using the Besag-York-Molliè autoregressive spatial model, including socio-economic level, rurality and percentage of population over 64 years of age as surrogates of reproductive and lifestyle risk factors. Municipal relative risks (RRs) were independently estimated for women aged under 50 years and for those aged 50 years and over. Maps were plotted depicting smoothed RR estimates and the distribution of the posterior probability of RR>1.

Results

In women aged 50 years and over, mortality increased with socio-economic level, and was lower in rural areas and municipalities with higher proportion of old persons. Among women aged under 50 years, rurality was the only statistically significant explanatory variable.

For women older than 49 years, the highest relative risks were mainly registered for municipalities located in the Canary Islands, Balearic Islands, the Mediterranean coast of Catalonia and Valencia, plus others around the Ebro River. In premenopausal women, the pattern was similar but tended to be more homogeneous. In mainland Spain, a group of municipalities with high RRs were located in Andalusia, near the left bank of the Guadalquivir River.

Conclusion

As previously observed in other contexts, mortality rates are positively related with socio-economic status and negatively associated with rurality and the presence of a higher proportion of people over age 64 years. Taken together, these variables represent the influence of lifestyle factors which have determined the increase in breast cancer frequency over recent decades. The results for the younger group of women suggest an attenuation of the socio-economic gradient in breast cancer mortality in Spain. The geographical variation essentially suggests the influence of other environmental variables, yet the descriptive nature of this study does not allow for the main determinants to be established.

Assessment of toxicity of a glyphosate-based formulation using bacterial systems in lake water

A new Aeromonas bioassay is described to assess the potential harmful effects of the glyphosate-based herbicide, Roundup, in the Albufera lake, a protected area near Valencia. Viability markers as membrane integrity, culturability and beta-galactosidase production of Aeromonas caviae were studied to determine the influence of the herbicide in the bacterial cells. Data from the multifactor analysis of variance test showed no significant differences (P>0.05) between A. caviae counts of viability markers at the studied concentrations (0, 50 and 100 mg l-1 of glyphosate). The effects of Roundup on microbial biota present in the lake were assessed by measuring the number of indigenous mesophilic Aeromonas in presence of different amounts of the herbicide at 0, 50 and 100 mg l-1 of glyphosate. In samples containing 50 and 100 mg l-1 of glyphosate a significant (P<0.05) increase in Aeromonas spp. counts and accompanying flora was observed. The acute toxicity of Roundup and of Roundup diluted with Albufera lake water to Microtox luminescent bacterium (Vibrio fischeri) also was determined. The EC50 values obtained were 36.4 mg l-1 and 64.0 mgl-1 of glyphosate respectively. The acidity (pH 4.5) of the herbicide formulation was the responsible of the observed toxicity.

Acute health problems among subjects involved in the cleanup operation following the Prestige oil spill in Asturias and Cantabria (Spain)

The purpose of this study was to evaluate exposure conditions and acute health effects in subjects participating in the Prestige oil spill cleanup activities and the association between these and the nature of the work and use of protection devices in the regions of Asturias and Cantabria (Spain). The sample comprised 400 subjects in each region, selected from a random sampling of all persons involved in cleanup activities, stratified by type of worker and number of working days. Data were obtained via a structured questionnaire and included information on specific tasks, number of working days, use of protective materials, and acute health effects. These effects were classified into two broad groups: injuries and toxic effects. Data analysis was performed using complex survey methods. Significant differences between groups were evaluated using Pearson's chi(2) test. Unconditional logistic regression was used to compute odds ratios and 95% confidence intervals. Bird cleaners accounted for the highest prevalence of injuries (19% presented with lesions). Working more than 20 days in highly polluted areas was associated with increased risk of injury in all workers. Occurrence of toxic effects was higher among seamen, possibly due to higher exposure to fuel oil and its components. Toxic effects were more frequent among those working longer than 20 days in highly polluted areas, performing three or more different cleaning activities, having skin contact with fuel oil on head/neck or upper limbs, and eating while in contact with fuel or perceiving disturbing odors. No severe disorders were identified among individuals who performed these tasks. However, potential health impact should be considered when organizing cleanup activities in similar environmental disasters.

Organochlorinated pesticides in sediments from the Lake Albufera of Valencia (Spain)

Bottom sediment samples from 121 sites of the Lake Albufera of Valencia were analyzed. Dieldrin, endrin, heptachlor and op'-DDT were not detected (<0.01 ng g(-1)) in 88-93% of the sites. Aldrin and HCB concentration ranges were between <0.01 and 0.1 ng g(-1) in 86% and 94% of the sites, respectively. Heptachlor-epoxide and lindane 95% confidence intervals were 0.2-0.5 and 0.06-0.12, respectively. The greatest average concentration corresponds to pp'-DDE, pp'-DDD and pp'-DDT. The sum of six isomers and derivatives of the DDT average concentration reaches 2.1 ng g(-1), as opposed to 2.7 ng g(-1) for the sum of 13 pesticides considered. In the site with a major contamination, 27.0 ng g(-1) of pp'-DDD and 12.8 ng g(-1) of pp'-DDT were accumulated. The DDE:DDT proportion average was 0.37, indicating an aged DDT contamination. Concentrations of pesticides in sediments were compared to three sediment quality guidelines, and indicated that a low biological effects level can be expected in either sediments or aquatic organisms.

Effects of propanil, tebufenozide and mefenacet on growth of four freshwater species of phytoplankton: a microplate bioassay

The Albufera Natural Park situated in Valencia (Spain), with a very rich flora and fauna is surrounded by rice fields in which pesticide spraying is a regular practice. With this in mind, the sensitivity of four algal species, Scenedesmus acutus, Scenedesmus subspicatus, Chlorella vulgaris and Chlorella saccharophila to pesticides propanil, tebufenozide and mefenacet was studied using single species toxicity tests. Organisms were exposed to different concentrations of these herbicides and the algal growth was measured in a microplate reader at 410 nm, at 0, 24, 48 and 72 h. Tebufenozide appeared to be the most inhibitory to Scenedesmus and Chlorella species growth. 72 h EC50 of propanil, tebufenozide and mefenacet ranged from 0.29 to 5.98 mg/l, 0.12 to 0.15 mg/l and from 0.25 to 0.67 mg/l, respectively for the four algal species. The two species of Chlorella were more tolerant than the two species of Scenedesmus.

Effects of pyridaphenthion on growth of five freshwater species of phytoplankton. A laboratory study

The acute toxicity of the insecticide and acaricide pyridaphenthion to five species of freshwater phytoplankton, Scenedesmus acutus, Scenedesmus subspicatus, Chlorella vulgaris, Chlorella saccharophila and Pseudanabaena galeata was determined. Insecticide concentrations eliciting a 50% growth reduction over 96 h (EC50) ranged from 2.2 to 30.9 mg/l. The two species of Chlorella and the cyanobacteria P. galeata were more tolerant than the two species of Scenedesmus. Concentrations of pyridaphenthion detected in some natural waters were less than the toxic threshold for these species.

Bioconcentration of the insecticide pyridaphenthion by the green algae Chlorella saccharophila

A study was undertaken to examine the uptake of the organophosphate insecticide pyridaphenthion in the chlorophyta Chlorella saccharophila. Algae cultures were exposed to the initial nominal concentration 10.0 mg l(-1) pyridaphention during seven days. The insecticide bioconcentrates in the biomass to the highest level of 441.5 +/- 25.9 mg kg(-1) on the fifth day of exposure and was followed by a decrease to 76.6 +/- 5.1 mg kg(-1) on the seventh day. A model was constructed to describe the dynamic process, which estimated a bioconcentration factor (BCF) equal to 28. The study demonstrates the potential of accumulation of pyridaphenthion in aquatic organisms and helps to expand the pyridaphenthion toxicity database. The replacement of fenitrothion by pyridaphenthion concerning their use in rice flooded cultures is discussed.

Effects of the organophosphorus insecticide fenitrothion on growth in five freshwater species of phytoplankton

The acute toxicity of the insecticide fenitrothion was measured using four freshwater algae (Chlorella saccharophila, Chlorella vulgaris, Scenedesmus acutus, and Scenedesmus subspicatus) and one cyanobacteria (Pseudanabaena galeata). Insecticide concentrations eliciting 50% growth reduction over 96 hr (EC50) ranged from 0.84 to 11.9 mg/L. Fenitrothion was more toxic than other pesticides studied with the same algal species such as chlorsulfuron, molinate, and pyridaphenthion. The transformation of effective concentrations of fenitrothion and other pesticides obtained from toxicity measurements into percent of the saturation level in water is used as a first evaluation of potential hazard to aquatic systems. The insecticides fenitrothion and pyridaphenthion were less hazardous than the herbicides atrazine, benthiocarb, cinosulfuron, chlorsulfuron, methyl-bensulfuron, and molinate. The two species of Chlorella and the cyanobacterium Pseudanabaena were more tolerant to fenitrothion than the two species of Scenedesmus.

Detection of fusarin C and trichothecenes in Fusarium strains from Spain

A group of 49 strains of Fusarium sp. isolated from different Spanish samples of cereals and mixed feedstuffs were screened for their ability to produce trichothecenes like T-2 toxin (T-2), HT-2 toxin (HT-2), diacetoxyscirpenol (DAS) and deoxynivalenol (DN), as well as other mycotoxin produced by Fusarium named fusarin C. The production of these mycotoxins was analyzed by means of spectrophotometry, thin layer chromatography (TLC), high performance liquid chromatography (HPLC) and gas chromatography (GC). Results showed that from 19 Fusarium strains in which cultures trichothecene production was detected, 15 were HT-2 producers, 9 T-2 producers, 14 DAS producers and 10 DN producers. On the other hand, from 28 Fusarium strains in which cultures fusarin C production was detected, 22 were low fusarin C producers (ranged from 0.04 to 1 microgram/l ICI medium), 5 Fusarium strains were intermediate-level producers (ranged from 1 to 10 micrograms/l ICI medium) and one Fusarium strain produced 240 micrograms/l ICI medium. The identified Fusarium strains that produced trichothecenes and fusarin C were F. moniliforme and F. oxysporum.

Incidence and distribution of Fusarium species associated with feeds and seeds from Spain

Samples of seeds and feeds (corn-based and mixed) were collected during surveys in 1991-92 and 1992-93 from two regions of Spain, one in northern Spain where the annual rainfall is over 900 mm, and the other in southeastern Spain where the annual rainfall is about 400 mm. The level of Fusarium contamination was determined in the 657 samples analysed, and results were analysed statistically to assess the effects of type of sample and meteorological conditions on Fusarium proliferation. The predominant Fusarium species was Fusarium moniliforme, which represented 92.2% of the total Fusarium strains isolated. Other species isolated were Fusarium oxysporum (5.9%), F. oxysporum var. redolens (0.6%), Fusarium poae (0.6%) and Fusarium sporotrichioides (0.6%).

[Lipid vehicles for the parenteral administration of drugs (1): emulsions]

To increase the efficiency of medication used in therapy and diagnostics, there have been, during the last decades, important advances in the inclusion techniques hereof, in vehicles which give greater selectivity and tolerance. Among the colloidal vehicle systems of medications with different medications, the object of the present review study. Therefore, we analyze the rationale of their use as a vehicle of medication, their physical and chemical characteristics, the ways of elimination after their administration, as well as the formulations in oil-water emulsions for the parenteral administration of diferent active substances such as diazepam, propofol, methohexital, ethomidate, amphotericin B, cytostatics, and cyclosporine, among others. The results of published studies on the efficiency and therapeutic applications of these are presented.

[Effect of the prolonged use of intrauterine devices and oral contraceptive on iron nutrition]

The aim of this work was to study the effect of prolonged use of intrauterine devices (IUD) and oral contraceptives (OCO) normally prescribed at outpatient clinics of the Health Service on iron nutrition. Two hundred twenty three healthy women, aged 20 to 39 years were studied. Of these, 100 were using IUD and 97 OCO for three to five years and 26 were not using any pharmacological or mechanical contraceptive method (control group). Serum ferritin was significantly higher in the OCO group compared to IUD and control groups (58.9 +/- 2.2; 26.2 +/- 2.1 and 21.1 +/- 2.4 ng/ml respectively). There was a positive correlation between serum ferritin and hemoglobin in IUD and control groups and between ferritin and transferrin saturation in the OCO and control groups. The frequency of storage iron depletion (defined as a serum ferritin < 12 ng/ml) was 6.3, 0 and 25% in the IUD, OCO and control groups respectively. The numbers for iron-deficient erythropoiesis (defined as a transferrin saturation < 15%) were 7, 3 and 4% and for iron deficiency anemia, 6.5, 0 and 8%. It is concluded that the chronic use of IUDs leads to iron depletion and that measures to improve iron nutrition among women using them should be adopted.

Pesticide residues in Lake Albufera, Valencia, Spain

Analysis of water samples from the lake in Albufera, Valencia, indicates that the pesticides molinate, benthiocarb, and fenitrothion do not reach levels that are lethal to fish.

Pesticide residues in total diet samples, Spain--1971-72

Average pesticide residue levels were determined for the 17 main food groups in the average Spanish diet. Using these levels and the estimated average intake of these foods, authors computed an individual's average daily consumption of pesticides from each of these food groups and her/his total diet. Foods were acquired over a 1-year period from the market of Valencia, a city that gets supplies from an agricultural area where pesticide consumption is appreciably higher than that of the rest of the country. Thus average residue levels found must be higher than the national average. Except for fruits and vegetables, the different items composing each food group were sampled in proportion to the amount consumed in the average Spanish diet. Foods forming each group were homogenized into composite samples. All foods were analyzed raw. The most frequently detected pesticides were DDT and BHC. Malathion was detected at levels less than 0.10 ppm in some samples of vegetable oils, pears, and apples. DDT and BHC levels varied from undetectable to amounts less than 1.0 ppm. Highest levels were found in lard. An individual's average daily intake of pesticides was calculated to be 78 mug DDT, a sum which includes residues of o,p'-DDT, p,p'-DDT, and p,p'-DDE, and 13.8 mug gamma-BHC. These levels are much lower than the maximum acceptable daily limits established by the United Nations Food Agricultural Organization and World Health Organization.