Long-term impact of the 2008 economic crisis in Spain on road traffic collisions mortality by socioeconomic position

We aimed to assess the effect of the 2008 crisis on road traffic collision (RTC) mortality in Spain, by socioeconomic position (SEP) and type of road use. This prospective, country-wide study covered all adults living in Spain and aged ≥30 years in November 2001. The long-term effect of the crisis was assessed by measuring the monthly percentage change (MPC) in RTC mortality between the pre-crisis (2002-2007) and crisis period (2008-2011). During the recession, RTC mortality fell more in people with low compared to high SEP, so MPCs difference between periods were of a higher magnitude in the low compared to high SEP groups, especially among men motorcyclists. RTC mortality trends were favorable following the 2008 crisis, particularly among low-SEP groups. In men motorcyclists, the upward trend of the pre-crisis period reversed course.

No effect of the Penalty Point System on road traffic accident mortality among men with a high socioeconomic status in Spain

The purpose of this study was to assess the effect of the Penalty Point System (PPS) on road traffic accident mortality by gender and socioeconomic status. We conducted a nationwide prospective study covering adult people living in Spain on November 2001. They were followed up until 30 Nov 2007 to determine vital status and cause of death. An interrupted time-series analysis was used to assess whether PPS (explanatory variable) had both immediate and long-term effect on the rates of road traffic accident mortality (RTAMs) separately by gender. Subjects were classified by socioeconomic status (low and high) using two indicators: educational attainment (up to lower secondary education; upper secondary education or more) and occupation (manual and non-manual workers). We performed several segmented Poisson regression models, controlling for trend, seasonality, 2004 road safety measures and fuel consumption as proxy for traffic exposure. Among men, we found a decrease on the RTAMs immediately after PPS in those with low educational level (16.2 %, IC95 %: 6.1 %-25.2 %) and manual workers (16.3 %, IC95 %: 2.8 %-27.8 %), and a non-significant increase among those with high education level and non-manual workers (6.2 % and 1.8 %). Among women, there were no significant differences in the immediate effect of PPS by socioeconomic status. We did not identify significant trend changes between pre-PPS and post-PPS periods in any socioeconomic group. In a context of downward trend of traffic mortality, the PPS implementation led to an immediate reduction on death rates only among men with a low socioeconomic status.

The incorporation of HIV self-testing as an exclusive option among men who have sex with men in Spain: results of an online cross-sectional study

Background

We assessed to what extent HIV self-testing would be incorporated by men who have sex with men (MSM) with previous testing history as their exclusive testing option and describe what actions they would take in the case of obtaining a reactive self-test.

Methods

We conducted an online survey among Spanish resident MSM recruited mainly in gay dating apps and analyze 6171 ever tested individuals. We used Poisson regression to estimate factors associated with the incorporation of self-testing as the exclusive testing option. Among those who would incorporate self-testing as their exclusive option, we described actions taken if obtaining a reactive self-test by number of tests in the past.

Results

Nearly half of the participants (48.3%) were > =35 years old, 84.6% were born in Spain, 57.9% had attained a university degree, 55.1% lived in a municipality of ≤500.000 and 86.4% self-identified as homosexual. For 37.2%, self-testing would become their exclusive testing option. The incorporation of self-testing as the exclusive option increased with age 25–34 (PR:1.1, 95%CI:1.0–1.3), 35–44 (PR:1.3, 95%CI:1.2–1.5), 45–49 (PR:1.5, 95%CI:1.3–1.7) and > 50 (PR:1.5, 95%CI:1.3–1.8) and in those who reported unprotected anal intercourse (PR:1.1, 95%CI:1.0–1.2) or having paid for sex (PR:1.2, 95%CI:1.0–1.3) in the last 12 months. It was also associated with having had < 10 HIV test in the past (2–9 tests (PR:1.3, 95%CI:1.1–1.4); 1 test (PR:1.5, 95%CI:1.3–1.7)), and having been tested ≥2 years (PR:1.4, 95%CI:1.3–1.5) or between 1 and 2 years ago (PR:1.1, 95%CI:1.0–1.2). Of participants who would use self-testing exclusively 76.6% would confirm their result in case of obtaining a reactive self-test and only 6.1% wouldn’t know how to react. Only one individual expressed that he would do nothing at all.

Conclusion

HIV self-testing could become the exclusive testing option for more than a third of our participants. It was chosen as the exclusive option especially by older, at risk and under-tested MSM. Self-testing strategies need to especially consider the linkage to care process. In this sense, only a small fraction would not know how to react and virtually nobody reported taking no action if obtaining a reactive result.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09976-9.

Correction to: A decade of progress in critical care echocardiography: a narrative review

The original version of this article unfortunately contained a mistake.

[Evolution of the need and coverage of syringe exchange programs in Spanish prisons, 1992-2009: A revised estimation]

INTRODUCTION

The objective of this paper is to amend the bias included in our previous work, presenting a corrected estimation of the need and coverage of syringes/needles in Spanish prisons between 1992 and 2009.

METHODS

Data on the provision of the needles exchange programs (NEPs) in prison is taken from official publications. The need was calculated by applying multiplicative methods to secondary data from several sources. Coverage was estimated as the quotient between provision and need and the difference between these magnitudes. The detected need estimate bias has been corrected.

RESULTS

NEP's in prisons started in 1997. Their maximum coverage reached 36% in 2005, which is much higher than the initially estimated value. However, it decreased by half in the next four years, reaching 17.4% in 2009.

CONCLUSION

The remarkable coverage reached by these programmes must be valued, but more recent evolution leads us to emphasize the need to be imaginative so that new epidemiological and economic circumstances do not lead to their disappearance.

[Evolution of the need and coverage of opioid substitution treatments and needle exchange programmes in Spanish prisons, 1992-2009]

INTRODUCTION

Spain is one of the few countries to have widely implemented opioid substitution treatments (OST) and needle exchange programmes (NEP) for drug users in prison. We analyze the evolution of the need, coverage and the timeliness of these interventions in Spain between 1992 and 2009.

METHODS

Data on the provision of interventions is taken from official publications. The need was calculated by applying multiplicative methods to secondary data from several sources. Coverage was estimated as the quotient between provision and need. Temporal opportunity was estimated by observing the gap between the acme of the incidence of consumption, of HIV infection or need and the curve of provision.

RESULTS

OST's began to be implemented in 1992. In 2002 they reached their maximum coverage (63.8%) and subsequently stabilized. NEP's started in 1997. Their maximum coverage reached 20.7% in 2006, but halved in a period of two years. The delay between the epidemic acme and the need and maximum intervention coverage was of 8-25 years.

CONCLUSIONS

OST and NEP introduction in Spanish prisons was a great advance, but the delay in their implementation and the low level of NEP coverage could have limited their potential impact on the improvement of the health of incarcerated drug users. The decline of NEP coverage in recent years is a cause of major concern for the evolution of HIV and Hepatitis C epidemics.

Bilateral autoimmune optic neuritis and vitreitis related to CRMP-5-IgG: intravitreal triamcinolone acetonide therapy of four eyes

PURPOSE

To report the vision outcome following intravitreal triamcinolone acetonide (IVTA) as adjunctive therapy in four eyes of two patients with paraneoplastic autoimmune optic neuritis and vitreitis related to CRMP (Collapsin-Response-Mediator Protein)-5-IgG.

DESIGN

Retrospective case series.MethodsChart review of four eyes.

RESULTS

Preoperative visions were: patient 1, 20/50 OD, 20/25 OS; patient 2, counting fingers (CF) at two feet OD, and CF at three feet OS. At last follow-up, the postoperative visions were 20/40, 20/50 and 20/200, 20/60, respectively. All signs of optic disc swelling and vitreitis had abated.

CONCLUSIONS

Use of IVTAin paraneoplastic autoimmune optic neuritis and vitreitis related to CRMP-5-IgG was followed by a marked decrease in inflammation and stabilization or improvement of vision. These observations support this form of adjunctive therapy in patients whose intraocular pathology is attributed to paraneoplastic autoimmunity.

Primary intraocular lymphoma (PIOL): An International Primary CNS Lymphoma Collaborative group report

1534

Background: PIOL is a hemopoietic tumor that arises in the retina, vitreous or optic nerve head, and carries a high risk of ocular and CNS relapse. The natural history and optimal management are unknown. Methods: A retrospective series of 81 patients with PIOL was assembled from 15 centers in 7 countries. Only patients with isolated ocular lymphoma were included; none had brain, spinal cord, or systemic lymphoma at diagnosis. Results: The median age at diagnosis was 65 (24–85). 58% were women. The median ECOG performance status was 0, and only three had a score > 1. The median latency from symptom onset to diagnosis was 6 months (0– 36). Slit lamp exam was positive in 51, negative in 6, and not reported in 24. Vitrectomy was positive in 72 and negative in 2. 6 had a positive choroidal or retinal biopsy and 1 had no ocular surgery. CSF cytology was positive in 10 (17%), negative in 48, and unknown in 23. 21 received local therapy at diagnosis: 6 intra-ocular methotrexate (400 ug), 14 ocular radiation (median 3600 cGy), and 1 both modalities. 52 received more extensive therapy including systemic chemotherapy alone in 20 and a combination of chemotherapy and radiotherapy in 32. 5 received no treatment and details are unknown in 3. 47 patients (58%) relapsed a median of 19 months (0.5–180) after initial therapy. Sites of relapse included brain 47%, eyes 30%, brain and eyes 15%, and systemic 8%. Patients treated with ocular therapy alone did not have an increased risk of failing in the brain (p = 0.6). Progression free survival (PFS) and overall survival (OS) were 29.6 and 57 months respectively and were unaffected by the choice of therapy. CNS disease was the cause of death in 19/33 (58%). Conclusions: In this series, treatment type did not affect sites of relapse, PFS or OS in patients with PIOL. To minimize toxicity, the best initial therapy should be limited to intraocular chemotherapy or focal radiotherapy. Prospective clinical trials are needed to improve our understanding and treatment of this disease.

No significant financial relationships to disclose.

Iris varix simulating an iris melanoma

Iris varix is rare and little is known about its clinical characteristics. We treated a thrombosed iris varix that simulated an iris melanoma. A 53-year-old man developed a dark brown iris mass and hyphema in his left eye. Ultrasound biomicroscopy revealed a circumscribed mass of the iris stroma. Because of suspicion for melanoma, it was removed by sector iridectomy. Histopathologic examination disclosed an extensive focus of stromal hemorrhage, partially surrounded by endothelial cells that showed immunoreactivity to vascular markers. The histopathologic diagnosis was thrombosed iris varix. Iris varix is a rare condition that should be included in the differential diagnosis of iris melanoma.

Supportive periodontal therapy in South America. A retrospective multi-practice study on compliance

BACKGROUND

Supportive periodontal therapy is needed for the success of periodontal therapy but there is little information about the extent of patient cooperation. It is known, however, that cooperation is poor and a matter of concern.

METHODS

The present study is part of a more extensive study including information from 5,041 patient records from private periodontal practices in Brazil, Venezuela, Chile, and Argentina. Patient cooperation was measured according to gender, age, type of therapy (surgical or non-surgical), maintenance period (first year, 5 years, 10 years, 15 years, and 20 years), and level of cooperation (non-compliant, regular or irregular) for each of the 4 practices.

RESULTS

We observed a great variation in the behavior of the patients from different practices, suggesting that studies on compliance cannot be generalized because differences in culture, economic conditions, knowledge of oral hygiene, and even the philosophy of treatment should be considered. The most significant data were sometimes similar for 2 or 3 of the countries but never for all 4 practices.

CONCLUSIONS

Compliance is a very complex matter and findings from individual studies cannot be generalized.

Prestige of training programs and experience of bypass surgeons as factors in adjusted patient mortality rates

OBJECTIVES

The relation of physician performance to physician training and experience is not well understood. The aim of this study was to examine whether indicators of physician background and experience were associated with an objective measure of physician performance.

METHODS

Physician background information obtained from the Directory of Board-Certified Medical Specialists was linked to physician risk-adjusted mortality rates obtained from three statewide data bases of coronary artery bypass surgeons. Subjects were 275 surgeons who performed CABG surgery on 83,547 patients during the years 1989 to 1992. Surgical performance was measured by the mortality ratio (MR), the ratio of the observed to the predicted patient mortality rate as determined by detailed clinical information. Training institutions and physicians were characterized as prestigious if they were listed as outstanding in published articles.

RESULTS

Surgical performance was not associated with graduation from an American medical school; attendance at a prestigious medical school, residency, or fellowship program; or an academic appointment. Mortality ratios decreased with increased volume and increased with years of experience, age, and academic rank. Surgeons were more likely to be considered a "best doctor" if they had more years experience and trained at a prestigious residency or fellowship program.

CONCLUSIONS

Training at a prestigious institution was associated with identification as a "best" doctor but not with lower mortality ratios.

Intravenous and intraocular ganciclovir for CMV retinitis in patients with AIDS or chemotherapeutic immunosuppression

The efficacy and toxicity of ganciclovir given by intravenous or intravenous plus intravitreal injection were studied in nine patients with cytomegalovirus (CMV) retinitis; seven with AIDS and two with drug induced immunodeficiency. Five patients had retinitis with macular involvement in six sighted eyes; six patients had only peripheral retinitis in seven eyes. In two patients (two eyes) with macular involvement intravenous plus intravitreal injection of ganciclovir preserved sight; intravenous infusion alone did not in four eyes of three other patients. In seven eyes (six patients) with peripheral retinitis vision was retained regardless of the route of ganciclovir treatment. Following intravenous ganciclovir drug levels in the vitreous fluid were 1.4-2.2 mmol/l, that is, 44 and 65% of the concomitant serum concentration. Clinically and at necropsy three eyes showed no evidence of toxicity from intravitreal injection of ganciclovir. All of five patients with AIDS who received intravenous ganciclovir for more than one week developed leucopenia. CMV retinitis of the macula may be benefited with minimal drug toxicity by intravitreal injection of ganciclovir. Treatment of peripheral CMV retinitis in patients with AIDS may be optional.

Prostaglandin release following Nd:YAG iridotomy in rabbits

In this study, iridotomies were performed in nine rabbit eyes using an Nd:YAG laser at 5.2 mJ, three pulses/burst, for one burst. Prostaglandin E2 (PGE2) in aqueous humor obtained at timed intervals after treatment was then measured using a sensitive and specific radioimmunoassay. Concentrations of PGE2 (mean +/- SD pg/ml) were: pretreatment, 377 +/- 89; 30 minutes, 1858 +/- 241; 120 minutes, 735 +/- 308; and 240 minutes, 401 +/- 59, postoperatively. The release of PGE2 into the aqueous humor parallels the rise in intraocular pressure following Nd:YAG iridotomies in rabbits and thus may contribute to this phenomenon.

Intraocular 9-([2-hydroxy-1-(hydroxymethyl) ethoxy] methyl) guanine levels after intravitreal and subconjunctival administration

Clearance studies in rabbits following intravitreal injection of 400 micrograms of 9-([2-Hydroxy-1-(hydroxymethyl)ethoxy]methyl) guanine demonstrated levels of the antiviral at 60 hours above the in vitro ID50 for several strains of human cytomegalovirus. Intravitreal administration of this new antiviral may have therapeutic application in the treatment of acute retinal necrosis and cytomegalovirus retinitis complicating acquired immune deficiency syndrome (AIDS).

Acute retinal necrosis

Five patients with the acute stages of acute retinal necrosis underwent vitrectomy, with acyclovir in the infusion fluid, and the placement of a 360 degrees scleral buckle after intravenous therapy with acyclovir. Anatomic reattachment was achieved in all patients, and improvement over preoperative visual acuity was obtained in four. Recommendations for the treatment of acute retinal necrosis include a high index of suspicion in healthy patients with retinitis, early diagnosis, early intravenous therapy with acyclovir, early pars plana vitrectomy with the use of intravitreal acyclovir in the infusion fluid, and a 360 degrees scleral buckling procedure.

Intravitreal toxicity of hydroxyacyclovir (BW-B759U), a new antiviral agent

We investigated the toxicity of the antiviral compound hydroxyacyclovir (9-[hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine, or BW-B759U), following intravitreal injection in the rabbit. Intravitreal doses of 10, 20, 40, 80, 100, 200, and 400 micrograms produced no discernible ophthalmoscopic or histologic changes. Intravitreal doses of 40, 200, and 400 micrograms produced no changes in the electroretinography B-waves. The low level of retinal toxicity and excellent median inhibitory dose values of intravitreal BW-B759U against cytomegalovirus suggest its potential therapeutic utility in the treatment of cytomegalovirus retinitis.

Vitrectomy and intravitreal antiviral drug therapy in acute retinal necrosis syndrome. Report of two cases

Two patients with acute retinal necrosis were treated with vitrectomy, intravitreal infusion of acyclovir, and prophylactic scleral buckling procedures. Both patients have had a uneventful postoperative course and a recovery of visual acuity; follow-up has been at five and 14 months. There has been no sign of toxicity from the intravitreally administered acyclovir by electroretinographic or clinical criteria.