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Background There is no reliable microbiological marker to guide the indication and the response to antiviral treatment in patients with coronavirus disease 2019 (COVID-19). We aimed to evaluate the dynamics of subgenomic RNA (sgRNA) in patients with COVID-19 before and after receiving treatment with remdesivir. Methods We included consecutive patients admitted for COVID-19 who received remdesivir according to our institutional protocol and accepted to participate in the study. A nasopharyngeal swab for quantitative reverse transcriptase–polymerase chain reaction (qRT-PCR) was collected at baseline and after 3 and 5 days of treatment with remdesivir. Genomic and sgRNA were analyzed in those samples and main comorbidities and evolution were collected for the analyses. The main outcomes were early discharge (≤10 days) and 30-day mortality. Results A total of 117 patients were included in the study, of whom 24 had a negative sgRNA at baseline, with 62.5% (15/24) receiving early discharge (≤10 days) and no deaths in this group. From the 93 remaining patients, 62 had a negative sgRNA at day 5 with 37/62 (59.6%) with early discharge and a mortality rate of 4.8% (3/62). In the subgroup of 31 patients with positive sgRNA after 5 days of remdesivir, the early discharge rate was 29% (9/31) and the mortality rate was 16.1% (5/31). In multivariable analyses, the variables associated with early discharge were negative sgRNA at day 3 and not needing treatment with corticosteroids or intensive care unit admission. Conclusions Qualitative sgRNA could help in monitoring the virological response in patients who receive remdesivir. Further studies are needed to confirm these findings.

Resumen Objetivo Evaluar la efectividad de una entrevista telefonica realizada por profesionales de Atencion Primaria en personas no participantes en la primera ronda del Programa de deteccion precoz de cancer colorrectal (PDPCCR), en el area basica de salud (ABS) urbana Guineueta de Barcelona (Espana). Pacientes y metodos Un grupo de profesionales de Atencion Primaria del ABS Guineueta contacto, mediante un protocolo de llamadas telefonicas estandarizadas, con personas que no atendieron la invitacion a participar en la primera ronda del PDPCCR. Se analiza el impacto de esta intervencion en la tasa de participacion y las enfermedades detectadas. Resultados Se realizaron 3.327 llamadas telefonicas a 2.343 personas. Tras la intervencion, la tasa de participacion fue del 54,9%, lo que supone un incremento del 5,7% con respecto a la participacion del protocolo habitual del programa (49,2%). Se han diagnosticado 5 canceres, 2 neoplasias de riesgo alto y 8 lesiones de riesgo bajo e intermedio. En promedio, han sido necesarias 9 llamadas para conseguir la aceptacion de una persona adicional. Discusion La intervencion telefonica de los profesionales de Atencion Primaria ha aumentado de forma significativa la tasa de participacion de la poblacion y la deteccion de neoplasias con respecto al protocolo habitual del PDPCCR.

Aim To assess the effectiveness of a telephonic interview performed by primary care professionals among non-participants in the first round of the colorectal cancer early detection programme in the basic urban health area Guineueta in Barcelona, Spain. Patients and methods The Primary Healthcare Team of La Guineueta contacted people who did not respond to the invitation to the first round of the colorectal cancer early detection programme using a standardised telephone call protocol. We analysed the impact of the intervention based on participation and diagnosed disease. Results We made 3327 phone calls to 2343 people. After the intervention the participation rate was 54.9%, which meant an increase of 5.7% with respect to the participation in the usual protocol for the programme (49.2%). The intervention allowed 5 cancers, 2 high-risk neoplasms and 8 low- and intermediate-risk lesions to be diagnosed. An average of 9 phone calls was necessary to achieve the participation of one additional person. Discussion The telephonic intervention performed by primary care professionals has significantly increased the population participation rate and the detection of neoplasms with respect to the usual colorectal cancer early detection programme protocol.

Background To date, no immunological data on COVID-19 heterologous vaccination schedules in humans have been reported. We assessed the immunogenicity and reactogenicity of BNT162b2 (Comirnaty, BioNTech, Mainz, Germany) administered as second dose in participants primed with ChAdOx1-S (Vaxzevria, AstraZeneca, Oxford, UK). Methods We did a phase 2, open-label, randomised, controlled trial on adults aged 18–60 years, vaccinated with a single dose of ChAdOx1-S 8–12 weeks before screening, and no history of SARS-CoV-2 infection. Participants were randomly assigned (2:1) to receive either BNT162b2 (0·3 mL) via a single intramuscular injection (intervention group) or continue observation (control group). The primary outcome was 14-day immunogenicity, measured by immunoassays for SARS-CoV-2 trimeric spike protein and receptor binding domain (RBD). Antibody functionality was assessed using a pseudovirus neutralisation assay, and cellular immune response using an interferon-γ immunoassay. The safety outcome was 7-day reactogenicity, measured as solicited local and systemic adverse events. The primary analysis included all participants who received at least one dose of BNT162b2 and who had at least one efficacy evaluation after baseline. The safety analysis included all participants who received BNT162b2. This study is registered with EudraCT (2021-001978-37) and ClinicalTrials.gov (NCT04860739), and is ongoing. Findings Between April 24 and 30, 2021, 676 individuals were enrolled and randomly assigned to either the intervention group (n=450) or control group (n=226) at five university hospitals in Spain (mean age 44 years [SD 9]; 382 [57%] women and 294 [43%] men). 663 (98%) participants (n=441 intervention, n=222 control) completed the study up to day 14. In the intervention group, geometric mean titres of RBD antibodies increased from 71·46 BAU/mL (95% CI 59·84–85·33) at baseline to 7756·68 BAU/mL (7371·53–8161·96) at day 14 (p

ObjectiveTo investigate the incidence of coronavirus disease 2019 (COVID-19) in a single-center cohort of patients with MS and to explore the contribution of their comorbidities and therapies to the outcome.MethodsA cross-sectional mixed-method study was conducted involving an email-based, self-administered questionnaire sent on May 21, 2020, to 586 patients with MS followed at the MS Unit of Hospital Clinic, University of Barcelona, along with telephone interview, and review of electronic medical records until June 18, 2020. The cumulative incidence of confirmed COVID-19 (positive PCR or antibody test) and all COVID-19 cases (confirmed and suspected) from the start of the pandemic was compared with the population estimates for Barcelona.ResultsA total of 407 patients (69.5%) completed the survey. Most of the responders (67%) were female. The responders had a median age of 48 years (range 19–86), relapsing-remitting disease (84%), at least 1 comorbidity (45%), and were on disease-modifying therapy (DMT; 74.7%). COVID-19 was confirmed in 5 patients (1.2%) and suspected in 46 (11.3%). The cumulative incidence of confirmed COVID-19 cases was similar to that of the general population but was almost 2-fold higher when all cases were considered (p < 0.001). Six patients (11.7%) were hospitalized, of which 5 had good recovery and 1 died. Hospitalized patients were more frequently male, had diabetes and had progressive forms of MS (p < 0.05). DMT was not associated with the risk of infection or the outcome.ConclusionsIn the studied MS cohort, the incidence of COVID-19 was higher than that of the general population; however, most patients did not require hospitalization and had a good outcome despite the frequent presence of comorbidities and treatment with DMT.

Background: There are no immunological data on SARS-CoV-2 heterologous vaccinations schedules in humans. We assessed the immunogenicity and reactogenicity of BNT162b2 (Comirnaty, BioNTech) administered as second dose in participants primed with ChAdOx1-S (Vaxzevria, Astra Zeneca). Methods: We did a phase 2, open-label, adaptive, randomised, controlled clinical trial on adults under 60 years old, vaccinated with a single dose of ChAdOx1-S between 8 and 12 weeks before screening, and no history of SARS-CoV-2 infection (EudraCT No. 2021-001978-37 and NCT04860739). Participants were randomly assigned (2:1) to receive BNT162b2 (0.3 mL, single intramuscular injection) or observation. The primary outcomes were 7-day reactogenicity and 14-day anti-spike IgG response, measured by immunoassays covering SARS-CoV-2 trimeric spike protein and receptor binding domain (RBD). Antibodies functionality and cellular immune response were assessed using a pseudovirus neutralization assay and IFN-gamma immunoassay, respectively. Findings: Between April 24 and April 30, 2021, 676 individuals were randomized (n=450 intervention group, n=226 control group) at 5 sites in Spain, and 663 (441 and 222, respectively) completed the study up to day 14 (mean age 44 [SD 9], 56·5% female). In the intervention group, geometric mean titres (GMT) of IgG-RBD increased from 71·46 BAU/mL (95% CI 59·84-85·33) at baseline to 7756·68 (7371·53; 8161·96) at day 14 (p < 0·0001). IgG against trimeric spike-protein increased from 98·4 [85.69–112.99] to 3684·87 [3429·87–3958·83]). 100% participants exhibited neutralizing antibodies 14 days after BNT162b2 administration, in comparison to 34.1% at enrolment. A 4-fold increase in cellular immune response was also observed. Reactions were predominantly mild (68·3%) or moderate (29·9%), and consisted more frequently on injection site pain (88·2%), induration (35·5%), headache (44·4%) and myalgia (43·3%). No serious adverse events were reported. Interpretation: BNT162b2 given as a second dose in individuals prime vaccinated with ChAdOx1-S induced a robust immune response with an acceptable and manageable reactogenicity profile. Clinical Trial Registration Details: EudraCT No. 2021-001978-37 and NCT04860739. Funding Information: Funded by Instituto de Salud Carlos III (ISCIII). Declaration of Interests: CB is the Deputy General Manager of the ISCIII. JRA has received fees from Janssen, outside of the submitted work. AMB is principal investigator of clinical trials sponsored by GSK, Daiichi-Sankyo, Janssen and Farmalider, outside of the submitted work. The other authors declare no competing interests. Ethics Approval Statement: All the participants provided written informed consent before enrolment. The trial complies with the principles of the Declaration of Helsinki and Good Clinical Practice. This study was approved by the Spanish Agency of Medicines and Healthcare Products (AEMPS) and by the Ethics Committee at University Hospital La Paz.

Several questions regarding the role of vaccination in women treated for high-grade cervical intraepithelial lesion (HSIL) have not been clarified. One of the main queries is whether the time at which the vaccine is administered (before or after treatment) influences the protection against post-treatment HSIL. A second unanswered question is whether the vaccine has any effect in women with persistent HPV after treatment. We aimed to address these questions in a study of 398 women undergoing excisional treatment from July 2016 to December 2019. Vaccination was funded and offered to all women undergoing treatment. A total of 306 women (76.9%) accepted HPV vaccination (vaccinated group): 113 (36.9%) received the first dose before excision and 193 (63.1%) after the procedure. A total of 92 women (23.1%) refused the vaccine (non-vaccinated group). Women vaccinated before treatment showed a lower rate of post-treatment HSIL compared with non-vaccinated women (0.9% vs. 6.5%; p = 0.047). Among women with persistent HPV infection after treatment, those who had received the vaccine showed a lower prevalence of post-treatment HSIL than non-vaccinated women (2.6% vs. 10.5%; p = 0.043). In conclusion, this study shows that HPV vaccination before treatment reduces the prevalence of post-treatment HSIL and suggests that vaccination might even benefit women with persistent HPV after treatment.

Resumen Objetivo Describir y analizar, segun la via diagnostica, las caracteristicas de los tumores de cancer de mama. Se analizan los efectos adversos de los tratamientos recibidos y la utilizacion de terapias no convencionales para paliarlos. Metodo Diseno descriptivo anidado en cohorte mixta (Cohorte DAMA). La variable dependiente fue la via diagnostica del cancer de mama. Las variables independientes fueron la edad, el indice de masa corporal, la clase social, con renta familiar disponible, el tipo de tumor, el grado histologico, el estadio tumoral, las recidivas, el tratamiento, los efectos adversos de los tratamientos y las terapias no convencionales. Se realizaron analisis descriptivos bivariados y se ajustaron modelos de regresion univariados y multivariados, y se hicieron representaciones graficas de la frecuentacion de terapias no convencionales. Resultados Existen diferencias en las caracteristicas de los tumores y en el impacto de los efectos adversos derivados de los tratamientos. Las pacientes diagnosticadas por cribado fueron de mayor edad y de clase social alta, presentaron un mayor porcentaje de tumores de grado I histologico, estadios iniciales, menos recidivas y efectos adversos debidos al tratamiento, aunque este no fuera distinto en el grupo de cribado respecto al resto. Tambien hubo un menor uso de terapias no convencionales. Conclusiones Los resultados indican que la implantacion de programas de cribado aumenta la posibilidad de detectar tumores en etapas iniciales y con terapias con menos efectos adversos; en consecuencia, con menor necesidad de recurrir a terapias no convencionales.

Introduction Increased values in the fecal immunochemical test (FIT) are correlated with increasingly severe colorectal neoplasia, but little attention has been given to FIT values below the cut-off point (negative FIT, nFIT). We analysed the relationship between the concentrations of two consecutive nFIT and the risk of following screen-detected advanced neoplasia and interval cancer (IC) in a population-based colorectal cancer screening program. Methods FIT results were categorised into non-detectable nFIT (0–3.8 μg haemoglobin/g feces), low nFIT (3.9–9.9) and high nFIT (10.0–19.9). Multivariable adjusted logistic regression was used to estimate the odds ratios (OR) of advanced neoplasia and IC with the nFIT results in the first two screens. Results More than 90% of the 42,524 persons had non-detectable nFIT in the first and second screen; 4.5% and 5.8% had a low nFIT, respectively, and 2.2% and 2.9% had a high nFIT. The probability of testing positive and being diagnosed of advanced neoplasia or IC rose with increasing values of nFIT. Compared with those with two non-detectable nFIT results, the highest OR were found among those who had two high nFIT results (OR 21.75; 95% confidence interval: 12.44, 38.04) and those with one low nFIT and one high nFIT (ORs around 20). Conclusions Participants with nFIT results above the detection limit of the test had an increased risk of advanced neoplasia and IC in subsequent participations. This information could be used in the design of personalised screening strategies.

To assess the effectiveness of a telephonic interview performed by primary care professionals among non-participants in the first round of the colorectal cancer early detection programme in the basic urban health area Guineueta in Barcelona, Spain.The Primary Healthcare Team of La Guineueta contacted people who did not respond to the invitation to the first round of the colorectal cancer early detection programme using a standardised telephone call protocol. We analysed the impact of the intervention based on participation and diagnosed disease.We made 3,327 phone calls to 2,343 people. After the intervention the participation rate was 54.9%, which meant an increase of 5.7% with respect to the participation in the usual protocol for the programme (49.2%). The intervention allowed 5cancers, 2high-risk neoplasms and 8low- and intermediate-risk lesions to be diagnosed. An average of 9phone calls was necessary to achieve the participation of one additional person.The telephonic intervention performed by primary care professionals has significantly increased the population participation rate and the detection of neoplasms with respect to the usual colorectal cancer early detection programme protocol.

To describe and analyze the characteristics of breast cancer tumours according to the diagnostic pathway. We analyse the adverse effects of the treatments and the use of unconventional therapies in order to alleviate them.Descriptive design nested in a mixed cohort (Cohort DAMA). The dependent variable was the route to diagnosis of breast cancer. The independent variables were age, body mass index, social class, disposable family income, type of tumour, histological degree, tumour stage, recurrences, treatment, adverse effects derived from treatments and unconventional therapies. Bivariate descriptive analyses were performed and univariate and multivariate regression models were adjusted; and graphic representations of the unconventional therapies.There are differences in the characteristics of the tumours, and the impact of the adverse effects derived from the treatments. The patients diagnosed by screening were older, from a high social class, had a higher percentage of tumours of grade I differentiation, initial stages, fewer recurrences and fewer adverse effects due to treatment, although this was not different in the screening group compared to the rest. There was also less use of unconventional therapies.The results indicate that the implementation of screening programmes increases the possibility of detecting tumours in initial stages and with therapies with fewer adverse effects. As a result, there is less need to resort to unconventional therapies.

Resumen Introduccion Durante la campana de vacunacion antigripal 2011-2012 establecimos un sistema de autodeclaracion de acontecimientos adversos (AA) en el personal sanitario (PS). El objetivo de este estudio es describir la poblacion vacunada y analizar la cobertura de vacunacion y los AA autodeclarados tras la vacunacion voluntaria del PS frente a la gripe en un hospital universitario de tercer nivel en Barcelona. Metodos Estudio observacional. Para el calculo de la cobertura de vacunacion se utilizo el registro de vacunacion de profesionales sanitarios del hospital. Los AA se recogieron mediante una encuesta voluntaria, anonima y autoadministrada durante la campana de vacunacion antigripal 2011-2012, y se analizaron mediante regresion logistica. Se construyo un modelo de regresion logistica para determinar los factores que predisponen a declarar AA. Resultados La campana alcanzo una cobertura de vacunacion antigripal del 30,5% (n = 1.507/4.944) del PS. De los vacunados, el 23,8% (n = 358) respondieron la encuesta de AA autodeclarados. El 52,0% (n = 186) de los que respondieron a la encuesta declaro haber presentado algun tipo de AA. De estos, el 75,3% (n = 140) refirio signos y sintomas locales tras la vacunacion, el 9,7% (n = 18), signos y sintomas sistemicos, y el 15,1% (n = 28), sintomas tanto locales como sistemicos. No se declaro ningun AA grave. Ser mujer y tener menos de 35 anos se asocio a declarar algun tipo de AA. Conclusiones El sistema de autodeclaracion no registro AA graves en el PS, suponiendo una oportunidad para aumentar la confianza del PS en la vacuna antigripal.

Background: Population-based studies on neuromyelitis optica spectrum disorders (NMOSD) are limited, and it is unclear whether the rates have changed with the implementation of the new 2015 criteria. Objectives: To estimate the incidence and prevalence of NMOSD in Catalonia (Spain), using both the 2006 and the 2015 criteria. Methods: In this clinic-based retrospective study, patients diagnosed with NMOSD between 2006 and 2015 were identified using multiple sources, including direct contact to all Catalan hospitals, identification of cases through the Catalan Health Surveillance System, and registry of antibodies to aquaporin-4 (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG-IgG) in a reference laboratory. The incidence rate was calculated for the period 1 January 2006–1 January 2016 and prevalence for the date 1 January 2016. Results: We identified 74 patients (by the 2015 criteria). Most patients were Caucasian (81%), and female (76%) with a median age at disease onset of 42 years (range, 10–76 years). In total, 54 (73%) patients were positive for AQP4-IgG, 11 (15%) double-seronegative, and 9 (12%) MOG-IgG-positive. Rates of incidence and prevalence (0.63/1,000,000 person-years and 0.89/100,000, respectively) were 1.5-fold higher than those reported by the 2006 criteria. Lowest rates were seen in children and elder people and highest in women and middle-aged people (40–59 years). The female predominance was lost in incident AQP4-IgG-seronegative children and AQP4-IgG-positive elder people. MOG-IgG and double-seronegativity contributed similarly but did not influence the long-term outcome. Conclusion: The new criteria increase the estimates, but NMOSD remains as a rare disease. The differences in age- and sex-specific estimates highlight the importance of the serologic classification.

Resumen Fundamento y objetivo La causa o causas de la anemia que acompana a la anorexia nerviosa (AN) no ha sido establecida, pero no parece relacionarse con deficiencias nutricionales ni cambios medulares. El objetivo de este trabajo fue evaluar la produccion de eritropoyetina (EPO) en respuesta a la anemia en un pequeno grupo de pacientes con AN y anemia. Pacientes y metodos Los niveles de EPO en muestras de suero de 41 mujeres con AN (11 con anemia y 30 sin alteraciones en los parametros de la serie eritroide) se compararon con la respuesta observada en un grupo de pacientes de peso normal con anemia. Resultados Las concentraciones de EPO en pacientes con AN anemicas fueron mayores que en las no anemicas: 20,63 mU/ml (4,04 a 28,46) frente a 8,7 mU/ml (3,9 a 20,93), p = 0,0088, pero el aumento de EPO fue menor de lo esperado (27,85 mU/ml [17,7 a 118,9]), p = 0,014. La correlacion entre el IMC y la diferencia entre la EPO y la EPO esperada es inversa. Conclusiones Una produccion inadecuada de EPO puede explicar en parte la anemia en la AN. Son necesarios mas estudios para investigar la causa de esta respuesta.

Influenza vaccination campaigns based on educational interventions do not seem to increase coverage in the hospital setting, and their impact on educational goals is not usually evaluated. This study describes the campaign implemented in a university hospital and assesses the achievement of the strategic objectives, which were to increase health care workers (HCW) perceptions of the risk of influenza and of their role as promoters of influenza vaccination among their colleagues and to increase knowledge about influenza.A before-after study was conducted using a self-administered survey in a randomized sample of HCW during the 2010-2011 influenza vaccination campaign. The Wilcoxon paired measures test was used to assess attainment of the strategic objectives.The campaign had a positive impact on the strategic objectives (Wilcoxon test, P value.05 in all cases). The reach of the campaign was high (91.9%), and HCW rated it as positive (7.19 [standard deviation, 2.3] out of 10) but did not achieve increased coverage (34%; 95% confidence interval: 33.8-36.4).Evaluation of the campaign shows that its effect responded to the strategic objectives. However, it seems that increasing the information provided to HCW and heightening their risk perception do not necessarily lead to greater acceptance of influenza vaccination.

El balance entre la oferta y la demanda de las plazas para la Formacion Sanitaria Especializada (FSE) tiene implicaciones en el funcionamiento de los servicios de salud y en la sostenibilidad del sistema sanitario. La educacion medica tiene un elevado coste, tanto para el estado, como para la familia del estudiante. En la toma de decision sobre la especialidad a escoger se ven involucrados tanto los intereses del estudiante y su entorno mas cercano, como los del sistema sanitario. Centrando la atencion en el estudiante, existen diversos factores que se combinan en el momento de elegir especialidad de Medico Interno Residente (MIR). Como se ha demostrado en otros paises, el sexo del estudiante se asocia a la eleccion de una u otra especialidad: proporcionalmente, las especialidades esencialmente quirurgicas son mas escogidas por los varones, excepto Ginecologia y Obstetricia que, como ocurre con la especialidad de Pediatria, es mayormente escogida por las mujeres. La percepcion de la calidad de vida y del prestigio profesional que la especialidad puede proporcionar tiene tambien su implicacion en la eleccion. Estudios realizados en EE.UU. apuntan a la potencial mejor calidad de vida durante la practica profesional como un factor determinante en la eleccion, quedando en un segundo plano especialidades que tradicionalmente conllevan un elevado numero de guardias, como Cirugia General, Medicina Interna o Ginecologia y Obstetricia. Por otra parte, el prestigio profesional percibido, que se asocia a unos

Se han revisado críticamente las citas en Chile de especies y subespecies de áfidos (Aphididae) contenidas en 139 contribuciones científicas. Se añaden citas de numerosas especies a partir de especímenes de las colecciones del Muséum national d’Histoire naturelle (París, Francia), del Servicio Agrícola y Ganadero (SAG) (Santiago de Chile, Chile), del Natural History Museum (Londres, Reino Unido), de las universidades de León (España) y Talca (Chile) y de J. Ortego (Mendoza, Argentina). El catálogo afídico chileno queda formado por 169 especies y subespecies, quedando excluidas de él Aphis (Toxoptera) citricidus, Aphis medicaginis, Aphis rumicis, Dysaphis apiifolia petroselini, Lipaphis erysimi y Uroleucon aaroni. Se citan por primera vez en América del Sur Aphis rubicola, Brachycaudus amygdalinus e Illinoia pepperi. Se citan por primera vez en Chile Aphis forbesi, Aphis senecionicoides, Hyadaphis passerini, Hyperomyzus carduellinus, Illinoia azaleae, Neotoxoptera oliveri y Pentalonia nigronervosa. Se dan más de un centenar de primeras citas regionales o provinciales de especies. Se presenta por primera vez la relación de plantas hospedadoras de los pulgones citados en el país. Se comentan las composiciones de las afidofaunas regionales y provinciales. Se ofrece una valoración de los componentes alóctono y autóctono de la afidofauna chilena. Records of the aphid species and subspecies contained in 139 scientific contributions have been revised. New records of many species are presented from specimens conserved in the collections of Muséum national d’Histoire naturelle (Paris, France), the Servicio Agrícola y Ganadero (SAG) (Santiago, Chile), the Natural History Museum (London, U.K.), the universities of León (Spain) and Talca (Chile) and of J. Ortego (Mendoza, Argentina). The Chilean aphid-catalog is composed of 169 species and subspecies; Aphis (Toxoptera) citricidus, Aphis medicaginis, Aphis rumicis, Dysaphis apiifolia petroselini, Lipaphis erysimi and Uroleucon aaroni are excluded from the catalog. Aphis rubicola, Brachycaudus amygdalinus and Illinoia pepperi are first recorded from South America. Aphis forbesi, Aphis senecionicoides, Hyadaphis passerini, Hyperomyzus carduellinus, Illinoia azaleae, Neotoxoptera oliveri and Pentalonia nigronervosa are also recorded for first time from Chile. More a hundred new regional and provincial records are given. Host plant list of aphids recorded in Chile are presented for first time. The compositions of Chilean regional and provincial aphidfaunas are discussed. An evaluation of the allochthonous and autochthonous components of the Chilean aphidfauna is presented. Fil: Nieto Nafría, Juan Manuel. Universidad de León. Departamento de Biodiversidad y Gestión Ambiental, área de Zoología; España Fil: Fuentes-Contreras, Eduardo. Universidad de Talca. Centro de Ecología Molecular y Aplicaciones Evolutivas en Agroecosistemas – Núcleo Milenio; Chile Fil: Castro Colmenero, Marta. Universidad de León. Departamento de Biodiversidad y Gestión Ambiental, área de Zoología; España Fil: Piera, Marta Aldea. Universidad de León. Departamento de Biodiversidad y Gestión Ambiental, área de Zoología; España Fil: Ortego, Jaime. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Mendoza; Argentina Fil: Mier Durante, Milagros Pilar. Universidad de León. Departamento de Biodiversidad y Gestión Ambiental, área de Zoología; España

The low acceptance of influenza vaccination by both medical students and healthcare workers (HCWs) signals the need for innovative strategies. We administered an anonymous questionnaire to 410 University of Barcelona medical students who were asked about using the Internet to find information on influenza vaccination of HCWs and about their willingness to use technical and informal Facebook pages as an information channel on this topic. Of the 410 participants, 74.1 percent were female and 58.3 percent were in the first preclinical 3-year university cycle. A total of 7.6 percent participants reported using the Internet for queries on influenza vaccination, 89.8 percent reported that they were Facebook users, and 275 (67.1 percent) would accept an invitation from the technical or informal Facebook pages. The technical Web site would be actively followed by 77, or by 30.0 percent of those who would accept the invitation and the informal site by 116 (43.6 percent of those who would accept). The marked willingness to use Facebook to obtain information on the influenza vaccination of HCWs potentially opens a new window in health education: social networks could be used to help create professional habits. Students would be more likely to engage with this type of Facebook page if the contents were informal rather than highly technical.

Background The traditional model of community pharmacy has changed, with patients, caregivers and consumers having access to many cognitive services other than the traditional dispensing and supply of medicines. In December 2009, a population-based colorectal cancer screening program started in Barcelona, introducing the community pharmacist and the professional expertise of the pharmacist into the organisational model. Aim To evaluate the program implementation process in the pharmacies, identify barriers and facilitators, and know the opinion of the professionals involved in the colorectal cancer screening program in Catalonia (Spain). Methods Cross-sectional study of the pharmacies that participated in the first round of the program during the first and second trimester of 2010 in Barcelona. A validated questionnaire was used to analyse several functional aspects in the implementation process. Qualitative aspects about the opinion of the pharmacist were studied. A descriptive and bivariate analysis was performed. Results All the pharmacies involved in the program (n = 74) participated in the study. The majority of the sample population was composed of women (70.3%), mean age 44.9 years, and most of them (74%) had attended a specific training session. Pharmacists considered their participation in the program to be an added value to their professional role and a way to increase consumer’s confidence on this kind of services. The average time to provide the service was estimated to be less than 10 minutes per consumer. Only three (4.1%) pharmacists considered that the program involved a lot of extra work in the daily activities of the pharmacy. The level of satisfaction of the pharmacists was very high. Conclusions Community pharmacies can be a successful alternative and great resource to implement a population cancer screening program. This functional model can improve the accessibility and participation rates on target population. The level of motivation of the community pharmacist, the specific training program and the perception to give a better care for their patients can be an enabler.

Introduction During the influenza vaccination campaign 2011–2012 we established a self-declaration system of adverse events (AEs) in healthcare workers (HCW). The aim of this study is to describe the vaccinated population and analyse vaccination coverage and self-declared AEs after the voluntary flu vaccination in a university hospital in Barcelona. Methods Observational study. We used the HCW immunisation record to calculate the vaccination coverage. We collected AEs using a voluntary, anonymous, self-administered survey during the 2011–2012 flu vaccination campaign. We performed a logistic regression model to determine the associated factors to declare AEs. Results The influenza vaccination coverage in HCW was 30.5% (n = 1507/4944). We received completed surveys from 358 vaccinated HCW (23.8% of all vaccinated). We registered AEs in 186 respondents to the survey (52.0% of all respondents). Of these, 75.3% (n = 140) reported local symptoms after the flu vaccination, 9.7% (n = 18) reported systemic symptoms and 15.1% (n = 28) both local and systemic symptoms. No serious AEs were self-reported. Female sex and aged under 35 were both factors associated with declaring AEs. Conclusions Our self-reporting system did not register serious AEs in HCW, resulting in an opportunity to improve HCW trust in flu vaccination.

A new species in one of the largest genera of Macrosiphini (Hemiptera, Aphididae), Acyrthosiphon pilosum sp. n., is described from apterous and alate viviparous females and oviparous females from French and Spanish Mediterranean localities, living on species of Ononis (Fabaceae), mainly O. natrix. The new species is characterized by the presence of many accessory setae on the ultimate rostral segment, and usually five setae on the first tarsal segments, a combination that is not present in any other known Acyrthosiphon species; in addition marginal tubercles are present on prothorax and several of abdominal segments 2-5.

Background and objective The cause of the anemia in anorexia nervosa (AN) has not been fully ascertained. Ferritin, folate and cobalamin values are usually within normal ranges. Anemia does not have a relationship with bone marrow changes and erythropoietin (EPO) levels have not been investigated. The objective of this study was to evaluate the EPO response in a small group of AN patients. Patients and methods EPO levels were measured in serum samples of 41 female AN patients (11 with anemia, and 30 with normal blood cell count). The adequacy of EPO response was assessed by comparing the increase observed in a group of normal weight patients with anemia. Results EPO concentrations in anemic AN patients were higher than in non-anemic: 20.63 mU/ml (4.04–28.46) vs 8.7 mU/ml (3.9–20.93), p = .0088, but the increase in EPO was lower than expected (27.85 mU/ml [17.7–118.9]), p = .014. BMI and the difference between actual and expected EPO were inversely correlated. Conclusions Inadequate EPO response may partly explain anemia in AN, but further studies are necessary.

BACKGROUND: Controlled human malaria infection (CHMI) by mosquito bite is a powerful tool for evaluation of vaccines and drugs against Plasmodium falciparum malaria. However, only a small number of research centres have the facilities required to perform such studies. CHMI by needle and syringe could help to accelerate the development of anti-malaria interventions by enabling centres worldwide to employ CHMI. METHODS: An open-label CHMI study was performed with aseptic, purified, cryopreserved P. falciparum sporozoites (PfSPZ Challenge) in 36 malaria naive volunteers. In part A, the effect of the inoculation volume was assessed: 18 participants were injected intramuscularly (IM) with a dose of 2,500 PfSPZ divided into two injections of 10 microL (n = 6), 50 microL (n = 6) or 250 microL (n = 6), respectively. In part B, the injection volume that resulted in highest infectivity rates in part A (10 microL) was used to formulate IM doses of 25,000 PfSPZ (n = 6) and 75,000 PfSPZ (n = 6) divided into two 10-microL injections. Results from a parallel trial led to the decision to add a positive control group (n = 6), each volunteer receiving 3,200 PfSPZ in a single 500-microL injection by direct venous inoculation (DVI). RESULTS: Four/six participants in the 10-microL group, 1/6 in the 50-microL group and 2/6 in the 250-microL group developed parasitaemia. Geometric mean (GM) pre-patent periods were 13.9, 14.0 and 15.0 days, respectively. Six/six (100%) participants developed parasitaemia in the 25,000 and 75,000 PfSPZ IM and 3,200 PfSPZ DVI groups. GM pre-patent periods were 12.2, 11.4 and 11.4 days, respectively. Injection of PfSPZ Challenge was well tolerated and safe in all groups. CONCLUSIONS: IM injection of 75,000 PfSPZ and DVI injection of 3,200 PfSPZ resulted in infection rates and pre-patent periods comparable to the bite of five PfSPZ-infected mosquitoes. Remarkably, it required 23.4-fold more PfSPZ administered IM than DVI to achieve the same parasite kinetics. These results allow for translation of CHMI from research to routine use, and inoculation of PfSPZ by IM and DVI regimens. TRIAL REGISTRATION: ClinicalTrials.gov NCT01771848.

BACKGROUND: Recent decades have seen a rise in population movements and, therefore, the spread of tropical diseases and changes in the epidemiology of global disease patterns. Only 50% of travelers to tropical areas receive pre-travel advice and most of them present risk behaviors for acquiring infections. The aim of this study was to describe the clinical and epidemiological characteristics of travelers and identify factors associated with risk behaviors. METHODS: We made a retrospective, descriptive and analytical study of 772 travelers consulting a tropical medicine clinic in Barcelona in 2010. Data on demographic and clinical variables, travel characteristics and risk behaviors were collected. RESULTS: Among all travelers studied, 65.8% (466/708) received pre-travel advice and 30.7% (209/680) took malaria prophylaxis. At least one risk behavior was reported by 82.6% (587/711) of travelers. People travelling for 1-6 months had a 3-fold higher likelihood of experiencing risk behaviors than people travelling for 6 months had a 13-fold higher likelihood (95% CI 3.11-56.14, p

Vacunas.org (http://www.vacunas.org), a website founded by the Spanish Association of Vaccinology offers a personalized service called Ask the Expert, which answers any questions posed by the public or health professionals about vaccines and vaccination. The aim of this study was to analyze the factors associated with questions on vaccination safety and determine the characteristics of questioners and the type of question asked during the period 2008–2010. A total of 1341 questions were finally included in the analysis. Of those, 30% were related to vaccine safety. Questions about pregnant women had 5.01 higher odds of asking about safety (95% CI 2.82–8.93) than people not belonging to any risk group. Older questioners (>50 years) were less likely to ask about vaccine safety compared to younger questioners (OR: 0.44, 95% CI 0.25–0.76). Questions made after vaccination or related to influenza (including H1N1) or travel vaccines were also associated with a higher likelihood of asking about vaccine safety. These results identify risk groups (pregnant women), population groups (older people) and some vaccines (travel and influenza vaccines, including H1N1) where greater efforts to provide improved, more-tailored vaccine information in general and on the Internet are required.

A new species in one of the largest genera of Macrosiphini (Hemiptera, Aphididae), Acyrthosiphon pilosum sp. n., is described from apterous and alate viviparous females and oviparous females from French and Spanish Mediterranean localities, living on species of Ononis (Fabaceae), mainly O. natrix. The new species is characterized by the presence of many accessory setae on the ultimate rostral segment, and usually five setae on the first tarsal segments, a combination that is not present in any other known Acyrthosiphon species; in addition marginal tubercles are present on prothorax and several of abdominal segments 2–5.

Background Completion of multiple dose vaccine schedules is crucial to ensure a protective immune response, and maximise vaccine cost-effectiveness. While barriers and facilitators to vaccine uptake have recently been reviewed, there is no comprehensive review of factors influencing subsequent adherence or completion, which is key to achieving vaccine effectiveness. This study identifies and summarises the literature on factors affecting completion of multi-dose vaccine schedules by adolescents. Methods Ten online databases and four websites were searched (February 2014). Studies with analysis of factors predicting completion of multi-dose vaccines were included. Study participants within 9–19 years of age were included in the review. The defined outcome was completion of the vaccine series within 1 year among those who received the first dose. Results Overall, 6159 abstracts were screened, and 502 full texts were reviewed. Sixty one studies were eligible for this review. All except two were set in high-income countries. Included studies evaluated human papillomavirus vaccine, hepatitis A, hepatitis B, and varicella vaccines. Reported vaccine completion rates, among those who initiated vaccination, ranged from 27 % to over 90 %. Minority racial or ethnic groups and inadequate health insurance coverage were risk factors for low completion, irrespective of initiation rates. Parental healthcare seeking behaviour was positively associated with completion. Vaccine delivery in schools was associated with higher completion than delivery in the community or health facilities. Gender, prior healthcare use and socio-economic status rarely remained significant risks or protective factors in multivariate analysis. Conclusions Almost all studies investigating factors affecting completion have been carried out in developed countries and investigate a limited range of variables. Increased understanding of barriers to completion in adolescents will be invaluable to future new vaccine introductions and the further development of an adolescent health platform. PROSPERO reg# CRD42014006765. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2845-z) contains supplementary material, which is available to authorized users.