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Objective: To examine the certainty of the evidence supporting health claims about probiotics, yoghurt, kefir, kombucha, fibre and prebiotics, and to assess the quality of online information in Spanish., Design: Content analysis., Methods: We compiled a data set of 114 web pages by searching six popular search phrases in Spanish relating to probiotics, yoghurt, kefir, kombucha, fibre and prebiotics on Google.es and coded them for typology and health claims. We examined the certainty of the evidence for health claims from systematic reviews. Information quality was assessed according to 10 criteria, where a web page: mentions scientific publications and reports their conclusions; quantifies relative and absolute effects; acknowledges some limitations; discusses certainty of evidence; reports the potential harms, alternatives and costs; and does not argue based on personal experiences., Results: Gastrointestinal health (86.0%), general health (57.9%), cardiovascular health (53.5%) and immune system health (50.9%) were the most widely mentioned topics. Half of claims (52.6%, 70/133) were supported by evidence from systematic reviews. Probiotics had the highest number of claims supported by evidence and kombucha the lowest. The highest certainty was found for antibiotic-associated diarrhoea, necrotising enterocolitis and otitis (moderate) in probiotics and yoghurt, infectious diarrhoea and hepatic encephalopathy (moderate) in prebiotics, and cardiovascular health (high to moderate) and colorectal cancer (moderate) in fibre. On a scale of 0-10, the median information quality score for all web pages was 3. Only 18.4% reported study conclusions, 7.9% quantified the effects, 28.9% acknowledged some limitations in the research and 42.1% reported potential harms., Conclusions: Most online health claims for dietary interventions intended for improving health through the gut microbiome are supported by low or very low certainty of evidence. Online information does not align with the evidence and is incomplete or unbalanced., Competing Interests: Competing interests: AP-B works as a health writer for companies commercially involved in the gut microbiota and probiotics., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To characterise the infodemic associated with the COVID-19 and to analyse information consumption, trust in sources, the role of the media and government communication, focusing in the case of Spain, as well as to discuss some provisional communication lessons from studies on this and other pandemics., Method: Bibliographic search in PubMed and Scopus and review of selected documents with the criteria of relevance to the objectives and the Spanish setting., Results: The COVID-19 pandemic has overlapped with an infodemic that has led to the largest avalanche of disinformation known to date and to difficulties in finding reliable information for almost half of the population. In Spain, information consumption has focused on traditional media and WhatsApp; the media were relatively well-rated and helped understand the pandemic, although they are considered less trustworthy in Spain than in other Western countries. The analysis of Spanish government communication shows errors such as overly reassuring messages at the beginning of the pandemic, lack of transparency, excess of information and the spokesperson model adopted., Conclusions: Knowledge about the infodemic associated with COVID-19 is fragmentary and insufficient. Even though the health crisis is not closed for adequate evaluation, some provisional communication lessons can be drawn. The complexity of the disinformation phenomenon requires considering infodemiology as a scientific discipline to understand both the spread of disinformation and the spread of disease., (Copyright © 2022 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction The Informed Health Choices (IHC) project developed learning resources to teach primary school children (10 to 12-year-olds) to assess treatment claims and make informed health choices. The aim of our study is to explore the educational context for teaching and learning critical thinking about health in Spanish primary schools. Methods During the 2020-2021 school year, we will conduct 1) a systematic assessment of educational documents and resources, and 2) semi-structured interviews with key education and health stakeholders. In the systematic assessment of educational documents and resources, we will include state and autonomous communities' curriculums, school educational projects, and commonly used textbooks and other health teaching materials. In the semi-structured interviews, we will involve education and health policy makers, developers of learning resources, developers of health promotion and educational interventions, head teachers, teachers, families, and paediatric primary care providers. We will design and pilot a data extraction form and a semi-structured interview guide to collect the data. We will perform a quantitative and a qualitative analysis of the data to explore how critical thinking about health is being taught and learned in Spanish primary schools. Conclusion We will identify opportunities for and barriers to teaching and learning critical thinking about health in Spanish primary schools. We will formulate recommendations-for both practice and research purposes-on how to use, adapt (if needed), and implement the IHC resources in this context., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Martínez García L et al.)

The microbiome is a matter of interest for science, consumers and business. Our objective is to quantify that interest in academic journals and newspapers, both quantitatively and by study design. We calculated the number of articles on the microbiome from the total number of biomedicine articles featured in both PubMed and Spanish science news agency SINC, from 2008 to 2018. We used the Factiva database to identify news stories on microbiome papers in three general newspapers (The New York Times, The Times and El País) and three business newspapers (The Wall Street Journal, the Financial Times and Expansión), from 2007 to 2019. Then, we compared news stories with microbiome papers in PubMed, while also analyzing the frequencies of five study design types, both in the newspapers and in the papers themselves. Microbiome papers represented 0.8% of biomedicine papers in PubMed from 2008 to 2018 (increasing from 0.4% to 1.4%), while microbiome news published by SINC represented 1.6% of total biomedical news stories during the same period (increasing from 0.2% to 2.2%). The number of news stories on microbiome papers correlated with the number of microbiome papers (0.91, p < 0.001) featured in general newspapers, but not in business ones. News stories on microbiome papers represented 78.9% and 42.7% of all microbiome articles in general and business newspapers, respectively. Both media outlet types tended to over-report observational studies in humans while under-reporting environmental studies, while the representation of systematic reviews of randomized controlled trials, randomized controlled trials and animal/laboratory studies was similar when comparing newspapers and PubMed. The microbiome is receiving increasing attention in academic journals and newspapers. News stories on the microbiome in general and business newspapers are mostly based on research findings and are more interested in observational studies in humans and less in environmental studies compared to PubMed., Competing Interests: have read the journal’s policy and the authors of this manuscript have the following competing interests: APB is a paid consultant to companies commercially involved in the gut microbiota and probiotics. GC has declared no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

The fact that Internet companies may record our personal data and track our online behavior for commercial or political purpose has emphasized aspects related to online privacy. This has also led to the development of search engines that promise no tracking and privacy. Search engines also have a major role in spreading low-quality health information such as that of anti-vaccine websites. This study investigates the relationship between search engines' approach to privacy and the scientific quality of the information they return. We analyzed the first 30 webpages returned searching "vaccines autism" in English, Spanish, Italian, and French. The results show that not only "alternative" search engines (Duckduckgo, Ecosia, Qwant, Swisscows, and Mojeek) but also other commercial engines (Bing, Yahoo) often return more anti-vaccine pages (10-53%) than Google.com (0%). Some localized versions of Google, however, returned more anti-vaccine webpages (up to 10%) than Google.com. Health information returned by search engines has an impact on public health and, specifically, in the acceptance of vaccines. The issue of information quality when seeking information for making health-related decisions also impact the ethical aspect represented by the right to an informed consent. Our study suggests that designing a search engine that is privacy savvy and avoids issues with filter bubbles that can result from user-tracking is necessary but insufficient; instead, mechanisms should be developed to test search engines from the perspective of information quality (particularly for health-related webpages) before they can be deemed trustworthy providers of public health information., (Copyright © 2020 Ghezzi, Bannister, Casino, Catalani, Goldman, Morley, Neunez, Prados-Bo, Smeesters, Taddeo, Vanzolini and Floridi.)

LpxT is an inner membrane protein that transfers a phosphate group from the essential lipid undecaprenyl pyrophosphate (C-55PP) to the lipid A moiety of lipopolysaccharide, generating a lipid A tris -phosphorylated species. The protein is encoded by the non-essential lpxT gene, which is conserved in distantly related Gram-negative bacteria. In this work, we investigated the phenotypic effect of lpxT ectopic expression from a plasmid in Escherichia coli . We found that lpxT induction inhibited cell division and led to the formation of elongated cells, mostly with absent or altered septa. Moreover, the cells became sensitive to detergents and to hypo-osmotic shock, indicating that they had cell envelope defects. These effects were not due to lipid A hyperphosphorylation or C-55PP sequestering, but most likely to defective lipopolysaccharide transport. Indeed, lpxT overexpression in mutants lacking the L,D-transpeptidase LdtD and LdtE, which protect cells with outer membrane defects from osmotic lysis, caused cell envelope defects. Moreover, we found that pyrophosphorylated lipid A was also produced in a lpxT deletion mutant, indicating that LpxT is not the only protein able to perform such lipid A modification in E. coli ., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

The objective of Nutrimedia is to evaluate, based on the scientific evidence, the veracity of nutrition claims disseminated to the public by the media. In this article, we describe the methodology, characteristics and contents of this web-based resource, as well as its web traffic and media impact since it was launched. Nutrimedia uses a systematic process to evaluate common beliefs, claims from newspapers and advertising identified and selected by its research team, as well as questions from the public. After formulating a structured question for each claim, we conduct a pragmatic search, prioritizing guidelines and/or systematic reviews. We evaluate the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, and classify the veracity of each claim into seven categories (true, probably true, possibly true, possibly false, probably false, false, and uncertain). For each evaluation, we develop a scientific report, a plain language summary, a summary of findings table, and, in some cases, a video. From November 2017 to May 2019, we published 30 evaluations (21 were related to foods, six to diets, and three to supplements), most of which were triggered by questions from the public (40%; 12/30). Overall, nearly half of the claims were classified as uncertain (47%; 14/30). Nutrimedia received 47,265 visitors, with a total of 181,360 pages viewed. The project and its results were reported in 84 written media and 386 websites from Spain and 14 other countries, mostly from Latin America. To our knowledge, Nutrimedia is the first web-based resource for the public that evaluates the certainty of evidence and the veracity of nutrition claims using the GRADE approach. The scientific rigor combined with the use of friendly presentation formats are distinctive features of this resource, developed to help the public to make informed choices about nutrition., Competing Interests: The authors have declared that no competing interests exist.

Background: Venom immunotherapy (VIT) is a highly effective treatment but can induce systemic adverse effects., Objective: To evaluate the safety and tolerability of VIT with purified and nonpurified extracts for treating yellow jacket and honeybee allergy., Methods: Ninety-four patients (mean age, 46 years) with a history of insect venom allergy were randomly allocated to undergo purified extract VIT (group A [44 patients]) or nonpurified extract VIT (group B [50 patients]). Fifty-six patients were allergic to yellow jacket venom (group A: 25; group B: 31) and 38 to honeybee (19 per group). The induction phase was performed using a 2- or 7-day ultrarush scheme. The maintenance phase lasted 11 weeks. Local and systemic reactions were recorded after each injection., Results: A total of 1,401 VIT injections were performed. Six systemic reactions were observed in 4 patients (honeybee-allergic patients only) (4% of patients; 0.4% of injections): 1 patient in group A (2%) and in 3 in group B (6%) (P = .57). Local extensive reactions were recorded after 5 injections in 4 patients (9%) in group A (2 yellow jacket- and 2 honeybee-allergic patients) and after 17 injections in 12 patients (24%) in group B (8 yellow jacket- and 4 honeybee-allergic patients) (P = .02). Total reactions (systemic and large local) numbered 6 in group A (0.9% of injections; 11% of patients) and 20 in group B (2.7% of injections; 30% of patients) (P = .001)., Conclusion: In patients with honeybee or yellow jacket venom allergy, VIT with purified extracts has a significantly lower propensity toward severe local reactions compared with VIT with nonpurified extracts.

Background: The natural history of respiratory allergy is commonly characterized by a worsening of symptom severity, frequent comorbidity of rhinitis and asthma, and polysensitization to aeroallergens. The polysensitization phenomenon starts since childhood and is rare to find monosensitized adult patients. However, there are few studies investigating the characteristics of polysensitized patients., Methods: This study was performed on a large cohort of patients with allergic rhinitis (assessed by ARIA criteria) and/or mild to moderate asthma (assessed by GINA). The kind and the number of sensitizations, their patterns, and the relation with quality of life (QoL) measured by the Juniper's RQLQ guestionnaire, were evaluated., Results: Globally 418 patients (50.2% males, 49.8% females, mean age 26.4 years, range 3.5-65 years, 64 smokers, 371 non-smokers) were enrolled: 220 had allergic rhinitis alone, and 198 allergic rhinitis and asthma. The mean number ofsensitizations was 2.6. Three hundred-five patients (73%) had persistent rhinitis (PER), 220 of them with moderate-severe form. There was no significant derence in rate of rhinitis and asthma in monosensitized or polysensitized patients. Most patients were sensitized to pollens, whereas only 24.2% of them were sensitized to perennial allergens. Polysensitization was significantly associated with some issues of QoL, confirming previous findings, but not with number ofsensitizations., Conclusions: This study provides data confirming for poly-sensitized patients the relevance of ARIA classification of AR. PER is the most common form of AR in this cohort, symptoms are frequently moderate-severe, and asthma is present in about the half of patients with AR.

A case of anaphylaxis to honey in a 19 year old female sensitized to Compositae pollen is described. The patient suffered from summer rhinoconjunctivitis since seven years; in January 2006, ten minutes after eating bread and honey she developed angioedema of the lips and tongue, runny nose, cough, dyspnoea, and collapse, requiring hospitalization and treatment with high dose corticosteroids and anti-histamines. After two weeks, skin prick tests (SPT) with a standard panel of inhalant allergens and prick + prick with a number of kinds of honey were performed. SPTs were positive to mugwort, ragweed, dandelion, and goldenrod. Concerning honey, the prick + prick was positive to "Millefiori" (obtained from bees foraging on Compositae) and also to sunflower, limetree, and gum tree honey, while was negative for other kinds of honey, including the frequently used chestnut honey and acacia honey. The allergenic component responsible of anaphylaxis in this case seems to be a molecule occurring in Compositae pollens, as previously reported for other three reports, but also in pollen from plants of different families. Honey contains a large number of components derived from bees, such as gland secretions and wax, as well as from substances related to their foraging activity, such flower nectar and pollens (1, 2). Honey as a food has been associated to allergic reactions and particularly to anaphylaxis (3-6). Among the pollens, the role of Compositae is somewhat controversial, since its responsibility is clear in some studies (3, 5, 6) but considered negligible in others (7). Here we present the case of a patient sensitized to Compositae pollen who had an anaphylactic reaction to the ingestion of honey obtained from bees foraging on Compositae flowers and was tested with a number of different varieties of honey.

The growing interest which the daily press in Spain has been showing in recent years on medical matters, health and public health in general is revealed when you study the number of articles which the daily newspaper El País has published on these subjects since its foundation in 1976 up until the end of 1990. During this time, the number of articles on this topic which have appeared have nearly quadrupled, rising from 1.8 in 1977 to 6.9 in 1990. The toxic syndrome and Aids seem to have been the main subjects which have fostered, at least quantitively, medical journalism and are topics on which El País has written several editorials. This study is in three sections: the first is a methodological introduction to the study of the "health" value via the daily press; the second classifies and quantifies the articles published en El País during the period in question; and the last studies, via the editorials, the position of this paper, which is in favour of individual freedoms as opposed to those of the state medical system.