Agustín Llopis-González

Evidence of the Gluten-Free and Casein-Free Diet in Autism Spectrum Disorders: A Systematic Review

In autism spectrum disorders, many parents resort to alternative treatments and these are generally perceived as risk free. Among these, the most commonly used is the gluten-free, casein-free diet. The objective of this work was to conduct a systematic review of studies published from 1970 to date related to the gluten-free, casein-free diet in autism spectrum disorder patients. Few studies can be regarded as providing sound scientific evidence since they were blinded randomized controlled trials, and even these were based on small sample sizes, reducing their validity. We observed that the evidence on this topic is currently limited and weak. We recommend that it should be only used after the diagnosis of an intolerance or allergy to foods containing the allergens excluded in gluten-free, casein-free diets. Future research should be based on this type of design, but with larger sample sizes.

Determination of pesticides and veterinary drug residues in food by liquid chromatography-mass spectrometry: A review

Monitoring of pesticides and veterinary drug residues is required to enforce legislation and guarantee food safety. Liquid chromatography-mass spectrometry (LC-MS) is the prevailing technique for assessing both types of residues because LC offers a versatile and universal separation mechanism suitable for non-gas chromatography (GC) amenable and the majority of GC-amenable compounds. This characteristic becomes more relevant when LC is coupled to MS because the high sensitivity and specificity of the detector allows to apply generic sample preparation procedures, which simultaneously extract a wide variety of residues with different physico-chemical properties. Determination of metabolites and degradation products, non-target suspected screening of an increasing number of residues, and even unknowns identification are also becoming inherent LC-MS advantages thanks to the latest advances. For routine analysis and, in particular, for official surveillance purposes in food control, analytical methods properly validated following strict guidelines are needed. After a brief introduction and an outline of the legislation applicable around the world, aspects such as improvement of specificity of high-throughput methods, resolution and mass accuracy of identification strategies and quantitative accuracy are critically reviewed in this article. In them, extraction, separation and determination are emphasized. The main objective is to offer an assessment of the state of the art and identify research needs and future trends in determining pesticide and veterinary drug residues in food by LC-MS.

Socio-occupational status and congenital anomalies.

Background: The aim of this study is to investigate the association between socio-occupational status and the frequency of major congenital anomalies in offspring. Methods: The study population comprised 81 435 live singletons born to mothers enrolled in the Danish National Birth Cohort between 1996 and 2002. A total of 3352 cases of major congenital anomalies (EUROCAT criteria) were identified by linkage to the National Hospital Discharge Register. Malformations were recorded at birth or in the first year of life. Information about maternal and paternal socio-occupational status was collected prospectively using telephone interviews in the second trimester of pregnancy and was categorized as high, middle or low. Associations were measured as relative prevalence ratios using the highest socio-occupational status within the couple as the reference group. Results: The prevalence of all recorded major congenital anomalies was similar, about 4%, in all the socio-occupational categories. Low social status of the couple did, however, correlate with a higher prevalence of congenital anomalies of the ‘respiratory system’. No association was substantially attenuated when we adjusted for maternal and paternal age, smoking status, maternal alcohol habits, folic acid intake and body mass index. When malformations of the heart and the cardiovascular system were grouped together, they were more frequent in families where both parents presented a low socio-occupational status. Conclusion: We detected an association between low socio-occupational status and congenital anomalies of the respiratory system, the heart and the circulatory system. These malformations are good candidates for a large study on occupational, environmental and social determinants.

Are alcohol intake and smoking associated with mycosis fungoides? A European multicentre case-control study

The incidence of mycosis fungoides (MF) is low, and the aetiology of the disease is unknown. The aim of this study was to investigate whether wine consumption protects against the disease and whether smoking constitutes a risk factor. This paper is part of the European Rare Cancers Study that tries to determine the risk factors for seven selective rare cancers, including mycosis fungoides, involved in the development of cancer. A multicentre case-control study was conducted in six European countries. Only incident cases with confirmed histology were included in the analysis which include a total of 76 cases of MF and 2899 controls. Wine intake had no protective effect; on the contrary the consumption of more than 24 g of alcohol per day was associated with a high risk of MF (odds ratio (OR)=3.02, 95% confidence interval (CI), 1.34-6.79), after adjusting for centre, country, age, sex and education. There was a dose-dependent increase in the risk of MF with increased smoking habits, albeit the observed trend was not statistically significant. A combined exposure to high tobacco and alcohol use yielded a significantly increased risk factor for MF (P=0.0073). Alcohol intake was associated with MF.

Food Selectivity in Autism Spectrum Disorders A Systematic Review

Autism spectrum disorders are characterized by difficulties with reciprocal social interactions and restricted patterns of behavior and interest; one of these characteristic behaviors is food selectivity. The objective of this study was to perform a systematic review of the literature published between 1970 and 2013 concerning this eating behavior. The articles identified were analyzed in terms of sample size, study design, and criteria for assessment and intervention, as well as the results, level of evidence and grade of recommendation. The main search was conducted in Medline, Cochrane Library, Scielo, ScienceDirect, and Embase). There is empirical evidence and an overall scientific consensus supporting an association between food selectivity and autism spectrum disorders.

Spontaneous pneumothorax related with climatic characteristics in the Valencia area (Spain).

Spontaneous pneumothorax (SP) is a common respiratory condition that is easily recognized and treated, though the etiology remains largely unknown. Apart from individual factors, it has been suggested that changes in atmospheric pressure may trigger the onset of SP. Our aim was to examine the association between the onset of episodes of SP with atmospheric pressure changes in the general population of an area with a Mediterranean climate. A prospective survey was conducted to detect all episodes of SP in a region of Valencia (Spain) from January 1994 to January 1996. A total of 69 cases were identified; of these, 62 episodes of SP met the inclusion criteria for this survey. Climatic measurements during the two years studied were obtained from the Spanish National Meteorological Institute, including 6-hour readings of temperature, relative humidity, clear sunlight, atmospheric pressure, visibility, wind speed and rainfall. Associations were evaluated between the daily number of hospital admissions for SP and diurnal changes in atmospheric pressure involving rises and falls of as much as 7 and 10 mbar. In addition, the association of atmospheric pressure changes to time periods of 1 a.m., 7 a.m., 1 p.m. and 7 p.m. was assessed. Drops in atmospheric pressure below the fifth percentile and elevations above the ninety-fifth percentile were regarded as ‘unusual’. There was no association between the development of SP and changes in atmospheric pressure, and no correlation was found with repeated exposure to unusual changes of atmospheric pressure. Further research is needed using similar methods to establish comparisons between countries with different climates.

Evidence based general practice.

Objectives: to estimate the proportion of interventions in general practice that are based on evidence. Design: a one-year cross-sectional study involving all consultations by patients over age 15 years seen in 34 national primary health care centers. Setting: the rural Castellón provincial district within the Valencian Community in eastern Spain, with a total population of 21,155 inhabitants. Subjects: of 1990 case histories registered in the course of one year, 4800 consultations were identified; of these, 2341 (49%) distinct diagnosis–intervention pairs were identified and coded. Main results: the evidence basis for the diagnosis–intervention pairs in the study was derived from a computerized search of the scientific literature published in 1992–1996. The quality of the evidence was classified according to the method of Ellis et al. Within the 2341 diagnosis–intervention pairs, there was positive evidence in support of the intervention used in 55%. The evidence basis was sound for 42%, with 38% being based on Type I (clinical trials) evidence and 4% on Type II evidence. The most frequently presenting diseases involved the circulatory (18.7%), respiratory (14.9%), nervous (14.2%), musculo-skeletal (12.5%) and nutrition and metabolism and digestive systems, with 12.1% each. Conclusions: clinical practice was clearly supported by positive evidence of all Types (I–III) in a total of 55% of interventions, and by good positive evidence of Type I or II in 42% of interventions. The percentage of evidence-based interventions in general practice serving a substantial population in rural Spain was lower than had been reported by some authors.

Occupational factors and risk of adult bone sarcomas: A multicentric case-control study in Europe

We investigated the association between occupational factors and risk of bone sarcoma, a rare tumor with a largely unknown aetiology. A multicentric case‐control study was conducted in 7 European countries in 1995–97. Ninety‐six cases aged 35–69 years with a centrally reviewed diagnosis of bone sarcoma (68 chondrosarcomas and 28 osteosarcomas) were compared to 2,632 population (68%) or colon cancer (32%) controls. Subjects were interviewed to obtain information on occupational, medical and reproductive history, smoking and alcohol consumption and selected exposures including use of pesticides. Response proportions were 90% among cases and 66% among controls. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for selected categories of job titles and branches of industry and for use of pesticides. We found an increased OR for bone sarcoma among blacksmiths, toolmakers, machine‐tool operators (OR = 2.14, 95% CI 1.08–4.26), woodworkers (OR = 2.68, 95% CI 1.36–5.29) and construction workers (OR = 1.62, 95% CI 0.92–2.87). Ever users of pesticide had an OR of 2.33 (95% CI 1.31–4.13), with similar risks for exposure to insecticides and exposure to herbicides. Neither duration of employment in any of the analyzed occupational categories nor duration of use of pesticides showed an increasing trend in the risk of bone sarcoma. ORs of bone sarcoma were 1.03 (95% CI 0.23–4.57), 3.13 (95% CI 1.26–7.76) and 1.44 (95% CI 0.43–4.85) for the first, second and third tertile of days of use of pesticides. Our study suggests that novel and previously reported (woodworking) occupational factors play a role in the aetiology of bone sarcomas.

Risk of infection and adverse outcomes among pregnant working women in selected occupational groups: A study in the Danish National Birth Cohort

BackgroundExposure to infectious pathogens is a frequent occupational hazard for women who work with patients, children, animals or animal products. The purpose of the present study is to investigate if women working in occupations where exposure to infections agents is common have a high risk of infections and adverse pregnancy outcomes.MethodsWe used data from the Danish National Birth Cohort, a population-based cohort study and studied the risk of Infection and adverse outcomes in pregnant women working with patients, with children, with food products or with animals. The regression analysis were adjusted for the following covariates: maternal age, parity, history of miscarriage, socio-occupational status, pre-pregnancy body mass index, smoking habit, alcohol consumption.ResultsPregnant women who worked with patients or children or food products had an excess risk of sick leave during pregnancy for more than three days. Most of negative reproductive outcomes were not increased in these occupations but the prevalence of congenital anomalies (CAs) was slightly higher in children of women who worked with patients. The prevalence of small for gestational age infants was higher among women who worked with food products. There was no association between occupation infections during pregnancy and the risk of reproductive failures in the exposed groups. However, the prevalence of CAs was slightly higher among children of women who suffered some infection during pregnancy but the numbers were small.ConclusionDespite preventive strategies, working in specific jobs during pregnancy may impose a higher risk of infections, and working in some of these occupations may impose a slightly higher risk of CAs in their offspring. Most other reproductive failures were not increased in these occupations.

Oral and dental health of non-institutionalized elderly people in Spain

With aging of the populations, the oral health and hygiene of elderly people has become an important public health issue. In this cross-sectional study we investigated the prevalence of tooth decay and other periodontal diseases in a representative cohort of 480 non-institutionalized adults ≥65 years from the province of Valencia, Spain. Using a World Health Organization standard for an adult oral survey methodology, we obtained data on remnant teeth with the decayed, missing and filled teeth (DMFT) index, a Community Periodontal Index of Treatment Needs (CPTIN), attachment loss, and temporo-mandibular articulation (TMA) status. The prevalence of these conditions were compared by age and gender, using the Chi-square, and Students t-, and ANOVA statistical tests. The mean number of remaining teeth were 17.1 in the total sample, which was higher for women (17.9 versus 15.7 in men; p=0.04). This mean number decreased as age increased (p<0.05). The overall DMFT index was 19%, showing a persistent increase with age from 14% (65-69-year) to 23% (≥80-year) (p=0.118). Only 6% of participants had no periodontal pathology, while 26% had bleeding gums and 57% had calculus, while attachment loss was observed in 31%. TMA malfunction with a click was present in 6%, was painful in 5%, and was associated with reduced mouth-opening in 2%. The prevalence of oral health pathologies was high among these elderly people, who would benefit from optimal oral health care.