Silvia Collado

Efficacy of Influenza A H1N1/2009 Vaccine in Hemodialysis and Kidney Transplant Patients

BACKGROUND AND OBJECTIVES Data are needed to assess safety and efficacy of the 2009 pandemic influenza A H1N1 vaccine in renal patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We prospectively evaluated seroconversion, predictors of response, and vaccine safety in renal patients. Hemagglutination inhibition tests to detect serum antibodies against a new influenza A-H1N1 virus were performed in 79 transplant patients, 48 hemodialysis patients, and 15 healthy workers before and 1 month after vaccination. Healthy controls and 88 of 127 renal patients were vaccinated. Seroconversion was defined as at least 2 dilutions increase in titer. RESULTS We excluded 19 individuals seroprotected (≥1/40) against the novel H1N1 in the initial sample. Efficacy rate in the 96 vaccinated individuals was 43.7% (42 of 96 seroconverted versus four of 27 nonvaccinated patients, P = 0.007). For vaccinated subgroups, efficacy was 41.8% in transplant patients (P = 0.039 versus nonvaccinated), 33.3% in hemodialysis patients (P = 0.450), and 81.8% in controls. Healthy controls showed better response to vaccine than transplant (P = 0.021) and dialysis (P = 0.012) patients. For the transplant subgroup, longer time after transplantation (P = 0.028) was associated with seroconversion, but no influence was found for age, gender, renal function, or immunosuppression. In the hemodialysis subgroup, younger age was associated with response (55.7 ± 20.8 versus 71.6 ± 10.1 years, P = 0.042), but other specific variables, including Kt/V or time on dialysis, were not. No serious adverse events were reported, and kidney function was stable. CONCLUSION The novel influenza A 2009 H1N1 vaccine was safe in renal patients, although administration of a single dose of adjuvanted vaccine induced a poor response in these patients.

Children’s Restorative Experiences and Self-Reported Environmental Behaviors

Positive experiences in nature relate to children’s environmental behaviors. The reasons for this link remain unknown. One possibility is that children behave more ecologically because they obtain benefits from spending time in nature. In the present study, we looked at positive experiences in nature, specifically restoration, as a motivational factor enhancing children’s proenvironmental behavior. Children (N = 832) rated their school yards in terms of restoration and reported their frequency of proenvironmental behaviors as well as their environmental attitudes. Perceived restoration predicted 37% of the variance in reported proenvironmental behavior. Moreover, this relationship was completely mediated by environmental attitudes. In addition, fascination, a component of restoration, was the only direct predictor of proenvironmental behavior.

Diabetic nephropathy is an independent factor associated to severe subclinical atheromatous disease

BACKGROUND Atheromatous disease (AD) is a risk factor for death in renal patients. Traditional CV risk factors do not predict the presence of AD in this population. The aim of this study is to analyze whether the etiology of the primary renal disease influences in the risk of having silent AD. STUDY DESIGN Observational cross-sectional study in chronic kidney disease patients without previous cardiovascular events. SETTINGS AND PARTICIPANTS 2436 CKD subjects without any previous CV event included in the prospective Spanish multicenter NEFRONA study. Patients were classified according to primary renal disease: diabetic nephropathy (n = 347), vascular nephropathy (n = 476), systemic/glomerular disease (n = 447), tubulointerstitial and drug toxicity nephropathy (n = 320), polycystic kidney disease (n = 238), non-filiated nephropathy (n = 406) and other causes (n = 202). PREDICTORS B-mode and Doppler ultrasonography analysis of the carotid arteries were performed to measure intima media thickness (IMT) and the presence of plaques. Clinical and laboratory parameters related to CV risk were also determined. OUTCOMES AD was scored according with the ultrasonography findings and the ankle-brachial index into two large groups: absence or incipient AD and severe AD. RESULTS In multivariate regression analysis, older age (OR 1.09/year [1.088-1.108]), smoking habit (OR 2.10 [1.61-2.74]), male gender (OR 1.33 [1.09-1.64]), grade-5D of CKD (OR 2.19 [1.74-2.74]), and diabetic nephropathy (OR 2.59 [1.93-3.48]) are independent risk factors for severe AD. The prevalence of silent AD was highest for diabetic nephropathy with grade-5D of CKD (82.2%) and lowest with stages 2-3 CKD systemic/glomerular disease (36.6%). LIMITATIONS Observational study with the potential for confounding. CONCLUSION In CKD patients without any CV event in the background clinical history, diabetic nephropathy as primary renal disease is the most significant factor associated to severe silent AD. Furthermore, this difference was independent of other conventional risk factors for atherosclerosis and CV events.

Experiencing nature and children’s conceptualizations of the natural world

This paper examines young children’s concepts of nature, paying attention to the role played by types of daily experiences with nature on 832 children’s constructions of the natural world. We observed the roles of three types of experiences, as determined by the children’s place of residence (urban, rural mountain range, and rural agricultural) in Spain. Participants wrote what they thought about when hearing the word ‘nature’. Content analysis revealed a conceptual structure formed with four underlying and interconnected themes: (1) natural and non-natural elements, (2) the human–nature relationship, (3) emotional experience of nature, and (4) actions in natural settings. The type of daily experiences with nature (i.e. urban, rural mountain range, and rural agricultural) accounted for variability in children’s concept of nature. These results reinforce the importance of considering the role played by personal and situational characteristics in shaping children’s constructions of the natural world.

Children's Perceived Restoration: Adaptation of the PRCS for Children to a Spanish sample

Abstract Several studies have shown that when childrens attention capacity is diminished, they cannot focus, they find it hard to cope with stressful situations and they become more likely to take unnecessary risks. A large number of studies have demonstrated that natural environments boost the restoration of attention capacity more than urban or semi urban environments. Hence, several instruments have been used to measure perceived restoration in adults in different environments; however, little attention has been paid to designing tools to measure childrens perceived restoration. In this study, the Perceived Restorative Components Scale for Children (Bagot, Kuo & Allen, 2007) has been adapted to a Spanish sample. It has been used with 832 children aged between 6 and 13 years old. The results show that it is important to include nature in school playgrounds, since playgrounds with a greater amount of nature in them (trees, ground vegetation, etc.) have a higher positive effect on childrens perceived restoration.

Carotid Atherosclerotic Disease Predicts Cardiovascular Events in Hemodialysis Patients: A Prospective Study

Background To evaluate the predictive value of carotid atherosclerotic disease (CAD) and intima-media thickness (IMT) on incident cardiovascular disease and mortality in hemodialysis patients. Methods Multicenter, observational, prospective study including 110 patients, followed-up to 6 years. Carotid doppler ultrasonographic findings were classified in 4 degrees of severity: 1) IMT <0.9 mm, 2) IMT >0.9 mm, 3) carotid plaque with stenosis <50% and 4) plaque with stenosis >50%. The associations between IMT and CAD and cardiovascular events, total and cardiovascular mortality were assessed. Results 83% of the patients had atherosclerotic plaques (CAD degrees 3-4). During follow-up, 29.1% of patients experienced cardiovascular events, and 28.2% died, 38.7% of cardiovascular origin. The presence of plaques was associated with cardiovascular events (p = 0.03) while calcified plaques were associated with both cardiovascular events (p = 0.01), cardiovascular mortality (p = 0.03) and non-significantly with overall mortality (p = 0.08) in the survival analysis. Carotid IMT was not associated with outcomes. Cardiovascular events correlated with CAD severity (HR 2.27, 95% CI 1.13-4.54), age (HR 1.04, 1.01-1.06), previous cardiovascular disease (HR 1.75, 1.05-4.42), dyslipidemia (HR 2.25, 1.11-4.53), lipoprotein (a) (HR 1.01, 1.00-1.02), troponin I (HR 3.89, 1.07-14.18), fibrinogen levels (HR 1.38, 0.98-1.94) and antiplatelet therapy (HR 2.14, 1.04-4.4). In an age-adjusted multivariate model, cardiovascular events were independently associated with previous coronary artery disease (HR 3.29, 1.52-7.15) and lipoprotein (a) (HR 1.01, 1.00-1.02). Conclusions The presence of carotid plaques and, especially, calcified plaques, are predictors of new cardiovascular events and cardiovascular mortality in hemodialysis patients, while IMT was not. The prognostic value of calcified plaques should be confirmed in future studies.

Effective removal of colistin methanesulphonate and formed colistin during intermittent haemodialysis in a patient infected by polymyxin-only-susceptible Pseudomonas aeruginosa

Abstract Colistin use has reemerged for the treatment of infections caused by multidrug-resistant Gram-negative bacteria. However, the information on its pharmacokinetics is limited, especially in patients with end-stage renal disease, in which dosage adjustments are contradictory, and evidences the need to investigate the removal of colistin through renal replacement therapies like haemodialysis. This case study showed efficient removal of colistin methanesulphonate and formed colistin during intermittent haemodialysis in a patient infected by polymyxin-only-susceptible Pseudomonas aeruginosa. These results suggest the importance to monitor colistin plasma concentrations in these patients to minimize treatment failure due to suboptimal exposure to antibacterial colistin.

Restorative Environments and Health

The vast majority of people live in urbanized areas. These offer numerous advantages, such as access to a great variety of entertainment and cultural events, services such as educational and medical centers, and opportunities for mixing with different kinds of people in lively public places. Urbanized areas also challenge residents, however, with pollution, crowding and information overload. The effort to deal with the various demands of everyday urban life taxes the physical, psychological and social resources of residents and, over time, this may impair their health. During the past few decades, environmental psychologists have initiated research into the role that the sociophysical environment plays in restoring people’s diminished capabilities. This chapter focuses on restorative environments, which promote people’s health and well-being by supporting their recovery from efforts to meet the demands of everyday life. We first discuss some basic concepts, including health, restoration and the theories that have guided research to date. Then, we move on to describe some key findings in the research area, with particular regard to the restorative potential of different settings in and around cities and their implications for urban residents’ health and well-being. The research evidence concerning environmental supports for restoration is organized into four sections: the residential context, work and school settings, care settings, and other settings. Overall, the results obtained show that restoration is more likely to occur in environments that offer contact with nature, from wilderness to a window view of trees. Most of the empirical studies we review refer to environments with natural elements and features; however, not all restorative environments offer contact with nature, and we also discuss the restorative qualities found in other settings, such as monasteries, museums and urban plazas. In covering the research on these different environments, we consider a variety of short-term psychological benefits that reflect restorative processes, such as improvements in emotional states, the ability to concentrate, and the capacity to inhibit impulsive behavior. We also consider how achieving long-term health goals, such as weight control, might be facilitated by repeated restorative experiences. The empirical evidence obtained over the past few decades offers some guidance for environmental design and planning that can boost the restorative quality of residential areas, workplaces, schools, hospitals and other settings of everyday life. We close by discussing these practical implications and by making recommendations for future research.

Normative Influences on Adolescents’ Self-Reported Pro-Environmental Behaviors: The Role of Parents and Friends:

Pro-environmental behavioral patterns are influenced by relevant others’ actions and expectations. Studies about the intergenerational transmission of environmentalism have demonstrated that parents play a major role in their children’s pro-environmental actions. However, little is known about how other social agents may shape youth’s environmentalism. This cross-sectional study concentrates on the role that parents and peers have in the regulation of 12- to 19-year-olds’ pro-environmental behaviors. We also consider the common response bias effect by examining the associations between parents, peers, and adolescents’ pro-environmentalism in two independent data sets. Data Set 1 (N = 330) includes adolescents’ perceptions of relevant others’ behaviors. Data Set 2 (N = 152) includes relevant others’ self-reported pro-environmental behavior. Our results show that parents’ and peers’ descriptive and injunctive norms have a direct effect on adolescents’ pro-environmental behavior and an indirect one, through personal norms. Adolescents seem to be accurate in the perception of their close ones’ environmental actions.

Preference, restorativeness and perceived environmental quality of small urban spaces / Preferencia, restauración y calidad ambiental percibida en plazas urbanas

Abstract The purpose of this study is to evaluate the role of small urban spaces (or pocket parks) in cities as an opportunity to access nature and restorativeness. The study was performed in nine squares located in the central zone of the city of Madrid. A total of 537 people were interviewed in situ about their preferences, as well as the perceived quality and environmental restorativeness of these places. The results show that preference is influenced by the amount of vegetation and perceived restorativeness, and that restorativeness in turn is determined by perceived vegetation and social interaction. The benefits of this restorative role should be considered when designing small urban squares, taking care to include plants and vegetation as well as appropriate equipment, and making these spaces a valuable element within the green infrastructure of major cities.