Directed conservation of the world's reef sharks and rays.

Many shark populations are in decline around the world, with severe ecological and economic consequences. Fisheries management and marine protected areas (MPAs) have both been heralded as solutions. However, the effectiveness of MPAs alone is questionable, particularly for globally threatened sharks and rays ('elasmobranchs'), with little known about how fisheries management and MPAs interact to conserve these species. Here we use a dedicated global survey of coral reef elasmobranchs to assess 66 fully protected areas embedded within a range of fisheries management regimes across 36 countries. We show that conservation benefits were primarily for reef-associated sharks, which were twice as abundant in fully protected areas compared with areas open to fishing. Conservation benefits were greatest in large protected areas that incorporate distinct reefs. However, the same benefits were not evident for rays or wide-ranging sharks that are both economically and ecologically important while also threatened with extinction. We show that conservation benefits from fully protected areas are close to doubled when embedded within areas of effective fisheries management, highlighting the importance of a mixed management approach of both effective fisheries management and well-designed fully protected areas to conserve tropical elasmobranch assemblages globally.

Overnutrition as a risk factor for more serious respiratory viral infections in children: A retrospective study in hospitalized patients.

BACKGROUND: The prevalence of obesity has increased dramatically in children worldwide. Obesity has been recognized as a risk factor for more serious viral respiratory infections, mainly in adults. OBJECTIVE: To study the relationship between overnutrition (obesity and overweight) and clinical severity in children hospitalized with acute respiratory infections of viral origin. METHODS: One hundred and forty-three clinical records of children between 2 and 18 years old hospitalized for acute respiratory infection at Clínica Dávila (2014-2018) were analyzed, recording the respiratory viruses detected at the time of hospitalization, weight, and height. Nutritional status was estimated using Z score or body mass index, according to age. RESULTS: Eighty-tree3 children (58%) were positive for more than one respiratory virus. The main virus detected in monoinfection was adenovirus (9.8%), followed by respiratory syncytial virus (7.7%) and parainfluenza virus (7.7%). There were no deaths. Patients with obesity presented more days of hospitalization (P = .04), oxygen therapy (P = .03) and mechanical ventilation (P < .001), as well as a higher probability of requiring mechanical ventilation (P = .001) and of ICU admission (P = .003) compared with children with normal weight. Patients with overweight presented more days of mechanical ventilation (P < .001) than patients with normal weight. No significant differences were found between the presence of viral coinfection and nutritional status. CONCLUSION: Overnutrition is associated with greater severity of viral respiratory infection in hospitalized children.

Widespread diversity deficits of coral reef sharks and rays.

A global survey of coral reefs reveals that overfishing is driving resident shark species toward extinction, causing diversity deficits in reef elasmobranch (shark and ray) assemblages. Our species-level analysis revealed global declines of 60 to 73% for five common resident reef shark species and that individual shark species were not detected at 34 to 47% of surveyed reefs. As reefs become more shark-depleted, rays begin to dominate assemblages. Shark-dominated assemblages persist in wealthy nations with strong governance and in highly protected areas, whereas poverty, weak governance, and a lack of shark management are associated with depauperate assemblages mainly composed of rays. Without action to address these diversity deficits, loss of ecological function and ecosystem services will increasingly affect human communities.

Womens access to health care: Gaps that the future health care reform in Chile must solve. / Acceso de la mujer a la atención de salud: brechas que la futura reforma de salud en Chile debe resolver.

INTRODUCTION: In the Chilean health system, difficulties complicate womens access to health care and aggravate the complexity of health-illness processes in their interaction as users or caregivers. OBJECTIVE: In the national and international literature, we aimed to identify gaps in womens access to health care derived from gender disparities and the exercise of gender roles in a prioritized set of health problems. These problems exacerbate gender gaps and should be considered in health reform. METHODS: We made a literature review through algorithms, snowball sampling, and reference lists from November 2020 to March 2021. The population included were women of all ages, including women users of the health system and women caregivers of specific pathologies. The search was conducted in parallel by four investigators divided into two groups. It was cross-validated to ensure inter-investigator reliability by standardizing evidence eligibility criteria. The analysis showed women users' and caregivers' dimensions for a set of pathologies prioritized by the extent of the disease burden. The pathologies analyzed included stroke, obesity, depression, musculoskeletal pain, and breast cancer. RESULTS: Among women users of the health system, problems of access, rates of use, experience, and outcome for the whole group of prioritized pathologies were observed. In the women caregiver dimension, we found that women are the primary health care providers. There is a knowledge gap concerning obesity and musculoskeletal conditions. However, both were reported as health consequences of womens caregiving roles.

INTRODUCCIÓN: En el sistema de salud chileno persisten dificultades que complejizan el acceso de mujeres de forma efectiva a las atenciones de salud, o bien, derivan en que experimenten procesos de salud-enfermedad más complejos en su interacción como usuarias o cuidadoras. OBJETIVO: Identificamos en la literatura nacional e internacional, brechas de acceso a la atención de salud en la mujer derivadas de disparidades de género y/o ejercicio del rol de género, en un conjunto priorizado de problemas de salud. Estos problemas contribuyen a la problematización de las brechas de género a ser consideradas en la reforma de salud. MÉTODOS: Hicimos una revisión de la literatura a través de algoritmos, muestreo en bola de nieve y listas de referencias, desde noviembre de 2020 hasta marzo de 2021. La población de análisis fueron mujeres de todas las edades usuarias de prestaciones de salud y cuidadoras en las mismas patologías abordadas. La búsqueda fue desarrollada en paralelo por cuatro investigadores, en dos grupos. Fue validada de forma cruzada asegurando la confiabilidad interevaluadores, estandarizando criterios de elegibilidad de la evidencia. El análisis se muestra en dimensiones de mujer usuaria y cuidadora, para un conjunto de patologías priorizadas por magnitud y carga de enfermedad: accidente vascular cerebral, obesidad, depresión, dolor musculoesquelético y cáncer de mama. RESULTADOS: En la dimensión de mujer usuaria, para todo el grupo de patologías priorizadas se observan problemas de acceso, tasas de uso, experiencia y resultados. Desde la dimensión de mujer cuidadora, la mujer ejerce principalmente los cuidados de salud. Existe un vacío en la literatura en relación con la obesidad y afecciones musculoesqueléticas. Sin embargo, ambas se reportaron como consecuencias de salud en su rol de cuidadora. CONCLUSIONES: El problema en la base, en ambas dimensiones, queda explicado por brechas de género biológicas, sociales y culturales que permean el ámbito de cuidados sanitarios. Proponer una nueva reforma de salud que solo se funde en la proposición de acceso a más prestaciones, es insuficiente de acuerdo con el contexto biopsicosocial de la mujer.

Author Correction: Global status and conservation potential of reef sharks.

An Amendment to this paper has been published and can be accessed via a link at the top of the paper.

Global status and conservation potential of reef sharks.

Decades of overexploitation have devastated shark populations, leaving considerable doubt as to their ecological status1,2. Yet much of what is known about sharks has been inferred from catch records in industrial fisheries, whereas far less information is available about sharks that live in coastal habitats3. Here we address this knowledge gap using data from more than 15,000 standardized baited remote underwater video stations that were deployed on 371 reefs in 58 nations to estimate the conservation status of reef sharks globally. Our results reveal the profound impact that fishing has had on reef shark populations: we observed no sharks on almost 20% of the surveyed reefs. Reef sharks were almost completely absent from reefs in several nations, and shark depletion was strongly related to socio-economic conditions such as the size and proximity of the nearest market, poor governance and the density of the human population. However, opportunities for the conservation of reef sharks remain: shark sanctuaries, closed areas, catch limits and an absence of gillnets and longlines were associated with a substantially higher relative abundance of reef sharks. These results reveal several policy pathways for the restoration and management of reef shark populations, from direct top-down management of fishing to indirect improvement of governance conditions. Reef shark populations will only have a high chance of recovery by engaging key socio-economic aspects of tropical fisheries.

Score de Alvarado en pacientes apendicectomizados

Alvarado score is a practical score for the early diagnosis of acute appendicitis used as a clinical resource for diagnosing this disease. Acute appendicitis is the most common cause of an acute abdomen requiring surgery, with a lifetime risk of about 7 %. The Alvarado score was originally designed more than two decades ago, it enables risk stratification in patients presenting with abdominal pain, being a clinical prediction which rules and quantify the diagnosis of a target disorder based on findings or key symptoms and signs, thus having an independent diagnostic or prognostic value. Sensitivity and specificity of the score in acute appendicitis determines likehood of appendicitis based on symptoms, signs and laboratory data, and can be used to stratify patients with symptoms of suspected appendicitis. The aim of this study was to assess the diagnostic accuracy and calibration performance of the Alvarado score in a suspected acute appendicitis.

Prevalencia y estado epidemiológico de embarazadas obesas del Hospital A. Llano de Corrientes durante el período enero 2014 - abril 2015 / revalence and epidemiological status of obese pregnant women at the Hospital A. Llano de Corrientes during the period January 2014 - April 2015

Según la Organización Mundial de la Salud, el número de obesos en el mundo para el 2015 sería de 700 millones. Más del 40% de las mujeres que cursan un embarazo se encuentran con sobrepeso u obesidad. La obesidad complica el 28% de los embarazos. Las pacientes con obesidad antes del embarazo tienen mayor riesgo de desarrollar diabetes, preeclampsia, macrosomía, muerte fetal, complicaciones en el parto y puerperio. En nuestro estudio se buscó conocer los valores que maneja una de las maternidades de la región, para comenzar a obtener una base de datos sobre nuestra población. Se realizó un estudio del tipo transversal. El universo está formado por todas las embarazadas que acudieron al servicio de maternidad del Hospital que culminaron su gestación durante Enero 2014-Abril 2015. Muestreo No-probabilístico de tipo intencional. Se analizaron 2913 historias clínicas perinatales, y se incluyeron 785 historias clínicas pertenecientes a embarazadas obesas. Nuestro análisis informo una prevalencia del 26,94% de embarazadas obesas. Las edades más frecuentes en nuestra población fueron entre 20 y 30 años. No se encontró una diferencia significativa entre la atención en salas periféricas y hospital, indicando la escasa participación en el control prenatal del primer nivel de atención. El 73,63% fueron embarazos controlados, demostrando una buena accesibilidad de las embarazadas para el control prenatal. Un 38,98% fue derivado del interior, lo cual podría indicar una falta de manejo en los partos. Lo destacable fue que un 66,75% presentaron patologías, demostrando relación entre obesidad y complicación en el embarazo

Segundo a organizacao mundial da saude, o numero de obesos no mundo para 2015 seria de 700 milhoes. Mais do que 40% das mulheres que cursam com uma gravidez se encontram com uma situacao de sobrepeso ou obesidade. A obesidade complica o 28% das gravidezes. A paciente com obesidade antes da gravidez tem maior perigo de desenvolver diabete, pré-eclámpsia, macrossomia, morte fetal, complicares no parto y no puerpério. No nosso estudo se buscou conhecer os valores que se lidam em uma das maternidades da regiao, para comecar a ter uma base de dados sobre as nossa populacao. O universo é formado por todas as gravidas que acudiram ao servico de maternidade do hospital que finalizaram sua gestacao durante janeiro 2014 abril 2015 uma amostragem nao provavilistico de tipo intencional. Analisaram-se 2913 historias clinicas perinatais, e se incluíram 785 historias clinicas pertencentes a gravidas obesas. Cáceres, Camila A. y Col. Rev. Fac. Med. UNNE XXXVI: 1, 18-24, 2016 Nosso analise informou uma prevaléncia do 26,94% de gravidas obesas. As idades mais frequentes na nossa populacao foram entre 20 e 30 anos. Nao se encontrou uma diferenca significativa entre a atencao em salas periféricas e hospitais, indicando a escassa participacao no controle pré-natal do primeiro nível de atencao. O 73,63% foram "gravideis" controlados, demostrando uma boa acessibilidade das gravidas para o controle prénatal. Um 38,98% foi derivado do interior, o qual podia indicar uma falta habilidade dos partos. O destacável foi que um 66,75% apresentaram doencas, demostrando relacao entre obesidade e complicacoes na gravidez