Neuromuscular control of masticatory muscles in people with intellectual disability, middle-aged adults and older adults.

BACKGROUND: Motor control issues are common for people with intellectual disabilities (PWID), resulting in difficulties with basic activities of daily living, including eating. Mastication, which is crucial for digestion and overall health, is poorly understood in this population. PWID shows frailty similar to older people, highlighting the importance of comparing masticatory motor control with older adults. This study compared the neuromuscular control of the masticatory muscles in middle-aged, PWID and older adults. METHODS: A cross-sectional analytical design was used. During the mastication task of a carrot piece (2 cm in diameter and weighing 0.5 g), surface electromyography was used to record muscle activity patterns from the right and left masseter and temporalis muscles. Principal component analysis (PCA) was used to assess neuromuscular control. A z-score normalisation of the first component's variance from PCA to identify those individuals with altered neuromuscular control. A mixed ANOVA was performed to assess the interaction between principal components, groups and body composition. RESULTS: Thirty PWIDs (aged 35-55 years), middle-aged adults and 32 older adults were recruited. PWID and older adults showed decreased neuromuscular control of the masticatory muscles compared to middle-aged control adults (P < 0.05). PWID had the highest proportion of individuals with altered neuromuscular control of the masticatory muscle (53%) compared to older adults (19%) and middle-aged adults (0%) (P < 0.05). CONCLUSIONS: Our results indicate that PWID and older adults have reduced neuromuscular control compared to middle-aged adults. Notably, a significant proportion of the PWID showed altered masticatory muscle control compared to older adults. Further research is needed to explore the potential benefits of masticatory muscle training for PWID.

Mental health and vitality predict spinal pain in healthcare workers.

BACKGROUND: Despite extensive investigation of ergonomic risk factors for spinal pain in healthcare workers, limited knowledge of psychological risk factors exists. AIMS: To assess the prospective association of mental health and vitality with development of spinal pain in healthcare workers. METHODS: A prospective cohort study was carried out involving 1950 healthcare workers from 19 hospitals in Denmark. Assessments were done at baseline and at 1-year follow-up. Mental health and vitality were measured using the Short Form-36 Health Survey, while spinal pain intensity was measured using a 0-10 scale in the low-back, upper-back and neck, respectively. Cumulative logistic regressions adjusted for several confounding factors were applied, reporting risk estimates as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Using good mental health as reference, moderate (but not poor) mental health at baseline was associated with increased pain intensity in the low-back (OR: 1.41 [95% CI: 1.21-1.77]), upper-back (OR: 1.63 [95% CI: 1.31-2.02]) and neck (OR: 1.31 [95% CI: 1.07-1.61]) at 1-year follow-up. Likewise, using high vitality as reference, both moderate and low vitality at baseline were associated with increased pain intensity in the low-back (OR: 1.54 [95% CI: 1.22-1.94] and OR: 2.34 [95% CI: 1.75-3.12], respectively), upper-back (OR: 1.72 [95% CI: 1.34-2.23] and OR: 2.46 [95% CI: 1.86-3.25], respectively) and neck (OR: 1.66 [95% CI: 1.34-2.06] and OR: 2.06 [95% CI: 1.61-2.63], respectively) at 1-year follow-up. CONCLUSIONS: Compared to healthcare workers with good mental health and high vitality, those with moderate mental health and low/moderate vitality, respectively, were more likely to increase spinal pain intensity at 1-year follow-up. These components should also be considered in the prevention of spinal pain in healthcare workers.

Single photon emission computed tomography (SPECT) diagnostic accuracy in active unilateral condylar hyperplasia: Retrospective study.

The aim of this study was to assess the diagnostic accuracy of single photon emission tomography (SPECT) in unilateral condylar hyperplasia (UCH). To this end, 3D morphometric changes of the mandibles in one year were assessed (T0 vs. T1) and compared over SPECT results in T1, in a sample of 40 patients. A contingency table was constructed based on these results for SPECT diagnostic accuracy evaluation, classifying patients as SPECT true-positive, true-negatives, false positives and false-negatives. Additionally, the morphometric analysis was used to describe the presentation of mandibular changes using principal component analysis (PCA) and non-parametric statistics. We obtained diagnostic accuracy results of sensitivity 81%, specificity 63%, positive predictor value (PPV) 59%, negative predictor value (NPV) 83% and accuracy 70%, showing that SPECT yields poor results regarding accuracy diagnostic performance. The morphometric analysis showed that individuals without progress of asymmetry and those with more progress differ particularly in a group of landmarks representing the mental region and the right mandibular body. Based on these landmarks, difference among the four SPECT-accuracy groups was statistically significant (p < 0.001), where the landmark showing the largest change within a year had a mean increase of 1.13 + 0.66 mm. Within the limitations of the study, it seems that SPECT alone is not suitable for making surgical decisions regarding condylectomy in active UCH. Follow up with morphological assessment methods are recommended for confirming an active UCH in combination with SPECT.

Reduced lip seal strength and missing teeth are associated with poorer masticatory performance in young adults with intellectual disabilities: a cross-sectional analytical study.

BACKGROUND: Alterations in oral health have a negative impact on the quality of life of persons with intellectual disabilities (PwIDs). Chewing is a process that influences and determines optimal oral health. However, little is known about how intellectual disability (ID) affects masticatory performance. This study aimed to analyse the differences in masticatory performance between young adults with IDs, young adults without IDs and older adults without IDs. METHODS: A cross-sectional analytical design was used. The masticatory performance was evaluated with a chewing gum validated instrument. In addition, the labial and tongue strength was assessed with the Iowa Oral Performance Instrument. We compared the masticatory performance between groups using one-way analysis of covariance. Body mass index, muscle mass, missing teeth, lip strength and tongue strength were included as separate covariates. A multivariate regression analysis was performed to identify which independent variables could explain masticatory performance in each group. RESULTS: Thirty-two PwIDs, 31 young adults without IDs and 32 older adults without IDs were recruited. PwIDs showed poorer masticatory performance compared with older adults (mean difference: -3.06, 95% confidence interval: -3.87 to -2.26) and healthy controls (mean difference: -2.38, 95% confidence interval: -3.19 to -1.57). The analysis of covariance showed significant difference between groups in the masticatory performance (F = 47.35, P < 0.001, ηp 2  = 0.507). Missing teeth (P < 0.001), right lip strength (P = 0.025) and tongue strength (P = 0.007) as covariables showed a significant interaction with the model. In the PwID group, lip strength and lack of teeth explained 58% of the variance in masticatory performance (R2  = 0.580, standard error = 1.12, P < 0.001). CONCLUSIONS: Persons with intellectual disabilities have a poorer masticatory performance than adults without IDs. Our findings indicate that the primary determinants of optimal masticatory function in PwIDs are the strength of the lip seal and the number of missing teeth.

SARS-CoV-2 seroprevalence in workers from a Colombian University Hospital.

BACKGROUND: Antibody (Ab) tests for SARS-CoV-2 virus allows for the estimation of incidence, level of exposure and duration of immunity acquired by a previous infection. In health workers, the hospital setting might convey a greater risk of infection. AIMS: To describe the frequency of immunoglobulin G (IgG) Abs (IgG-Abs) to the SARS-CoV-2 virus among workers at a third-level university hospital in Colombia. METHODS: In this cross-sectional study, we included medical and non-medical personnel with at least one real-time polymerase chain reaction (RT-PCR)/antigen test between March 2020 and March 2021. In April 2021, an IgG-Ab test against SARS-CoV-2 was conducted for all participants and replicated 2 weeks later in a random sample (10%). The frequency of IgG-Abs is presented based on status (positive/negative) and time elapsed since RT-PCR/antigen test (<3 months, 3-6 months, >6 months). RESULTS: We included 1021 workers (80% women, median age 34 years (interquartile range 28-42), 73% medical personnel, 23% with previous positive RT-PCR/antigen). The overall seroprevalence was 35% (95% CI 31.6-37.4, 35% in medical and 33% in non-medical personnel). For those with a previous positive RT-PCR/antigen test, the seroprevalence was 90% (<3 months), 82% (3-6 months) and 48% (>6 months). In participants with a previous negative RT-PCR/antigen test, the seroprevalence was 17% (<3 months), 21% (3-6 months) and 29% (>6 months). CONCLUSIONS: High IgG-Ab positivity was found in hospital personnel, regardless of work activities. The prevalence of detectable Abs differed by previous RT-PCR/antigen status and time elapsed since the diagnostic test.

Análisis de factores de riesgo cardiometabólicos y nutricionales en pacientes diabéticos tipo 2 e hipertensos esenciales usuarios de atención privada y pública / Analysis of cardiometabolic and nutritional risk factors in patients with diabetes type 2 and essential hypertension users of private and public care

La enfermedad cardiovascular es una de las principales causas de morbimortalidad en Chile, según resultados entregados por la Encuesta Nacional de Salud 2017 un 3,3% de la población ha presentado un infarto agudo al miocardio, un 2,6% reporta haber sufrido un ataque cerebrovascular, el 74% de los chilenos presenta obesidad y un 87% sedentarismo, siendo la diabetes mellitus tipo 2 (DM2) con un 12% y la hipertensión arterial con un 28% resultados que preocupan por su importante incremento. La investigación tuvo un diseño observacional de corte transversal. Se realizó en 69 pacientes con DM2 e hipertensos esenciales, entre 40 y 80 años de edad, pertenecientes al Sistema salud municipal (SMS) y privado (SPS) en la ciudad de Iquique. Se realizó encuesta alimentaria, medición antropométrica y exámenes bioquímicos y presión arterial. Al analizar ambos grupos se destaca los siguientes resultados: actividad física 17,24% SPS y 42,5% en SSM, presión arterial controlada 55,2% SPS y 87,5% en SSM, control de hemoglobina glicosilada 26,9% SPS y 52,5% en SSM, colesterol total alterado 17,9% SPS y 45% en SSM, síntomas depresivos 96,5% SPS y 26,3% en SSM. Se evidenció una prevalencia de mal nutrición por exceso de un 89,7% SPS y 95% SSM, riesgo cardiovascular (RCV) según circunferencia de cintura (CC) 96,5% SPS y 92,3% SSM. En relación a la encuesta alimentaria se observó que un 44,8% en usuarios SPS y 52,5% de SSM presentaron consumo alimentario hipercalórico. Los usuarios de atención privada y pública presentaron factores de riesgo cardiovascular, donde destacan la obesidad, sedentarismo y RCV según CC. Al comparar ambos grupos los usuarios SPS presentan menor control metabólico de su enfermedad y factores de riesgo cardiovascular aumentados en relación a los usuarios SSM.

Cardiovascular disease is one of the main causes of morbidity and mortality in Chile, according to the results provided by the 2017 National Health Survey, 3.3% of the population has presented acute myocardial infarction, 2.6% reported have suffered a cerebrovascular accident, 74% of Chileans are obese and 87% have sedentary behavior, belonging to type 2 diabetes mellitus (DM2) into 12% and arterial hypertension into 28%, alarming results due to their significant increase. The research had a cross-sectional observational study design. 69 patients with DM2 and essential hypertensive patients, between 40 and 80 years of age were studied, belonging to the municipal (SSM) and private (SPS) health systems in the city of Iquique. A food intake survey, anthropometric measurements, and biochemical and blood pressure tests were taken. When analyzing both groups, the following results stand out: physical activity 17.24% in SPS and 42.5% in SSM, controlled blood pressure 55.2% in SPS and 87.5% in SSM, controlled glycosylated hemoglobin 26.9% in SPS and 52.5% in SSM, altered values of total cholesterol 17.9% in SPS and 45% in SSM, depression symptoms 96.5% in SPS and 26.3% in SSM. Prevalence of malnutrition due to excess 89.7% in SPS and 95% in SSM, cardiovascular risk (RCV) according to waist circumference (CC) 96.5% in SPS and 92.3% in SSM were evidenced. In relation to the food intake survey, it was observed that 44.8% of SPS users and 52.5% of SSM users consume hypercaloric diet. The users of private and public care presented cardiovascular risk factors, where the obesity, sedentary lifestyle and RCV related to CC stand out. When comparing both groups, SPS users have less control of their disease in relation to SSM users.

Usefulness of inflammatory markers in detecting esophagojejunostomy leakage.

INTRODUCTION AND AIM: Total gastrectomy is utilized in different pathologies. Esophagojejunostomy leakage is a frequent complication. Our aim was to determine the association of the neutrophil-lymphocyte ratio (NLR) with esophagojejunostomy leakage that subsequently required invasive treatment. MATERIALS AND METHODS: A retrospective study included patients that underwent esophagojejunostomy within the time frame of 2002-2017. Patients were grouped into those with or without anastomotic leakage that had conservative treatment (group A) and those with anastomotic leakage that had invasive treatment (group B). ROC curves and the Youden index were used for the optimum cutoff values of the NLR. RESULTS: Fifty-seven patients were included. Thirty-two (56.14%) were men, and mean patient age was 61.8 ± 13.4 years. Forty-five patients were assigned to group A and 12 to group B. Mean NLR was higher for group B on postoperative day 3 (group A 9.5 ± 7.5 vs. group B 13.9 ± 4.9) (p = 0.05). Mean total leukocytes was higher in group B on postoperative day 5 (group A 7.8 ± 3.4 × 103/mcl vs. group B 10.3 ± 4.4 × 103/mcl) (p = 0.03). NLR and total leukocyte accuracy on postoperative day 3 was calculated with ROC curves, at 0.78 and 0.63, respectively. For the NLR and leukocyte count, sensitivity was 91.7% and 58%, specificity was 64.4% and 60%, positive predictive value was 40% and 28%, and negative predictive value was 96% and 84%, respectively. CONCLUSIONS: Postoperatively, the NLR identified the total gastrectomy with esophagojejunostomy patients that subsequently required an invasive procedure secondary to esophagojejunostomy leakage.

Integrating ecosystem services into sustainable landscape management: A collaborative approach.

The Paiva River is considered one of the least polluted rivers in Europe and its watershed has a high conservation value. However, the Paiva River basin suffers pressures related with recurrent disturbances in land use, such as forest fires, agricultural activities, urbanization and pressures that affect the natural hydromorphological conditions and the continuity of watercourses. Blue and Green Infrastructures (BGINs) emerge to improve biodiversity, sustainability and the supply of ecosystem services while improving socioeconomic aspects. Thus, this article aims to identify priority areas in the basin, for intervention with these infrastructures. For that, a spatial multicriteria decision analysis (MDCA) was carried out according to several data related to the Paiva River Basin. As local politicians and responsible entities for the natural resources management are the main experts on the problems and their possible solutions at the local level, they were involved in this decision-making model. Therefore, these specialized stakeholders did the weighting assignment according to the most or least importance of the same for the work. The map of priority locations to implement BGINs was obtained in the sequel. To the top 5 priority areas, stakeholders attributed the best solutions based on nature. The most recommended BGINs were recovery/maintenance of riparian vegetation and conservation and reforestation of the native forest, both presented in four of the five areas, and introduction of fuel management strips presented in three of the five areas. Thus, we concluded that it is extremely important to include the communities and the competent entities of nature and environment management in scientific projects related to conservation, forming a synergy that makes it possible to combine scientific knowledge with local experience acquired in the field. This project uses a very flexible methodology of local data and can be a great example to be implemented in other hydrographic basins anywhere in the world.

Is it safe to remove a dam at the risk of a sprawl by exotic fish species?

The longitudinal dimension of river connectivity has been significantly disrupted by barriers to compensate for water demand in the long periods of water scarcity in the Iberian Peninsula. The scale of this modification is widespread in the Portuguese part of Douro River network where, side to side with agriculture water demand, there is a constant increase in hydropower production. Thus, native species in Iberian freshwater systems, performing reproductive migrations along the rivers, are strongly affected by the amplification of fragmentation caused by the tremendous density of transversal obstacles in this river basin. We aimed to prioritize dam removal in the Portuguese part of Douro River, mainly considering obsolete barriers (small dams, weirs) based on a spatial multicriteria decision analysis (GIS-MCDA) based on a prioritization procedure. A diversity of parameters were used to prioritize (rank) the dam's suitability for removal, considering the losses of connectivity and fish biodiversity, habitat degradation, negative effects on water quality and ecological conditions, and socio-economic factors. Different weights were assigned to the different attributes in each criterion according to their importance. The analysis also included a significant constraint: the potential spreading of exotic invasive fish species if connection was reestablished through dam removal. This procedure started with the georeferencing of 1201 transversal obstacles that were further characterized for their relative permeability to fish migration. In conclusion the model used allowed to identify 158 priority barriers, as well as the 5 most fragmented tributaries, which means the most impacted by river regulation. In 8 cases the barriers were big dams (> 15 m), whereas in the remaining 150 were weirs. From a final rank of 20 most impacting structures, the MCDA results also identified two cases where potential removal could trigger the additional impact to native fish species related to the sprawl of alien populations.

Seasonal effect of land use management on gill histopathology of Barbel and Douro Nase in a Portuguese watershed.

The Vilariça River (located in the northeast of Portugal) is inserted in an agricultural basin and it was chosen to replace the spawning grounds for fish, that was lost due to the construction of dams in the Sabor River. Thus, it is essential to study the effect of agricultural practices on water quality and in the health status of fish. The barbel (Luciobarbus bocagei) and Douro nase (Pseudochondrostoma duriense) were the selected species and the work was developed in two seasons (Summer 2016 and Winter 2017). For that, the histopathological changes of fish gill were used as biomarkers, through a semi-quantitative approach that considers the injuries severity. And the water quality assessment criteria followed the methodologies proposed for classifying the status of surface water bodies from Portugal. The current study showed severe histopathological changes in both species and both seasons, and the water was classified as polluted and extremely polluted in Summer and Winter respectively. The pollution in Summer was due to high temperatures, low dissolved oxygen and major concentration of As and Mn, and in Winter is due to the high concentration of Total Suspended Solids, nitrites and Cd. The increase of values of physico-chemical parameters on the water was caused by the less streamflow and excessive agricultural fertilization in Summer which arrive the river by irrigation, and by the erosion of soil particles with heavy metals associated in Winter. Also, the canonical analysis showed that physico-chemical parameters concentrations in Summer justify the major prevalence of aneurism in barbel and exudate in nase and Winter the major prevalence of hypertrophy in barbel. In conclusion, the study showed that the gill injuries of barbel and Douro nase was correlated with the water quality and it is influenced by seasonal agricultural practices and the flow regime.

Flood risk attenuation in critical zones of continental Portugal using sustainable detention basins.

According to the Floods Directive (Directive 60/2007/EC), the management of floods represents an obligation of each EU member state to defend human lives as well as the economic well-being of societies, especially in areas defined as critical. The purpose of this study was to develop a flood attenuation model based on detention basins in the 23 critical flood risk zones of continental Portugal, capable to eliminate the high and very high flood risk areas instead of attempting to ensure full control of the flood in all potentially threatened areas. The model workflow comprised the sequential use of engineering formulae based on historical peak flows and a zoning algorithm embedded in a Geographic Information System. The formulas allowed to set up the volume of river water to retain in a detention basin during a flood, as well as the smallest catchment area (A) producing this volume. The results were divided into sustainable (h ≤ 8 m) or non-sustainable (h > 8 m) detention basins. Thus, these results indicated the possibility to install 27 sustainable and 75 non-sustainable detention basins in specific catchments within the critical zones contributing watersheds. The number of sustainable detention basins is reduced by about 30% when the full flood control model is used. Because the construction of non-sustainable (engineered) dams is extremely costly, the only possible way to mitigate flood risk in these critical zones would be to couple flood attenuation with hydroelectric use, or through the implementation of an extensive reforestation program in the catchment with the purpose to increase evapotranspiration and reduce runoff.

Contrast-enhanced swallow study sensitivity for detecting esophagojejunostomy leakage. / Sensibilidad del trago de contraste hidrosoluble para la detección de fugas de anastomosis esofagoyeyunal.

INTRODUCTION AND AIM: Sixty percent of the patients with gastric carcinomas are candidates for surgical resection through total gastrectomy and esophagojejunostomy, the latter of which is associated with leaks in up to 12.3% of cases. There is no standardized procedure for diagnosing anastomotic leaks. The aim of the present study was to establish the diagnostic sensitivity of the contrast-enhanced swallow study for detecting esophagojejunostomy leakage after total gastrectomy. MATERIALS AND METHODS: A retrospective analysis was conducted on patients that underwent total gastrectomy due to gastric adenocarcinoma, within the time frame of 2002 and 2017. Demographic, clinical, and laboratory factors were identified, emphasizing the clinical and radiologic detection of anastomotic leaks. Descriptive statistics were carried out and the sensitivity of the contrast-enhanced swallow study for diagnosing leakage was calculated. RESULTS: Fifty-eight patients were included in the study. Their mean age was 61.5 years. A total of 55.2% of the patients were men and 44.8% were women. Gastric adenocarcinoma was the indication for gastrectomy in 100% of the cases. Anastomotic leak presented in 31.01% of the patients. Diagnostic sensitivity of the contrast-enhanced swallow study for detecting leaks was 66%. CONCLUSIONS: According to our analysis, the contrast-enhanced swallow study had limited diagnostic efficiency for detecting anastomotic leaks, with a sensitivity of 66%. We suggest maintaining high diagnostic suspicion in patients with studies that are initially negative and basing decisions on a more extensive approach.

A structural equation model to predict macroinvertebrate-based ecological status in catchments influenced by anthropogenic pressures.

A Partial Least Squares-Path Model (PLS-PM) was developed for the Ave River Basin (North of Portugal), and the results used in a scenario analysis. The data for PLS-PM comprised a set of anthropogenic pressures, water quality parameters, and a macroinvertebrate-based biodiversity index (IPtIN) used to assess the ecological status of streams. These groups of measured parameters (called latent variables) were given the names "Pressures", "Contamination" and "Ecological Integrity". Besides, latent variables were connected through path coefficients representing potential causal effects among them. In a large portion of Ave the ecological status of streams is currently bad or poor. Nitrate and coliforms were the most weighted measured variables of latent variable "Contamination", with w ≈ 0.7 and w ≈ 0.2, respectively. The highest "Pressures" weights were ascribed to livestock farming (0.7) and population density (0.4). The connections "Pressures"-"Contamination" and "Contamination" - "Ecological Integrity" exposed a sequence of direct negative effects between the three variables, expressed in the corresponding path coefficients (pc = 0.87 and pc = -1.11). Paradoxically, a direct negative effect of "Pressures" over "Ecological Integrity" was absent (pc = 0.29). Therefore, the poor ecological status of local stream waters might not be directly related to the presence of potentially threatening contaminant sources (the "Pressures"), but to ineffective monitoring of livestock farming and wastewater treatment activities that potentiate (accidental) releases of contaminants into the streams. The lack of a direct link "Pressures" - "Ecological Integrity" supported the results of pressure change versus IPtIN change scenarios. Regardless of some significant reductions of anthropogenic activity and population density until 2027, announced by the Portuguese Environmental Agency, the scenarios could not predict improvement of ecological status beyond the "moderate" category. The study recommendations were therefore to prevent contamination through proper implementation and monitoring of existing watershed management plans. The adequate treatment of domestic effluents and the control of livestock farming residues are urgent.

A partial least squares - Path modeling analysis for the understanding of biodiversity loss in rural and urban watersheds in Portugal.

The main purpose of this study was to use Partial Least Squares - Path Modeling (PLS-PM) to quantify the contributions of natural and human-induced threats to biodiversity loss in rural and urban watersheds. The study area comprised the Sabor and Ave river basins, located in northern Portugal. The Sabor is rural and sparsely populated while the Ave is urbanized, industrialized and densely populated. Within PLS-PM, threats are called exogenous latent variables while the ultimate environmental consequence (biodiversity loss) is termed endogenous latent variable. Latent variables are concepts represented by numerical parameters called formative variables. The selected latent variables were given the names "pressures", "contamination" and "ecological integrity". The most important "pressures" were the wildfire risk, the percentage of urban area in sub-catchments, the diffuse emissions of livestock nitrogen (N) and agriculture/forest phosphorus (P), and the point source emissions of urban N, P and biochemical oxygen demand, as well as of industrial N. The latent variable called "contamination" was primarily represented by stream water concentrations of phosphate, suspended solids and dissolved oxygen. And finally, the "ecological integrity" was represented by the he North Invertebrate Portuguese Index. The results unequivocally showed that point source emissions in the Sabor (except industrial N) and stream water contamination in the Ave determine biodiversity loss. These contrasting influences suggest that Ave basin has evolved from a catchment where man once produced localized negative effects on stream ecological integrity (a condition still observed in the Sabor basin) to a catchment where the dense human occupation has covered the entire area with urban contaminant sources, somewhat generalizing the local effects. The attribution of local effects to biodiversity loss in the rural catchment and of regional effects in the urban catchment is confirmed by the results of a study covering the entire planet.

Rainwater harvesting in catchments for agro-forestry uses: A study focused on the balance between sustainability values and storage capacity.

Rainwater harvesting (RWH) is used to support small-scale agriculture and handle seasonal water availability, especially in regions where populations are scattered or the costs to develop surface or groundwater resources are high. However, questions may arise as whether this technique can support larger-scale irrigation projects and in complement help the struggle against wildfires in agro-forested watersheds. The issue is relevant because harvested rainwater in catchments is usually accumulated in small-capacity reservoirs created by small-height dams. In this study, a RWH site allocation method was improved from a previous model, by introducing the dam wall height as evaluation parameter. The studied watershed (Sabor River basin) is mostly located in the Northeast of Portugal. This is a rural watershed where agriculture and forestry uses are dominant and where ecologically relevant regions (e.g., Montezinho natural park) need to be protected from wildfires. The study aimed at ranking 384 rainfall collection sub-catchments as regards installation of RWH sites for crop irrigation and forest fire combat. The height parameter was set to 3m because this value is a reference to detention basins that hold sustainability values (e.g., landscape integration, environmental protection), but the irrigation capacity under these settings was smaller than 10ha in 50% of cases, while continuous arable lands in the Sabor basin cover on average 222ha. Besides, the number of sub-catchments capable to irrigate the average arable land was solely 7. When the dam wall height increased to 6 and 12m, the irrigation capacity increased to 46 and 124 sub-catchments, respectively, meaning that more engineered dams may not always ensure all sustainability values but warrant much better storage. The limiting parameter was the dam wall height because 217 sub-catchments were found to drain enough water for irrigation and capable to store it if proper dam wall heights were used.

Integrative assessment of river damming impacts on aquatic fauna in a Portuguese reservoir.

The impacts of river damming on aquatic fauna are assessed and then integrated across hierarchical scales, portrayed as nested circles. The outer circles characterize the studied site for habitat disturbance and hydrologic regime during the construction and filling phases. The inner circles characterize the construction and filling phase zones for water quality parameters and aquatic fauna. The procedure for integrating the impacts comprises two consecutive stages: in the task stage, inner circles are characterized through field and laboratory work involving sampling and analyses of water aliquots and aquatic fauna; in the impact assessment stage, circle data are processed in ecological and statistical algorithms, which allow identification of changes in abundance and composition of aquatic fauna communities and their integration with changes in water quality parameters across the construction and filling phase zones. The integrative assessment of river damming impacts on aquatic fauna was carried out in the Sabor River dam (Portugal). This dam created two reservoirs: primary and secondary. Changes in water quality caused by dam construction and stream water impoundment were significant, marked by increases in temperature and electric conductivity downstream, accumulation of phosphorus and nitrogen in the reservoirs triggering the growth of algae and the increase of chlorophyll a, and drop of transparency. These changes were aggravated in the secondary reservoir. The consequences of water deterioration for aquatic fauna were severe, marked by abrupt declines of native fish species and invasion of exotic species even upwards the reservoirs. The ecological status determined from ecological quality ratios of benthic macroinvertebrate assemblages were also affected, changing from good-fair in the unaffected watercourses to fair-poor in the lakes.

Assessing anthropogenic impacts on riverine ecosystems using nested partial least squares regression.

The results of three Partial Least Squares (PLS) regression models were used to gain a holistic view on the consequences of natural processes and anthropogenic pressures for water quality degradation and biodiversity decline in a multi-use watershed. The processes were soil erosion and wildfire risk; the pressures comprised land use conflicts, leachates from domestic and industrial waste, arable farming intensity and livestock density. Water quality was characterized for concentrations of nutrients (nitrate, phosphate), oxygen demands (Biochemical Oxygen Demand - BOD5, Chemical Oxygen Demand - COD) and various metals (e.g., As, Cr). Ecological integrity was assessed by the recently developed MELI (Multiple Ecological Level Index). In total, 18 variables were processed in the regression models. Two models were called "nested models" because they dealt with initial (pressures), intermediate (water quality) and final (MELI) environmental descriptors, used as dependent (MELI, quality) or independent (quality, pressures) variables. The third was called "bypass model" because it dealt solely with initial and final descriptors. Overall, the results of PLS regression linked the ineffective treatment of domestic sewage to water quality and ecological integrity declines in the studied watershed. Put another way, all models recurrently affirmed the major role of local factors, meaning of point source pollution, in determining the quality of stream water and the integrity of freshwater ecosystems. Sources of diffuse pollution were accounted for as contributing factors in the PLS regressions, but their influence was scarcely perceptible in the results. The poor treatment of domestic effluents is a public concern. In their strategic plans for mitigating this problem in the forthcoming years, administrative authorities are concentrated on management initiatives to improve the quality of provided services, instead of considering the construction of new wastewater treatment plants.

Cumplimiento de las recomendaciones de la guía clínica ministerial para diabetes mellitus tipo 1 en un centro de nivel secundario / Compliance with the recommendations of the ministerial guideline for type 1 diabetes mellitus in a center of secondary level

Introduction: diabetes mellitus type 1 (DM1) is incorporated into the Law of Universal Access with Explicit Guarantees (AUGE) and the Ministry of Health issued a clinical guideline. There is an association between compliance with clinical guidelines and health outcomes. Metabolic control reduces the risk of vascular complications. Objective: To describe the implementation of the guidelines for DM1 AUGE 2013, in patients treated in the endocrinological adult polyclinic hospital Carlos Van Buren. Methods: observational, descriptive and cross-sectional study. A simple random sampling was performed. A sample size of 139 patients was calculated. Quality indicators was drawn up to determine compliance with the recommendations. Quantitative variables were described with median and interquartile range (IQR), and qualitative, with absolute frequency and percentages. Results: Age had a median of 30 years (interquartile range 22 to 42 years). The time since diagnosis had a median of 14 years (interquartile range of 9-22 years). 61 patients were female (43.9 percent) sex. The recommendation was greater proportion of compliance scheme using intensified insulin (89.9 percent). Conducting an annual foot exam showed the lowest compliance (3.6 percent). Discussion: There are no similar studies on these guidelines. It is concerned about the low implementation of the recommendations, especially therapeutic goals. Among the limitations is the quality of the registration system and the systematic omission of variables. It is necessary to determine the cause of low compliance with recommendations for action.

Optimization of the spray drying process for obtaining cape gooseberry powder: an innovative and promising functional food / Optimización del proceso de secado por aspersión para la obtención uchuva en polvo: un alimento funcional innovador y promisorio

Background: currently, functional foods are the type of foods of most interest to the modern consumer, due to the health benefits they provide. Objectives: Optimize the spray drying process to obtain cape gooseberry powder added with active compounds. Methods: A process of spray drying was carried out to obtain a powder from cape gooseberry suspensions added with vitamin C, iron, folic acid, isolated soy protein and dietary fiber. The drying process was optimized according to the characteristics of food formulations and operating conditions, obtaining a product with low hygroscopicity, high solubility and high levels of physiologically active compounds. Response surface methodology was used, considering a central composite design with four factors: maltodextrin (0-40%p/p), inlet air temperature (170-210°C), atomizer disc speed (16000-24000 rpm) and outlet air temperature (75-95°C). Results: The results showed a higher retention of vitamin C (69.7±0.7%), folic acid (90.9±1.8%) and iron (90.8±1.0%) with the food formulation containing a 24.4% of maltodextrin and the drying process defined by an atomizer disc speed of 19848 rpm and inlet and outlet air temperature of 194.2°C and 87.7°C, respectively. Conclusions: The spray drying process is an effective technology that provides added value to the fruit of cape gooseberry, allowing the incorporation and conservation of active compounds such as iron, folic acid and ascorbic acid.

Antecedentes: Actualmente, los alimentos funcionales son la gama de alimentos de mayor interés para el consumidor moderno, debido a los beneficios saludables que estos proporcionan. Objetivo: Optimizar el proceso de secado por aspersión para la obtención de uchuva en polvo adicionado con componentes activos. Métodos: Suspensiones de uchuva adicionadas con vitamina C, hierro, ácido fólico, proteína de soya texturizada y fibra fueron sometidas a secado por aspersión para la obtención de un producto en polvo fortificado. El proceso de secado fue optimizado de acuerdo con las características de formulación de la suspensión y condiciones de operación del secador con el objetivo de obtener un producto en polvo con baja higroscopicidad, alta solubilidad y altos niveles de compuestos fisiológicamente activos. Se utilizó la metodología de superficie de respuesta, considerando un diseño central compuesto con 4 factores: maltodextrina (0-40%p/p), temperatura del aire de entrada (170-210°C), velocidad del disco atomizador (16000-24000 rpm) y temperatura del aire de salida (75-95°C). Resultados: Los resultados mostraron una mayor retención de vitamina C (69,7±0,7%), ácido fólico (90,9±1,8%) e hierro (90,8±1,0%) con la formulación de la suspensión que contiene un 24,4% de maltodextrina y condiciones de operación del proceso de secado definidas por una velocidad de disco atomizador de 19848 rpm y temperatura del aire a la entrada y salida de 194,2°C y 87,7°C, respectivamente. Conclusiones: El proceso de secado por aspersión es una tecnología efectiva que proporciona valor agregado al fruto de uchuva, permitiendo la incorporación y conservación de componentes activos como hierro, ácido fólico y ácido ascórbico.

Guacamole powder: standardization of the spray drying process / Guacamole en polvo: estandarización del proceso de secado por aspersión

Background: Guacamole is a sauce or dressing composed of avocado pulp and other ingredients. Guacamole powder is an important advance in the generation of value added for the avocado chain, as it is an alternative product with the potential to be used by the final consumer. Objectives: The aim of this study was to standardize the spray drying process for guacamole powder using the response surface methodology. Methods: Four independent variables were taken into account for the experiment design: atomizing disk speed (ADS), air inlet temperature (AIT), air outlet temperature (AOT) and vacuum pressure (VP). In addition, the following dependent variables were considered: water activity (aw), moisture (Xw), solubility (S), hygroscopicity (H), color (L*, a* and b*), extractable oil content (EO), peroxide index (PI) and particle size (D10, D50 and D90). Likewise, the following two dependent variables associated with the process were identified: yield (Y) and deposit formation (DF). Results: The best conditions for the process were obtained with ADS = 27451 rpm, AIT = 168ºC, AOT = 90ºC and VP = 1.77 ″H2O. These conditions yielded guacamole powder with the desired properties, namely: maximum Y, S, L*, b*, EO and minimal DF, aw, Xw, H, a*, PI, D10, D50, D90. Conclusions: The spray drying process is an effective technology that provides added value to avocado, the ADS being the independent variable that has the greatest impact on the quality of powdered guacamole.

Antecedentes: El guacamole es una salsa o aderezo compuesto por pulpa de aguacate y otros ingredientes. El guacamole en polvo representa un avance importante en la generación de valor agregado de la cadena del aguacate, al identificarse como un producto alternativo con potencial uso por el consumidor final. Objetivos: El objetivo del presente estudio fue estandarizar el proceso de secado por aspersión para la obtención de guacamole en polvo, utilizando la metodología de superficie de respuesta. Métodos: Para el diseño experimental se consideró cuatro variables independientes: velocidad del disco atomizador (VDA), temperatura de entrada de aire (TEA), temperatura de salida de aire (TSA) y presión de vacío (PV). Además, se consideraron las siguientes variables dependientes: actividad de agua (aw), humedad (Xw), solubilidad (S), higroscopicidad (H), color (L* , a* y b* ), contenido de aceite extraíble (AE), índice de peróxido (IP) y tamaño de partícula (D10, D50 y D90). Además, se determinaron dos variables dependientes asociadas al proceso, rendimiento (Y), y la formación de depósito (FD). Resultados: La mejor condición de proceso se alcanzó con VDA = 27451 rpm, TEA = 168ºC, TSA = 90ºC y PV = 1,77 ″H2O. En esta condición se obtuvo guacamole en polvo con propiedades deseadas máximo R, S, L*, b*, AE y mínima FD, aw, Xw, H, a* , IP, D10, D50, D90. Conclusiones: El proceso de secado por aspersión es una tecnología efectiva que proporciona valor agregado al aguacate, siendo la VDA la variable independiente que mayor afectación tiene sobre la calidad del guacamole en polvo.