The effect of climate change on avian offspring production: A global meta-analysis.

Climate change affects timing of reproduction in many bird species, but few studies have investigated its influence on annual reproductive output. Here, we assess changes in the annual production of young by female breeders in 201 populations of 104 bird species (N = 745,962 clutches) covering all continents between 1970 and 2019. Overall, average offspring production has declined in recent decades, but considerable differences were found among species and populations. A total of 56.7% of populations showed a declining trend in offspring production (significant in 17.4%), whereas 43.3% exhibited an increase (significant in 10.4%). The results show that climatic changes affect offspring production through compounded effects on ecological and life history traits of species. Migratory and larger-bodied species experienced reduced offspring production with increasing temperatures during the chick-rearing period, whereas smaller-bodied, sedentary species tended to produce more offspring. Likewise, multi-brooded species showed increased breeding success with increasing temperatures, whereas rising temperatures were unrelated to reproductive success in single-brooded species. Our study suggests that rapid declines in size of bird populations reported by many studies from different parts of the world are driven only to a small degree by changes in the production of young.

Host space, not energy or symbiont size, constrains feather mite abundance across passerine bird species.

Comprehending symbiont abundance among host species is a major ecological endeavour, and the metabolic theory of ecology has been proposed to understand what constrains symbiont populations. We parameterized metabolic theory equations to investigate how bird species' body size and the body size of their feather mites relate to mite abundance according to four potential energy (uropygial gland size) and space constraints (wing area, total length of barbs and number of feather barbs). Predictions were compared with the empirical scaling of feather mite abundance across 106 passerine bird species (26,604 individual birds sampled), using phylogenetic modelling and quantile regression. Feather mite abundance was strongly constrained by host space (number of feather barbs) but not by energy. Moreover, feather mite species' body size was unrelated to the body size of their host species. We discuss the implications of our results for our understanding of the bird-feather mite system and for symbiont abundance in general.

Global warming modifies the seasonal distribution of clutches on a Mediterranean great tit population.

Global warming has multiple effects on phenological events on a wide range of plants and animals. Specifically, many bird species have advanced the start of their breeding season, which could also imply an extension in its duration and also a change in the distribution of clutches throughout the breeding season. We have tested whether this occurred in a population of Great Tits (Parus major), in Sagunto (eastern Spain). The increase of March temperatures between 1986 and 2019 was related to an advancement of the breeding season. Although the breeding season was longer in years with higher June temperatures, the length did not show a temporal trend throughout the study period. The clutches were more concentrated at the beginning of the season (increase in the skewness), while the kurtosis ("tailedness" of the distribution) or the modality did not change significantly. Finally, the number of "equally good months" for breeding (a combined measure of length and distribution) has not changed throughout the years. Overall, all these phenological changes probably caused the observed increased proportion of pairs laying two clutches per year. It remains to be studied whether this increase in reproductive effort has positive or negative impact on fitness.

Immunoprotection against mixed Eimeria spp. infections in goat kids induced by X-irradiated oocysts.

Strategies to control goat coccidiosis traditionally rely on the use of management practices combined with anticoccidial treatments, and limited effort has been made, so far, to address immunological control of caprine Eimeria infections. Previously, we showed that monospecific immunization with X-Rad-attenuated Eimeria ninakohlyakimovae oocysts induced considerable immunoprotection upon challenge. In the present study, we conducted a similar vaccination trial but using a mixture of caprine Eimeria species typically present in natural infected goats. For immunization, sporulated oocysts were attenuated by X irradiation (20 kilorad). All infections were performed orally applying 105 sporulated oocysts of mixed Eimeria spp. per animal. In total, 18 goat kids were grouped as follows: (G1) immunized + challenge infected; (G2) primary + challenge infected; (G3) challenge infection control; and (G4) non-immunized/non-infected control. Overall, goat kids infected with attenuated oocysts (= immunized) shed less oocysts in the faeces and showed a lower degree of clinical coccidiosis than animals infected with non-attenuated oocysts. Animals of both challenge groups (G1 and G2) showed partial immunoprotection upon reinfection when compared to challenge infection control (G3). However, the degree of immunoprotection was less pronounced than recently reported for monospecific vaccination against Eimeria ninakohlyakimovae, most probably due to the complexity of the pathogenesis and related immune responses against mixed Eimeria spp. infections. Nevertheless, the data of the present study demonstrate that immunization with attenuated Eimeria spp. oocysts may be worth pursuing as a strategy to control goat coccidiosis.

Connecting the data landscape of long-term ecological studies: The SPI-Birds data hub.

The integration and synthesis of the data in different areas of science is drastically slowed and hindered by a lack of standards and networking programmes. Long-term studies of individually marked animals are not an exception. These studies are especially important as instrumental for understanding evolutionary and ecological processes in the wild. Furthermore, their number and global distribution provides a unique opportunity to assess the generality of patterns and to address broad-scale global issues (e.g. climate change). To solve data integration issues and enable a new scale of ecological and evolutionary research based on long-term studies of birds, we have created the SPI-Birds Network and Database (www.spibirds.org)-a large-scale initiative that connects data from, and researchers working on, studies of wild populations of individually recognizable (usually ringed) birds. Within year and a half since the establishment, SPI-Birds has recruited over 120 members, and currently hosts data on almost 1.5 million individual birds collected in 80 populations over 2,000 cumulative years, and counting. SPI-Birds acts as a data hub and a catalogue of studied populations. It prevents data loss, secures easy data finding, use and integration and thus facilitates collaboration and synthesis. We provide community-derived data and meta-data standards and improve data integrity guided by the principles of Findable, Accessible, Interoperable and Reusable (FAIR), and aligned with the existing metadata languages (e.g. ecological meta-data language). The encouraging community involvement stems from SPI-Bird's decentralized approach: research groups retain full control over data use and their way of data management, while SPI-Birds creates tailored pipelines to convert each unique data format into a standard format. We outline the lessons learned, so that other communities (e.g. those working on other taxa) can adapt our successful model. Creating community-specific hubs (such as ours, COMADRE for animal demography, etc.) will aid much-needed large-scale ecological data integration.

Host dispersal shapes the population structure of a tick-borne bacterial pathogen.

Birds are hosts for several zoonotic pathogens. Because of their high mobility, especially of longdistance migrants, birds can disperse these pathogens, affecting their distribution and phylogeography. We focused on Borrelia burgdorferi sensu lato, which includes the causative agents of Lyme borreliosis, as an example for tick-borne pathogens, to address the role of birds as propagation hosts of zoonotic agents at a large geographical scale. We collected ticks from passerine birds in 11 European countries. B. burgdorferi s.l. prevalence in Ixodes spp. was 37% and increased with latitude. The fieldfare Turdus pilaris and the blackbird T. merula carried ticks with the highest Borrelia prevalence (92 and 58%, respectively), whereas robin Erithacus rubecula ticks were the least infected (3.8%). Borrelia garinii was the most prevalent genospecies (61%), followed by B. valaisiana (24%), B. afzelii (9%), B. turdi (5%) and B. lusitaniae (0.5%). A novel Borrelia genospecies "Candidatus Borrelia aligera" was also detected. Multilocus sequence typing (MLST) analysis of B. garinii isolates together with the global collection of B. garinii genotypes obtained from the Borrelia MLST public database revealed that: (a) there was little overlap among genotypes from different continents, (b) there was no geographical structuring within Europe, and (c) there was no evident association pattern detectable among B. garinii genotypes from ticks feeding on birds, questing ticks or human isolates. These findings strengthen the hypothesis that the population structure and evolutionary biology of tick-borne pathogens are shaped by their host associations and the movement patterns of these hosts.

Metaphylactic strategies using toltrazuril against coccidiosis in goat kids.

Goat coccidiosis compromises animal welfare, reduces productivity and may cause mortality and delayed growth rates in goat kids around the weaning period worldwide. This field study was conducted to evaluate the efficacy of metaphylactic treatments with two doses of toltrazuril (20 or 40 mg/kg body weight - BW, p. o.), at different timing, in kids naturally infected with Eimeria spp. A total of 97 healthy goat kids (Majorera milk aptitude breed) were divided into five groups, depending on the age of treatment (2 or 7 weeks). One group remained untreated as a negative control until the end of the study. Faecal oocyst shedding, faecal consistency, and body weight of the animals were monitored at day 0 and at weekly intervals. Counts of oocysts per gram of faeces (OPG) were determined by a modified McMaster technique. Morphometric identification of Eimeria species was carried out on individual faecal samples from each experimental group after oocyst sporulation. Goat kids treated at two weeks of age maintained OPG values close to zero during the 5 weeks post-treatment and, overall, had lower faecal oocyst counts than untreated control animals. No significant differences were observed between the two doses of toltrazuril used in two-week-old treated animals. By contrast, when treatment was carried out at seven weeks of age, the dose of 40 mg/kg BW of toltrazuril reduced oocyst levels for longer and to a greater extent than the 20 mg/kg dose. Irrespectively of the treatment and dose, toltrazuril delayed the appearance of pathogenic Eimeria species, i. e. Eimeria ninakohlyakimovae and Eimeria arloingi. As a whole, Eimeria christenseni, with a rather moderate pathogenicity, was highly predominant throughout the study period, including the untreated control group, which was probably the reason why clinical signs of coccidiosis were barely observed throughout the experiment. Under these circumstances, the positive effect of toltrazuril on body weight condition observed in some treated groups was difficult to correlate to the timing and doses. Metaphylactic treatments with 20 mg/kg BW toltrazuril given at two weeks of age are sufficient to control oocyst excretion in goat kids; whereas if administered later in 7-week-old animals, thereby coinciding with the frequently observed peak of oocyst elimination in goat kids under field conditions, a higher dose might be advisable to prevent environmental contamination with infectious oocysts.

Divergence in evolutionary potential of life history traits among wild populations is predicted by differences in climatic conditions.

Short-term adaptive evolution represents one of the primary mechanisms allowing species to persist in the face of global change. Predicting the adaptive response at the species level requires reliable estimates of the evolutionary potential of traits involved in adaptive responses, as well as understanding how evolutionary potential varies across a species' range. Theory suggests that spatial variation in the fitness landscape due to environmental variation will directly impact the evolutionary potential of traits. However, empirical evidence on the link between environmental variation and evolutionary potential across a species range in the wild is lacking. In this study, we estimate multivariate evolutionary potential (via the genetic variance-covariance matrix, or G-matrix) for six morphological and life history traits in 10 wild populations of great tits (Parus major) distributed across Europe. The G-matrix significantly varies in size, shape, and orientation across populations for both types of traits. For life history traits, the differences in G-matrix are larger when populations are more distant in their climatic niche. This suggests that local climates contribute to shaping the evolutionary potential of phenotypic traits that are strongly related to fitness. However, we found no difference in the overall evolutionary potential (i.e., G-matrix size) between populations closer to the core or the edge of the distribution area. This large-scale comparison of G-matrices across wild populations emphasizes that integrating variation in multivariate evolutionary potential is important to understand and predict species' adaptive responses to new selective pressures.

No Apparent Immediate Reproductive Costs of Overlapping Breeding and Moult in a Mediterranean Great Tit Population.

Some phenological events in birds, such as breeding and moulting, are being affected by rising temperatures due to global warming, and many species have undergone temporary changes in these energetically demanding phases that are often separated in time. This has led to an increased overlap between breeding and moulting in some populations. This overlap causes conflicts in resource allocation and may impose fitness costs that could affect immediate reproductive performance. We tested whether this occurs in a great tit (Parus major) population in eastern Spain. In 71% of 390 pairs, in which both parents were captured during the period of overlap between moulting and breeding, at least one parent was moulting when feeding the chicks of its second brood. Later breeders were more likely to overlap breeding and moulting, and when both parents overlapped, clutch size was smaller, fewer eggs hatched and fewer fledglings in poorer body condition were produced. Some results were intermediate when only one parent moulted. However, all these differences between moulting and non-moulting pairs disappeared when the seasonal trend in reproductive parameters was taken into account, as moulting birds bred later and reproductive performance decreased seasonally. Therefore, the overlap of breeding and moulting does not impose additional reproductive costs in this population.

Temperature synchronizes temporal variation in laying dates across European hole-nesting passerines.

Identifying the environmental drivers of variation in fitness-related traits is a central objective in ecology and evolutionary biology. Temporal fluctuations of these environmental drivers are often synchronized at large spatial scales. Yet, whether synchronous environmental conditions can generate spatial synchrony in fitness-related trait values (i.e., correlated temporal trait fluctuations across populations) is poorly understood. Using data from long-term monitored populations of blue tits (Cyanistes caeruleus, n = 31), great tits (Parus major, n = 35), and pied flycatchers (Ficedula hypoleuca, n = 20) across Europe, we assessed the influence of two local climatic variables (mean temperature and mean precipitation in February-May) on spatial synchrony in three fitness-related traits: laying date, clutch size, and fledgling number. We found a high degree of spatial synchrony in laying date but a lower degree in clutch size and fledgling number for each species. Temperature strongly influenced spatial synchrony in laying date for resident blue tits and great tits but not for migratory pied flycatchers. This is a relevant finding in the context of environmental impacts on populations because spatial synchrony in fitness-related trait values among populations may influence fluctuations in vital rates or population abundances. If environmentally induced spatial synchrony in fitness-related traits increases the spatial synchrony in vital rates or population abundances, this will ultimately increase the risk of extinction for populations and species. Assessing how environmental conditions influence spatiotemporal variation in trait values improves our mechanistic understanding of environmental impacts on populations.

Clutch size and egg volume in great tits (Parus major) increase under low intensity electromagnetic fields: a long-term field study.

Exposure to electromagnetic fields (EMFs) can affect a wide range of biological processes, including reproduction, growth and development. Experiments aimed at investigating the biological effects of EMFs, focused on potential harmful effects on humans, have been mostly carried out in vitro or with animal models in laboratory conditions. By contrast, studies performed on wild animals are scarce. The effects of EMFs created by an electric power line on reproductive traits of a wild great tit (Parus major) population were explored by analysing data gathered during nine breeding seasons. EMF exposure significantly increased clutch size (7%) and egg volume (3%), implying a 10% increase in clutch volume. This indicates an increase in reproductive investment from parent birds exposed to EMFs as compared to the adjacent reference area. These results cannot be attributed to habitat or adult quality differences between the exposed and reference group. Nevertheless, no differences in hatching success or final productivity (fledging and reproductive success or nestling body mass) could be detected. Our study clearly shows that EMFs created by power lines can have biological consequences in wild organisms that live intimately with them. To our knowledge, this is the first study showing an increase in clutch size, and one of the few reporting an increase in egg size, associated with EMF exposure. The possible mechanisms by which great tits invest more under EMF exposure are discussed, and future research directions to evaluate the effect of EMFs on avian reproduction in the wild are suggested.

Bird populations most exposed to climate change are less sensitive to climatic variation.

The phenology of many species shows strong sensitivity to climate change; however, with few large scale intra-specific studies it is unclear how such sensitivity varies over a species' range. We document large intra-specific variation in phenological sensitivity to temperature using laying date information from 67 populations of two co-familial European songbirds, the great tit (Parus major) and blue tit (Cyanistes caeruleus), covering a large part of their breeding range. Populations inhabiting deciduous habitats showed stronger phenological sensitivity than those in evergreen and mixed habitats. However, populations with higher sensitivity tended to have experienced less rapid change in climate over the past decades, such that populations with high phenological sensitivity will not necessarily exhibit the strongest phenological advancement. Our results show that to effectively assess the impact of climate change on phenology across a species' range it will be necessary to account for intra-specific variation in phenological sensitivity, climate change exposure, and the ecological characteristics of a population.

[Teaching sessions in primary care. Experience in health centres in an area of Madrid]. / Sesiones docentes en Atención Primaria. Experiencia en los centros de un Área de Madrid.

Those responsible for teaching of primary care teams of Area 7 of Madrid have noted a significant disparity in the organisation of teaching sessions. Therefore, the Madrid Area 7 Commission for Teaching and Research organised an idea-sharing day. This article aims to show the different organisational forms, model sessions, the benefits of education sessions, perceived problems and suggestions for improvement. Finally there is a decalogue, which can serve as a guide for organising teaching sessions in primary care.

Effectiveness of a communication skills training program for medical students to identify patients communicative clues.

OBJECTIVE: This study explores whether an Experiential Training Programme (ETP) in communication skills (CS) improves students' ability to identify patients clues compared to those who follow a non-experiential training throughout their medical studies. METHOD: Intervention Group (IG): 85 4th-year medical students who received the ETP and Control Group (CG): 67 recently graduated students who did not receive it. Their immediate (written) response was requested to three expressions offered by patients containing communicative clues. The answers were grouped into 2 categories: Clue recognised and response patient-centred and the opposite. Three researchers analysed the answers. RESULTS: Responses 366 (65 from the CG and 77 from the IG): 280 did not recognise clues: 131 (62%) in IG and 149 (96%) in CG and 86 recognised them: 80 (37.9%) in IG and 6 (3.9%) in CG (p = 0.000). Some clues were more elusive than others (p = 0,003). CONCLUSIONS: The students who received the ETP in CS showed greater ability to explore patients perspective taking advantage of different types of communicative clues than those who did not receive it in a non-relational context. PRACTICE IMPLICATIONS: Further research is needed to assess whether this ability is maintained in simulated or real clinical situations.

Autoevaluación de adquisición de competencias en estudiantes de grado de Medicina mediante simulación clínica / Self-assessment of skill acquisition in clinical simulations for medical undergraduate students

Introducción: La autopercepción que tienen los estudiantes para desarrollar su práctica clínica es la manera más acertada de evaluar cuán preparados se sienten y cuáles son sus habilidades. La universidad desarrolla un programa de simulación que permite a los alumnos potenciar su propio aprendizaje, con situaciones de feedback de los instructores de simulación.Sujetos y métodos.El estudio tuvo lugar en el curso académico 2019-2020. Los estudiantes de tercer año completaron tres escenarios de simulación; los de cuarto año, cuatro; y los de quinto año, tres. Antes y después de cada sesión de simulación, completaron un cuestionario electrónico de autopercepción de competencias técnicas y no técnicas.Resultados.De los 121 estudiantes de tercer curso, 79 (65,3%) contestaron a la encuesta inicial y 68 (61,2%) a la encuesta final. En cuarto curso participaron 111 alumnos, y contestaron la encuesta inicial 63 alumnos (56,8%) y 68 la final (61,2%). El quinto curso estuvo compuesto por 97 estudiantes, de los cuales 94 (96,9%) contestaron la encuesta inicial y 69 (71,1%) la final. Todos los ítems de la encuesta de autopercepción mejoraron de forma estadísticamente significativa (p < 0,001) en la encuesta final. Las puntuaciones iniciales medias en la dimensión no técnica fueron más altas que las puntuaciones medias en la dimensión técnica para todos los cursos de estudio.Conclusiones.Los resultados que obtuvimos mostraron una mejora en la autopercepción de las habilidades de los estudiantes y en su confianza para realizar las tareas de las simulaciones. Los alumnos de cursos superiores se sienten más seguros tanto en habilidades técnicas como en no técnicas, como la comunicación. (AU)

Introduction: The self-perception that students have to develop their clinical practice is the most accurate way to assess how prepared they feel and what their abilities are. The University develops an innovative and complete simulation program that allows students to enhance their own learning and that of their classmates, with feedback situations from the simulation instructors of the faculty itself.Subjects and methods.The study took place in the academic year 2019-2020. During the study period, 3rd-year students completed 3 simulation scenarios, 4th-year students 4 cases, and 5th-year students completed 3 scenarios. Before and after each simulation session, they anonymously and voluntarily completed an electronic questionnaire on self-perception of technical and non-technical skills.Results.Of the 121 third-year students, 79 (65.3%) answered the initial questionnaire and 68 (61.2%) the final questionnaire. In the fourth year, 111 students participated, and 63 students (56.8%) answered the initial questionnaire and 68 (61.2%) the final one. The fifth course was composed of 97 students, of which 94 (96.9%) answered the initial questionnaire and 69 (71.1%) the final one. All the items of the self-perception survey improved in a statistically significant way (p < 0.001) in the final survey. The mean baseline scores on the non-technical dimension were higher than the mean scores on the technical dimension for all study courses.Conclusions.The results we obtained showed an improvement in the self-perception of the students' abilities and in their confidence to perform the tasks of the simulations. Higher grade students feel more confident in both technical and non-technical skills, such as communication. (AU)

Nestling Growth is Impaired by Heat Stress: an Experimental Study in a Mediterranean Great Tit Population.

Samuel Rodríguez and Emilio Barba (2016) During the nestling stage, nestlings of small altricial birds face energetic limitations due to their rapid development and the need to maintain a stable body temperature once homeothermy is achieved. In Mediterranean habitats, high air temperatures reached during the breeding season could negatively affect the health and condition of the nestlings. The aim of this study was to determine the effect of an experimental increase of nest temperatures during the nestling stage on the growth and survival of Great Tit (Parus major) nestlings. Additionally, changes in parental brooding and feeding behavior as a result of the alteration of the nest microclimate were addressed. Increased nest temperatures affected nestling mass, as heated nestlings were lighter than controls on day 15 in the warmer of the two breeding seasons considered. Moreover, females from the heating treatment reduced their brooding time. Fledging success and parental feeding rates were not altered by the experimental treatment. The results of this study suggest that high nest temperatures may impair nestling development and therefore affect post-fledging survival probability. Negative effects are more likely to occur in warm habitats and/or warmer years, where juveniles are liable to suffer from thermal stress.

A recipe for postfledging survival in great tits Parus major: be large and be early (but not too much).

Survival of juveniles during the postfledging period can be markedly low, which may have major consequences on avian population dynamics. Knowing which factors operating during the nesting phase affect postfledging survival is crucial to understand avian breeding strategies. We aimed to obtain a robust set of predictors of postfledging local survival using the great tit (Parus major) as a model species. We used mark-recapture models to analyze the effect of hatching date, temperatures experienced during the nestling period, fledging size and body mass on first-year postfledging survival probability of great tit juveniles. We used data from 5192 nestlings of first clutches ringed between 1993 and 2010. Mean first-year postfledging survival probability was 15.2%, and it was lower for smaller individuals, as well as for those born in either very early or late broods. Our results stress the importance of choosing an optimum hatching period, and raising large chicks to increase first-year local survival probability in the studied population.

Interspecific variation in the relationship between clutch size, laying date and intensity of urbanization in four species of hole-nesting birds.

The increase in size of human populations in urban and agricultural areas has resulted in considerable habitat conversion globally. Such anthropogenic areas have specific environmental characteristics, which influence the physiology, life history, and population dynamics of plants and animals. For example, the date of bud burst is advanced in urban compared to nearby natural areas. In some birds, breeding success is determined by synchrony between timing of breeding and peak food abundance. Pertinently, caterpillars are an important food source for the nestlings of many bird species, and their abundance is influenced by environmental factors such as temperature and date of bud burst. Higher temperatures and advanced date of bud burst in urban areas could advance peak caterpillar abundance and thus affect breeding phenology of birds. In order to test whether laying date advance and clutch sizes decrease with the intensity of urbanization, we analyzed the timing of breeding and clutch size in relation to intensity of urbanization as a measure of human impact in 199 nest box plots across Europe, North Africa, and the Middle East (i.e., the Western Palearctic) for four species of hole-nesters: blue tits (Cyanistes caeruleus), great tits (Parus major), collared flycatchers (Ficedula albicollis), and pied flycatchers (Ficedula hypoleuca). Meanwhile, we estimated the intensity of urbanization as the density of buildings surrounding study plots measured on orthophotographs. For the four study species, the intensity of urbanization was not correlated with laying date. Clutch size in blue and great tits does not seem affected by the intensity of urbanization, while in collared and pied flycatchers it decreased with increasing intensity of urbanization. This is the first large-scale study showing a species-specific major correlation between intensity of urbanization and the ecology of breeding. The underlying mechanisms for the relationships between life history and urbanization remain to be determined. We propose that effects of food abundance or quality, temperature, noise, pollution, or disturbance by humans may on their own or in combination affect laying date and/or clutch size.

Comunicación consciente para acompañar de forma eficaz: protocolo de 5 pasos / Conscious communication to accompany effectively: protocol of 5 steps

Las personas con enfermedades crónicas y graves, necesitan ser escuchadas, entendidas y atendidas a su ritmo. Los profesionales necesitan herramientas sencillas y eficientes que les faciliten una buena comunicación con sus pacientes, en el menor tiempo posible. OBJETIVO: describir un protocolo sistemático de comunicación en cinco pasos. MÉTODO: Se ha diseñado un enfoque cualitativo basado en la revisión documental, que ha incluido la revisión bibliográfica y de evidencias para apoyar el análisis y poder llegar a conclusiones con la información extraída del proceso. RESULTADO: Como resultado se propone un protocolo básico de comunicación fundamentado en el counselling y en los principios de la bioética moderna, capaz de facilitar las funciones de informar, motivar la adhesión terapéutica, promover cambios de conducta, abordar situaciones de comunicación difícil y, especialmente, de tener un encuentro auténtico con el paciente y su familia. Por conclusión sin comunicación eficaz no hay encuentro, y sin encuentro, la relación clínica entre profesional y paciente se puede convertir en un intercambio de palabras vacías, de imposiciones de tratamientos, que difícilmente el paciente va a cumplir adecuadamente. Los tiempos cambian y la Medicina participativa va encontrando un lugar más adecuado en el entorno clínico

People with chronic and serious diseases, need to be heard, understood and answered at their own pace. Professionals need simple and efficient tools to have good communication with their patients, in the shortest possible time. The aim of this paper is to describe a systematic communication in five steps, protocol based on counselling and on the principles of bioethics, to facilitate the information skills, motivate therapeutic adherence, promote behavioral changes, deal with difficult situations and to have an authentic encounter with the patient and his family. It is concluded that without effective communication there is no encounter, and without encounter, the clinical relationship between professional and patient can become an exchange of empty words, of impositions of treatments, which the patient will hardly adequately comply with. Times change and participatory medicine is finding a more appropriate place in the clinical environment

DNA barcodes reveal the presence of the introduced freshwater leech Helobdella europaea in Spain.

Abstract We report the finding of the freshwater leech Helobdella europaea in Spain for the first time. Three leech specimens were found attached to the European pond turtle Emys orbicularis. Helobdella europaea is not a blood feeder and, like all members of the genus, feeds on the hemolymph of aquatic invertebrates including snails and worms. Despite the fact that the original geographical distribution or source population of this species is unknown, the close relationship between H. europaea and leeches of the "triserialis" series (sensu Sawyer, 1986) suggests a New World origin. Given its ability to invade and persist in new environments, this leech has been described as a new species by local taxonomists resulting in some nomenclatural problems. The presence of this introduced organism in Spain may represent serious obstacles to the current efforts to preserve endemic fauna and the potential negative impacts of this species in European environments should be investigated.