Peru was the country with the highest COVID-19 case fatality rate worldwide during second wave of infection, with dentists and pre-professional students being susceptible to infection due to clinical procedures they perform. This situation could have generated some kind of psychological disorder within this group. Therefore, the present study aimed to assess how COVID-19 pandemic affected this population group during second wave, in relation to depression, anxiety and stress. This observational and cross-sectional study in 368 Peruvian dentists (186 students and 182 professionals), was carried out during August to November 2021. The DASS-21 Scale was used to diagnose depression, anxiety and stress. For the statistical analysis, Pearson's chi-square test was used, in addition to a logit model using odds ratio (OR) to evaluate depression, anxiety and stress with the following factors: gender, age group, marital status, monthly family income, children, academic level, history of COVID-19, COVID-19 symptomatology, close relative with COVID-19, living with vulnerable people and work dedication. In addition, predictive models were constructed considering all possible significant causes. A significance level of p < 0.05 was considered. Dental students and professionals presented significant differences in levels of depression, anxiety and stress (p < 0.001, p = 0.022, p = 0.001; respectively). Male students were 56% less likely to develop stress (OR 0.44; CI 0.22-0.85) compared to females; while those unmarried were 81% less likely to develop stress (OR 0.19; CI 0.04-0.85). Likewise, those with children were 83% less likely to develop stress (OR 0.17; CI 0.06-0.52) and 65% less likely to develop depression (OR 0.35; CI 0.15-0.80). In addition, COVID-19 asymptomatics were 60% less likely to develop depression (OR 0.40; CI 0.17-0.92). However, having relatives with COVID-19 caused almost three times the probability of developing depression (OR 2.96; CI 1.29-6.79) and twice the probability of developing stress (OR 2.49; CI 1.07-5.78). As for dental professionals, it was noticed that those unmarried had almost three times the probability of developing stress (OR 2.93; CI 1.38-6.23); while those who only worked had twice the probability of developing stress (OR 2.37; CI 1.17-4.78). Dental students had a higher prevalence of depression, anxiety and stress. In addition, having children and being asymptomatic were protective predictors for depression, while being male, unmarried and having children were protective predictors for stress. However, having a relative with COVID-19 was a risk predictor for depression and stress. In professionals, only working and being unmarried were risk predictors for stress.
COVID-19 , Pandemics , Anxiety/psychology , COVID-19/epidemiology , Child , Cross-Sectional Studies , Depression/psychology , Female , Humans , Male , SARS-CoV-2 , Stress, Psychological/epidemiology , Stress, Psychological/psychology , Students, Dental
Proposed hydropower dams at more than 350 sites throughout the Amazon require strategic evaluation of trade-offs between the numerous ecosystem services provided by Earth's largest and most biodiverse river basin. These services are spatially variable, hence collective impacts of newly built dams depend strongly on their configuration. We use multiobjective optimization to identify portfolios of sites that simultaneously minimize impacts on river flow, river connectivity, sediment transport, fish diversity, and greenhouse gas emissions while achieving energy production goals. We find that uncoordinated, dam-by-dam hydropower expansion has resulted in forgone ecosystem service benefits. Minimizing further damage from hydropower development requires considering diverse environmental impacts across the entire basin, as well as cooperation among Amazonian nations. Our findings offer a transferable model for the evaluation of hydropower expansion in transboundary basins.
River flows connect people, places, and other forms of life, inspiring and sustaining diverse cultural beliefs, values, and ways of life. The concept of environmental flows provides a framework for improving understanding of relationships between river flows and people, and for supporting those that are mutually beneficial. Nevertheless, most approaches to determining environmental flows remain grounded in the biophysical sciences. The newly revised Brisbane Declaration and Global Action Agenda on Environmental Flows (2018) represents a new phase in environmental flow science and an opportunity to better consider the co-constitution of river flows, ecosystems, and society, and to more explicitly incorporate these relationships into river management. We synthesize understanding of relationships between people and rivers as conceived under the renewed definition of environmental flows. We present case studies from Honduras, India, Canada, New Zealand, and Australia that illustrate multidisciplinary, collaborative efforts where recognizing and meeting diverse flow needs of human populations was central to establishing environmental flow recommendations. We also review a small body of literature to highlight examples of the diversity and interdependencies of human-flow relationships-such as the linkages between river flow and human well-being, spiritual needs, cultural identity, and sense of place-that are typically overlooked when environmental flows are assessed and negotiated. Finally, we call for scientists and water managers to recognize the diversity of ways of knowing, relating to, and utilizing rivers, and to place this recognition at the center of future environmental flow assessments. This article is categorized under: Water and Life > Conservation, Management, and Awareness Human Water > Water Governance Human Water > Water as Imagined and Represented.
Hundreds of dams have been proposed throughout the Amazon basin, one of the world's largest untapped hydropower frontiers. While hydropower is a potentially clean source of renewable energy, some projects produce high greenhouse gas (GHG) emissions per unit electricity generated (carbon intensity). Here we show how carbon intensities of proposed Amazon upland dams (median = 39 kg CO2eq MWh-1, 100-year horizon) are often comparable with solar and wind energy, whereas some lowland dams (median = 133 kg CO2eq MWh-1) may exceed carbon intensities of fossil-fuel power plants. Based on 158 existing and 351 proposed dams, we present a multi-objective optimization framework showing that low-carbon expansion of Amazon hydropower relies on strategic planning, which is generally linked to placing dams in higher elevations and smaller streams. Ultimately, basin-scale dam planning that considers GHG emissions along with social and ecological externalities will be decisive for sustainable energy development where new hydropower is contemplated.
Resumen Objetivo: Determinar las características epidemiológicas de adultos con insuficiencia cardiaca aguda admitidos en un hospital universitario. Métodos: Estudio de cohorte retrospectivo, descriptivo. Revisión de historias clínicas de mayores de 18 años hospitalizados entre julio y diciembre de 2015 en un hospital de Medellín, Colombia. Resultados: Se incluyeron 361 pacientes con insuficiencia cardíaca aguda. 193 (53,4%) fueron mujeres, cuya mediana de edad fue 76 años. 183 (50,6%) tenían fracción de eyección (FEVI) reducida, 19 (5,2%) FEVI intermedia y 148 (40,9%) FEVI preservada. El tratamiento farmacológico previo al ingreso incluía IECA/ARA2 en 253 (70%) pacientes, betabloqueador en 212 (58,7%) y espironolactona en 92 (25,4%). La principal causa de falla cardíaca aguda fue la presencia de taqui-bradiarritmias (17,5%), seguida de infección (17,2%) y exacerbación de neumopatía crónica (16,3%). La clasificación clínica de la descompensación fue Stevenson B en 335 (92,7%) pacientes, Stevenson C en 20 (5,5%) y Stevenson L en 6 (1,6%). La mediana de hospitalización fue 6 días (4-9 días). 30 pacientes (8,3%) fallecieron, 50% por infecciones asociadas a la descompensación cardiaca y 20% por síndrome coronario agudo. Conclusión: Se hallaron similitudes con estudios internacionales, pero mayor mortalidad vinculada principalmente a infección como factor precipitante de descompensación. Se caracterizaron factores desencadenantes y etiología, datos útiles en la práctica clínica. Hubo alta carga de comorbilidades, cuya descompensación impactó de manera significativa en la agudización de la falla cardiaca. El subgrupo con fracción de eyección intermedia presentó particularidades que ameritan mayor caracterización.
Abstract Objective: To determine the epidemiological characteristics of adults with acute heart failure admitted to a University Hospital. Method: A retrospective, descriptive cohort study conducted by reviewing the medical notes of patients over 18 years-old and admitted between July and December 2015 to a hospital in Medellin, Colombia. Results: The study included 361 patients with acute heart failure, with a mean age of 76 years, and of whom 193 (53.4%) were women. A reduced ejection fraction (LVEF) was observed in 183 (50.6%) patients, 19 (5.2%) with an intermediate LVEF, and 148 (40.9%) with normal LEVF. The pharmacological treatment prior to admission included angiotensin-converting-enzyme (ACE) inhibitors / angiotensin II receptor antagonists (ARA2) in 253 (70%) patients, a beta-blocker in 212 (58.7%), and spironolactone in 92 (25.4%). The main cause of acute heart failure was the presence of tachy-brady-arrhythmias (17.5%), followed by infection (17.2%), and exacerbation of chronic pulmonary disease (16.3%). The clinical classification of the decompensation was Stevenson B in 335 (92.7%) patients, Stevenson C in 20 (5.5%), and Stevenson L in 6 (1.6%). The mean admission time was 6 (4-9) days. There were 30 (8.3%) deaths, 50% due to infections associated with cardiac decompensation and 20% due to acute coronary syndrome. Conclusion: Similarities were found with international studies, but there was a higher mortality mainly linked to infection as a decompensation precipitating factor. The triggering factors and aetiology are presented, which are useful data in clinical practice. There was a high level of comorbidities, and their decompensation had a significant impact on the exacerbation of heart failure. The sub-group with the intermediate ejection fraction had features that require further characterisation.
Humans , Aged , Heart Failure , Medical Records , Risk Factors , Mortality , Hospitalization
Resumen La infección crónica por parvovirus B19 en pacientes seropositivos para el virus de inmunodeficiencia humana (VIH) es una causa identificable y tratable de anemia en esta población, que en nuestro medio aún no ha sido muy estudiada. La búsqueda activa de este patógeno en pacientes VIH positivos con anemia grave sin compromiso de otras líneas celulares puede llevar a una mejoría en la calidad de vida en el tiempo y reducción de los costos de la enfermedad para el sistema de salud. Nosotros presentamos el caso de un paciente con síndrome de inmunodeficiencia adquirida y anemia a quien se le identifico parvovirus B19. (Acta Med Colomb 2018; 43: 42-44).
Abstract The chronic infection by parvovirus B19 in seropositive patients for the human immunodeficiency virus (HIV) is an identifiable and treatable cause of anemia in this population, which in our environment has not yet been widely studied. The active search for this pathogen in HIV positive patients with severe anemia without compromising other cell lines can lead to an improvement in the quality of life over time and reduction of the costs of the disease to the health system. We present the case of a patient with acquired immunodeficiency syndrome and anemia who was identified as parvovirus B19. (Acta Med Colomb 2018; 43: 42-44).
Humans , Male , Adult , Red-Cell Aplasia, Pure , Quality of Life , Acquired Immunodeficiency Syndrome , HIV-1 , Parvovirus B19, Human , Erythema Infectiosum
