Ethnoecology of the palm Brahea dulcis (Kunth) Mart. in central Mexico.

BACKGROUND: There have been few studies on the sustainable use of non-timber forest products in arid and semi-arid zones. The palm Brahea dulcis has been one of the most important resources in semi-arid Mesoamerica, since pre-Hispanic times. Currently, some populations grow within protected natural areas, representing both a challenge and an opportunity for local development. This ethnoecological study of B. dulcis in central Mexico aimed to evaluate their uses, harvesting context, and potential for exploitation, in order to give practical advice on their best use and management. METHODS: Ethnographic and ecological information was obtained in Barranca de Metztitlán Biosphere Reserve and Valle del Mezquital, Mexico. We studied the population structure and density; additionally, we evaluated the rate of leaf production, leaf renewal rate, percent survival of new leaves, the development of reproductive structures and performed a one-year defoliation experiment (involving a control and four treatments including a mix of semiannual and annual frequency of harvest and removal of two new leaves and/or two mature leaves). RESULTS: Twenty uses of the palm were recorded in the study area. Religious/symbolic and handicraft uses are highlighted. The population density of this species was the highest reported for the genus (1244 ± 231.7 ind/ha). The leaf production rate was the highest reported for arborescent palms of the Americas (11.83 ± 0.036 leaves/individual/year). The sexual reproductive cycle was 2.3 years long. A one-year defoliation experiment did not show statistically significant differences. Recommendations include: 1) implement management focused on increasing the abundance and quality of this useful resource in Metztitlán; 2) employ a strategy of focusing on ethnicity and gender in promoting their exploitation; 3) learn from theoretical frameworks of other non timber forest product studies. CONCLUSIONS: We propose that Brahea dulcis is the palm with the highest potential for sustainable use in the arid and semi-arid zones of Mexico. The challenge to improving management includes simplifying the legal protection framework, promoting uses and developing a market strategy. Collaborations to share experiences with peasant farmers from Guerrero is recommended. We further recommend the development of a governmental strategy to enhance and reassess this important resource.

Delphi consensus statement: Quality Indicators for Inflammatory Bowel Disease Comprehensive Care Units.

BACKGROUND AND AIMS: While it is commonly accepted that Inflammatory bowel disease (IBD) Comprehensive Care Units (ICCUs) facilitate the delivery of quality care to Crohn's disease and ulcerative colitis patients, it remains unclear how an ICCU should be defined or evaluated. The aim of the present study was to develop a comprehensive set of Quality Indicators (QIs) of structure, process, and outcomes for defining and evaluating an ICCU. METHODS: A Delphi consensus-based approach with a standardized three-step process was used to identify a core set of QIs. The process included an exhaustive search using complementary approaches to identify potential QIs, and two Delphi voting rounds to select the QIs defining the core requirements for an ICCU. RESULTS: The consensus selected a core set of 56 QIs (12 structure, 20 process and 24 outcome). Structure and process QIs highlighted the need for multidisciplinary management and continuity of care. The minimal IBD team should include an IBD nurse, gastroenterologists, radiologists, surgeons, endoscopists and stoma management specialists. ICCUs should be able to provide both outpatient and inpatient care and admission should not break the continuity of care. Outcome QIs focused on the adequate prophylaxis of disease complication and drug adverse events, the need to monitor appropriateness of treatment and the need to reinforce patient autonomy by providing adequate information and facilitating the patients' participation in their own care. CONCLUSIONS: The present Delphi consensus identified a set of core QIs that may be useful for evaluating and certifying ICCUs.