February 2024 ACIP Meeting Update: Meningococcal, RSV, COVID-19, and Other Vaccines.

The Advisory Committee on Immunization Practices, a group of medical and public health experts that provides advice to the Centers for Disease Control and Prevention, normally meets 3 times per year to develop US vaccine recommendations. The Advisory Committee on Immunization Practices met February 28 to 29, 2024, to discuss coronavirus disease 2019 vaccines, chikungunya vaccines, diphtheria-tetanus vaccine, influenza vaccines, polio vaccines, respiratory syncytial virus vaccines, meningococcal vaccines, pneumococcal vaccines, and Vaxelis (Diphtheria, Tetanus, Pertussis, Inactivated Poliovirus, Haemophilus influenzae b Conjugate, and Hepatitis B Vaccine). This update summarizes the proceedings of these meetings, with an emphasis on topics that are most relevant to the pediatric population. Major updates for pediatric clinicians include information about changes on influenza vaccine composition, meningococcal vaccination considerations, updated guidance for children with a contraindication to pertussis-containing vaccines, and recommendations of the world's first chikungunya vaccine for certain populations.

Fall 2023 ACIP Update on Meningococcal, RSV, COVID-19, and Other Pediatric Vaccines.

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that provides advice to the Centers for Disease Control and Prevention, normally meets 3 times per year to develop US vaccine recommendations. The ACIP met October 25 to 26, 2023, to discuss meningococcal vaccines, mpox vaccines, respiratory syncytial virus (RSV) vaccines, influenza vaccines, coronavirus disease 2019 (COVID-19) vaccines, and the combined pediatric and adult immunization schedules for 2024. The ACIP also held special meetings on September 12 and September 22 to discuss COVID-19 2023-2024 vaccine recommendations and RSV immunization in pregnant women. This update summarizes the proceedings of these meetings that are most relevant to the pediatric population. Major updates for pediatric clinicians include recommendations for XBB monovalent COVID-19 immunization for the 2023-2024 respiratory season, the recently licensed pentavalent meningococcal conjugate vaccine and mpox vaccination in high-risk young adults, and discussion regarding the parallel strategies of protection against RSV disease in infants via maternal immunization during pregnancy or direct prophylaxis of infants with nirsevimab.

A Novel Digital Educational Strategy Improves Treatment Adherence and Quality of Life in Patients with Multiple Myeloma.

Multiple myeloma, the second most common hematologic malignancy worldwide, is an aggressive disease with high morbidity and mortality rates. Although myeloma remains incurable, new treatments have improved patients' life expectancy and quality of life. However, as these therapies are administered for prolonged and often indefinite periods, their success depends on high treatment adherence and significant patient engagement. This study aimed to evaluate the impact of a novel digital educational strategy on treatment adherence, quality of life, and the development of complications in patients with newly diagnosed myeloma. To this end, a two-arm, randomized, prospective, double-blind study was conducted to compare the conventional educational approach alone or combined with the novel digital strategy. This strategy was based on some principles of the Persuasive Systems Design model and incorporated the educational recommendations of patients and caregivers. Compared to the control group that only received information through the conventional educational approach, patients randomized to the digital strategy showed significantly higher treatment adherence and quality of life, associated with increased functionality and rapid reincorporation into daily routines. The digital strategy empowered patients and caregivers to understand the disease and therapeutic options and helped patients recall treatment information and implement healthy lifestyle habits. These results support that patient-targeted educational strategies can positively influence treatment adherence and thus improve their quality of life.

Summer 2023 ACIP Update: RSV Prevention and Updated Recommendations on Other Vaccines.

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that provides advice to the Centers for Disease Control and Prevention, normally meets 3 times per year to develop US vaccine recommendations. The ACIP met June 21-23, 2023, to discuss respiratory syncytial virus (RSV) vaccines, influenza vaccines, pneumococcal vaccines, meningococcal vaccines, and COVID-19 vaccines. The ACIP also held a special meeting on August 3, 2023, to discuss RSV prophylaxis in infants. This update summarizes the proceedings of these meetings that are most relevant to the pediatric population. Major updates for pediatric clinicians include a new recommendation for the monoclonal antibody nirsevimab for prevention of RSV disease in all infants, recommendations regarding use of 20-valent pneumococcal conjugate vaccine, and discussion of potential forthcoming changes to meningococcal and COVID-19 vaccination recommendations.

February 2023 Updates of the Advisory Committee on Immunization Practices.

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts who provides expert advice to the Centers for Disease Control and Prevention, normally meets three times per year to develop U.S. vaccine recommendations. The ACIP met on February 22-24, 2023, to discuss mpox vaccine, influenza vaccines, pneumococcus vaccines, meningococci vaccines, polio vaccines, respiratory syncytial virus (RSV) vaccine, chikungunya vaccines, dengue vaccines, and COVID-19 vaccines.

Update From the September 2022 Meeting of the Advisory Committee on Immunization Practices.

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that provides expert advice to the Centers for Disease Control and Prevention, normally meets three times per year to develop US vaccine recommendations. The ACIP increased its meeting frequency over the past 2.5 years to address vaccine-related issues during the severe acute respiratory syndrome coronavirus 2 pandemic. They met to discuss updating coronavirus disease-2019 (COVID-19) booster dose recommendations on September 1, 2022 recommending the use of new bivalent COVID-19 booster vaccines which include equal amounts of ancestral and Omicron BA.4/BA.5 variant mRNA that encodes the spike protein.

Impact of COVID-19 Pandemic on Pediatric Infectious Disease Telehealth Practices in North America.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has driven a significant increase in the use of telehealth (TH) but little is published about changes in TH usage by pediatric infectious disease (PID) providers. We assessed their pre- and intra-pandemic TH usage and experience. METHODS: The Pediatric Infectious Diseases Society Telehealth Work Group surveyed PID specialists in the United States and Canada from 6 December 2020 until 26 February 2021. Data collected included TH modalities, barriers, and satisfaction. RESULTS: The survey response rate was 11.3% (288 of 2,550 PID clinicians) with 243 (96% of 253 analysis-eligible responses) managing children only. Women accounted for 62.1% (n = 157), 51.4% (130) of respondents devoted 50-99% of their time to direct patient care, and 93.3% (236) were located in the United States. The greatest increase in TH usage during the pandemic was in synchronous provider-patient communications (3.9-fold increase). During the pandemic, provider-provider TH increased by less than 10%, comfort with TH usage doubled from 42% to 91%, and satisfaction grew from 74% to 93.3% with different aspects of TH. The top challenge was incomplete or no physical examination (182, 71.9%). Multivariate analysis showed that pre-pandemic TH usage and lack of barriers, but not reimbursement, were significantly associated with higher intra-pandemic usage. EMR-integrated TH was associated with significantly higher usage and satisfaction. Over 70% of respondents anticipate continuing TH usage after the pandemic. CONCLUSIONS: There was high intra-pandemic usage of, and increased comfort and satisfaction with telehealth by PID specialists. Our data help inform post-pandemic TH expectations and strategies.

Vaccine Hesitancy in Pediatrics.

Vaccine hesitancy is a growing complex and multifaceted phenomenon. It encompasses a wide spectrum of context-dependent attitudes and beliefs. Multiple factors influence parental decision-making including knowledge, sources of information, risk perception, trust, and individual experiences among others. This review focuses on describing the most common reasons that contribute to vaccine hesitancy among parents. Social media and the Internet have been described as major elements that can negatively influence parental decision-making regarding vaccines. The next focus is describing effective interventions that clinical providers can apply. Nonconfrontational and open discussions along with trusting and strong relationships between parents and providers seem to create a solid foundation toward vaccine acceptance. In addition, motivational interviewing is a helpful tool that has proven to be effective during these discussions. Ultimately, an individualized approach tailored to a specific community will likely be most effective in addressing vaccine hesitancy.

Incidence and Prognostic Significance of High-Risk Cytogenetically Abnormalities in Multiple Myeloma Patients in Colombia.

INTRODUCTION: Multiple Myeloma (MM) is the second most common hematological cancer, several cytogenetics abnormalities such as t(4;14), del (17p), and t(14;16) were identified as a high-risk for survival, in Latin America, we have very little data on cytogenetic alterations in MM. This study describes the incidence of high-risk cytogenetically abnormalities in a Colombian population and prognostic significance. METHODS: In a retrospective cohort of new diagnostic Multiple Myeloma between 2016 and 2020, we identified a high-risk cytogenetically abnormalities t(4;14), t(14;16), and 17p deletions by FISH techniques and described incidence. We followed patients until progression or death and comparing progression free survival (PFS) and overall survival (OS), according with high- risk cytogenetically features. RESULTS: We included 135 newly diagnosed MM patients, the incidence of high-risk cytogenetically abnormalities were 30.3%, with 17.1% of 17p deletions, 14.1% of t(4;14) and 2.25% of t(14;16). According to the high risk cytogenetically abnormalities, the median PFS for the group of no abnormalities were 50.2 months 95% CI [25.2-62.4] and for the group of high-risk cytogenetic abnormalities 33.9 months 95% CI [23.6-NA] (P = .2). For OS the median were 76.9 months, 95% CI [67.5-NA] and 42.7 months 95% CI [33.3-NA], respectively (P = .009). CONCLUSION: High-risk cytogenetically abnormalities were independent risk factor for OS but not PFS in this cohort of patients, and the incidence of del (17p) was slightly higher than the literature reports.  MICROABSTRACT: Prognostic significance of high-risk cytogenetic abnormalities in Multiple Myeloma in Colombia is unknown. In a retrospective cohort study of 135 newly, diagnostic Multiple Myeloma we found incidence of high-risk cytogenetic abnormalities was 30.3%. The hazard ratio (HR) for disease progression or death compared high-risk cytogenetic group vs. control was 1.22, (95% CI, 0.73-2.05) (P = .2), and The HR for death for the group of high-risk cytogenetic abnormalities was 2.17, (95% CI, 1.19-3.97). In the group of high-risk cytogenetic abnormalities, if the patient received VRD as induction treatment the median PFS were 41.2 months 95% CI [13.3-NA] and 33.9 months 95% CI [24.9-NA] for patients with different induction treatment (P = .56).

Recommendations for the diagnosis and management of persons with suspected vaccine-induced immune thrombotic thrombocytopenia (VITT) / Recomendaciones para diagnostico y manejo de personas con trombocitopenia trombotica inmune inducida por vacunas (VITT)

Abstract In recent months, rare cases of thrombosis at unusual sites associated with thrombocytopenia, occurring within a typical risk window (i.e., 4-28 days) after receiving SARS CoV2 vaccines, have been reported. Healthcare professionals should be prepared to detect these cases on time. The Expert Panel of the Knowledge Management and Transfer Network conducted a free search of the related literature. With the available information and the clinical expertise of the working group, we formulated, reviewed, and endorsed recommendations for the timely suspicion, diagnosis (case definitions, the use of initial laboratory and imaging tests, specific tests), and management of these thrombotic conditions. This document is considered a living document that will be updated as new evidence emerges, and recommendations may change over time.

Resumen En meses recientes se han reportado casos raros de trombocitopenia y trombosis en sitios inusuales, que ocurren dentro de una ventana de riesgo típica ( por ejemplo de 4 a 28 días) luego de recibir vacunas de SARS CoV 2. Los profesionales de la salud deben estar preparados para detectar estos casos a tiempo. Un panel de expertos y una red de transferencia de conocimiento realizó una búsqueda libre de literatura seleccionada. Con la información disponible y la experticia clínica del grupo de trabajo revisamos y dimos recomendaciones para la sospecha temprana, el diagnostico (definición de caso, el uso de pruebas de laboratorio especificas y de imágenes diagnósticas) para le manejo de estas condiciones tromboticas. Este documento es considerado un documento vivo que debe ser actualizado a medida que surja nueva evidencia y las recomendaciones vayan cambiando con el tiempo

Treatment-free remission in patients with chronic myeloid leukemia: recommendations of the LALNET expert panel.

Tyrosine kinase inhibitors (TKIs) have dramatically changed the survival of chronic myeloid leukemia (CML) patients, and treatment-free remission (TFR) has recently emerged as a new goal of CML treatment. The aim of this work was to develop recommendations for TKI discontinuation in Latin America (LA), outside of clinical trials. A working group of CML experts from LA discussed 22 questions regarding TFR and reached a consensus for TFR recommendations in the region. TFR is indicated in patients in first chronic phase, with typical BCR-ABL transcripts, under TKI treatment of a minimum of 5 years, in sustained deep molecular response (DMR; molecular response 4.5 [MR4.5]) for 2 years. Sustained DMR must be demonstrated on at least 4 international reporting scale quantitative polymerase chain reaction (PCR) tests, separated by at least 3 months, in the immediate prior 2 years. After second-line therapy, TFR is indicated in previously intolerant, not resistant, patients. Molecular monitoring is recommended monthly for the first 6 months, every 2 to 3 months from months 7 to 12, and every 3 months during the second year, indefinitely. Treatment should be reintroduced if major molecular response is lost. Monitoring of withdrawal syndrome, glucose levels, and lipid profile is recommended after discontinuation. After TKI reintroduction, molecular monitoring is indicated every 2 to 3 months until MR4.0 achievement; later, every 3 to 6 months. For the TFR attempt, having standardized and reliable BCR-ABL PCR tests is mandatory. These recommendations will be useful for safe discontinuation in daily practice and will benefit patients who wish to stop treatment in emergent regions, in particular, with TKI-related chronic adverse events.

Measurable Residual Disease Assessment and Allogeneic Transplantation as Consolidation Therapy in Adult Acute Lymphoblastic Leukemia in Colombia.

INTRODUCTION: Detectable minimal residual disease (MRD) after therapy for acute lymphoblastic leukemia (ALL) is the strongest predictor of hematologic relapse. The objective of the study was to assess disease-free survival (DFS) and overall survival (OS) of patients with ALL according with MRD status at the end of induction therapy in a Colombian population. PATIENTS AND METHODS: We assessed a retrospective cohort to compare DFS and OS in adults with de novo ALL according to MRD status at the end of induction chemotherapy, and the type of postinduction consolidation strategy used. RESULTS: A total of 165 adults with ALL were included in the MRD part of the study, 73 patients in the MRD-negative group and 92 in the MRD-positive group. Median DFS for the MRD-positive group was 11 months (95% confidence interval, 11.7-22.2) and was not reached for the MRD-negative group (P < .001). At 3 years, DFS was 18% and 55%, respectively (P < .001). The median OS for MRD-positive patients was 16 months (95% confidence interval, 8.8-23.15) and was not reached in the MRD-negative group. At 3 years, OS was 26% and 51% for the former and latter group, respectively. Among subjects who did not receive a transplant, median DFS was 21 months for MRD-negative patients and 9 months for MRD-positive patients (P < .001). The median DFS was not reached in either group, whereas 3-year DFS was 64% for MRD-negative and 70% for MRD-positive patients who underwent transplantation in first remission (P = .861). CONCLUSION: MRD status at the end of induction is an independent prognostic factor for DFS and OS in adult ALL. Allogeneic transplantation in first remission could overcome the adverse prognostic impact of MRD.

Pre-Coronavirus Disease 2019 Telehealth Practices Among Pediatric Infectious Diseases Specialists in the United States.

BACKGROUND: Telehealth (TH) practices among pediatric infectious disease (PID) specialists prior to the coronavirus disease 2019 (COVID-19) pandemic are largely unknown. METHODS: In 2019, the Pediatric Infectious Diseases Society (PIDS) Telehealth Working Group surveyed PIDS members to collect data on the use of TH modalities, adoption barriers, interest, extent of curbside consultations (CCs), and reimbursement. RESULTS: Of 1213 PIDS members, 161 (13.3%) completed the survey, and the responses of 154 (12.7%) from the United States were included in our report. Medical school (63.6%) and hospital (44.8%) were the commonest work settings with 16.9% practicing in both of them. The most common TH modalities used were synchronous provider-patient virtual visits (20.8%) and synchronous provider-provider consultations (13.6%). TH services included outpatient consultations (48.1%), vaccine recommendations (43.5%), inpatient consultations (39.6%), and travel advice (39.6%). Barriers perceived by respondents included reimbursement (55.8%), lack of experience with TH (55.2%), lack of institutional support (52.6%), lack of administrative support (50%), and cost of implementation (48.7%). Most of the respondents (144, 93.5%) were interested in implementing a wide range of TH modalities. CCs accounted for 1-20 hours/week among 148 respondents. CONCLUSIONS: Most of the PIDS survey respondents reported low utilization of TH and several perceived barriers to TH adoption before the COVID-19 pandemic. Nonetheless, they expressed a strong interest in adopting different TH modalities. They also reported spending considerable time on non-reimbursed CCs from within and outside their institutions. The results of this survey provide baseline information that will allow comparisons with post-COVID-19 changes in the adoption of TH in PID.

Novel Ingredients Based on Grapefruit Freeze-Dried Formulations: Nutritional and Bioactive Value.

Grapefruit is a fruit with interesting nutritional value and functional properties, but a short life. Freeze-drying (FD) is a valuable technique as it produces high-quality dehydrated products. This study is aimed to obtain new food ingredients based on freeze-dried grapefruit formulated with high molecular weight solutes (gum arabic and bamboo fiber) in three different proportions (F1, F2, and F3). To improve the FD, a mild microwave drying pre-treatment was applied. Influence of the water content and the presence of high molecular weight solutes on freeze-drying kinetics was tested by Midilli-Kucuk and Page models. The best FD kinetic model fit on grapefruit powders were Midilli-Kucuk for F2 and F3, and Page for F1, and the adequate freeze-drying times for F1, F2, and F3 were 24, 16, and 18 h, respectively. Final samples were evaluated for nutritional and antioxidant capacity. Gum arabic and bamboo fiber present a protector effect, which results in a significant antioxidant capacity due to the protection of flavonoids and antioxidant vitamins. These novel food ingredients could be of great interest for the food industry in order to develop foods with improved antioxidant capacity as well as enriched in natural fibers and/or micronutrients.

Functional composition of epiphyte communities in the Colombian Andes.

We identify changes in the functional composition of vascular epiphytes along a tropical elevational gradient with the aim of quantifying the role of climate in determining the assembly of epiphyte communities. We measured seven leaf functional traits (leaf area, specific leaf area, leaf dry-matter content, leaf thickness, force to punch, stomatal density, and potential conductance index) in the 163 most abundant epiphyte species recorded across 10 sites located along an elevational gradient between 60 and 2,900 m above sea level in the Colombian Andes. We grouped the epiphyte species into seven hierarchical functional groups according to their most characteristic leaf traits. Along the elevational gradient, the two main independent leaf trait dimensions that distinguished community assemblages were defined primarily by leaf area-photosynthetic (LAPS) and mass-carbon (LMCS) gradients. Mean annual temperature was the main determinant of species position along LAPS. In contrast, local changes in specific leaf area due to variation in the epiphytes' relative height of attachment was the main determinant of their position along the LMCS. Our findings indicate that epiphytic plant leaves have evolved to optimize and enhance photosynthesis through a leaf area-based strategy and carbon acquisition through investments in construction costs of leaf area per unit of biomass that aim to regulate light capture and tissue development. Given that most studies of plant functional traits neglect vascular epiphytes, our quantification of the multiple dimensions of epiphyte leaf traits greatly augments our understanding of vascular plant function and adaptation to changing environments.

Sensory characterization of juice obtained via rehydration of freeze-dried and spray-dried grapefruit.

BACKGROUND: The acceptability of grapefruit juice obtained from rehydrated freeze-dried and spray-dried fruit was studied and compared with that of natural freshly squeezed juice and that of a commercial juice. The rheological properties, colour and solute concentration were determined. A sensory evaluation was developed to evaluate juice acceptability. Furthermore, a penalty analysis was used to determine the attributes with improvement potential as well as some CATA (check all that apply) questions, where consumers marked the most characteristic attributes of each sample. RESULTS: The rehydrated samples were different from the commercial and natural juices. When grapefruit is freeze-dried or spray-dried, gum arabic and bamboo fibre are added and part of the fruit pulp is present; this is not so in the other juices under study. This supposes greater viscosity, luminosity and chroma together with a reddish tone of the rehydrated juices, especially the freeze-dried ones. It also affects their acidity, astringency and sweetness. CONCLUSION: Rehydrating the freeze-dried or spray-dried powder to the level of the natural juice, instead of that of the crushed or liquidized grapefruit, and incorporating sugar at this stage would probably improve the quality of the samples. © 2018 Society of Chemical Industry.

The Effect of 13-Valent Pneumococcal Conjugate Vaccine on the Serotype Distribution and Antibiotic Resistance Profiles in Children With Invasive Pneumococcal Disease.

BACKGROUND: Invasive pneumococcal disease (IPD) continues to be a significant burden in children despite the implementation of two generations of conjugate vaccines. Serotype replacement by nonvaccine serotypes is reported in multiple areas around the world. This study is a continuation of previous studies and describes the incidence, serotype distribution, and antibiotic resistance pattern of Streptococcus pneumoniae serotypes causing IPD at Children's Medical Center Dallas after introduction of 13-valent pneumococcal conjugate vaccine (PCV13). METHODS: Streptococcus pneumoniae isolates from normally sterile sites were collected from January 1, 1999 to June 30, 2014. Demographic and clinical information was extracted for analysis. Incidence of IPD was calculated using inpatient and emergency center admissions to Children's Medical Center of Dallas as the denominator. Isolates were serotyped and penicillin/cefotaxime susceptibilities were determined. Selected nontypeable isolates were further characterized by multilocus sequence typing. A χ2 test and the Cochran-Armitage Trend Test for trend analysis were used to evaluate change in serotype and antibiotic susceptibility patterns over time. RESULTS: Comparison of the different study periods showed a significant reduction in the incidence of IPD in PCV13 era compared with prevaccine era and PCV7 era (P < .05). Children younger than 24 months showed the largest reduction of disease incidence. More than 40% of patients with IPD had a documented comorbidity. Cases of pneumonia continued to decrease in the PCV13 era (P < .002). The most common non-PCV13 serotypes after vaccine introduction were as follows: 23B, 6C, 23A, 9N/L, and 12. Penicillin resistance by meningitis breakpoint decreased significantly in the PCV13 era. CONCLUSIONS: After introduction of PCV13 in Dallas, incidence of IPD caused by strains contained in the vaccine and penicillin resistance continued to decrease. Serotype replacement phenomena and persistence of PCV7 serotypes were documented. Patients with comorbidities represented a large percentage of patients with IPD. Concerns for geographic variation in serotype replacement phenomena arise from the present study.

INDICADOR SINTÉTICO PARA LA MEDICIÓN DE LA NECESIDAD DE INVESTIGACIÓN Y GESTIÓN AMBIENTAL BASADO EN MORBIMORTALIDAD OCURRIDA EN 2009-2012, META, COLOMBIA / SYNTHETIC INDICATOR FOR MEASURING THE NEED FOR RESEARCH AND ENVIRONMENTAL MANAGEMENT BASED ON MORBIMORTALITY IN THE PERIOD 2009-2012, IN META, COLOMBIA

Objetivo: Construir un indicador sintético basado en degradación en salud en los municipios del departamento del Meta en el periodo 2009-2012, que permita priorizar las necesidades de investigación e intervención ambiental de estos municipios. Metodología: Se realizó un estudio analítico, observacional, exploratorio, retrospectivo. Los datos se obtuvieron de las base de datos estatales de vigilancia en salud pública y el registro único de afiliados (RUAF), de 2009 a 2012 del departamento del Meta. Una vez fueron seleccionados los casos de análisis se construyeron nuevas bases de datos, las cuales fueron analizadas en 4 fases: construcción de los indicadores simples, índices temáticos, los indicadores compuestos, y el indicador sintético global. Resultados: El indicador arrojó un valor para cada uno de los 29 municipios, evidenciando diferencias en los efectos ambientales sobre la salud. San Carlos de Guaroa con el mayor puntaje (10200) y Puerto Concordia (1000). Al estratificar el indicador lo municipios clasificaron así: necesidad alta, necesidad media, necesidad baja: Discusión: Considerar a la salud como un indicador del estado del ambiente y al ambiente como determinante causal de la salud ha generado el desarrollo de diferentes metodologías para medir la relación causa-efecto entre el ambiente y la salud. Se infiere la presencia de factores ambientales desencadenantes de la morbimortalidad, reconocidos por la OMS como fuerza impulsora, presión o de exposición en la causalidad de origen ambiental (Yassi et al., 2002; Posada et al., 2004), responsables de los diferentes comportamientos en la degradación en salud. Conclusiones: El indicador permite medir las diferencias ambientales entre municipios, las diferencias en los efectos del ambiente sobre la salud, permiten inferir las condiciones ambientales de los municipios, se observan la presencia de efectos provenientes de: el agua, el aire, sustancias químicas, fauna.

Objective: To build a synthetic indicator based on health degradation in the municipalities of the Department of Meta in the period 2009-2012 to enable prioritizing research needs and environmental intervention in these municipalities. Methodology: An analytical, observational, exploratory, retrospective study was carried out. Data were obtained from the state public health surveillance databases and the unified affiliated record (UAR), in the period 2009-2012 in the Department of Meta. Once the cases for analysis were selected, new databases were created which were analyzed in 4 stages: construction of simple indicators; thematic indexes; composite indicators, and the overall synthetic indicator. Results: The indicator showed a value for each of the 29 municipalities, making clear differences in environmental effects on health. San Carlos de Guaroa with the highest score (10,200) and Puerto Concordia (1,000). By stratifying the indicator, municipalities classified as: high need, average requirement, and low need. Discussion: Considering health as an indicator of the state of the environment and the environment as a determinant causal of health has generated the development of different methodologies to measure the cause-effect relationship between environment and health. The presence of environmental factors which trigger morbimortality, recognized by the World Health Organization (WHO) as a driving force, pressure or exposure in the causation of environmental origin (Yassi et al., 2002; Posada et al., 2004), responsible for different behaviors in health degradation is concluded. Conclusions: The indicator allows measuring environmental differences between municipalities, and the differences in the effects of environment on health, as well as inferring the environmental conditions of the municipalities buy observing the presence of effects from: water, air, chemical substances, and fauna.

Valores y prácticas educativas de familias latinoamericanas inmigradas a Barcelona: ¿qué cambia y qué permanece? / Values and educational practices of immigrant families from Latin America to Barcelona: what changes and what stays the same? / Valores e práticas educativas de famílias latino-americanas imigradas de Barcelona: o que muda e o que permanece?

Analizamos las transformaciones en los valores y prácticas educativas, y algunas condiciones que median, en un grupo de 15 familias latinoamericanas residentes en Barcelona (España). Realizamos entrevistas en profundidad con las figuras parentales, generalmente las madres, y entrevistas semiestructuradas con algunos de sus hijos e hijas. Los hallazgos destacan tanto la persistencia de las familias en socializar a sus hijos e hijas de acuerdo con valores de las tradiciones culturales de sus países de origen, como la necesidad de negociar nuevos significados y comportamientos e incorporar nuevas estrategias y prácticas. La composición familiar, la escolarización de los padres y madres, las redes con que cuentan, la inserción laboral, median en la adaptación de las familias a los cambios contextuales y culturales que afectan la socialización de sus hijos e hijas.

This study analyses changes in values and educational practices as well as some conditions that mediate these practices among a group of 15 Latin American families residing in Barcelona (Spain). In-depth interviews were conducted with parental figures, mostly mothers, and semi-structured interviews with some of their children. The findings highlight both the persistence of families in instilling values from the cultural traditions of their countries of origin and the need to negotiate new meanings and behaviors and incorporate new strategies and practices. Family composition, parents‘ education, available networks and job inclusion all play a role in the adaptation of families to the contextual and cultural changes that affect the socialization of their children.

A pesquisa analisa as transformações nos valores e nas práticas educativas e as condições que permeiam um grupo de 15 famílias latino-americanas residentes em Barcelona (Espanha). Foram realizadas entrevistas em profundidade com os pais, geralmente com as mães, e entrevistas semiestruturadas com alguns de seus filhos e filhas. Os resultados encontrados destacam tanto a persistência das famílias em socializar os seus filhos e filhas de acordo com os valores associados às tradições culturais de seus países de origem, como a necessidade de negociar novos significados e comportamentos e de incorporar novas estratégias e ações. A composição familiar, o nível de escolarização dos pais e das mães, as redes com as quais a família pode contar, a inserção no mercado de trabalho, influenciam na adaptação das famílias às mudanças contextuais e culturais que afetam a socialização de seus filhos e filhas.

Estructura y composición florística de los manglares de la bahía de Cispatá, Caribe colombiano

Los manglares son asociaciones de plantas que se adaptan fácilmente a las condiciones salinas y los niveles fluctuantes de inundación. Estos ecosistemas suministran gran cantidad de bienes y servicios tales como el almacenamiento de carbono. Diferencias estructurales, de composición de especies y de características microambientales entre tipos fisiográficos implican diferencias en el almacenamiento de carbono en sus suelos. La presente investigación tuvo como objetivo identificar la variación de las especies de mangle a través de los cambios en las variables físico-bióticas de bosques de manglar de la bahía Cispatá, Colombia. Se realizaron mediciones de variables estructurales del bosque (D, H, densidad de individuos) y medición de variables físico-bióticas (nivel de inundación, cobertura de A. aureum, salinidad del agua intersticial. pH del suelo, % N, % limo, % arena, % COs, raíces y densidad aparente en el suelo) en 12 parcelas establecidas aleatoriamente. Con un CCA identificaron tres manglares: cuenca, borde en buen estado de conservación y borde con intervención antropogénica. El primero dominado por A. germinans y los otros por R. mangle. El manglar de cuenca se diferencia de los de borde en términos estructurales y en variables físico-bióticas, presentó los valores más altos de COs, salinidad, densidad aparente y pH. Aunque los dos manglares de borde presentan características físico-bióticas similares, la alteración antropogénica cambia fuertemente la estructura de uno de ellos. Se ha concluido que la distribución de las especies de manglar de la bahía responde a la variación espacial de las características ambientales. Sin embargo, la intervención antropogénica es una variable determinante en la estructura de los manglares lo cual afecta las estimaciones del papel de diferentes tipos de manglar como sumideros de carbono.

Mangroves are plant associations that are easily adapted to saline conditions and fluctuating levels of flooding. This ecosystem provides a wide variety of goods and services as carbon storage. Structural differences, species composition and micro-environmental characteristics between physiographic types involve differences in carbon storage in their soils. This research aimed to identify the variation of mangrove species through changes in the physical-biotic variables of mangrove forest of Cispatá bay, Colombia. We measured structural variables of forest (D, H, density of individuals) as well as physico-biotic variables (flood level, A. aureum coverage, water interstitial salinity, soil pH, % N, % COs, roots and apparent density soil) in 12 plots established randomly. With a CCA it was identified three mangroves: basin, fringe in good condition and fringe with anthropogenic intervention. The first was dominated by A. germinans and the others by R. mangle. The basin mangrove differs from fringe in physical-biotic variables and structurally, it presented the highest values of COs, salinity, apparent density and pH. Although the two fringe mangrove exhibit similar physical-biotic variables, human disturbance may strongly change the structure of one of them. It was concluded that the distribution of mangrove species of bay responds to a spatial variation in environmental characteristics. However, anthropogenic intervention is a determining variable in the structure of mangroves which affects estimations of the role of different types of mangrove forests as carbon sinks.