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1.
Support Care Cancer ; 32(4): 264, 2024 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-38564034

RESUMEN

OBJECTIVE: This paper aims to provide an evidence-based summary of the most effective strategies for comprehensive healthcare of chemotherapy-induced peripheral neuropathy (CIPN) in cancer patients. METHOD: Following the "6S" model, relevant evidence on CIPN management was collected from reputable evidence-based resource websites and databases nationally and internationally. The included articles were evaluated for methodological quality, and evidence was extracted using the Australian JBI Evidence-based Health Care Center's literature evaluation standard (2016 edition). RESULTS: A total of 60 articles were included in this study, comprising 2 guidelines, 5 expert consensus statements, and 53 systematic reviews. The findings of these articles were summarized across 7 dimensions, including risk factor screening, assessment, diagnosis, prevention, treatment, management, and health education, resulting in the identification of 42 relevant pieces of evidence. CONCLUSIONS: This study provides a comprehensive synthesis of evidence-based recommendations for managing CIPN in cancer patients, offering guidance for healthcare professionals engaged in clinical practice. However, when implementing these recommendations, it is crucial to consider the individual patient's clinical circumstances, preferences, and expert judgment, ensuring feasibility and applicability in real-world clinical settings.


Asunto(s)
Antineoplásicos , Neoplasias , Enfermedades del Sistema Nervioso Periférico , Humanos , Australia , Atención Integral de Salud , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/terapia , Neoplasias/tratamiento farmacológico , Antineoplásicos/efectos adversos
2.
BMC Health Serv Res ; 24(1): 116, 2024 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-38254152

RESUMEN

BACKGROUND: Patient follow-up is an essential component of hospital management. In the current information era, the patient follow-up scheme is expected to be replaced by Internet technology. This study constructed a cloud follow-up platform for gynecological chemotherapy patients and assessed its cost-effectiveness and patients' feedback. METHODS: A total of 2,538 patients were followed up using a cloud follow-up system between January and October 2021. Prior to this, 690 patients were followed manually via telephone calls. Patients' characteristics, follow-up rate, satisfaction, and session duration were compared between the cloud follow-up and manual follow-up groups. In addition, the read rate of health education materials in the cloud follow-up group was analyzed. RESULTS: General information, including age, education attainment, cancer stage, and disease category, and follow-up rate (cloud: 6,957/7,614, 91.4%; manual: 1,869/2,070, 90.3%; P = 0.13) did not significantly differ between the two groups. The follow-up satisfaction of the cloud follow-up patients was significantly better than that of the manual follow-up group (cloud: 7,192/7,614, 94.5%; manual: 1,532/2,070, 74.0%; P<0.001). The time spent on the follow-up was approximately 1.2 h for 100 patients in the cloud follow-up group and 10.5 h in the manual follow-up group. Multivariate analysis indicated that the cloud follow-up group had significantly greater follow-up satisfaction (odds ratio: 2.239, 95% CI: 1.237 ~ 5.219). Additionally, the average follow-up duration of the cloud follow-up group decreased by 9.287 h (coefficient: -9.287, 95% CI: -1.439~-0.165). The read rate of health education materials was 72.9% in the cloud follow-up group. CONCLUSIONS: The follow-up effect of the cloud follow-up group was not inferior to that of the manual follow-up group. The cloud follow-up was more effective for prevention and control requirements in the post-epidemic era. Cloud follow-up can save medical resources, improve cost-effectiveness, provide sufficient health education resources for patients, and improve their satisfaction.


Asunto(s)
Epidemias , Ginecología , Humanos , Estudios de Seguimiento , Escolaridad , Educación en Salud
3.
J Nurs Res ; 31(4): e285, 2023 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-37257016

RESUMEN

BACKGROUND: The shortage of nurses is a global problem. Increasing the level of work engagement is known to effectively reduce turnover rate among nursing staff. Strategies to improve work engagement based on the job demands-resources model may effectively improve nurses' job satisfaction and reduce staff turnover. PURPOSE: A job demands-resources model was used in this study to test the hypothesis that work engagement is affected by both external resources (professional nursing practice environment) and internal resources (self-efficacy and achievement motivation). In addition, the mediating role of self-efficacy and achievement motivation in the relationship between professional nursing practice environment and work engagement was also verified. METHODS: A cross-sectional survey employing a convenience sampling design was implemented. Five hundred fifteen registered nurses were recruited from four tertiary hospitals in Chengdu, China, from January to June 2020. The Practice Environment Scale of the Nursing Work Index, General Self-Efficacy Scale, Achievement Motive Scale, and Utrecht Work Engagement Scale were used to measure the four variables. RESULTS: The results of the structural equation model showed that the degree of fit for each index model was good, indicating that all of the three variables, including professional nursing practice environment, self-efficacy, and achievement motivation, directly affected work engagement. In addition, the variable professional nursing practice environment was found to indirectly influence work engagement through the partial mediation of self-efficacy and achievement motivation. CONCLUSIONS: The results may be used to guide health policymakers and nurse managers attempting to enhance the work engagement of nurses by providing a supportive working environment, improving the welfare mechanism, formulating a talent training plan, and fostering appropriate empowerment to improve the working environment, self-efficacy, and motivation in nurses.


Asunto(s)
Enfermeras y Enfermeros , Personal de Enfermería en Hospital , Compromiso Laboral , Humanos , Estudios Transversales , Satisfacción en el Trabajo , Motivación , Autoeficacia , Encuestas y Cuestionarios
4.
Artículo en Inglés | MEDLINE | ID: mdl-35392649

RESUMEN

Objective: We aimed to assess the impact of an expressive arts therapy combined with progressive muscle relaxation following music on mental health (anxiety and hope) in patients with gynecological malignancies undergoing surgery. Methods: This was a nonrandomized controlled trial. Eligible patients had a primary or recurrent gynecological malignancy scheduled to be treated with surgery. The intervention consisted of three sessions (preoperation, postoperation, and predischarge) during the perioperative period. Firstly, before starting the first session of intervention, all patients completed three questionnaires including a Hospital Anxiety and Depression Scale (HADS), a Herth Hope Index (HHI), and a State Anxiety Inventory (SAI), and the intervention group patients also had to complete the SAI questionnaire again after completing the intervention. Secondly, after the second session of intervention, all patients completed the SAI questionnaire, with the intervention group completed the SAI questionnaire before the intervention. Thirdly, after the third session of intervention, all patients completed HHI and SAI questionnaires, with the intervention group completed the SAI questionnaire before the intervention. Also, to subjectively rate the benefit of expressive arts therapy, the intervention group additionally completed a separate, supplemental questionnaire. Results: A total of 116 patients were enrolled and 110 included in the final analysis. No group differences were found for HHI scores between the intervention and control participants (Cohen's d = 0.19, P=0.31), although there was a substantial improvement in intervention participants' HHI scores compared to the standard care control participants. There was a statistically significant improvement in intervention participants' SAI from preintervention to postintervention of preoperation (Cohen's d = -0.23, P=0.002) and postoperation (Cohen's d = -0.34, P ≤ 0.001). However, no differences were observed for the predischarge period (Cohen's d = -0.09, P=0.118). Besides, a supplemental questionnaire indicated that 52 (98%) patients felt that expressive arts therapy was beneficial. Conclusions: Expressive art therapy combined with progressive muscle relaxation under music may be of some effect on alleviating perioperative anxiety in patients with gynecologic malignancies. Therefore, further relevant studies with large samples and multicenters are urgently needed to provide a reliable evidence-based basis for perioperative psychological care of patients with gynecologic malignancies and to promote rapid recovery of patients. It is recommended that further art therapy studies to examine the impact of patient-tailored arts therapy interventions on spiritual well-being in patients with gynecological malignancies, especially in the perioperative period.

5.
Front Oncol ; 12: 1059924, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36733360

RESUMEN

Objective: To assess the effect and safety of gum-chewing on the prevention of postoperative ileus after gynecological cancer surgery. Methods: We conducted a systematic review of randomized controlled trials (RCTs) published between 2000 and 2022 in English and Chinese, using the EBSCO, Web of Science, Scopus, Cochrane Central Register of Controlled Trials (Cochrane database), PubMed, Medline (via Ovid), Chinese National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database, and Wan Fang databases. A total of 837 studies were screened using Endnote software, and those that met the inclusion criteria were selected for analysis. The main outcome of interest was the incidence of postoperative ileus, and secondary outcomes included time to first flatus, time to first bowel movement, and length of hospital stay. Results: Two authors extracted data and performed quality assessment independently. The review included six RCTs with a total of 669 patients. Compared with routine care, gum-chewing could significantly reduce the incidence of postoperative ileus (RR 0.46, 95% CI: 0.30, 0.72, P=0.0006), shorten the time to first flatus (WMD -9.58, 95% CI: -15.04, -4.12, P=0.0006), first bowel movement (WMD -11.31, 95% CI: -21.05, -1.56, P=0.02), and the length of hospital stay (WMD -1.53, 95% CI: -2.08, -0.98, P<0.00001). Conclusions: Gum-chewing is associated with early recovery of gastrointestinal function after gynecological cancer surgery and may be an effective and harmless intervention to prevent postoperative ileus. Systemaic review registration: https://www.crd.york.ac.uk/prospero/#searchadvanced, identifier CRD42022384346.

6.
Mar Pollut Bull ; 172: 112894, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34464821

RESUMEN

Natural processes and human activities exert important impacts on elemental cycling in coastal sediments, which has not been well documented. Sediments in the Bohai Sea and North Yellow Sea were investigated to assess the impacts of the Yellow River inputs and/or anthropogenic perturbations on diagenesis of iron and sulfur. Labile iron (0.5 M HCl-extractable iron) in the sediments is low due to iron-poor nature of source materials. Dynamic regimes and low availability of labile organic carbon (OC) result in relatively low sulfide contents in deltaic sediments. However, low but continuous supply of labile OC exported from an anthropogenically impacted bay could substantially elevate sulfide burial in sediments near the bay. Neither offshore oil exploitations nor frequent algal blooms in the seas have detectable influences on iron and sulfur diagenesis in the sediments. The sediments are capable of quickly consuming porewater sulfide by reaction with reactive iron under the current conditions.


Asunto(s)
Sedimentos Geológicos , Contaminantes Químicos del Agua , China , Monitoreo del Ambiente , Humanos , Hierro/análisis , Océanos y Mares , Azufre/análisis , Contaminantes Químicos del Agua/análisis
7.
Front Public Health ; 9: 678738, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34268290

RESUMEN

Background: Infections are the second leading cause of death among patients undergoing hemodialysis. However, preventive measures against infectious diseases are limited and have not been made mandatory for patients. Objective: To investigate the incidence of infectious diseases before and during the coronavirus disease (COVID-19) pandemic. Design: A historical comparative study of a prospective cohort. Setting(s): February 1, 2015 to January 31, 2020 was defined as the period before the mitigative confrontation of the COVID-19 pandemic in China. The period from February 1 to June 29, 2020 was defined as the period of mitigative confrontation of the COVID-19 pandemic in China. Participants: A cohort of patients undergoing hemodialysis whose infectious disease episodes were documented prospectively in the hemodialysis unit of the Third Affiliated Hospital of Guangzhou Medical University since February 1, 2015. Methods: Mandatory mask-wearing and reinforced hand-hygiene education were implemented to prevent COVID-19 from January 23, 2020 in China. The incidence of infectious episodes, including catheter-related infection, digestive tract infection, upper respiratory tract infection (UTRI), pneumonia, and infection at other sites, were documented and compared in the periods before and during the pandemic. Results: The historical control group consisted of 157 patients, with 79 patients in the COVID-19 prevention group. The mask-wearing rate of patients increased from 1.5 to 100%. Hand sanitizer consumption increased significantly during the COVID-19 pandemic. The compliance rates of hand hygiene increased from 66, 75.5, to 55% in physicians, nurses, and other employees before the pandemic to 90.5, 92.5, and 76.5%, respectively. The incidences of UTRI and pneumonia decreased during the pandemic (p < 0.001). Notably, catheter-related and digestive tract infections also decreased during the pandemic (p = 0.003 and 0.034, respectively). A matched-pair study was conducted to further analyze the 79 individual changes in the incidences of infectious disease before and during the pandemic. As a result, the incidences of UTRI, pneumonia, catheter-related infections, digestive tract infections, and infections at other sites all decreased during the pandemic. Conclusions: The present study indicated an association between mandatory mask-wearing and reinforced hand hygiene education and decreased respiratory, catheter-related, and digestive tract infection episodes in the hemodialysis unit.


Asunto(s)
COVID-19 , Enfermedades Transmisibles , Higiene de las Manos , China/epidemiología , Unidades de Hemodiálisis en Hospital , Humanos , Pandemias , Estudios Prospectivos , Diálisis Renal/efectos adversos , SARS-CoV-2
8.
Medicine (Baltimore) ; 99(23): e20641, 2020 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-32502049

RESUMEN

BACKGROUND: Universal 2-child policy was proposed in 2015 in China, but it was still uncertain whether having a second child would have any impacts on maternal health, especially mental health. So, the aim of this study was to compare the incidence of perinatal depression between the first-child women and the second-child women and to describe the patterns of perinatal depression from the first and third trimesters to 6 weeks postpartum. METHODS: A prospective cohort study was conducted in a university hospital, 969 first-child women and 492 second-child women registered in this hospital from Dec 2017 to Mar 2018 were involved in the study. The Mainland Chinese version of the Edinburgh Postnatal Depression Scale (EPDS) was applied to screen perinatal depressive symptoms, while socio-demographic and obstetric data were obtained by self-administered questionnaires. Multiple logistic regression analyses were used to compare the risk of depression between 2 groups, and repeated measures of analysis of variances (ANOVAs) were used to determine the EPDS scores of 2 groups across 3 stages. RESULTS: The incidence of perinatal depression was 21.78% to 24.87% and 18.29% to 22.15% in the first-child group and the second-child group, respectively. The second-child women were less likely to exhibit depressive symptoms than the first-child women in the first trimester (Adjusted OR = 0.630, 95%CI = 0.457-0.868, P = .005), but no significant difference was found between the 2 groups in the third trimester and at postpartum period. During the whole perinatal period, no significant difference was found in EPDS scores of the first-child group among the three stages. However, the EPDS scores of the second-child group were higher in the first trimester than that at the postpartum period. CONCLUSION: The risk of perinatal depression for the second-child women was no higher than for the first-child women, and the EPDS scores of the second-child women were decreasing during the perinatal period. So couples in West China are recommended to consider having a second child without much worry about its negative effects on mental health under the universal 2-child policy.


Asunto(s)
Depresión/epidemiología , Madres/psicología , Complicaciones del Embarazo/epidemiología , Adulto , China/epidemiología , Política de Planificación Familiar , Femenino , Humanos , Incidencia , Madres/estadística & datos numéricos , Embarazo , Estudios Prospectivos , Escalas de Valoración Psiquiátrica
9.
J Chromatogr B Analyt Technol Biomed Life Sci ; 1118-1119: 180-186, 2019 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-31054452

RESUMEN

Salidroside is one of the bio-active compounds found in Rhodiola crenulata. To find an easy, time saving and efficient way to extract, purify and enrich salidroside from Rhodiola and other natural plants, we prepared a highly selective molecularly imprinted polymer (MIP) for extraction and preconcentration of salidroside using salidroside (SD) as a template, acrylamide (AM) as a functional monomer, ethylene glycol dimethacrylate (EDMA) as a crosslinking monomer, and dimethyl formamide (DMF) as a porogen. The performance of the MIPs was evaluated through selective recognition capacity and adsorption isotherms and kinetics. The results showed that MIPs possessed excellent specific recognition toward SD and could effectively discriminate its structural analogue. The application of the developed MIPs as a selective sorbent for solid-phase extraction (SPE) of SD was also investigated. Under the optimum conditions, a rapid, economical, and efficient method based upon MIP-SPE coupled with high-performance liquid chromatography (HPLC) was developed for the determination of SD in Rhodiola crenulata. The method showed satisfactory recoveries (from spiked real samples at 3 fortification levels of 0.5, 1 and 10 mg L-1) of 88.74%- 97.64% with relative standard deviations (RSDs) ranging from 2.05%-3.54%. Furthermore, MIP-SPE was successfully used to separate and purify SD from different parts in Rhodiola crenulata and it should be available for determination of salidroside in others herbs.


Asunto(s)
Cromatografía Líquida de Alta Presión/métodos , Glucósidos/aislamiento & purificación , Impresión Molecular/métodos , Fenoles/aislamiento & purificación , Rhodiola/química , Extracción en Fase Sólida/métodos , Glucósidos/análisis , Glucósidos/química , Límite de Detección , Modelos Lineales , Fenoles/análisis , Fenoles/química , Extractos Vegetales/química , Reproducibilidad de los Resultados
12.
Kidney Int ; 91(5): 1236-1242, 2017 05.
Artículo en Inglés | MEDLINE | ID: mdl-28215666

RESUMEN

Myeloid-derived suppressor cells (MDSCs) are recently identified immune suppressive cells in multiple chronic inflammations. Here, we investigated MDSCs in patients with end-stage renal disease (ESRD) and their clinical significance in these patients and healthy individuals (49 each). Polymorphonuclear and mononuclear MDSCs were investigated by flow cytometry. Patients with ESRD before hemodialysis presented a significantly higher level of polymorphonuclear MDSCs. Depletion of polymorphonuclear-MDSCs resolved T cell IFN-γ responses. By co-culture, T cell proliferation and the production of IFN-γ were abrogated by the addition of polymorphonuclear MDSCs in a dose-dependent manner. Both of these effects were reversed by a reactive oxygen species inhibitor. The levels of reactive oxygen species were higher in polymorphonuclear MDSCs derived from patients with ESRD than from normal individuals. The mRNA level of NOX2, the key protein complex responsible for reactive oxygen species production, was higher in ESRD-related polymorphonuclear MDSCs. The phospho-STAT3 level, a key activator of MDSCs, was higher in ESRD-related polymorphonuclear MDSCs. Finally, the polymorphonuclear MDSC level before and after hemodialysis was positively related to infectious diseases. Patients with ESRD were dichotomized into 2 groups by the amount of polymorphonuclear MDSCs. Patients with high levels of polymorphonuclear MDSCs presented with a higher incidence of infectious events. Thus, polymorphonuclear MDSCs were elevated in ESRD patients with strong immune-suppressive capability through a phospho-STAT3/reactive oxygen species pathway. Hence, polymorphonuclear MDSCs might increase the risk of infectious complications.


Asunto(s)
Tolerancia Inmunológica/inmunología , Infecciones/inmunología , Fallo Renal Crónico/inmunología , Células Supresoras de Origen Mieloide/inmunología , Linfocitos T/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Proliferación Celular , Técnicas de Cocultivo , Femenino , Citometría de Flujo , Estudios de Seguimiento , Humanos , Incidencia , Infecciones/epidemiología , Interferón gamma/inmunología , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Masculino , Glicoproteínas de Membrana/metabolismo , Persona de Mediana Edad , Células Supresoras de Origen Mieloide/metabolismo , NADPH Oxidasa 2 , NADPH Oxidasas/metabolismo , Estudios Prospectivos , ARN Mensajero/metabolismo , Especies Reactivas de Oxígeno/metabolismo , Diálisis Renal , Factor de Transcripción STAT3/metabolismo , Linfocitos T/fisiología , Adulto Joven
13.
ScientificWorldJournal ; 2014: 563015, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25101317

RESUMEN

Soil salinity is a global problem, especially in developing countries, which affects the environment and productivity of agriculture areas. Salt has a significant effect on the complex dielectric constant of wet soil. However, there is no suitable model to describe the variation in the backscattering coefficient due to changes in soil salinity content. The purpose of this paper is to use backscattering models to understand behaviors of the backscattering coefficient in saline soils based on the analysis of its dielectric constant. The effects of moisture and salinity on the dielectric constant by combined Dobson mixing model and seawater dielectric constant model are analyzed, and the backscattering coefficient is then simulated using the AIEM. Simultaneously, laboratory measurements were performed on ground samples. The frequency effect of the laboratory results was not the same as the simulated results. The frequency dependence of the ionic conductivity of an electrolyte solution is influenced by the ion's components. Finally, the simulated backscattering coefficients measured from the dielectric constant with the AIEM were analyzed using the extracted backscattering coefficient from the RADARSAT-2 image. The results show that RADARSAT-2 is potentially able to measure soil salinity; however, the mixed pixel problem needs to be more thoroughly considered.


Asunto(s)
Modelos Teóricos , Radar , Suelo/química , Álcalis/química , China , Salinidad
14.
Disaster Med Public Health Prep ; 8(4): 315-25, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25098648

RESUMEN

OBJECTIVE: The aim of this review was to systematically search and critique relevant literature on the potential psychological impact of earthquakes on peripartum women to synthesize existing knowledge for further action. METHODS: A search through 5 databases was conducted for relevant publications in English, and the results were screened through a set of inclusion and exclusion processes. RESULTS: Eight articles were included. Depression and posttraumatic stress disorder were the most often reported mental disorders. Some factors (eg, family relationships and social support) were associated with mental disorders suffered by peripartum women after earthquakes. An assessment of the quality of the studies showed that most did not have high levels of evidence because of their cross-sectional design and limitations. CONCLUSIONS: Among the factors that influenced the mental health of pregnant and postpartum women after earthquakes, family function appears to be one of the most important and deserves further exploration. Other mental health conditions such as minor psychiatric disorders should also be studied for their relationship with disasters and pregnancy. Well-designed studies are needed to enable a better understanding of the relationship between earthquakes and the mental disorders of peripartum women so that the most appropriate interventions can be proposed.


Asunto(s)
Desastres , Terremotos , Relaciones Familiares , Trastornos Mentales/psicología , Periodo Posparto/psicología , Mujeres Embarazadas/psicología , Apoyo Social , Bases de Datos Bibliográficas , Trastorno Depresivo Mayor/etiología , Trastorno Depresivo Mayor/prevención & control , Trastorno Depresivo Mayor/psicología , Femenino , Humanos , Trastornos Mentales/etiología , Trastornos Mentales/prevención & control , Embarazo , Factores Protectores , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/prevención & control , Trastornos por Estrés Postraumático/psicología , Factores de Tiempo
15.
Guang Pu Xue Yu Guang Pu Fen Xi ; 34(12): 3385-90, 2014 Dec.
Artículo en Chino | MEDLINE | ID: mdl-25881444

RESUMEN

The present paper aims to analyze the capabilities and limitations for retrieving vegetation water content from Landsat8 OLI (Operational Land Imager) sensor-new generation of earth observation program. First, the effect of soil background on canopy reflectance and the sensitive band to vegetation water content were analyzed based on simulated dataset from ProSail model. Then, based on vegetation water indices from Landsat8 OLI and field vegetation water content during June 1 2013 to August 14 2013, the best vegetation water index for estimating vegetation water content was found through comparing 12 different indices. The results show that: (1) red, near infrared and two shortwave infrared bands of OLI sensor are sensitive to the change in vegetation water content, and near infrared band is the most sensitive one; (2) At low vegetation coverage, solar radiation reflected by soil background will reach to spectral sensor and influence the relationship between vegetation water index and vegetation water content, and simulation results from ProSail model also show that soil background reflectance has a significant impact on vegetation canopy reflectance in both wet and dry soil conditions, so the optimized soil adjusted vegetation index (OSAVI) was used in this paper to remove the effect of soil background on vegetation water index and improve its relationship with vegetation water content; (3) for the 12 vegetation water indices, the relationship between MSI2 and vegetation water content is the best with the R-square of 0.948 and the average error of vegetation water content is 0.52 kg · m(-2); (4) it is difficult to estimate vegetation water content from vegetation water indices when vegetation water content is larger than 2 kg · m(-2) due to spectral saturation of these indices.


Asunto(s)
Plantas , Imágenes Satelitales , Agua , Suelo
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