Grey water footprint as an indicator for diffuse nitrogen pollution: The case of Navarra, Spain.

Nitrogen is an essential element for plant growth, while its application and associated pollution is a worldwide concern. Generally, diffuse source pollution and its impacts on ecosystem health are difficult to monitor and regulate. Here we used the grey water footprint (GWF) and water pollution level (WPL) indicators, based on a soil nitrogen balance approach to differentiate between surface and groundwater, in order to better understand and quantify the pressure that nitrogen fertilisation generates on freshwater. For the first time, we compared the results of these indicators with actual nitrogen concentration data in surface and groundwater bodies, showing in both cases a positive significant correlation according to Spearman correlation coefficient. This means that the theoretical WPL results might be valuable to anticipate and identify nitrate pollution in surface and groundwater bodies. However, several factors influence the N-related processes that should be considered, such as natural attenuation. We estimated the agricultural and livestock nitrogen loads delivered to freshwater and the associated GWFs and WPLs at the municipality level in Navarra. Large GWFs are observed in southern Navarra, particularly in intensive agricultural regions such as Ribera Alta-Aragón and Ribera Baja. We estimated that 64% of the GWF related to nitrogen loads came from artificial fertilisers, 16% from manure, 11% from atmospheric deposition and the remaining 9% from biological fixation, seeds and other organic fertilisers. Among the crops, cereals had the largest contribution to the nitrogen-related GWF (54%) followed by vegetables (17%) and fodder (11%).

An academic analysis with recommendations for water management and planning at the basin scale: A review of water planning in the Segura River Basin.

Water resources management is particularly challenging in water-scarce basins, where low water availability is combined with a potential water demand exceeding the supply capacity of the natural system. This is the case of the Segura River Basin in south-eastern Spain. This paper aims at analysing the usefulness of incorporating new hydrological data and perspectives to improve the understanding of water availability and management and help promote more integrated water planning in the Segura Basin. In this basin, agriculture amounts to approximately 1366 hm3/year and accounts for 80% of the total blue water use. The forest and agriculture use of soil water amounts to 3065 and 1962 hm3/year, respectively. The unaccounted virtual water trade is also relevant and helps in mitigating water scarcity in the basin. The basin is a net virtual water-exporting region, with an average export of 1598 hm3/year, mainly in the form of fruits and vegetables, and imports approximately 1253 hm3/year, mainly related to feed for pig farms. Virtual water imports are four times larger than the disputed water transfer rate to the Segura Basin from other river basins. Water productivity analyses by sub-sectors are useful in understanding the economic rationale of the basin activities. Two types of agriculture coexist in the basin, namely, intensive industrial agriculture and occupational farming, which maintain the territory and landscape. From a Mediterranean country perspective, the analysis recommends considering climate fluctuations and temporal variability and trends of water availability and use, moving beyond the average values considered in river basin management plans. Groundwater reserve depletion continues to occur at a rate of 231 hm3/year, as water from wells is currently cheaper than using desalinated water in farms, and it does not cause boron-related water quality problems for irrigation. If socially costly administrative measures are not taken, groundwater reserve depletion will continue.

2016 Survey of State-Level Health Resources for Men and Boys: Identification of an Inadvertent and Remediable Service and Health Disparity.

This survey evaluated resources available to men and boys at the state level including state public health departments (SPHDs), other state agencies, and governor's offices. Most of the resources and programs are found in the SPHDs and these administer state-initiated and federally funded health programs to provide services and protection to a broad range of populations; however, many men's health advocates believe that SPHDs have failed to create equivalent services for men and boys, inadvertently creating a health disparity. Men's Health Network conducts a survey of state resources, including those found in SPHDs, every 2 years to identify resources available for men and women, determine the extent of any disparity, and establish a relationship with SPHD officials. Data were obtained from all 50 states and Washington, D.C. An analysis of the 2016 survey data indicates that there are few resources allocated and a lack of readily available information on health and preventive care created specifically for men and boys. The data observed that most health information intended for men and boys was scarce among states or oftentimes included on websites that primarily focused on women's health. A potential result of this is a loss of engagement with appropriate health-care providers due to a lack of information. This study continues to validate the disparity between health outcomes for women and men. It continues to highlight the need for better resource allocation, outreach, and health programs specifically tailored to men and boys in order to improve overall community well-being.

A Call for Gender-Inclusive Global Health Strategies.

The WHO's "Global Strategy for Women's, Children's, and Adolescents' Health 2016-2030" (GS-WCAH 2016-2030) is a comprehensive plan developed to improve the lives of women, children, and adolescents. Due to the success in the creation, ratification, and advocacy of the GS-WCAH 2016-2030, the clear health outcome disparities between males and females, and the general absence of male health from existing policies and sponsored programs, it is time now to develop a global strategy specifically drafted to improve the lives of men and boys. The following commentary provides three points for why a male-oriented program, like the GS-WCAH 2016-2030, should be created: (a) health outcomes disparities, (b) economic impact of poor male health, and (c) fathers' role in promoting the health of women, children, and adolescents. Implications for how male health can be incorporated into future projects and priorities are provided, as well as advocacy for overall gender-inclusivity in regard to global public health efforts.

[National guidelines of diagnosis and treatment of the non-Hodgkin lymphoma]. / Guías nacionales de diagnóstico y tratamiento de linfoma no Hodgkin.

Non-Hodgkin lymphoma comprises a heterogeneous group of haematological malignancies, classified according to their clinic, anatomic-pathological features and, lately, to their molecular biomarkers. Despite the therapeutic advances, nearly half of the patients will die because of this disease. The new diagnostic tools have been the cornerstone to design recent therapy targets, which must be included in the current treatment guidelines of this sort of neoplasms by means of clinical trials and evidence-based medicine. In the face of poor diagnoses devices in most of the Mexican hospitals, we recommend the present diagnose stratification, and treatment guidelines for non-Hodgkin lymphoma, based on evidence. They include the latest and most innovative therapeutic approaches, as well as specific recommendations for hospitals with limited framework and therapy resources.

Molecular characterization of chronic myeloproliferative neoplasias in México.

By using novel molecular markers, it is possible to gain information on both the classification and the pathophysiology of the chronic myeloproliferative neoplasia (MPN). In a group of 36 Mexican mestizo patients with MPN, we studied five molecular markers: The BCR/ABL1 fusion gene, the JAK2 V617F mutation, the JAK2 exon 12 mutations, the MPL W515L mutation and the MPL W515K mutation; 17 patients with essential thrombocythemia (ET), eight with polycythemia vera (PV), four with primary mielofibrosis (MF), five with undifferentiated MPN, one with primary erythrocytosis and one with familial thrombocytosis. Patients with the BCR/ABL1 fusion gene were excluded. Twelve individuals with the JAK2 V617F mutation were found; 11 of them had been clinically classified as PV and one had been classified as MF. One patient with the MPL W515L was identified with a clinical picture of ET. No individuals with either the MPL W515K mutation or the JAK2 exon 12 mutations were identified. Of the 17 individuals with ET, six (35%) had the JAK2 V617F mutation and one (6%) was found to have the MPL W515L mutation. Of the eight individuals with PV, five displayed the JAK2 V617F mutation, whereas of the four patients with MF, one had the JAK2 V617F mutation. The most consistent relationship was that between PV and the JAK2 V617F mutation (p=0.08). In the diagnosis and classification of the MPN, in addition to the newly identified molecular markers, clinical and laboratory data are still very important.

[Clinical and epidemiologic characteristics of dengue cases: the experience of a general hospital in Culiacan, Sinaloa, Mexico]. / Caracterización clínica y epidemiológica de los casos de dengue: experiencia del Hospital General de Culiacán, Sinaloa, México.

OBJECTIVES: To document the clinical and epidemiological characteristics present in dengue patients served by a hospital in Culiacan, Sinaloa, Mexico. METHODS: A cross-sectional, observational, and analytical study was carried out at the Hospital General Dr. Bernardo J. Gastélum de Culiacan from 1 October to 2 December 2003. Associations between the independent variables (the patients' clinical and epidemiological characteristics) and the dependent variable (confirmed hemorrhagic dengue) were determined through simple regression analysis. The variables that were significantly associated (P < 0.05) were submitted to multifactorial logistic regression analysis. RESULTS: Of the only 241 cases that met the study's inclusion criteria (207 dengue and 34 hemorrhagic dengue), the mean age was 34.7 +/- 15.1 years. According to the results of the multifactorial analysis (adjusted by age, sex, and the presence of dengue cases at the geographic location), the variables predictive of major complications of the disease were: the presence of ascites (odds ration [OR] = 22.12; 95% confidence interval [95%CI]: 5.00-97.87), gingivorrhagia (OR = 7.35; 95%CI: 2.11-25.61), hematemesis (OR = 7.40; 95%CI: 1.04-52.42), thrombocytopenia (platelets from 40,001/mm(3)-60,000/mm(3)) (OR = 5.43; 95%CI: 1.58-18.72), conjunctival hyperemia (OR = 4.27; 95%CI: 1.37-13.28), persistent vomiting (OR = 3.04; 95%CI: 1.05-8.80), and the absence of nasal congestion (OR = 0.015; 95%CI: 0.0004-0.473). CONCLUSIONS: The presence of ascites, gingivorrhagia, hematemesis, thrombocytopenia (with platelet values from 40,001/mm(3)-60,000/mm(3)), and persistent vomiting were confirmed as warning signs of an imminent dengue attack. Platelet counts of > 100,000/mm(3) were confirmed in cases with acute clinical symptoms (capillary leak) that were not classified as hemorrhagic dengue due to falling short of the criteria established by WHO.

Caracterización clínica y epidemiológica de los casos de dengue: experiencia del Hospital General de Culiacán, Sinaloa, México / Clinical and epidemiologic characteristics of dengue cases: the experience of a general hospital in Culiacan, Sinaloa, Mexico

OBJETIVO: Documentar las características clínicas y epidemiológicas de los pacientes con dengue atendidos en un hospital de Culiacán, Sinaloa, México. MÉTODOS: Estudio transversal, observacional y analítico realizado en el Hospital General Dr. Bernardo J. Gastélum de Culiacán entre el 1 de octubre y el 2 de diciembre de 2003. Se evaluó la asociación entre las variables independientes (las características clínicas y epidemiológicas de los pacientes) y la variable dependiente (diagnóstico confirmado de dengue hemorrágico) mediante el análisis de regresión simple. Las variables que mostraron una relación significativa (P < 0,05) se incluyeron en el análisis de regresión logística multifactorial. RESULTADOS: En los 241 casos que cumplieron los criterios de inclusión para este estudio (207 de dengue y 34 de dengue hemorrágico), la edad promedio fue de 34,7 ± 15,1 años. Según los resultados del análisis multifactorial ajustado por la edad, el sexo y la presencia de casos de dengue en la localidad, las variables con valor predictivo de una mayor gravedad de la enfermedad fueron: la presencia de ascitis (OR = 22,12; IC95 por ciento: 5,00 a 97,87), la gingivorragia (OR = 7,35; IC95 por ciento: 2,11 a 25,61), la hematemesis (OR = 7,40; IC95 por ciento: 1,04 a 52,42), la trombocitopenia (plaquetas entre 40 001/mm³ y 60 000/mm³) (OR = 5,43; IC95 por ciento: 1,58 a 18,72), la hiperemia conjuntival (OR = 4,27; IC95 por ciento: 1,37 a 13,28), los vómitos persistentes (OR = 3,04; IC95 por ciento: 1,05 a 8,80) y la ausencia de congestión nasal (OR = 0,015; IC95 por ciento: 0,0004 a 0,473). CONCLUSIONES: Se confirmó el valor de la presencia de ascitis, gingivorragia, hematemesis, trombocitopenia (con valores de plaquetas entre 40 001/mm³ y 60 000/mm³) y vómitos persistentes como signos de alarma que anuncian la inminencia del choque por dengue. Se observaron conteos plaquetarios > 100 000/mm3 en casos con cuadros clínicos graves (fuga capilar) que no se...

OBJECTIVES: To document the clinical and epidemiological characteristics present in dengue patients served by a hospital in Culiacan, Sinaloa, Mexico. METHODS: A cross-sectional, observational, and analytical study was carried out at the Hospital General Dr. Bernardo J. Gastélum de Culiacan from 1 October to 2 December 2003. Associations between the independent variables (the patients' clinical and epidemiological characteristics) and the dependent variable (confirmed hemorrhagic dengue) were determined through simple regression analysis. The variables that were significantly associated (P < 0.05) were submitted to multifactorial logistic regression analysis. RESULTS: Of the only 241 cases that met the study's inclusion criteria (207 dengue and 34 hemorrhagic dengue), the mean age was 34.7 ± 15.1 years. According to the results of the multifactorial analysis (adjusted by age, sex, and the presence of dengue cases at the geographic location), the variables predictive of major complications of the disease were: the presence of ascites (odds ration [OR] = 22.12; 95 percent confidence interval [95 percentCI]: 5.00-97.87), gingivorrhagia (OR = 7.35; 95 percentCI: 2.11-25.61), hematemesis (OR = 7.40; 95 percentCI: 1.04-52.42), thrombocytopenia (platelets from 40001/mm³- 60000/mm³) (OR = 5.43; 95 percentCI: 1.58-18.72), conjunctival hyperemia (OR = 4.27; 95 percentCI: 1.37-13.28), persistent vomiting (OR = 3.04; 95 percentCI: 1.05-8.80), and the absence of nasal congestion (OR = 0.015; 95 percentCI: 0.0004-0.473). CONCLUSIONS: The presence of ascites, gingivorrhagia, hematemesis, thrombocytopenia (with platelet values from 40001/mm³-60000/mm³), and persistent vomiting were confirmed as warning signs of an imminent dengue attack. Platelet counts of > 100000/mm3 were confirmed in cases with acute clinical symptoms (capillary leak) that were not classified as hemorrhagic dengue due to falling short of the criteria established by WHO.

Epidemiología de los padecimientos oncohematológicos por mortalidad hospitalaria en Sinaloa / Epidemiology in oncohematologic diseases based upon hospital mortality in Sinaloa

Se revisaron 25,449 muertes hospitalarias en base a certificados de defunción, ocurridas en la Delegación Estatal del Instituto Mexicano del Seguro Social en Sinaloa, de 1980 a 1991. Por cáncer fallecieron 3.115 (12.2 por ciento): del aparato digestivo 3.2 por ciento, respiratorio 2.6 por ciento, genitourinario 2.2 por ciento y hematológico 2.0 por ciento. De las 510 defunciones por padecimientos oncohematológicos, el 62.5 por ciento correspondió a las leucemias, destacando la linfoide aguda, cuya presentación fue más frecuente en el grupo de 5 a 14 años. Los casos de leucemian mieloide aguda fueron la mitad de los de linfoide, igual en uno y otro sexo y en todos los grupos de edad. En cuanto a las leucemias crónicas, la mieloide es dos veces más frecuente que la linfoide, siendo ambos padecimientos de adultos mayores de edad. La leucemia minocítica, la linfocítica crónica y la eritroleucemia son padecimientos poco frecuentes. Los linfomas significaron la quinta parte del total de las defunciones y su tendencia es presentarse en los grupos de mayor edad. La enfermedad de Hodgkin fue un padecimiento encontrado en niños y jóvenes, con una proporción por sexos de tres a uno a favor del masculino. El mieloma múltile predomina en los dos grupos de mayor edad, sin diferencias por sexo. En la mortalidad se ha observado un decremento hasta del 60 por ciento en los padecimientos oncohematológicos, principalmente leucemias y linfomas, probablemente debido a detecciones más oportunas y programas terapéuticos más intensivos, siendo estable por cáncer en general. Se comparan estos hallazgos con otros informes y se elaboran recomendaciones para la programación de actividades asistenciales, educativas y de investigación