Escuchando a los abuelos: transdisciplina, aves y gente para cultivar la memoria biocultural / Listening to elders: transdisciplinarity, birds and people to cultivate biocultural memory / Ouvindo os avós: transdisciplina, pássaros e pessoas para cultivar a memória biocultural

Resumen (analítico) Presentamos una iniciativa y proponemos una metodología transdisciplinaria para cultivar la memoria biocultural, basada en los procesos de participación y materialización en comunidades de práctica (educativas). Presentamos el proyecto «Escuchando a los abuelos¼, que buscó facilitar diálogos intergeneracionales en tres escuelas mapuche (~ 90 niños y niñas) en Wallmapu, Chile. «Escuchando a los abuelos¼ utilizó a las aves como protagonistas de narrativas locales sobre el territorio. Cocreamos un ciclo de cinco pasos para promover la participación y la materialización. Los niños y niñas desarrollaron un ejercicio de abstracción para dar significado a las narrativas que ellos mismos recopilaron para crear memes positivos sobre las aves. Estos memes fueron comunicados dentro y más allá de sus comunidades. Concluimos que la experiencia de los abuelos debe ser honrada para contrarrestar la actual extinción de la experiencia biocultural.

Abstract (analytical) This article presents an initiative and proposes a transdisciplinary methodology to cultivate biocultural memory based on the processes of participation and materialization in (educational) communities-of-practice. We implemented the project "Listening to elders" that sought to facilitate intergenerational dialogues in three mapuche schools (with approximately 90 children) in Wallmapu, Chile. Listening to elders used birds as the basis of constructing local narratives about the territory. We co-created a 5-Step cycle to promote participation and materialization. The children participated in an abstraction exercise to give meaning to the narratives they constructed themselves to create positive memes involving birds. These memes were communicated within and beyond their communities. The authors conclude that the experiences of elders must be honored in communities to counter the current dynamic involving the extinction of biocultural experience.

Resumo (analítico) Apresentamos uma iniciativa e propomos uma metodologia transdisciplinar para o cultivo da memória biocultural, baseada nos processos de participação e materialização, em comunidades de prática (educacionais). Apresentamos o projeto «Escutando os avós¼ que buscou facilitar o diálogo intergeracional em três escolas mapuche (~ 90 crianças) em Wallmapu, Chile. «Ouvir os avós¼ usou os pássaros como base para as narrativas locais sobre o território. Co-criamos um ciclo de cinco passos para promover a participação e materialização. As crianças desenvolveram um exercício de abstração para dar sentido às narrativas que elas próprias coletaram para criar memes positivos sobre pássaros. Esses memes foram comunicados dentro e fora de suas comunidades. Concluímos que a experiência dos avós deve ser honrada para conter a atual extinção da experiência biocultural.

Association between serum calcium levels and the presentation of postpartum endometritis in housed dairy cows.

The present work aims to identify the minimum threshold of serum calcium (SC) values in cows during the first week postpartum and evaluate their relationship with the presentation of endometritis in housed dairy cows. In this prospective longitudinal observational study, 467 cows from 3 farms in Lima-Peru were studied. Blood samples were collected from cows during the first week postpartum. Endometritis was diagnosed on day 35 ± 3 days postpartum by evaluation of vaginal discharge samples. The samples were obtained using the MetricheckTM device (Simcro, New Zealand). Two cut-off points were used to diagnose endometritis: a) endometritis metricheck score ≥ 3, and b) endometritis metricheck score ≥ 2. In the univariate model that considers a SC threshold of 5.25 to 8.75 mg/dL (1.31 to 2.18 mmol/L), a significant relationship (p < 0.05) was found for endometritis metricheck score ≥ 3, while no significant relationship was found (p = 0.12) with endometritis metricheck score ≥ 2. In both cases, the optimal SC threshold for the appearance of endometritis was determined to be a value ≥7.0 mg/dL (≥1.75 mmol/L). In the logistic regression models (parity, calving season, calcium level, and their interaction), only two variables were retained, parity and calcium level (p < 0.10). It was found that the probability of having endometritis metricheck score ≥ 3 was 1.9 (95% CI: 1.1 to 3.1), whereas the probability of having endometritis metricheck score ≥ 2 was 1.5 (95% CI: 1.0 to 2.5) in cows with calcium levels <7.0 mg/dL (<1.75 mmol/L). In conclusion, cows with calcium levels <7.0 mg/dL (<1.75 mmol/L) have a 1.9-fold greater risk of developing endometritis metricheck score ≥ 3 in the first week postpartum.

Comparison across 12 countries on knowledge, attitude, and behavior scores about medication errors in Intensive Care Units: an international study.

OBJECTIVE: The aim of the study was to explore the degree of agreement of intensive care unit nurses working on a set of medication error preventive strategies and to examine possible predictors of nurses' knowledge, attitude and behavior. MATERIALS AND METHODS: Observational, international, and cross-sectional study. Iran, Malta, Spain, Pakistan, Nepal, Qatar, Ecuador, Australia, Finland, Italy, Egypt, and Jordan were the countries included in this survey. To collect data, the Knowledge, Attitude and Behavior in Medication Errors questionnaire was used. A descriptive statistical analysis was performed for the socio-demographic characteristics of the sample and three multiple logistic regressions were performed. RESULTS: The international sample consists of 1383 nurses, of whom 478 (34.6%) were men and 900 (65.1%) were women and their mean age was 35.61 years with a range of 19-61. Descriptive statistics conducted on the international sample show a medium to high degree of agreement among participants concerning some preventive strategies of medication error. In addition, the results of the present study show a strong relationship between positive nurses' attitudes and correct behaviors and/or adequate knowledge, as well as between adequate knowledge and correct behaviors (p< 0.01). CONCLUSIONS: Further studies are needed to explore the issue of medication error concerning nurses' cultural backgrounds, as well as to assess similarities and disparities among international nurses.

Vulnerability to climate change of a microendemic lizard species from the central Andes.

Given the rapid loss of biodiversity as consequence of climate change, greater knowledge of ecophysiological and natural history traits are crucial to determine which environmental factors induce stress and drive the decline of threatened species. Liolaemus montanezi (Liolaemidae), a xeric-adapted lizard occurring only in a small geographic range in west-central Argentina, constitutes an excellent model for studies on the threats of climate change on such microendemic species. We describe field data on activity patterns, use of microhabitat, behavioral thermoregulation, and physiology to produce species distribution models (SDMs) based on climate and ecophysiological data. Liolaemus montanezi inhabits a thermally harsh environment which remarkably impacts their activity and thermoregulation. The species shows a daily bimodal pattern of activity and mostly occupies shaded microenvironments. Although the individuals thermoregulate at body temperatures below their thermal preference they avoid high-temperature microenvironments probably to avoid overheating. The population currently persists because of the important role of the habitat physiognomy and not because of niche tracking, seemingly prevented by major rivers that form boundaries of their geographic range. We found evidence of habitat opportunities in the current range and adjacent areas that will likely remain suitable to the year 2070, reinforcing the relevance of the river floodplain for the species' avoidance of extinction.

Embarazo en enfermedad inflamatoria intestinal: no solo 9 meses de cuidado

The prevalence of inflammatory bowel disease (IBD) increased in the last decades. Thus, the number of pregnant women with the condition is also increasing. Given that active disease itself is the main risk factor for complications during pregnancy, it is necessary to achieve a complete remission before planning a pregnancy. Also, pregnant women with IBD must be monitored noninvasively and be treated proactively, including escalated therapies, if needed, to prevent potential flares during pregnancy. Patients can undergo vaginal delivery in most forms of IBD. However, cesarean delivery is still preferable in women with a history of ileal pouch-anal anastomoses (IPAA) or active perianal disease.

Recomendaciones para el manejo de pacientes con enfermedad Inflamatoria Intestinal (EII) y COVID-19 / Recommendations for the management of patients with Inflammatory Bowel Disease (IBS) and COVID-19

The new Coronavirus (SARS-CoV-2) appeared in China in December 2019. Since then and until April 2020 it spread worldwide affecting more than three million people. Its exponential rise is still growing all over the world, taking thousands of lives. SARS-CoV-2 is very contagious, person to person, by droplets which can generate a respiratory infection known as COVID-19. Some patients are at higher risk: Older people, those with cardiovascular disease, diabetes and hypertension are the most prone to an unfavorable outcome. Our Inflammatory Bowel Disease (IBD) patients are a special cluster, with many of them taking immunosuppressive treatment for long periods, which could pose an important risk. Scientifics societies all over the world have joined efforts to generate data, share experiences and make recommendations for good clinical management. This is a review of the available evidence, expert opinion, and proposed ways of working during the pandemic

El nuevo coronavirus (SARS-CoV-2) apareció en China en diciembre de 2019. Desde su inicio hasta abril de 2020 se ha expandido por todo el mundo, afectando a más de tres millones de personas. Su ascenso exponencial sigue creciendo, generando miles de muertes. Su contagiosidad es persona a persona por gotitas, pudiendo llegar a generar un cuadro clínico de infección respiratoria conocido como COVID-19. Algunos pacientes tienen más riesgos de tener un curso desfavorable; adultos mayores, pacientes con enfermedad cardiovascular, hipertensos y diabéticos. Nuestros pacientes con enfermedad inflamatoria intestinal son un grupo de pacientes con características particulares, muchos de ellos reciben tratamiento inmunosupresor por largos períodos, lo que pudiese suponer un riesgo específico. Las sociedades científicas de Europa y Norteamérica han realizado un esfuerzo conjunto para generar datos, compartir experiencias y dictar recomendaciones de buen manejo clínico. Esta es una revisión de la evidencia disponible, opiniones de expertos y formas de trabajo propuestos durante la pandemia.

[Inflammatory bowel disease during pregnancy]. / Embarazo en enfermedad inflamatoria intestinal: no solo 9 meses de cuidado.

The prevalence of inflammatory bowel disease (IBD) increased in the last decades. Thus, the number of pregnant women with the condition is also increasing. Given that active disease itself is the main risk factor for complications during pregnancy, it is necessary to achieve a complete remission before planning a pregnancy. Also, pregnant women with IBD must be monitored noninvasively and be treated proactively, including escalated therapies, if needed, to prevent potential flares during pregnancy. Patients can undergo vaginal delivery in most forms of IBD. However, cesarean delivery is still preferable in women with a history of ileal pouch-anal anastomoses (IPAA) or active perianal disease.

Investigation on Sb distribution for InSb/InAs sub-monolayer heterostructure using TEM techniques.

InSb/InAs sub-monolayer (SML) nanostructures such as SML quantum dots offer sharper emission spectra, a better modal gain and a larger modulation bandwidth compared to its Stranski-Krastanov counterpart. In this work, the Sb distribution of SML InSb layers grown by migration enhanced epitaxy has been analyzed by transmission electron microscopy (TEM) techniques. The analysis of the material by diffraction contrast in 002 dark field conditions and by atomic column resolved high angle annular dark field-scanning TEM reveal the presence of a low Sb content InSbAs continuous layer with scarce Sb-rich InSbAs agglomerates. The intensity profiles obtained by both techniques point to Sb segregation during growth. This segregation has been quantified using the Muraki segregation model obtaining a high segregation coefficient R of 0.81 towards the growth direction. The formation of a continuous InSbAs wetting layer as a result of a SML deposition of Sb on the InAs surface is discussed.

Effect of the cap layer growth temperature on the Sb distribution in InAs/InSb/InAs sub-monolayer heterostructures for mid-infrared devices.

Sub-monolayer (SML) deposition of InSb within InAs matrix by migration enhanced epitaxy tends to form type II SML nanostructures offering efficient light emission within the mid-infrared (MIR) range between 3 and 5 µm. In this work, we report on the Sb distribution in InSb/InAs SML nanostructures with InAs cap layers grown at temperatures lower than that associated with the under-grown InSb active layer. Analysis by transmission electron microscopy (TEM) in 002 dark field conditions shows that the reduction in the growth temperature of the InAs cap layer increases the amount of Sb deposited in the layers, in good agreement with the x-ray diffraction results. TEM micrographs also show that the layers are formed by random InSbAs agglomerates, where the lower cap temperature leads to a more continuous InSb layer. Quantitative atomic column resolved high angle annular dark field-scanning (S)TEM analyses also reveal atomic columns with larger composition of Sb for the structure with the lowest InAs cap layer temperature. The dependence of the Sb distribution on InAs cap growth temperature allows tuning the corresponding emission wavelength in the MIR range, as shown by the photoluminescence emission spectra.

Do people care about pine invasions? Visitor perceptions and willingness to pay for pine control in a protected area.

Tree invasions are increasing globally, causing major problems for biodiversity, ecosystem services and human well-being. In South America, conifer invasions occur across many ecosystems and while numerous studies address the ecological consequences of these invasions, little is known about social perceptions and people's attitudes toward their control. The social perceptions on the effect of invasive conifers can include recreational, cultural and conservation dimensions. This study, conducted in the Malalcahuello National Reserve, aims to assess visitor's perception about invasive pines (Pinus spp.) and their effects on the endangered Araucaria araucana forests and determine their willingness to pay for pine control. We used a questionnaire to survey visitors to the reserve in both winter and summer (n = 138 for each season). When confronted with six images of araucaria and pine forests with and without snow, visitors consistently preferred landscapes without pines and disliked those completely dominated by pines the most. Almost half, 46.5%, of the visitors expressed their willingness to pay (WTP) for pine control and after given a brief explanation about pine impacts, this number rose to 79%. Visitors who said they were unwilling to pay argue ethical, aesthetic and pragmatic considerations relating closely to a number of social value systems and beliefs. Our study shows that there is a high variation in how people assess the threat of invasive pine species in natural areas, but education even in a very brief format can help to increase awareness of the problem and build social and financial support for its control.

Enfermedad de Crohn fistulizante perianal, manejo médico-quirúrgico / Fistulizing perianal Crohn’s Disease, medical and surgical management

Crohn’s disease (CD) and ulcerative colitis (UC) are immunologically mediated chronic digestive diseases, with a trend to progressive damage, which generally have an onset at young age and a course characterized by remission and relapse. Its incidence and prevalence present a steady upward trend globally. CD is characterized by transmural inflammation in the digestive tract and it is a complex disease. The perianal involvement –“p”, abscesses or perianal fistulas– is considered a condition that is different from penetrating phenotype, a condition that indicates an aggressive behavior of CD. Early identification and proper treatment of fistulas, including correct diagnosis and classification are essential elements to establish an appropriate treatment plan. A multidisciplinary approach is essential including medical and surgical approach.

La Enfermedad de Crohn (EC) y la colitis ulcerosa (CU) son enfermedades digestivas crónicas, progresivas, mediadas inmunológicamente, que en general, tienen un inicio durante la edad adulta-joven y un curso que se caracteriza por remisión y recaída. Su incidencia y prevalencia ha presentado una tendencia constante de incremento a nivel global. La EC se caracteriza por comprimo transmural del tracto digestivo y por ser una patología compleja. El compromiso perianal –“p”, abscesos o fístulas perianales– se considera una condición diferente al fenotipo penetrante, señalándose en la actualidad como una variable modificadora del comportamiento de la patología y de gravedad. La identificación dirigida y precoz de trayectos fistulosos, su correcto diagnóstico y clasificación son elementos primordiales para poder establecer un plan terapéutico apropiado. Es imprescindible un abordaje multidisciplinario, en el cual exista integración médico-quirúrgica.

Clarifying values, risk perceptions, and attitudes to resolve or avoid social conflicts in invasive species management.

Decision makers and researchers recognize the need to effectively confront the social dimensions and conflicts inherent to invasive species research and management. Yet, despite numerous contentious situations that have arisen, no systematic evaluation of the literature has examined the commonalities in the patterns and types of these emergent social issues. Using social and ecological keywords, we reviewed trends in the social dimensions of invasive species research and management and the sources and potential solutions to problems and conflicts that arise around invasive species. We integrated components of cognitive hierarchy theory and risk perceptions theory to provide a conceptual framework to identify, distinguish, and provide understanding of the driving factors underlying disputes associated with invasive species. In the ISI Web of Science database, we found 15,915 peer-reviewed publications on biological invasions, 124 of which included social dimensions of this phenomenon. Of these 124, 28 studies described specific contentious situations. Social approaches to biological invasions have emerged largely in the last decade and have focused on both environmental social sciences and resource management. Despite being distributed in a range of journals, these 124 articles were concentrated mostly in ecology and conservation-oriented outlets. We found that conflicts surrounding invasive species arose based largely on differences in value systems and to a lesser extent stakeholder and decision maker's risk perceptions. To confront or avoid such situations, we suggest integrating the plurality of environmental values into invasive species research and management via structured decision making techniques, which enhance effective risk communication that promotes trust and confidence between stakeholders and decision makers.

Náuseas y vómitos: evaluación y manejo / Nausea and vomiting: assessment and management

Vomiting is a reflex action of motor and autonomous responses, resulting in violent expulsion of gastric contents through the mouth, triggered by humoral and neural stimuli. It must be distinguished from regurgitation or gagging. Nausea, on the other hand, is a subjective uncomfortable feeling that most people have experienced and is generally described as an imminent need to vomit, felt in the epigastrium and throat. These can be symptoms of a series of pathologies, and represent a reason for frequent consultation at emergency health care units. Both acute and chronic occurrence must be assessed carefully to identify its etiological agent in order to administer proper treatment focused on the symptoms. Nausea and vomiting during pregnancy, after chemotherapy, and cyclic vomiting syndrome will be further developed. In addition, nausea and vomiting treatment in the emergency room is reviewed.

El vómito es un reflejo coordinado de respuestas motoras y autonómicas que resulta en la expulsión violenta del contenido gástrico por la boca, activado por estímulos humorales o neuronales. Debe distinguirse de regurgitación o arcadas. La náusea, por otro lado, es una sensación subjetiva desagradable que la mayoría de las personas han experimentado en algún momento de su vida y, por lo general, reconocen como una sensación de inminente vómito, en el epigastrio o garganta. Son un síntoma de una pléyade de diversas patologías, y corresponde a un motivo de consulta frecuente en servicios de urgencia. Tanto su presentación aguda, como crónica deben ser evaluadas en forma integral de modo de identificar la etiología y poder brindar un tratamiento, tanto sintomático como dirigido. Las náuseas y vómitos en el embarazo, en relación a quimioterapia, y el síndrome de vómito cíclico serán abordados en profundidad. Del mismo modo se realiza una revisión del tratamiento de náuseas y vómitos indiferenciados, en el servicio de urgencia.

Influence of land use and climate on the load of suspended solids in catchments of Andean rivers.

Understanding the interaction between anthropogenic land use and the rainfall pattern can be crucial to predict changes in total suspended solids (TSS) in streams and rivers. We assessed the effects of land use and annual rainfall on the TSS load of 19 southern Chilean catchments. The results indicated that the concentration of TSS increased in catchments with a rainy regime and greater annual precipitation. TSS load also increased as the surface of open areas increased at the catchment scale and decreased with increasing cover of glaciers and perennial snow. However, we did not find support for models with interaction terms between climate and land use. Results suggest that a regional decrease in annual rainfall accompanied by an increase in the altitude of the zero isotherms, as predicted by climate models, should have multiple effects on TSS. In particular, increased TSS load can be expected from a contraction of glaciers and perennial snow areas as well as the intensification of new crops and urban expansion.

Aspectos relevantes en la realización de la endoscopia digestiva: propuestas basadas en la evidencia. Curso ACHED 2013 / Relevant aspects of digestive endoscopy. Evidence-based suggestions. Chilean Association of Digestive Endoscopy (ACHED), Course 2013

Digestive endoscopy is a complex tool for diagnosis and treatment, with continuous development both in technical aspects and in their application for the different pathologies where this technique is required. Therefore, a continuous education program is necessary for the practitioner using this technique. With the purpose of reaching an agreement between different aspects of the performance of these procedures and also generating proposals for its application that are useful for the physicians of this area of expertise, during 2013 the Chilean Association of Digestive Endoscopy (ACHED) developed a workshop called ‘Relevant aspects of digestive endoscopy. Evidence-based suggestions’. This workshop was attended by gastroenterologists and trainee practitioners, who worked in groups during a period of two months where they reviewed available evidence to answer several questions relating to milestones and lesions that need to be described in upper gastrointestinal endoscopy, the preparation of the GI endoscopy report, technical aspects and quality measures in colonoscopy. This review resulted in proposals that were analyzed and agreed on in the form of recommendations presented for further analysis and discussion amongst endoscopic teams in our country.

La endoscopia digestiva es una herramienta de diagnóstico y tratamiento médico compleja, en continuo desarrollo tanto en lo técnico como en los conceptos de manejo de las patologías en las que se utiliza.Por lo tanto, es deseable una estrategia de formación continua del profesional que la realiza. Con el objetivode consensuar diferentes aspectos en la realización de estos procedimientos y generar propuestas de manejoque sean de utilidad para todos los médicos involucrados en esta especialidad, la Asociación Chilenade Endoscopia Digestiva (ACHED) realizó durante el año 2013 un curso taller denominado “Aspectosrelevantes en la realización de la endoscopia digestiva. Propuestas basadas en la evidencia”. Este cursoconvocó a gastroenterólogos y médicos en formación de la especialidad que conformaron grupos de trabajoque durante 2 meses revisaron la evidencia disponible para responder diversas preguntas en relación a los hitos y lesiones a describir en endoscopia digestiva alta (EDA), la realización del informe en EDA, aspectos técnicos y medidores de calidad en colonoscopia. La revisión les permitió generar propuestas que fuerondiscutidas y consensuadas en recomendaciones que se proponen para su discusión por los equipos endoscópicos de nuestro país.

Manejo de la colitis ulcerosa grave: experiencia a partir de un hospital ministerial / Management of severe ulcerative colitis: experience from a national health service hospital

Introduction: Ulcerative colitis (UC) may present, or evolve as severe crisis. Although guidelines have defined its management and timing in decision-making, this has not been implemented at national level. Objective: To describe the clinical characteristics and management of patients with severe UC in our hospital. Patients and Methods: Retrospective review of medical records of 116 patients with inflammatory bowel disease during the period 1975-2012. Of 97 patients with UC, 21 patients with at least one severe crisis were identified. Results: The median age among patients with UC crisis was 34 years (17-43). Ten patients debuted with severe crisis. Eleven were in maintenance treatment, all with 5-aminosalicylates (5- ASA), eight with systemic steroids and five with immunomodulators. During the crisis, colonoscopy was performed to 13 patients, 11 with extensive involvement and two left colitis. All patients received steroids and 5-ASA, 14 antibiotics, and seven immunomodulators. No patient received medical rescue therapy (cyclosporine/biological therapy). Nine patients required surgery, two due to toxic megacolon and seven due to intravenous-steroid refractory episode. Five patients received parenteral nutrition and six were hospitalized in the critical patients unit. The range of stay in the hospital was 9-51 days. Conclusions: In this study, a significant percentage of patients with CU presented a severe crisis without having a standardized management. It is necessary to establish a consensus for the multidisciplinary management of severe UC. No patient had access to cyclosporine/biological therapy, more than 40 percent of the cases required surgery. These therapeutic strategies should be incorporated into the therapeutic arsenal in hospitals.

La colitis ulcerosa (CU) puede debutar, o evolucionar, como crisis grave. Aunque guías han definido su manejo y temporalidad en la toma de decisiones,esto no ha sido masificado a nivel nacional. Objetivo: Describir las características clínicas y manejo de pacientes con CU grave en nuestro centro. Pacientes y Métodos: Revisión retrospectiva de fichas clínicas de 116 pacientes con enfermedad inflamatoria intestinal, durante el período 1975-2012. De 97 pacientes con CU se identifican 21 pacientes con al menos una crisis grave. Resultados: La mediana de edad en la crisis fue 34 años (17-43). Diez pacientes debutaron con crisis grave. Once estaban en tratamiento de mantención, todos con 5-aminosalicilatos (5-ASA), ocho con esteroides sistémicos y cinco con inmunomoduladores. Durante la crisis, se realizó colonoscopia a 13 pacientes, 11 con compromiso extenso y dos con colitis izquierda. Todos recibieron esteroides y 5-ASA, 14 antibióticos y siete inmunomoduladores. Ningún paciente recibió terapia médica de rescate (ciclosporina/terapia biológica). Nueve pacientes requirieron cirugía, dos por megacolon tóxico y siete por cortico-refractariedad. Cinco pacientes recibieron nutrición parenteral y seis fueron hospitalizados en una Unidad de Pacientes Críticos. El rango de estadía hospitalaria fue de 9-51 días. Conclusiones: En este estudio un porcentaje importante de los pacientes con CU presentó una crisis grave, sin tener un manejo estandarizado. Es necesario establecer un consenso para el manejo multidisciplinario de la CU grave. Ningún paciente tuvo acceso a ciclosporina/ terapia biológica, requiriendo cirugía más de 40 por ciento de los casos. Estas estrategias terapéuticas deben ser incorporadas al arsenal terapéutico hospitalario.

Household model of Chagas disease vectors (Hemiptera: Reduviidae) considering domestic, peridomestic, and sylvatic vector populations.

ABSTRACT Disease transmission is difficult to model because most vectors and hosts have different generation times. Chagas disease is such a situation, where insect vectors have 1-2 generations annually and mammalian hosts, including humans, can live for decades. The hemataphagous triatominae vectors (Hemiptera: Reduviidae) of the causative parasite Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae) usually feed on sleeping hosts, making vector infestation of houses, peridomestic areas, and wild animal burrows a central factor in transmission. Because of difficulties with different generation times, we developed a model considering the dwelling as the unit of infection, changing the dynamics from an indirect to a direct transmission model. In some regions, vectors only infest houses; in others, they infest corrals; and in some regions, they also infest wild animal burrows. We examined the effect of sylvatic and peridomestic vector populations on household infestation rates. Both sylvatic and peridomestic vectors increase house infestation rates, sylvatic much more than peridomestic, as measured by the reproductive number R0. The efficacy of manipulating parameters in the model to control vector populations was examined. When R0 > 1, the number of infested houses increases. The presence of sylvatic vectors increases R0 by at least an order of magnitude. When there are no sylvatic vectors, spraying rate is the most influential parameter. Spraying rate is relatively unimportant when there are sylvatic vectors; in this case, community size, especially the ratio of houses to sylvatic burrows, is most important. The application of this modeling approach to other parasites and enhancements of the model are discussed.

Estudio y tratamiento de los abscesos hepáticos / Study and treatment of liver abscesses

Liver abscess is an unusual but potentially lethal disease. We should be especially cautious in patients diagnosed with biliary pathology or immunosuppression, with right upper quadrant pain, fever or jaundice. The study should include images, cultures and serology for Entamoeba histolytica in certain scenarios. The treatment of pyogenic liver abscess is based on prolonged antibiotic therapy and usually in the drainage of the collection, which can be percutaneous, open or endoscopic. In case of amoebic liver abscesses, drug treatment -in two phases- achieve the parasitic removal at tissue and luminal levels, keeping the drain choice for larger abscesses.

El absceso hepático es una patología poco prevalente pero potencialmente letal. Se debe tener una alta sospecha en pacientes con patología de la vía biliar o inmunosupresión, que presenten dolor en hipocondrio derecho, fiebre o ictericia. El estudio debe incluir imágenes, cultivos y eventualmente serología para Entamoeba histolytica en determinados escenarios. El tratamiento de los abscesos hepáticos piógenos se basa en antibioterapia prolongada y habitualmente en el drenaje de la colección, el cuál puede ser percutáneo, abierto o endoscópico. En el caso de los abscesos hepáticos amebianos el tratamiento farmacológico, en dos fases, logra la eliminación parasitaria a nivel tisular y luminal, reservando el drenaje para los de gran tamaño.

Prevalence of childhood obesity in Spain: National Health Survey 2006-2007.

INTRODUCTION: Childhood Obesity has become a Public Health priority due to it high prevalence and consequences in health status. OBJECTIVE: To estimate prevalence of obesity in the children included in the National Health Survey of 2006-2007 and to determine its association with socioeconomic position and other socio-demographic variables. METHODS: Cross-sectional study using data available from 6,139 Spanish children between 2-15 years old, included in the National Health Survey. Parents or guardians reported weight and height to estimate obesity prevalence according to the International Obesity Task Force cut-offs for body mass index. RESULTS: Obesity prevalence was 10,3% and overweight prevalence was 18,8%. Obesity was more prevalent in children from 4-5 years age (18,3%) and overweight in the 8-9 years stratus (25,5%). Overweight was more frequent in boys than girls (19,8% versus 17,8%; p = 0,04). Canary Islands, Ceuta and Melilla, Valencia and Andalusia were the Autonomous Communities with higher obesity prevalence in contrast with the Basque Country, Galicia and Madrid which showed the lowest prevalence. This distribution generates a north to south gradient in obesity prevalence. Both, obesity and overweight showed an inverse association with socioeconomic position (p < 0,05). CONCLUSION: Childhood obesity rates in Spain accounts from ones of the highest in Europe, with a strong geographic and socioeconomic gradient. Priority should be given to effective interventions that can reach the most vulnerable groups as identified in this study, like restrictions on TV food advertising and tax reliefs to promote healthy eating.

Prevalence of childhood obesity in Spain; National Health Survey 2006-2007 / Prevalencia de obesidad infantil en España; Encuesta Nacional de Salud 2006-2007

Introduction: Childhood Obesity has become a Public Health priority due to it high prevalence and consequences in health status. Objective: To estimate prevalence of obesity in the children included in the National Health Survey of 2006-2007and to determine its association with socioeconomic position and other socio-demographic variables. Methods: Cross-sectional study using data available from 6,139 Spanish children between 2-15 years old, Included in the National Health Survey. Parents or guardians reported weight and height to estimate obesity prevalence according to the International Obesity Task Force cut-offs for body mass index. Results: Obesity prevalence was 10,3% and overweight prevalence was 18,8%. Obesity was more prevalent in children from 4-5 years age (18,3%) and overweight in the 8-9 years stratus (25,5%). Overweight was more frequent in boys than girls (19,8% versus 17,8%; p = 0,04).Canary Islands, Ceuta and Melilla, Valencia and Andalusia were the Autonomous Communities with higher obesity prevalence in contrast with the Basque Country, Galicia and Madrid which showed the lowest prevalence. This distribution generates a north to south gradient in obesity prevalence. Both, obesity and overweight showed an inverse association with socioeconomic position (p < 0,05). Conclusion: Childhood obesity rates in Spain accounts from ones of the highest in Europe, with a strong geographic and socioeconomic gradient. Priority should be given to effective interventions that can reach the most vulnerable groups as identified in this study, like restrictions on TV food advertising and tax reliefs to promote healthy eating (AU)

Introducción: La obesidad infantil constituye una prioridad de Salud Pública dada su elevada prevalencia y sus consecuencias en la salud. Objetivo: Estimar la prevalencia de obesidad en los niños incluidos en la Encuesta Nacional de Salud de 2006-2007 y determinar su asociación con la posición socioeconómica y otras variables socio-demográficas. Métodos: Estudio transversal que recogió datos secundarios de la Encuesta Nacional de Salud, contando con una muestra representativa de 6.139 niños españoles de 2-15 años de edad. Se utilizó peso y talla reportados por los padres o tutores para estimar la prevalencia de obesidad según los puntos de corte para el índice de masa corporal recomendados por la International Obesity Task Force. Resultados: La prevalencia de obesidad fue de 10,3% y de sobrepeso de 18,8%. La obesidad fue más prevalente en los niños de 4-5 años (18,3%) y el sobrepeso en niños de8-9 años (25,5%). El sobrepeso fue más frecuente en niños que en niñas (19,8% versus 17,8%; p = 0,04). Canarias, Ceuta y Melilla, Valencia y Andalucía fueron las Comunidades Autónomas con mayor prevalencia de obesidad encontraste con el País Vasco, Galicia y Madrid que presentaron las más bajas, generándose un gradiente norte-sur en la prevalencia de obesidad. Tanto la obesidad como el sobrepeso presentaron una asociación lineal inversa con la posición socioeconómica (p < 0,05).Conclusión: La prevalencia de obesidad infantil en España se sitúa entre las más altas de Europa y presenta importantes variaciones regionales y en función de factores socioeconómicos que deberían tenerse en cuenta para priorizar intervenciones dirigidas a los grupos más vulnerables, como restricciones a la publicidad alimentaria y exenciones de impuestos para promover una alimentación saludable (AU)