Vaccine adherence and adverse events of the SARS-COV vaccine in patients with inflammatory bowel disease.

OBJECTIVE: To assess adherence to and the adverse effects of the SARS-COV vaccine in patients with inflammatory bowel disease (IBD). PATIENTS AND METHODS: This is an observational, analytical, cross-sectional study. Sociodemographic and clinical data, SARS-COV vaccine data, medications for IBD with use during the vaccination period, and adverse events during the vaccination period were collected. Carried out logistic regressions with robust variance estimation to estimate the odds ratio with the respective 95% confidence intervals (95%CI) to assess the factors associated with non-serious adverse effects following vaccine doses as outcome variables. RESULTS: 194 patients participated, with vaccine compliance of 78.3% for three doses of any vaccine (n=152). Local symptoms and mild systemic symptoms predominated, regardless of the type of vaccine. The first dose of the SARS-COV vaccine with AstraZeneca had a higher percentage of patients with vaccine symptoms. AstraZeneca vaccine increased the chance of non-serious adverse effects in IBD patients by 2.65 times (95% CI: 1.38-5.08; p=0.003), regardless of age, gender, physical activity, excess weight, use of disease-modifying drugs, immunobiological and corticosteroids. CoronaVac vaccine was associated with asymptomatic patients at the first dose and reduced the chance of adverse effects by 0.28 times (OR: 0.284; 95%CI: 0.13-0.62; p=0.002). CONCLUSION: Local symptoms and mild systemic symptoms predominated, regardless of the type of vaccine. Using CoronaVac in the first dose reduced the chances of adverse effects, while AstraZeneca increased the risk of adverse effects.

Effects of seagrass restoration on coastal fish abundance and diversity.

Restoration is accelerating to reverse global declines of key habitats and recover lost ecosystem functions, particularly in coastal ecosystems. However, there is high uncertainty about the long-term capacity of restored ecosystems to provide habitat and increase biodiversity and the degree to which these ecosystem services are mediated by spatial and temporal environmental variability. We addressed these gaps by sampling fishes biannually for 5-7 years (2012-2018) at 16 sites inside and outside a rapidly expanding restored seagrass meadow in coastal Virginia (USA). Despite substantial among-year variation in abundance and species composition, seine catches in restored seagrass beds were consistently larger (6.4 times more fish, p < 0.001) and more speciose (2.6 times greater species richness, p < 0.001; 3.1 times greater Hill-Shannon diversity, p = 0.03) than seine catches in adjacent unvegetated areas. Catches were particularly larger during summer than autumn (p < 0.01). Structural equation modeling revealed that depth and water residence time interacted to control seagrass presence, leading to higher fish abundance and richness in shallow, well-flushed areas that supported seagrass. Together, our results indicate that seagrass restoration yields large and consistent benefits for many coastal fishes, but that restoration and its benefits are sensitive to the dynamic seascapes in which restoration is conducted. Consideration of how seascape-scale environmental variability affects the success of habitat restoration and subsequent ecosystem function will improve restoration outcomes and the provisioning of ecosystem services.

Efectos de la restauración de pastos marinos sobre la abundancia y diversidad de peces costeros Resumen La restauración ecológica está acelerándose para revertir la declinación mundial de hábitats importantes y para recuperar las funciones ambientales perdidas, particularmente en los ecosistemas costeros. Sin embargo, hay una gran incertidumbre en cuanto a la capacidad a largo plazo que tienen los ecosistemas restaurados de proporcionar hábitats e incrementar la biodiversidad y el grado al que estos servicios ambientales están mediados por la variabilidad ambiental espacial y temporal. Abordamos estos vacíos mediante el muestreo bianual de peces durante 5-7 años (2012-2018) en 16 sitios dentro y fuera de una pradera restaurada de pastos marinos con expansión acelerada en la costa de Virginia (E.U.A.). A pesar de la variación sustancial anual en abundancia y composición de especies, la captura de cerco en los lechos de pastos marinos restaurados fue mayor (6.4 veces más peces, p< 0.001) y con más especies (2.6 veces mayor riqueza de especies, p< 0.001; 3.1 veces mayor diversidad Hill-Shannon, p= 0.03) que la captura de cerco en las áreas aledañas sin vegetación. En particular, las capturas fueron mayores durante el verano que durante el otoño (p < 0.01). Los modelos de ecuaciones estructurales revelaron que la profundidad y el tiempo de residencia acuática interactúan para controlar la presencia de los pastos marinos, lo que resulta en una mayor abundancia y riqueza de peces en áreas someras con buena circulación que fomentan los pastos marinos. En conjunto, nuestros resultados indican que la restauración de los pastos marinos produce grandes beneficios constantes para muchos peces costeros, pero también que la restauración y sus beneficios son sensibles a la dinámica marina en la que se realiza la restauración. Si se considera cómo la variabilidad ambiental a escala de paisaje afecta el éxito de la restauración del hábitat y la función ambiental subsecuente, entonces mejorarán los resultados de restauración y el suministro de servicios ambientales.

A roadmap for ladybird conservation and recovery.

Ladybirds (Coleoptera: Coccinellidae) provide services that are critical to food production, and they fulfill an ecological role as a food source for predators. The richness, abundance, and distribution of ladybirds, however, are compromised by many anthropogenic threats. Meanwhile, a lack of knowledge of the conservation status of most species and the factors driving their population dynamics hinders the development and implementation of conservation strategies for ladybirds. We conducted a review of the literature on the ecology, diversity, and conservation of ladybirds to identify their key ecological threats. Ladybird populations are most affected by climate factors, landscape composition, and biological invasions. We suggest mitigating actions for ladybird conservation and recovery. Short-term actions include citizen science programs and education, protective measures for habitat recovery and threatened species, prevention of the introduction of non-native species, and the maintenance and restoration of natural areas and landscape heterogeneity. Mid-term actions involve the analysis of data from monitoring programs and insect collections to disentangle the effect of different threats to ladybird populations, understand habitat use by taxa on which there is limited knowledge, and quantify temporal trends of abundance, diversity, and biomass along a management-intensity gradient. Long-term actions include the development of a worldwide monitoring program based on standardized sampling to fill data gaps, increase explanatory power, streamline analyses, and facilitate global collaborations.

Las catarinas (Coleoptera: Coccinellidae) proporcionan servicios que son críticos para la producción de alimento, y juegan un papel ecológico como fuente de alimento para depredadores. Sin embargo, la riqueza, abundancia y distribución de catarinas están en peligro debido a muchas amenazas antropogénicas. La carencia de conocimiento sobre el estatus de conservación de la mayoría de las especies y los factores que inciden en su dinámica poblacional dificulta el desarrollo e implementación de estrategias de conservación para las catarinas. Realizamos una revisión de la literatura sobre la ecología, diversidad y conservación de catarinas para identificar sus amenazas ecológicas clave. Las poblaciones de catarinas fueron afectadas mayormente por factores climáticos, composición del paisaje e invasiones biológicas. Proponemos acciones de mitigación para la conservación y recuperación de catarinas. Acciones a corto plazo incluyen programas de ciencia y educación ciudadana, medidas de protección para la recuperación de hábitat y de especies amenazadas, prevención de la introducción de especies no nativas y el mantenimiento y restauración de áreas naturales y la heterogeneidad del paisaje. Acciones a mediano plazo implican el análisis de datos obtenidos de programas de monitoreo y colecciones de insectos para desenmarañar el efecto de las diferentes amenazas a las poblaciones de catarinas, comprender el uso del hábitat por taxa de los que se tiene conocimiento limitado y cuantifica las tendencias temporales de la abundancia, diversidad y biomasa a lo largo de un gradiente de intensidad de manejo. Acciones a largo plazo incluyen el desarrollo de un programa de monitoreo a nivel mundial basado en muestreos estandarizados para subsanar la falta de datos, incrementar el poder explicativo, optimizar los análisis y facilitar colaboraciones globales.

Effects of different management strategies on long-term trends of Australian threatened and near-threatened mammals.

Monitoring is critical to assess management effectiveness, but broadscale systematic assessments of monitoring to evaluate and improve recovery efforts are lacking. We compiled 1808 time series from 71 threatened and near-threatened terrestrial and volant mammal species and subspecies in Australia (48% of all threatened mammal taxa) to compare relative trends of populations subject to different management strategies. We adapted the Living Planet Index to develop the Threatened Species Index for Australian Mammals and track aggregate trends for all sampled threatened mammal populations and for small (<35 g), medium (35-5500 g), and large mammals (>5500 g) from 2000 to 2017. Unmanaged populations (42 taxa) declined by 63% on average; unmanaged small mammals exhibited the greatest declines (96%). Populations of 17 taxa in havens (islands and fenced areas that excluded or eliminated introduced red foxes [Vulpes vulpes] and domestic cats [Felis catus]) increased by 680%. Outside havens, populations undergoing sustained predator baiting initially declined by 75% but subsequently increased to 47% of their abundance in 2000. At sites where predators were not excluded or baited but other actions (e.g., fire management, introduced herbivore control) occurred, populations of small and medium mammals declined faster, but large mammals declined more slowly, than unmanaged populations. Only 13% of taxa had data for both unmanaged and managed populations; index comparisons for this subset showed that taxa with populations increasing inside havens declined outside havens but taxa with populations subject to predator baiting outside havens declined more slowly than populations with no management and then increased, whereas unmanaged populations continued to decline. More comprehensive and improved monitoring (particularly encompassing poorly represented management actions and taxonomic groups like bats and small mammals) is required to understand whether and where management has worked. Improved implementation of management for threats other than predation is critical to recover Australia's threatened mammals.

Efectos de diferentes estrategias de manejo sobre las tendencias a largo plazo de los mamíferos amenazados y casi amenazados de Australia Resumen El monitoreo es fundamental para evaluar la efectividad del manejo, aunque faltan evaluaciones sistemáticas y a gran escala de este monitoreo para evaluar y mejorar los esfuerzos de recuperación. Compilamos 1,808 series temporales de 71 especies y subespecies de mamíferos terrestres y voladores amenazadas y casi amenazadas en Australia (48% de todos los taxones de mamíferos amenazados) para comparar las tendencias relativas de las poblaciones sujetas a diferentes estrategias de manejo. Adaptamos el Índice Planeta Vivo para desarrollar el Índice de Especies Amenazadas para los Mamíferos Australianos y así rastrear las tendencias agregadas de todas las poblaciones muestreadas de mamíferos amenazados y de los mamíferos pequeños (<35 g), medianos (35-5,500 g) y grandes (>5,500 g) entre 2000 y 2017. Las poblaciones sin manejo (42 taxones) declinaron en un 63% en promedio; los mamíferos pequeños sin manejo exhibieron las declinaciones más marcadas (96%). Las poblaciones de 17 taxones incrementaron 680% en los refugios (islas o áreas encercadas que excluían o eliminaban al zorro rojo [Vulpes vulpes] y al gato doméstico [Felis catus], especies introducidas) Afuera de los refugios, las poblaciones sometidas al cebado constante de los depredadores en un inicio declinaron en un 75% pero después incrementaron al 47% de su abundancia para el 2000. En los sitios en donde los depredadores no fueron excluidos o cebados sino sometidos a otras acciones (manejo del fuego, control de herbívoros introducidos), las poblaciones de los mamíferos pequeños y medianos declinaron más rápido, pero los mamíferos grandes declinaron de manera más lenta que las poblaciones sin manejo. Sólo el 13% de los taxones contaron con datos para sus poblaciones con y sin manejo; las comparaciones entre índices para este subconjunto mostraron que los taxones con poblaciones en incremento dentro de los refugios declinaron afuera de éstos, pero los taxones con poblaciones sujetas al cebado de depredadores afuera de los refugios declinaron más lentamente que las poblaciones sin manejo y después incrementaron, mientras que las poblaciones sin manejo continuaron su declinación. Se requiere un monitoreo más completo y mejorado (particularmente el que engloba las acciones de manejo mal representadas y los grupos taxonómicos como los murciélagos y los mamíferos pequeños) para entender si ha funcionado el manejo y en dónde. La implementación mejorada del manejo para las amenazas distintas a la depredación es fundamental para recuperar a los mamíferos amenazados de Australia.

Prognostic risk factors in 113 patients undergoing cephalic duodenopancreatectomy for distal cholangiocarcinoma. / Factores de mal pronóstico en 113 pacientes sometidos a duodenopancreatectomía cefálica por colangiocarcinoma distal.

INTRODUCTION: Distal cholangiocarcinoma is a malignant epithelial neoplasia that affects the extrahepatic bile ducts, below the cystic duct. No relevant relationship between perioperative factors and worse long-term outcome has been proved. OBJECTIVE: To analyze the risk factors for mortality and long-term recurrence of distal cholangiocarcinoma in resected patients. MATERIALS AND METHODS: A single-center prospective database of patients operated on for distal cholangiocarcinoma between 1990 and 2021 was analyzed in order to investigate mortality and recurrence factors. RESULTS: One hundred and thirteen patients have undergone surgery, with mean actuarial survival of 100.2 (76-124) months after resection. The bivariate study did not show differences between patients depending on age or preoperative variables studied. When multivariate analysis was performed, the presence of affected adenopathy was a risk factor for long-term mortality. The presence of affected lymph nodes, tumor recurrence, and biliary fistula during the postoperative period implied worse actuarial survival when comparing the Kaplan-Meier curves. CONCLUSIONS: The presence of affected lymph nodes influence the prognosis of the disease. The occurrence of biliary fistula during postoperative cholangiocarcinoma distal could aggravate long-term outcomes, a finding that should be reaffirmed in future studies.

Impact of multiple small and persistent threats on extinction risk.

Many species may face multiple distinct and persistent drivers of extinction risk, yet theoretical and empirical studies tend to focus on the single largest driver. This means that existing approaches potentially underestimate and mischaracterize future risks to biodiversity. We synthesized existing knowledge on how multiple drivers of extinction can interact to influence a species' overall extinction probability in a probabilistic model of extinction risk that incorporated the impacts of multiple drivers of extinction risk, their interactions, and their accumulative effects through time. We then used this model framework to explore how different threats, interactions between them, and time trends may affect a species' overall extinction probability. Multiple small threats together had potential to pose a large cumulative extinction risk; for example, 10 individual threats posed a 1% extinction risk each and cumulatively posed a 9.7% total extinction risk. Interactions among drivers resulted in escalated risk in some cases, and persistent threats with a small (1%) extinction risk each decade ultimately posed large extinction risk over 100 (9.6% total extinction risk) to 200 years (18.2% total extinction risk). By estimating long-term extinction risk posed by several different factors and their interactions, this approach provides a framework to identify drivers of extinction risk that could be proactively targeted to help prevent species currently of least concern from becoming threatened with extinction.

Muchas especies pueden enfrentarse a múltiples impulsores distintivos y persistentes del riesgo de extinción, aunque los estudios teóricos y empíricos tienden a enfocarse en el impulsor más relevante. Esto significa que las estrategias existentes tienen el potencial de subestimar y caracterizar erróneamente los riesgos para la biodiversidad en el futuro. Sintetizamos el conocimiento existente sobre cómo los múltiples impulsores de la extinción pueden interactuar para influir sobre la probabilidad general de extinción de una especie en un modelo probabilístico del riesgo de extinción, el cual incorporó los impactos de los múltiples impulsores del riesgo de extinción, sus interacciones y sus efectos acumulativos a través del tiempo. Después usamos este modelo para explorar cómo las diferentes amenazas, las interacciones entre ellas y las tendencias temporales pueden afectar la probabilidad general de extinción de una especie. El conjunto de múltiples amenazas pequeñas tuvo el potencial de representar un gran riesgo de extinción acumulativo; por ejemplo, cada una de diez amenazas individuales representó 1% de riesgo de extinción, y acumuladas representaron un riesgo total de extinción de 9.7%. Las interacciones entre los impulsores resultaron en un riesgo escalado en algunos casos, y las amenazas persistentes con un riesgo pequeño (1%) de extinción durante cada década al final representaron un gran riesgo de extinción después de 100 (9.6% del riesgo total de extinción) y 200 años (18.2% del riesgo total de extinción). Mediante la estimación del riesgo de extinción a largo plazo que presentan los diferentes factores y sus interacciones, esta estrategia proporciona un marco para identificar los impulsores del riesgo de extinción que podrían focalizarse proactivamente para ayudar a prevenir que las especies que actualmente están en menor riesgo se conviertan en especies amenazadas.

Longitudinal impact of caregiver transition and family caregiving on psychiatric symptoms and psychosocial functioning among persons with schizophrenia in rural China.

This study examines the 21-year longitudinal impacts and predictive effects of family caregiver transition and the presence of family caregiving on the clinical status of persons with schizophrenia (PwSs) in a rural area of China. Using panel data derived from the Chengdu Mental Health Project (CMHP), 250 dyads of PwSs and their family caregivers were investigated in 1994 and 2015. The Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) were utilized. The generalized linear model (GLM) approach was used. The results of this study showed that more severe symptoms in PwSs were found to be significantly predicted by older age and nonmarried status at baseline. Compared with "spousal caregiving in two waves," the PANSS score was significantly higher in the "transition into sibling caregiving" group. A higher degree of psychosocial functioning was found to be significantly predicted by marital status, shorter duration of illness, and better mental status. Compared with "spousal caregiving in two waves," the GAF score was significantly lower in the "transition into parental caregiving" group. The presence of family caregiving was not a significant predictor of the severity of symptoms or psychosocial functioning in the PwSs. In conclusion, this study shows the 21-year predictive effects of family caregiver transition on the mental status of PwSs but not the presence of family caregiving. Psychosocial interventions and specific guidance should be provided to family caregivers to enhance their quality of caregiving and improve the prognosis of PwSs during long periods of home care.

En este estudio se analizan los efectos longitudinales a 21 años y los efectos pronósticos de la transición de los cuidadores familiares y la presencia de cuidado familiar en el estado clínico de las personas con esquizofrenia en un área rural de China. Utilizando datos de panel extraídos del Proyecto de salud mental de Chengdu (Chengdu Mental Health Project, CMHP), se investigaron 250 díadas de personas con esquizofrenia y sus cuidadores familiares en 1994 y 2015. Se utilizó la Escala de síndrome positivo y negativo (Positive and Negative Syndrome Scale, PANSS) y la Evaluación global del funcionamiento (Global Assessment of Functioning, GAF). También se utilizó el método de modelo lineal generalizado. Los resultados de este estudio demostraron que los síntomas más intensos en las personas con esquizofrenia fueron pronosticados principalmente por la edad avanzada y el estado de soltería en el momento basal. En comparación con el grupo de "cuidado de los cónyuges en dos intervalos", el puntaje de la PANSS fue considerablemente más alto en el grupo de "transición al cuidado de los hermanos". Se descubrió que principalmente el estado civil, la duración más corta de la enfermedad y un mejor estado mental pronosticaron un grado más alto de funcionamiento psicosocial. En comparación con el grupo de "cuidado de los cónyuges en dos intervalos", el puntaje de la GAF fue considerablemente más bajo en el grupo de "transición al cuidado de los padres". La presencia de cuidado familiar no fue un factor pronóstico importante de la intensidad de los síntomas ni del funcionamiento psicosocial en las personas con esquizofrenia. En resumen, en este estudio se muestran los efectos pronósticos a 21 años de la transición de los cuidadores familiares en el estado mental de las personas con esquizofrenia, pero no la presencia de cuidado familiar. Deben ofrecerse intervenciones psicosociales y orientación específica a los cuidadores familiares para mejorar su calidad de cuidado y mejorar el pronóstico de las personas con esquizofrenia durante los periodos prolongados de cuidado en el hogar.

[Patient safety in nursing homes. The experience of the Autonomous Community of the Region of Murcia]. / La seguridad del paciente en las residencias sociosanitarias. La experiencia de la Comunidad Autónoma de la Región de Murcia.

The pandemic has exposed the vulnerability of residential centers and the fragility of the population that lives there. In the Region of Murcia, care for this population group became a priority and a regional plan was drawn up to attend the needs of residents from the ethical framework of procedural justice. The immediacy imposed by the health crisis has meant that all this intervention is not without risks. Based on the Reason model, we have carried out a root cause analysis of the contributing factors that led the nursing homes to suffer a devastating impact, categorizing the security failures at three levels: infection control, social health environment and health-clinical environment. The pandemic has shown the urgency of strengthening the care model that we offer to our elders. A model that guarantees the coverage of the needs of extremely fragile patients that go beyond health and biomedical care and that considers their preferences and values.

COVID-19 and long-term care facilities in Mexico: a debt that cannot be postponed.

Since the emergence of the COVID-19 pandemic, the most affected population group has been that of older people living in long-term care facilities (LTCFs), which has accumulated between 30 and 60 % of total number of deaths in the world. In Mexico, outbreaks have been reported in LTCFs of at least eight states. Various factors make this population group and LTCFs susceptible to COVID-1 outbreaks, mainly due to coexistence in common spaces, shared bedrooms and permanent physical contact with the personnel who work there, coupled with a lack of protocols and standards of care of mandatory observance, as well as personnel training limitations. There is evidence of the need to formally develop a National Care System that provides support to those in need of care and their families, and that includes LTCFs. In view of the challenges due to the lack of information and competencies in infection prevention and control at LTCFs, a group of experts, in collaboration with different public institutions, joined efforts with the purpose to update the guidelines in order to allow LTCFs face the pandemic and to contribute to the generation of said National Care System.

Ante la pandemia de COVID-19, el grupo más afectado ha sido el de las personas mayores que viven en instituciones de cuidados a largo plazo (ICLP), el cual ha acumulado entre 30 y 60 % de los fallecimientos en el mundo. En México se han reportado brotes en residencias de por lo menos ocho entidades federativas. Diversos factores hacen susceptibles a este grupo y a las ICLP: la convivencia en lugares comunes, dormitorios compartidos y el contacto físico con el personal que ahí labora, aunado a la falta de protocolos y estándares de cuidados de observancia obligatoria, así como a la escasa capacitación del personal. Se evidencia la necesidad de desarrollar un Sistema Nacional de Cuidados que brinde apoyo a las personas dependientes de cuidados y sus familias y que incluya a las ICLP. Derivado de los retos por la carencia de información y competencias en prevención y control de infecciones en las ICLP, un conjunto de expertos, en colaboración con instituciones públicas, integramos un grupo con el objetivo de actualizar las guías que permitan a las ICLP hacer frente a la pandemia y que contribuyan a la generación de ese Sistema Nacional de Cuidados.

Complex and nonlinear climate-driven changes in freshwater insect communities over 42 years.

The ongoing biodiversity crisis becomes evident in the widely observed decline in abundance and diversity of species, profound changes in community structure, and shifts in species' phenology. Insects are among the most affected groups, with documented decreases in abundance up to 76% in the last 25-30 years in some terrestrial ecosystems. Identifying the underlying drivers is a major obstacle as most ecosystems are affected by multiple stressors simultaneously and in situ measurements of environmental variables are often missing. In our study, we investigated a headwater stream belonging to the most common stream type in Germany located in a nature reserve with no major anthropogenic impacts except climate change. We used the most comprehensive quantitative long-term data set on aquatic insects available, which includes weekly measurements of species-level insect abundance, daily water temperature and stream discharge as well as measurements of additional physicochemical variables for a 42-year period (1969-2010). Overall, water temperature increased by 1.88 °C and discharge patterns changed significantly. These changes were accompanied by an 81.6% decline in insect abundance, but an increase in richness (+8.5%), Shannon diversity (+22.7%), evenness (+22.4%), and interannual turnover (+34%). Moreover, the community's trophic structure and phenology changed: the duration of emergence increased by 15.2 days, whereas the peak of emergence moved 13.4 days earlier. Additionally, we observed short-term fluctuations (<5 years) in almost all metrics as well as complex and nonlinear responses of the community toward climate change that would have been missed by simply using snapshot data or shorter time series. Our results indicate that climate change has already altered biotic communities severely even in protected areas, where no other interacting stressors (pollution, habitat fragmentation, etc.) are present. This is a striking example of the scientific value of comprehensive long-term data in capturing the complex responses of communities toward climate change.

Cambios Complejos y No Lineales Causados por el Clima en Comunidades de Insectos de Agua Dulce durante 42 Años Resumen La continua crisis de la biodiversidad se vuelve evidente en la ampliamente documentada declinación en la abundancia y diversidad de especies, cambios profundos en la estructura de las comunidades y modificaciones en la fenología de las especies. Los insectos se encuentran entre los grupos más afectados; se han documentado reducciones en la abundancia de hasta el 76% en los últimos 25-30 años en algunos ecosistemas terrestres. La identificación de los causantes subyacentes es un gran obstáculo porque la mayoría de los ecosistemas están afectados por varios factores estresantes simultáneamente y con frecuencia faltan las medidas in situ de las variables ambientales. Investigamos un flujo naciente perteneciente al tipo de arroyo más común en Alemania ubicado dentro de una reserva natural sin impactos antropogénicos importantes a excepción del cambio climático. Usamos el conjunto más completo disponible de datos cuantitativos de largo plazo para insectos acuáticos que incluye las medidas semanales de abundancia de insectos a nivel especie, las medidas diarias de la temperatura del agua y la descarga del flujo y las medidas de variables físico-químicas adicionales durante 42 años (1969 - 2010). En general, la temperatura del agua incrementó 1.88°C y los patrones de descarga cambiaron significativamente. Estos cambios estuvieron acompañados por una declinación del 81.6% en la abundancia de insectos, pero también de un incremento en la riqueza (+8.5%), la diversidad Shannon (+22.7%), la uniformidad (+22.4%) y la renovación interanual (+34%). Además, la estructura trófica y la fenología de la comunidad cambiaron: la duración del surgimiento incrementó en 15.2 días y el pico del surgimiento ocurrió con 13.4 días de anticipación. Observamos fluctuaciones a corto plazo (<5 años) en casi todas las medidas, así como respuestas complejas y no lineales de la comunidad hacia el cambio climático que podrían haber sido ignoradas si sólo se usaran datos instantáneos o series de tiempo más cortas. Nuestros resultados indican que el cambio climático ya ha alterado seriamente a las comunidades bióticas, incluso en áreas protegidas en las que no están presentes otros factores estresantes en interacción (contaminación, fragmentación del hábitat, etc.). Ésto es un ejemplo notable del valor científico que tienen los datos completos de escalas de tiempo a largo plazo para la captura de las respuestas complejas de las comunidades ante el cambio climático.

Effect of in-hospital glycemic variability on mortality in patients with diabetes. / Efecto de la variabilidad glucémica intrahospitalaria en la mortalidad de los pacientes con diabetes.

INTRODUCTION: The aim of this study was to evaluate the impact of mean blood glucose (MBG) and glycaemic variability (GV) during hospitalisation on mortality after discharge. MATERIAL AND METHODS: We conducted a retrospective longitudinal analytical cohort study that included patients discharged form a department of internal medicine with a diabetes-related diagnosis The evaluated prognosis was mortality. During hospitalisation, the patients' clinical, laboratory and glycaemic control-related variables were recorded (MBG, GV and hypoglycaemia). The GV was measured with the coefficient of variation (CV). We calculated the mortality rates for every 1000 patient-years and compared them with Kaplan-Meier curves. We determined the predictors of mortality by performing a Cox regression. RESULTS: The study included 276 patients with a mean age of 77.6 (SD, 10.2) years. The median outpatient follow-up duration was 2.7 years. In the multivariate analysis, an MBG >140mg/dl (HR, 1.72; 95% CI 1.14-2.61; p=.01) and a CV >0.29 (HR, 1.52; 95% CI 1.12-2.06; p=.006) but not the presence of hypoglycaemia were additively and independently associated with an increased risk of mortality. An MBG >140mg/dl with a CV >0.29 increased the mortality rates (123 vs. 317 per 1000 patient-year; p <.001) and the adjusted mortality risk (HR, 2.70; 95% CI 1.71-4.27; p<.001) compared with having an MBG ≤140mg/dl. CONCLUSION: The simultaneous presence of a high MBG level and CV constitutes a powerful tool for stratifying mortality risk after hospital discharge.

Changes in bird-migration patterns associated with human-induced mortality.

Many bird populations have recently changed their migratory behavior in response to alterations of the environment. We collected data over 16 years on male Great Bustards (Otis tarda), a species showing a partial migratory pattern (sedentary and migratory birds coexisting in the same breeding groups). We conducted population counts and radio tracked 180 individuals to examine differences in survival rates between migratory and sedentary individuals and evaluate possible effects of these differences on the migratory pattern of the population. Overall, 65% of individuals migrated and 35% did not. The average distance between breeding and postbreeding areas of migrant individuals was 89.9 km, and the longest average movement of sedentary males was 3.8 km. Breeding group and migration distance had no effect on survival. However, mortality of migrants was 2.4 to 3.5 times higher than mortality of sedentary birds. For marked males, collision with power lines was the main cause of death from unnatural causes (37.6% of all deaths), and migratory birds died in collisions with power lines more frequently than sedentary birds (21.3% vs 6.3%). The percentage of sedentary individuals increased from 17% in 1997 to 45% in 2012. These results were consistent with data collected from radio-tracked individuals: The proportion of migratory individuals decreased from 86% in 1997-1999 to 44% in 2006-2010. The observed decrease in the migratory tendency was not related to climatic changes (temperatures did not change over the study period) or improvements in habitat quality (dry cereal farmland area decreased in the main study area). Our findings suggest that human-induced mortality during migration may be an important factor shaping the migration patterns of species inhabiting humanized landscapes.

[Prevalence study of the genetic markers associated with slow progression of human inmunodefiency virus type 1 in the Galician population (Northwest of Spain)]. / Estudio de la prevalencia de marcadores genéticos asociados a la lenta progresión del virus de la inmunodeficiencia humana tipo 1 en la población gallega.

INTRODUCTION: The deletion in the CCR5 gene (CCR5Δ32), the HLA-B*27:05, and polymorphisms rs2395029 and rs9264942 have been associated with slower progression of HIV-1. METHODS: An analysis was performed on 408 patients on follow-up. The analysis of viral load, CD4+ Tlymphocytes and other clinical variables since the diagnosis of the infection were collected. RESULTS: The prevalence of the genetic markers rs9264942, CCR5wt/Δ32, rs2395029, HLA-B*27:05 was 17.9%, 11.5%, 7.6%, and 6.4%, respectively. Of all the patients, 354 were classified as progressors and 46 as long-term non-progressors (LTNPs). Except for the HLA-B*27:05 allele, other genetic markers were associated with slower progression: CCR5wt/Δ32 (P=.011) and SNPs rs2395029 and rs9264942 (P<.0001), as well as their association (P<.0001). CONCLUSION: The prevalence of the HLA-B*57:01 allele was higher than described nationally. No association could be found between the HLA-B*27:05 allele and the presence of slower disease progression.

Results of short term radiotherapy followed by radical surgery for rectal cancer: A long-term unicenter observational study. / Resultados de la radioterapia de ciclo corto seguida de cirugía radical en el cáncer de recto: estudio unicéntrico y observacional a largo plazo.

INTRODUCTION: Short-term radiotherapy (STR) for rectal cancer (RC) has rarely been used in Spain. The aim of the present study is to describe oncological results after RTC and surgery for RC. METHODS: This is a retrospective analysis of a consecutive series of patients treated with STR and surgery for RC (1999-2012). Epidemiological data, staging, complications of STR, STR-surgery interval, surgical approach, rate of anastomotic/perineal wound dehiscence, and pathological data (regression degree and staging) were collected. Global survival, disease free survival, local recurrence rate and incidence of toxicity, response and complications of combined treatment are reported. RESULTS: Of 1229 patients treated, 209 patients received STR and surgery. The median follow-up was 6.2 years. Mean age was 68 years and 66% of the patients were men. A total of 88% were cT3-4 and 44% cN+17 (8.1%) patients had resectable synchronous metastases. Acute and chronic toxicity due to STR was <5%. In 75% of the cases the STR-surgery interval was <15 days, and in 9%> 4 weeks. Seven patients (3.3%) presented complete response. Nine (4.3%) patients presented an local recurrence rate. Global survival at 5, 10 and 15 years was 67.8, 49.2 and 37.5%, respectively. Disease free survival at 5, 10 and 15 years was 66.1, 47.1 and 33%, respectively. CONCLUSIONS: The results compare favorably with multicentric historical series. STR offers certain advantages that could be increased by increasing the STR-surgery interval and/or interspersed with sequential chemotherapy.

Adherence clubs for long-term provision of antiretroviral therapy: cost-effectiveness and access analysis from Khayelitsha, South Africa.

OBJECTIVES: As the scale of the South African HIV epidemic calls for innovative models of care that improve accessibility for patients while overcoming chronic human resource shortages, we (i) assess the cost-effectiveness of lay health worker-led group adherence clubs, in comparison with a nurse-driven 'standard of care' and (ii) describe and evaluate the associated patient cost and accessibility differences. METHODS: Our cost-effectiveness analysis compares an 'adherence club' innovation to conventional nurse-driven care within a busy primary healthcare setting in Khayelitsha, South Africa. In each alternative, we calculate provider costs and estimate rates of retention in care and viral suppression as key measures of programme effectiveness. All results are presented on an annual or per patient-year basis. In the same setting, a smaller sample of patients was interviewed to understand the direct and indirect non-healthcare cost and access implications of the alternatives. Access was measured using McIntyre and colleagues' 2009 framework. RESULTS: Adherence clubs were the more cost-effective model of care, with a cost per patient-year of $300 vs. $374 and retention in care at 1 year of 98.03% (95% CI 97.67-98.33) for clubs vs. 95.49% (95% CI 95.01-95.94) for standard of care. Viral suppression in clubs was 99.06% (95% CI 98.82-99.27) for clubs vs. 97.20% (95% CI 96.81-97.56) for standard of care. When interviewed, club patients reported fewer missed visits, shorter waiting times and higher acceptability of services compared to standard of care. CONCLUSIONS: Adherence clubs offer the potential to enhance healthcare efficiency and patient accessibility. Their scale-up should be supported.

Structural synaptic plasticity in the hippocampus induced by spatial experience and its implications in information processing. / Plasticidad sináptica estructural en el hipocampo inducida por la experiencia espacial y sus implicaciones en el procesamiento de información.

INTRODUCTION: Long-lasting memory formation requires that groups of neurons processing new information develop the ability to reproduce the patterns of neural activity acquired by experience. DEVELOPMENT: Changes in synaptic efficiency let neurons organise to form ensembles that repeat certain activity patterns again and again. Among other changes in synaptic plasticity, structural modifications tend to be long-lasting which suggests that they underlie long-term memory. There is a large body of evidence supporting that experience promotes changes in the synaptic structure, particularly in the hippocampus. CONCLUSION: Structural changes to the hippocampus may be functionally implicated in stabilising acquired memories and encoding new information.

Mortality and functional status at one-year of follow-up in elderly patients with prolonged ICU stay. / Mortalidad y estado funcional al año de pacientes ancianos con ingreso prolongado en una unidad de cuidados intensivos.

OBJECTIVE: To evaluate mortality and functional status at one year of follow-up in patients>75 years of age who survive Intensive Care Unit (ICU) admission of over 14 days. DESIGN: A prospective observational study was carried out. SETTING: A Spanish medical-surgical ICU. PATIENTS: Patients over 75 years of age admitted to the ICU. PRIMARY VARIABLES OF INTEREST: ICU admission: demographic data, baseline functional status (Barthel index), baseline mental status (Red Cross scale of mental incapacity), severity of illness (APACHE II and SOFA), stay and mortality. One-year follow-up: hospital stay and mortality, functional and mental status, and one-year follow-up mortality. RESULTS: A total of 176 patients were included, of which 22 had a stay of over 14 days. Patients with prolonged stay did not show more ICU mortality than those with a shorter stay in the ICU (40.9% vs 25.3% respectively, P=.12), although their hospital (63.6% vs 33.8%, P<.01) and one-year follow-up mortality were higher (68.2% vs 41.2%, P=.02). Among the survivors, one-year mortality proved similar (87.5% vs 90.6%, P=.57). These patients presented significantly greater impairment of functional status at hospital discharge than the patients with a shorter ICU stay, and this difference persisted after three months. The levels of independence at one-year follow-up were never similar to baseline. No such findings were observed in relation to mental status. CONCLUSIONS: Patients over 75 years of age with a ICU stay of more than 14 days have high hospital and one-year follow-up mortality. Patients who survive to hospital admission did not show greater mortality, though their functional dependency was greater.

Inferring the nature of anthropogenic threats from long-term abundance records.

Diagnosing the processes that threaten species persistence is critical for recovery planning and risk forecasting. Dominant threats are typically inferred by experts on the basis of a patchwork of informal methods. Transparent, quantitative diagnostic tools would contribute much-needed consistency, objectivity, and rigor to the process of diagnosing anthropogenic threats. Long-term census records, available for an increasingly large and diverse set of taxa, may exhibit characteristic signatures of specific threatening processes and thereby provide information for threat diagnosis. We developed a flexible Bayesian framework for diagnosing threats on the basis of long-term census records and diverse ancillary sources of information. We tested this framework with simulated data from artificial populations subjected to varying degrees of exploitation and habitat loss and several real-world abundance time series for which threatening processes are relatively well understood: bluefin tuna (Thunnus maccoyii) and Atlantic cod (Gadus morhua) (exploitation) and Red Grouse (Lagopus lagopus scotica) and Eurasian Skylark (Alauda arvensis) (habitat loss). Our method correctly identified the process driving population decline for over 90% of time series simulated under moderate to severe threat scenarios. Successful identification of threats approached 100% for severe exploitation and habitat loss scenarios. Our method identified threats less successfully when threatening processes were weak and when populations were simultaneously affected by multiple threats. Our method selected the presumed true threat model for all real-world case studies, although results were somewhat ambiguous in the case of the Eurasian Skylark. In the latter case, incorporation of an ancillary source of information (records of land-use change) increased the weight assigned to the presumed true model from 70% to 92%, illustrating the value of the proposed framework in bringing diverse sources of information into a common rigorous framework. Ultimately, our framework may greatly assist conservation organizations in documenting threatening processes and planning species recovery.

Declines in migrant shorebird populations from a winter-quarter perspective.

Many long-distance migrating shorebird (i.e., sandpipers, plovers, flamingos, oystercatchers) populations are declining. Although regular shorebird monitoring programs exist worldwide, most estimates of shorebird population trends and sizes are poor or nonexistent. We built a state-space model to estimate shorebird population trends. Compared with more commonly used methods of trend estimation, state-space models are more mechanistic, allow for the separation of observation and state process, and can easily accommodate multivariate time series and nonlinear trends. We fitted the model to count data collected from 1990 to 2013 on 18 common shorebirds at the 2 largest coastal wetlands in southern Africa, Sandwich Harbour (a relatively pristine bay) and Walvis Bay (an international harbor), Namibia. Four of the 12 long-distance migrant species declined since 1990: Ruddy Turnstone (Arenaria interpres), Little Stint (Calidris minuta), Common Ringed Plover (Charadrius hiaticula), and Red Knot (Calidris canutus). Populations of resident species and short-distance migrants increased or were stable. Similar patterns at a key South African wetland suggest that shorebird populations migrating to southern Africa are declining in line with the global decline, but local conditions in southern Africa's largest wetlands are not contributing to these declines. State-space models provide estimates of population levels and trends and could be used widely to improve the current state of water bird estimates.

[Epidemiology and long-term outcome of sepsis in elderly patients]. / Epidemiología y pronóstico tardío de la sepsis en ancianos.

OBJECTIVES: A study was made of the epidemiological data of sepsis requiring admission to the ICU in patients over 65 years of age, with an evaluation of independent predictors of survival at 2 years. DESIGN: A prospective cohort study was made. PATIENTS: Patients meeting criteria for sepsis upon admission to the ICU. SETTING: A 40-bed ICU in a tertiary hospital. RESULTS: The study group included 237 elderly patients (≥ 65 years of age) and 281 controls (<65 years of age) (n=518). At least one chronic comorbid condition was present in 70% of the elderly patients as compared to only 56.1% of patients under age 65 (P<.01). There were several epidemiological differences between the groups: the prevalence of chronic diseases (diabetes, chronic obstructive pulmonary disease, and chronic heart failure), presentation as septic shock (52.3% vs 42%; P<.05), and the abdomen as the source of sepsis (52% vs 36%; P<.01) were all more frequent in elderly patients. Nine percent of the global patients discharged from hospital died in the 2-year follow-up period, but this rate reached 20% among the elderly. Independent predictors of 2-year mortality in the elderly were: chronic heart failure (adjusted hazard ratio [aHR] 2.24, 95% confidence interval [CI 95%] 1.28-3.94; P<.01), acute renal failure (aHR 3.64, 95%CI 2.10-6.23; P<.01), acute respiratory failure (aHR 3.67, 95%CI 2.31-5.86; P<.01), and inappropriate empirical antimicrobial therapy (aHR 2.19, 95%CI 1.32-3.62; P<.01). CONCLUSIONS: Sepsis showed different demographic characteristics and clinical presentations in the elderly. In the aging cohort, after adjusting for potential confounders, inadequate empirical antimicrobial therapy was associated to a 2-fold decrease in survival at two years.