Evolution of water governance systems in agriculture in developing countries and proposals for improvement. The case of the Hermosillo Coast, Mexico.

This paper aims to study the determinants of the governance model of water resources in the agriculture of the Hermosillo-Coast (Mexico). To achieve this objective, a literature review, in-depth interviews and a workshop were carried out. The results show that the main threats to the system come from the model of granting concessions for access to water resources, the lack of supervision by the competent authority and the control of a group of stakeholders over water in relation to the rest of the interested parties. Finally, measures aimed at improving the sustainability of agricultural activity in the area are proposed.

Installation of hedgerows around greenhouses to encourage biological pest control: Farmers' perspectives from Southeast Spain.

The intensification of agriculture has led to the deterioration of various ecosystem services, including pest control. The installation of hedgerows around greenhouses is presented as a viable option to maintain and favour natural enemies of pests. Despite the economic and environmental advantages of this type of facility, farmers are reluctant to implement it. Therefore, it is necessary to determine the factors that influence the decision to install hedgerows and the most appropriate incentives to promote their establishment. This article analyses intensive agriculture in Southeastern Spain. The application of cluster analysis techniques allowed the detection of four types of farmers in relation to this practice. The factors that drive its installation are an increase in the effectiveness of biological control, a reduction in the use of pesticides and the possible economic and environmental benefits. As a barrier, a lack of knowledge of and confidence in the effectiveness of this practice stand out. Among the measures to encourage their installation, the most valued are training and advice and recurring payments for the ecosystem services generated. The results obtained can be useful for policy makers in regions in which the installation of non-crop vegetation is promoted.

Platinum ineligibility in squamous cell carcinoma of the head and neck: consensus from Central America and the Caribbean.

The high incidence of head and neck cancer in Central America and the Caribbean, together with limitations in the healthcare system for patients with locally advanced squamous cell carcinoma of the head and neck (LA SCCHN) in this region necessitate a consensus of opinion based on a review of the literature on therapy with cisplatin plus radiation. Such an approach will ensure appropriate selection of patients who can benefit from therapy and reduce the incidence of related adverse events. Therefore, we recorded the opinion of experts in the region in order to identify needs and challenges in the treatment of LA SCCHN.

Homocysteine: new tumor marker in pleural fluid.

There are no published studies examining the utility of total homocysteine (HCY) in pleural fluid. The aim was to measure the accuracy of pleural fluid HCY concentration for diagnosis of malignant pleural effusion (MPE). We studied pleural fluids obtained by thoracocentesis in patients with pleural effusion. Pleural fluid HCY concentration was measured by immunonephelometry using N Latex HCY reagent with monoclonal antibody in automated analyzers BNII (Siemens Diagnostics®). Patients were classified into two groups according to the etiology of pleural effusion: benign pleural effusions (BPE) and MPE. Pleural effusion was categorized as MPE if malignant cells were demonstrated in pleural fluid or pleural biopsy. The accuracy of pleural fluid HCY concentration for diagnosis of MPE was determined using receiver operating characteristic (ROC) techniques by analyzing the area under the ROC curve (AUC). We studied 89 patients with ages between 1 and 96 years old (median = 66). Forty-eight patients were BPE and 41 were MPE. Pleural fluid HCY concentration was significantly higher in patients with MPE (median = 13.70 µmol/L) than in those with BPE (median = 8.05 µmol/L). The AUC value was 0.833 (95 % confidence interval (CI) 0.739-0.903). The optimal cutoff value was 13.1 µmol/L exhibiting 56.1 % (95 % CI 39.8-71.5) sensitivity and 85.4 % (95 % CI 72.2-93.9) specificity. Pleural fluid HCY concentration showed high diagnostic accuracy to predict whether a pleural effusion is benign or malignant. Pleural fluid HCY concentration may be measured easily and quickly in automated analyzers and could be a tumor marker commonly used for diagnosis of MPE.

Treatment patterns in fibromyalgia including the use of opioids.

OBJECTIVE: Opioids (except for tramadol) have not been shown to be effective in patients with fibromyalgia, but they can increase the risk of adverse drug reactions. The aim was to determine the treatment patterns of a group of patients with fibromyalgia and to identify the factors associated with the use of opioids in Colombia. METHODS: This was a cross-sectional study of a group of patients with fibromyalgia from a pain clinic in Colombia. Sociodemographic, clinical and pharmacological variables were identified. Descriptive, bivariate, and multivariate analyses were performed. RESULTS: A total of 559 patients were analysed, 88.6% of whom were women, and the mean age was 53.4 ± 12.6 years. A total of 40.6% received nonpharmacological management, and the majority were treated with acetaminophen (96.1%) and pregabalin (62.8%). A total of 69.6% received opioids, the most common of which was hydrocodone (36.3%). The average morphine equivalent milligrammes was 36.9 ± 91.2 (range: 2.3-750 mg), and 43.8% had intermediate/high doses. Being male (OR: 3.12; 95% CI: 1.40-6.91), having arterial hypertension (OR: 1.67; 95% CI: 1.04-2.69), obesity (OR: 2.23; 95% CI: 1.18-4.24), degenerative disease of vertebral discs (OR: 2.32; 95% CI: 1.10-4.88) and comedication with gabapentinoids (OR: 1.75; 95% CI: 1,15-2.65) were associated with a higher probability of receiving opioids, while patients treated with muscle relaxants had a lower risk of opioid treatment (OR: 0.64; 95% CI: 0.41-0.98). CONCLUSIONS: A significant proportion of patients were treated with opioids, the most common of which was hydrocodone, which goes against the recommendations of clinical practice guidelines.

Years of Potential Life Lost Because of Breast and Cervical Cancers in Guatemala.

PURPOSE: Worldwide cervical and breast cancers are among the most commonly diagnosed cancers and are leading cause of cancer deaths among females in low- and middle-income countries. In Guatemala, breast and cervical cancers are the main cause of cancer-related deaths among women. Therefore, the aim of this study was to determine the years of potential life lost (YPLL) as an indicator of premature deaths as a result of breast and cervical cancers. METHODS: Data on the number of deaths as a result of breast and cervical cancers (International Classification of Diseases [10th revision] codes C50 and C53) between 2012 and 2016 and age composition by quinquennials were retrieved from the Health Information System of the Guatemalan Health Ministry. On the basis of each individual's age at death, YPLL was estimated for females between 20 and 70 years of age. RESULTS: A total of 1,476 deaths related to breast and cervical cancers was reported over the study period. The trend in breast cancer mortality rate and YPLL did not change from 2012 to 2016. The cervical cancer mortality rate has decreased to 10 deaths per 1 million habitants (P = .046). There has been a reduction in YPLL because of cervical cancer, from 50.18 YPLL in 2012 to 29.19 YPLL by 2016, mainly in women between 30 and 34 years of age, in whom YPLL decreased from 600 to 112.50 (P = .046). CONCLUSION: Cervical cancer screening has significantly reduced the mortality rate of this malignancy, and screening of breast cancer must include creating awareness of the disease and providing access to women at risk.

An Analysis of Global Research Trends on Greenhouse Technology: Towards a Sustainable Agriculture.

Greenhouse farming is an agricultural management system that has demonstrated its efficiency in intensifying food production. These systems constitute a feasible alternative for ensuring food supply, which is one of the greatest challenges faced by humankind in the twenty-first century. Technology has been able to meet the challenges related to greenhouse farming in both contributing to overcoming its limitations, correcting adverse impacts and ensuring system sustainability. The objective of this article is to analyse the global research trends in greenhouse technology over the last two decades, in order to identify the main driving agents, the most outstanding research lines and possible gaps in the literature. Different methodologies have been used for the analysis; both quantitative and qualitative. The principal results show that there are different relevant lines of research related to different aspects of greenhouse farming: the use of water for irrigation, the design of the optimum structure of the greenhouse, conserving the soil in the best growing conditions, energy consumption of the system as a whole, climate control within the facility and pest control. The research is characterized by the being composed largely of ad hoc studies, which hinders the international collaboration between researchers and institutions. The research approach has shifted from being focused on increasing production and cost savings to aspects related to resource conservation and sustainability.

Comparison of clinical outcomes in STEMI patients treated with primary PCI according to day-time of medical attention and its relationship with circadian pattern.

OBJECTIVE: Relationship between STEMI time of presentation, its circadian pattern and cardiovascular outcomes is unclear. Our objective is to analyze clinical outcomes of STEMI according to time of presentation and circadian pattern. METHODS: We analyzed data from patients treated within the regional STEMI Network from January 2010 to December 2015. On-hour group included patients treated between 8:00 h and 19:59 h on weekdays, the rest were catalogued as off-hour group. The primary endpoint was 1-year all-cause mortality. Secondary endpoints were 30-day all-cause mortality and in-hospital complications. RESULTS: A total of 8608 patients were included, 44.1% in the on-hour group and 55.9% in the off-hour group. We observed a shorter patient delay and longer system delay in the off-hour group compared to on-hour group with no difference in total ischemic time. At 30-day and 1-year follow-up there were no differences in adjusted all-cause mortality between groups [OR 0.91 (CI95%: 0.73-1.12; p = 0.35) and OR 0.99 (CI95%: 0.83-1.17; p = 0.87), respectively]. A circadian pattern was observed between 9:00 am and 12:30 pm, with no differences in 30-day and 1-year mortality between patients included in this time interval [OR 1.02 (IC95%: 0.81-1.30; p = 0.85) and OR 1.12 (IC95%: 0.92-1.36; p = 0.25) respectively]. CONCLUSIONS: Off-hour STEMI presentation was associated with a shorter patient delay and longer system delay without an increase in total ischemic time. The off-hour presentation was not related to an increase in 1-year all-cause mortality when compared to on-hour. A circadian pattern was found, without differences in 30-day and 1-year mortality.

Aquifer Sustainability and the Use of Desalinated Seawater for Greenhouse Irrigation in the Campo de Níjar, Southeast Spain.

In the Campo de Níjar (southeast Spain), an intensive horticulture model under plastic has been developed based on the use of groundwater. For many years, aquifers have been overexploited, almost generating an environmental collapse. The construction of a desalination plant was planned to improve this situation and to achieve sustainable aquifer management. However, the aquifer is still being overexploited, since farmers scarcely use desalinated seawater for irrigation. In this paper, farmers irrigating with desalinated seawater are characterized, since they contribute to aquifer sustainability. The study aimed to identify the variables which condition the use of this water resource, as well as the kinds of incentives that encourage this option. For this purpose, a survey was undertaken within a sample of 110 farmers. A cluster analysis and a binary logistic regression were employed. The results from the cluster analysis allowed the characterization of farmers who use desalinated seawater for irrigation. Furthermore, the regression model showed the variables that determine a more intensive use of this irrigation source, such as crop diversification, availability of different water resources and the conductivity of aquifer water available for irrigation. The incentives promoting the use of desalinated seawater for irrigation that most encourage farmers are the implementation of tax relief, price reductions and the obligation to install rainwater collection systems.

Neuroapoptosis in newborns with respiratory acidosis at birth.

BACKGROUND: S100B protein is one of the most accurate biomarkers for diagnosis of neuroapoptosis and brain damage. The aim was to evaluate the lactate concentration and acid-base balance (pH, pCO2, pO2, HCO3c and BEb) in umbilical cord blood to predict high risk of neuroapoptosis and analyze the relationship between the levels of these biomarkers and umbilical cord blood S100B protein concentration at birth. METHODS: Apparently healthy newborns were included. S100B protein and blood gas test (lactate and acid-base balance) were determined in umbilical cord blood at birth. Newborns were classified into two groups: with and without high risk of neuroapoptosis. Newborns with high umbilical cord blood S100B protein concentration were considered newborns at high risk of neuroapoptosis. RESULTS: Sixty-one newborns were included, 12 had high risk of neuroapoptosis and 49 did not. S100B protein concentration correlate directly with pCO2 levels (Rho: 0.286, p = .0321) and lactate concentration (Rho: 0.278, p = .0315); and indirectly with pH (Rho: -0.332, p = .01). The analysis of the ROC curves yielded significant curves for pH and pCO2 to predict high risk of neuroapoptosis, pH optimal cutoff value was 7.19 (sensitivity: 50%, specificity: 83.7%, AUC: 0.708); and pCO2 optimal cutoff value was 60 mmHg (sensitivity: 30%, specificity: 85.4%, AUC: 0.705). CONCLUSIONS: Respiratory acidosis is associated to high concentrations of S100B protein in umbilical cord blood at birth. Umbilical cord blood pH and pCO2 may be useful in differentiating newborns at high risk of neuroapoptosis. Umbilical cord blood gas test may be valuable as risk indicator for neuroapoptosis at birth.

Attention-deficit/hyperactivity disorder and comorbid disruptive behavior disorders: evidence of pleiotropy and new susceptibility loci.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) comorbid with oppositional defiant disorder (ODD) or conduct disorder (CD) and substance abuse/dependence seems to represent a specific subset within the phenotypic ADHD spectrum. METHODS: We applied complex segregation and linkage analyses in a set of multigenerational families densely segregating ADHD comorbid with ODD, CD, alcohol abuse/dependence, and nicotine dependence. RESULTS: Our data suggest that ADHD cosegregates with disruptive behaviors as a unique, phenotypically variable trait as evidenced by highly significant pair-wise linkages among: ADHD and ODD (logarithm of odds [LOD]=14.19), ADHD and CD (LOD=5.34), ODD and CD (LOD=6.68), and CD and alcohol abuse/dependence (LOD=3.98). In addition to previously reported ADHD susceptibility loci, we found evidence of linkage for comorbid ADHD phenotypes to loci at 8q24, 2p21-22.3, 5p13.1-p13.3, 12p11.23-13.3, 8q15, and 14q21.1-22.2. These results were replicated with an affected status phenotype derived from latent class clusters. CONCLUSIONS: Patterns of cosegregation of ADHD with comorbidities can inform our understanding of the inheritance patterns not only of ADHD but also of disruptive behavioral disorders and alcohol abuse/dependence. Refining the comorbid ADHD phenotype by determining the cosegregation profile of specific comorbidities might be a powerful tool for defining significant regions of linkage.

[Clinical characteristics and medium-term prognosis of patients with heart failure and preserved systolic function. Do they differ in systolic dysfunction?]. / Características clínicas y pronósticos a medio plazo de la insuficiencia cardíaca con funcón sistólica conservada. ¿Es diferente de la insuficienca cardíaca sistólica?

OBJECTIVES: To assess the prevalence, clinical profile and medium-term prognosis in patients with heart failure and preserved systolic ventricular function compared to those with systolic dysfunction. PATIENTS AND METHOD: 153 patients were included, 62 with preserved systolic ventricular function (left ventricular ejection fraction > or = 45%) and 91 with impaired systolic ventricular function (left ventricular ejection fraction < 45%). The mean follow-up period was 25 10 months. RESULTS: Mean age was similar (66 10 vs. 65 10; p = 0.54). There was a higher proportion of women among patients with preserved systolic function (53% vs. 28%; p < 0.01). Ischemic and idiopathic cardiomyopathy were the most common causes of heart failure in patients with systolic dysfunction, whereas valvular disease and hypertensive cardiopathy were the most common in patients with preserved systolic function. Angiotensin-converting enzyme inhibitors and beta-blockers were more often prescribed in patients with impaired systolic ventricular function (86% vs. 52%; p < 0.01 and 33% vs. 11%; p < 0.01, respectively). There were no differences between the groups in terms of mortality rate (37% vs. 29%), readmission rate for other causes (29% vs. 23%), readmission rate for heart failure (45% vs. 45%), cumulative survival (51% vs. 62%) and the likelihood of not being readmitted for heart failure (50% vs. 52%). In the multivariate analysis, left ventricular ejection fraction was not a predictor of death or readmission because of heart failure. CONCLUSIONS: In a large proportion of patients with heart failure, systolic ventricular function is preserved. Despite the clinical differences between patients with preserved and impaired systolic ventricular function, the medium-term prognosis was similar in both groups.

Depersonalization in psychiatric patients: a transcultural study.

There is evidence suggesting that the prevalence of depersonalization in psychiatric patients can vary across cultures. To explore the possible influence of culture on the prevalence of depersonalization, we compared psychiatric inpatient samples from the United Kingdom (N = 31), Spain (N = 68), and Colombia (N = 41) on standardized and validated self-rating measures of dissociation and depersonalization: the Cambridge Depersonalization Scale and the Dissociative Experiences Scale (DES). Colombian patients were found to have lower global scores on the Cambridge Depersonalization Scale and the DES and all its subscales, with the exception of DES-Absorption. No differences were found for measures of depression or anxiety. These findings seem to support the view that depersonalization is susceptible to cultural influences. Attention is drawn to the potential relevance of the sociological dimension "individualism-collectivism" on the experience of the self, and it is proposed that cultures characterized by high individualism may confer vulnerability to depersonalization experiences.

Supervivencia de niños con bajo peso al nacer en una unidad de cuidados intensivos neonatal, Medellín, 1997-2001 / Survival of children with low weight at birth in a neonatal intensive care unit, Medellín, 1997-2001

Objetivo: determinar la supervivencia de los niños con bajo peso al hospitalizarlos en la unidad de cuidados intensivos neonatal de un hospital de tercer nivel de complejidad de la ciudad de Medellín, entre 1997 y 2001, con el fin de identificar algunas características relacionadas con la probabilidad de morir y con el tiempo de supervivencia del recién nacido. Metodología: con base en una población de 809 recién nacidos, se recolectó la información afín al objetivo. Para estimar la supervivencia se construyeron las tablas de vida pertinentes y para valorar la significación de esta con respecto a variables de interés, se utilizó el método de Kaplan-Meier, el log rank test y el modelo de riesgos proporcionales de Cox. Resultados: de los 809 recién nacidos, 50 por ciento ingresaron al servicio en menos de 24 horas después de haber nacido, donde alcanzaron una estancia promedio de 7,8 días, tiempo en el cual la enfermedad de membrana hialina se presentó en 76 por ciento de ellos. La supervivencia acumulada de los niños disminuyó gradualmente en una tasa de 50 por ciento en los primeros 28 días de hospitalización y a partir del día 29, el descenso fue más lento; se destaca que antes de completar los 7 primeros días de hospitalización, se presentaron 59,7 por ciento de las defunciones. Durante la hospitalización, 51,5 por ciento de lo niños con excesivo bajo peso al nacer fallecieron. Estos presentaron un descenso de 33 por ciento en la supervivencia acumulada en los primeros 4 días de hospitalización. Los niños con excesivo bajo peso al nacer (menor de 1.000 gramos) y aquellos con peso entre 1.000 y 1.499 gramos presentaron riesgo de morir de 170 y 70 por ciento, respectivamente, con respecto a los niños con peso entre 1.500 y 2.499 gramos. El peso al nacer, la ictericia neonatal sin especificación y la neumonía sin especificación se asociaron significativamente con la supervivencia de los niños con bajo peso al nacer