Relationship between damage and mortality in juvenile-onset systemic lupus erythematosus: Cluster analyses in a large cohort from the Spanish Society of Rheumatology Lupus Registry (RELESSER)

Objectives: To identify patterns (clusters) of damage manifestation within a large cohort of juvenile SLE (jSLE) patients and evaluate their possible association with mortality. Methods: This is a multicentre, descriptive, cross-sectional study of a cohort of 345 jSLE patients from the Spanish Society of Rheumatology Lupus Registry. Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics Damage Index. Using cluster analysis, groups of patients with similar patterns of damage manifestation were identified and compared. Results: Mean age (years) ± S.D. at diagnosis was 14.2 ± 2.89; 88.7% were female and 93.4% were Caucasian. Mean SLICC/ACR DI ± S.D. was 1.27 ± 1.63. A total of 12 (3.5%) patients died. Three damage clusters were identified: Cluster 1 (72.7% of patients) presented a lower number of individuals with damage (22.3% vs. 100% in Clusters 2 and 3, P < 0.001); Cluster 2 (14.5% of patients) was characterized by renal damage in 60% of patients, significantly more than Clusters 1 and 3 (P < 0.001), in addition to increased more ocular, cardiovascular and gonadal damage; Cluster 3 (12.7%) was the only group with musculoskeletal damage (100%), significantly higher than in Clusters 1 and 2 (P < 0.001). The overall mortality rate in Cluster 2 was 2.2 times higher than that in Cluster 3 and 5 times higher than that in Cluster 1 (P < 0.017 for both comparisons). Conclusions: In a large cohort of jSLE patients, renal and musculoskeletal damage manifestations were the two dominant forms of damage by which patients were sorted into clinically meaningful clusters. We found two clusters of jSLE with important clinical damage that were associated with higher rates of mortality, especially for the cluster of patients with predominant renal damage. Physicians should be particularly vigilant to the early prevention of damage in this subset of jSLE patients with kidney involvement

Growth projections reveal local vulnerability of Mediterranean oaks with rising temperatures

Growth projections using ecological models fitted to data collected along climatic gradients can help to understand how forests will respond to climate change. Stem growth of two Mediterranean oaks was predicted using nonlinear multiplicative models as a function of precipitation and minimum temperature of the hydrological year fitted to dendrochronological data. The growth of both species increased nonlinearly with accumulated precipitation before reaching an asymptote, but the species with a warmer niche (Q. ilex, an evergreen species) required lower levels of precipitation to achieve high relative growth. The species-specific relationship between growth and minimum temperature exhibited an optimum for the two species. Trees were negatively affected by high minimum temperatures whereas they responded negatively (Q. ilex) or neutrally (Q. pyrenaica, a deciduous species) to low temperatures along the climatic gradient analyzed. Growth would decrease rapidly when minimum temperatures rose above approximately 7°C for Q. pyrenaica and 9°C for Q. ilex. Most growth projections suggest a likely future decrease in productivity along the species range for Q. pyrenaica and particularly at species-specific warm, dry locations pointed to a future drastic reduction in productivity as a result of the increase in temperatures without a paired increase in precipitation forecasted by the different climate scenarios considered. In agreement with results from studies modeling future distribution of species this suggests that Q. pyrenaica could be threatened by climate change at the species local dry edge where, in addition, stands often present a lack of seed regeneration. More drought tolerant Q. ilex might profit from warming temperatures at cold northern locations but would also reduce productivity at warm, dry locations. Stem growth was successfully modeled using biologically meaningful species-specific responses to climate which provided key ecological information to understand the functional response of the two species. The models used have much potential to be applied with dendroecological data to study the response of forests to climate change. © 2013 Elsevier B.V

Structural characterization and analysis of the regeneration of woodlands dominated by Juniperus oxycedrus L. in west-central Spain

This work addresses the structural characterization of Juniperus oxycedrus-dominated woodlands in west-central Spain, as well as the analysis of the regeneration of this species in the presence of other species (mainly Quercus ilex) as a function of different environmental and land-use factors. The two densest populations of the species were sampled and different physiographic and land-use parameters were obtained. First, a structural characterization, specifically focused on regeneration, was carried out, based on the count of individuals and their classification according to their size (seedlings, saplings, or adults) and position (either beyond or below the canopy). The use of Generalized Linear Models (GLM) and Regression Trees permitted the identification and analysis of environmental and land-use variables significantly related to regeneration. Juniper woodlands in this part of Spain generally show a remarkable level of regeneration, although some significant differences were detected between the two existing populations. Of the factors studied, time since regeneration started, elevation, and soil rock surface cover influence J. oxycedrus regeneration at most of the individual classes considered, indicating the significance of these variables in this species regeneration. Canopy cover and depth of the organic layer and zone also affect several of the recruitment classes. Furthermore, radiation, the time elapsed since regeneration started, elevation, and aspect affect stand structure to a significant extent. The results of this study enlarge the knowledge on J. oxycedrus regeneration and woodland structure, providing helpful information for the conservation of these protected habitats. © 2012 Springer Science+Business Media Dordrecht

Towards a set of national forest inventory indicators to be used for assessing the conservation status of the habitats directive forest habitat types

14 Pág.Since the enactment of the EU Habitats Directive, the conservation status of forest habitat types, habitats of species, and species has become the central concept of the Directive's nature conservation legislation. Despite its role, it has drawn relatively little attention. Within a rather short research period, a few research papers have addressed the existing definitions, indicators for the conservation status assessment, and assessment techniques. This paper attempted to complete the set of measurable indicators available in national forest inventories and connect them with the forest habitat types’ conservation status components (area, function, structure, and prospects). A set of 40 indicators was defined, labelled with one or more of the four conservation status components and assessed with the quality dimensions. The analysis uncovered that five indicators could be used to assess the component of range and area, 20 that of structure, 22 that of function and 27 that of prospects. It also showed that conventional forestry indicators such as tree species, diameter at breast height, and regeneration are less sensitive regarding the data quality. Conversely, some typical biodiversity indicators lacked completeness, timeliness, and precision. In addition to this analysis, the data distributions (data for them were provided by the national forest inventories of Italy, Slovenia, and Spain) of some indicators were analysed. Based on all the results, it was also possible to conclude that there is a shortage of national forest inventory indicators for the assessments of the area and function conservation status components. While the area component should be described with the indicators of forest habitat type fragmentation, mingling and perforation with non-forest and other forest vegetation communities, the functional component is bereft of indicators describing processes such as biomass growth and carbon cycling. Future research should thus search for more indicators to represent all conservation status components in a more balanced way. More efforts should also be expended into the harmonisation of indicators.This research was largely funded by the project DIABOLO (European Union’s Horizon 2020 research and innovation programme under grant agreement No 633464). Additional support came from the Research Programme P4 – 0107, financed by the Slovenian Research Agency (ARRS). We would like to thank Elena Robla, Roberto Vallejo, and Vicente Sandoval of the Ministry of Agriculture, Fisheries and Food for providing access to the Spanish NFI data-sets. The data for Italy were provided by the National inventory on forests and forest carbon pools INFC2005 (www.inventarioforestale.org, www.infc.it), conducted by the Carabinieri command for forest protection (former National Forest Service) and scientifically and technically supported by the CREA-Research centre for forestry and wood (former CRA-MPF). We also thank Mitja Skudnik, who prepared the Slovene 2012 Forest and forest ecosystem condition survey data. Lastly, we would like to thank the anonymous reviewers of the earlier version of the paper and Terry T. Jackson, who proofread both versions of the paper.Peer reviewe

[Translated article] Requirements for Accessing New Dermatology Drugs in Spain: Results of the EQUIDAD Study

Background: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. Material and methods: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. Results: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). Conclusions: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain. Resumen: Antecedentes: En España, aunque el Ministerio de Sanidad elabora el informe de posicionamiento terapéutico (IPT) y las condiciones de reembolso de los fármacos, las Comunidades Autónomas (CC. AA.) gestionan los servicios de salud y deciden sobre las condiciones de prescripción en su ámbito territorial. El objetivo del estudio EQUIDAD fue describir los condicionantes para la prescripción de los nuevos fármacos en Dermatología en las CC. AA. y sus posibles diferencias. Material y métodos: Estudio transversal realizado en abril-mayo del 2023. Dos dermatólogos con responsabilidades directivas de cada Comunidad Autónoma (C. A.) informaron sobre los condicionantes autonómicos y locales en la prescripción de los fármacos cuyo IPT para el tratamiento de enfermedades dermatológicas fue publicado en los años 2016-2022. Los datos fueron recogidos mediante un cuestionario online. Resultados: Un total de 33 investigadores de 17 CC. AA. participaron en el estudio. Se observaron inequidades entre CC. AA. para el acceso a los nuevos fármacos. Existieron condicionantes autonómicos adicionales al IPT en psoriasis en el 64,7% de las CC. AA., siendo este porcentaje menor en dermatitis atópica (35,3%) o melanoma (11,8%). El más frecuente fue el requisito de un orden de prescripción previo para el uso del fármaco. En algunas CC. AA. se detectaron además variaciones y condicionantes locales (diferencias entre centros de una misma C. A.). Conclusiones: Existe una multiplicidad de criterios tanto a nivel autonómico como local que añade restricciones adicionales a las establecidas por los IPT y que plantean una situación de inequidad entre los pacientes y los profesionales de las diferentes CC. AA. en el acceso a los nuevos fármacos