Estructura sanitaria de atención al tabaquismo

El presente artículo trata de analizar la necesidad de generar una estructura sanitaria de atención al tabaquismo en los distintos departamentos de salud, dependientes de la red pública sanitaria. Esta estructura cobra fuerza y llega a un mayor número de sujetos si se asienta sobre la Atención Primaria de salud, articulándose alrededor de las consultas específicas de tabaquismo en los distintos centros de Salud. Estas consultas deben contar como mínimo con un médico y una enfermera que se dediquen especialmente a atender la consulta al menos 4 horas a la semana. Aun siendo la Atención Primaria la principal puerta de entrada de los pacientes, no podemos descartar el papel de otras unidades o servicios como, medicina Preventiva, los servicios de Neumología o las Unidades de Conductas Adictivas, que también deben hacer un papel importante a la hora de su interrelación. Con todo esto hay que establecer una correcta coordinación entre los distintos servicios, consultas y unidades, sumando a ellas los recursos de Salud Pública e incluso el apoyo que se pueda ofrecer desde distintos ayuntamientos y otras administraciones no sanitarias. Al contar con una estructura definida y una organización coordinada se puede llegar al máximo número de pacientes, además de realizar otras tareas como la prevención o incluso la investigación en este campo, por parte de personas que conozcan toda la problemática de los fumadores. A pesar de los documentos previos, llega la hora de que los distintos gobiernos tanto a nivel autonómico como estatal, consensúen y establezcan un modelo de Atención sanitaria al tabaquismo para todo el Estado español. En este trabajo, aparte de presentar nuestro proyecto, ofrecemos los resultados preliminares que nos indica que nuestra experiencia es efectiva y eficiente en nuestro Departamento de Salud cuando se compara con otros trabajos. Esperamos que con el seguimiento aportemos datos más concluyentes

A review of the combination among global change factors in forests, shrublands and pastures of the Mediterranean Region : beyond drought effects

Research in CRAG is also supported byCERCA institution (Generalitat de Catalunya).Climate change, alteration of atmospheric composition, land abandonment in some areas and land use intensification in others, wildfires and biological invasions threaten forests, shrublands and pastures all over the world. However, the impacts of the combinations between global change factors are not well understood despite its pressing importance. Here we posit that reviewing global change factors combination in an exemplary region can highlight the necessary aspects in order to better understand the challenges we face, warning about the consequences, and showing the challenges ahead of us. The forests, shrublands and pastures of the Mediterranean Basin are an ideal scenario for the study of these combinations due to its spatial and temporal heterogeneity, increasing and diverse human population and the historical legacy of land use transformations. The combination of multiple global change factors in the Basin shows different ecological effects. Some interactions alter the effects of a single factor, as drought enhances or decreases the effects of atmospheric components on plant ecophysiology. Several interactions generate new impacts: drought and land use changes, among others, alter water resources and lead to land degradation, vegetation regeneration decline, and expansion of forest diseases. Finally, different factors can occur alone or simultaneously leading to further increases in the risk of fires and biological invasions. The transitional nature of the Basin between temperate and arid climates involves a risk of irreversible ecosystem change towards more arid states. However, combinations between factors lead to unpredictable ecosystem alteration that goes beyond the particular consequences of drought. Complex global change scenarios should be studied in the Mediterranean and other regions of the world, including interregional studies. Here we show the inherent uncertainty of this complexity, which should be included in any management strategy

Passeig ecofisiologic per l'espai i pel temps : l'estudi de les alteracions produides pels canvis climatics i atmosferics en l'estructura i el funcionament de les plantes i dels ecosistemes terrestres

En l'estudi de l'impacte del canvi global sobre les plantes i els ecosistemes és necessari estudiar com els gens, les plantes senceres, les espècies i les comunitats interaccionen amb l'ambient, tot duent a terme estudis ecofisiològics a diferents escales espacials i temporals, des de la molècula fins a l'ecosistema, i des de segons fins a segles. Presentem aquí alguns exemples de l'aplicació de l'ecofisiologia a les diferents escales espacials i temporals implicades en l'agenda del canvi global. Explorem alguns resultats recents que revelen la possibilitat d'estimar mitjançant teledetecció els processos fotosintètics a escala de fulla, coberta i ecosistema mitjançant l'índex de reflectància fotoquímic (PRI), un índex basat en un principi en canvis moleculars dels pigments del cicle de les xantofil·les, que pot acabar ajudant a estimar el balanç local, regional i global del carboni en el context del canvi climàtic. Pel que fa a l'aplicació de l'ecofisiologia a diferents escales temporals d'aquest canvi global, presentem alguns exemples d'estudis paleoecofisiològics (milers d'anys), històrics (segles), observacionals (últims anys i dècades), i simuladors (per a les properes dècades), en els quals abordem les interaccions entre les plantes i els diferents components del canvi global canvis en la concentració atmosfèrica de CO2, ozó, òxids de nitrogen, compostos orgànics volàtils, i altres gasos; canvis climàtics; eutrofització de la biosfera, disminució de l'ozó estratosfèric, canvis d'usos del sòl i pèrdua de biodiversitat). Els canvis biològics són sovint espectaculars. Exemples en tenim en l'avançada primavera biològica, els desplaçaments de la vegetació a les muntanyes, la progressiva eutrofització dels ecosistemes o l'augment de les emissions de compostos orgànics volàtils de les plantes, entre molts d'altres.In the study of human and global change impacts on plants and ecosystems, it is necessary to understand how genes, whole plants, species and communities interact with the environment. With this aim, current ecophysiological studies are conducted at different spatial and temporal scales, from molecule to ecosystem, and from seconds to centuries. We present here some examples of the application of ecophysiology at the different spatial and temporal scales involved in the Global Change agenda.We describe some recent results revealing the possibility of remote sensing estimation of photosynthetic processes at leaf, canopy and ecosystem levels by means of the Photochemical Reflectance Index (PRI), an index based in the molecular changes of xanthophylls cycle pigments that can help to estimate local, regional, and global carbon budget. Regarding the application of ecophysiology at different temporal scales of the Global Change, we present some examples of paloeoecophysiological (thousands of years), historical (centuries), observational (last years and decades), and experimental and modelling (next decades) studies, where we approach the interactions between plants and the different components of the Global Change (changes in atmospheric concentration of CO2, ozone, nitrogen oxides, volatile organic compounds, and other gases; climatic changes; biosphere eutrophication; stratospheric ozone decrease; land use changes; and biodiversity loss). Biological changes are often spectacular. Some examples are biological spring advancements, vegetation shifts in the mountains, ecosystems progressive eutrophication, or increases in the emissions of plants volatile organic compounds, among others

Reassessing global change research priorities in mediterranean terrestrial ecosystems : how far have we come and where do we go from here?

Aim: Mediterranean terrestrial ecosystems serve as reference laboratories for the investigation of global change because of their transitional climate, the high spatiotemporal variability of their environmental conditions, a rich and unique biodiversity and a wide range of socio-economic conditions. As scientific development and environmental pressures increase, it is increasingly necessary to evaluate recent progress and to challenge research priorities in the face of global change. - Location: Mediterranean terrestrial ecosystems. - Methods: This article revisits the research priorities proposed in a 1998 assessment. - Results: A new set of research priorities is proposed: (1) to establish the role of the landscape mosaic on fire-spread; (2) to further research the combined effect of different drivers on pest expansion; (3) to address the interaction between drivers of global change and recent forest management practices; (4) to obtain more realistic information on the impacts of global change and ecosystem services; (5) to assess forest mortality events associated with climatic extremes; (6) to focus global change research on identifying and managing vulnerable areas; (7) to use the functional traits concept to study resilience after disturbance; (8) to study the relationship between genotypic and phenotypic diversity as a source of forest resilience; (9) to understand the balance between C storage and water resources; (10) to analyse the interplay between landscape-scale processes and biodiversity conservation; (11) to refine models by including interactions between drivers and socio-economic contexts; (12) to understand forest-atmosphere feedbacks; (13) to represent key mechanisms linking plant hydraulics with landscape hydrology. - Main conclusions:(1) The interactive nature of different global change drivers remains poorly understood. (2) There is a critical need for the rapid development of regional- and global-scale models that are more tightly connected with large-scale experiments, data networks and management practice. (3) More attention should be directed to drought-related forest decline and the current relevance of historical land use

Religious transformations in the Middle Ages: towards a new archaeological agenda

The study of religious change in Europe between the collapse of the Roman Empire and the Reformation forms one of the cornerstones of medieval archaeology but has been riven by period, denominational and geographical divisions. This paper lays the groundwork for a fundamental rethink of archaeological approaches to medieval religions, by adopting a holistic framework that places Christian, pagan, Islamic and Jewish case studies of religious transformation in a long-term, comparative perspective. Focused around the analytical themes of ‘hybridity and resilience’ and ‘tempo and trajectories’, our approach shifts attention away from the singularities of national narratives of religious conversion towards a deeper understanding of how religious beliefs, practices and identity were renegotiated by medieval people in their daily lives

Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: A nationwide study in Spain

Objective To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain. Settings The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied. Participants This was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020. Interventions An exploratory factorial analysis was performed to select the most relevant variables of the sample. Primary and secondary outcome measures Univariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection. Results Sixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/10 5 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade =3 (OR 2.5) and preoperative GCS 3-8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/10 5 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated. Conclusions Perioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/10 5 people/week) was a statistically independent predictor of mortality. Trial registration number CEIM 20/217