Is it possible to diagnose the therapeutic adherence of patients with COPD in clinical practice? A cohort study

<p>Abstract</p> <p>Background</p> <p>Therapeutic adherence of patients with chronic obstructive pulmonary disease (COPD) is poor. It is therefore necessary to determine the magnitude of non-adherence to develop strategies to correct this behaviour. The purpose of this study was to analyse the diagnostic validity of indirect adherence methods.</p> <p>Methods</p> <p>Sample: 195 COPD patients undergoing scheduled inhaled treatment attending 5 Primary Care Centres of Malaga, Spain. Variables: Sociodemographic profile, illness data, spirometry, quality of life (St. George Respiratory Questionnaire: SGRQ), and inhaled medication counting (count of dose/pill or electronic monitoring) were collected. The patient's knowledge of COPD (Batalla test:BT),their attitude towards treatment (Morisky-Green test: MGT) and their self-reported therapeutic adherence (Haynes-Sackett test: HST) were used as methods of evaluating adherence. The follow-up consisted four visits over one year (the recruitment visit: V0; and after 1 month:V1; 6 months:V2; and 1 year:V3).</p> <p>Results</p> <p>The mean age was 69.59 (95% CI, 68.29-70.89) years old and 93.8% were male. Other findings included: 85.4% had a low educational level, 23.6% were smokers, 71.5% mild-moderate COPD stage with a FEV1 = 56.86 (SD = 18.85); exacerbations per year = 1.41(95% CI, 1-1.8). The total SGRQ score was 44.96 (95% CI, 42.46-47.46), showing a mild self-perceived impairment in health. The prevalence of adherence (dose/pill count) was 68.1% (95% CI, 60.9-75.3) at V1, 80% (95% CI, 73-87) at V2 and 84% (95% CI, 77.9) at V3. The MGT showed a specificity of 67.34% at V1, 76.19% at V2 and 69.62% at V3. The sensitivity was 53.33% at V1, 66.66% at V2 and 33.33% at V3.The BT showed a specificity of 55.1% at V1, 70.23% at V2 and 67.09% at V3. The sensitivity was 68.88% at V1, 71.43% at V2 and 46.66% at V3. Considering both tests together, the specificity was 86.73% at V1, 94.04% at V2 and 92.49% at V3 and the sensitivity was 37.77% at V1, 47.62% at V2 and 13.3% at V3.</p> <p>Conclusions</p> <p>The prevalence of treatment adherence changes over time. Indirect methods (dose/pill count and self-reported) can be useful to detect non-adherence in COPD patients. The combination of MGT and BT is the best approach to test self-reported adherence.</p

River Restoration in Spain: Theoretical and Practical Approach in the Context of the European Water Framework Directive.

River restoration is becoming a priority in many countries because of increasing the awareness of environmental degradation. In Europe, the EU Water Framework Directive (WFD) has significantly reinforced river restoration, encouraging the improvement of ecological status for water bodies. To fulfill the WFD requirements, the Spanish Ministry of the Environment developed in 2006 a National Strategy for River Restoration whose design and implementation are described in this paper. At the same time many restoration projects have been conducted, and sixty of them have been evaluated in terms of stated objectives and pressures and implemented restoration measures. Riparian vegetation enhancement, weir removal and fish passes were the most frequently implemented restoration measures, although the greatest pressures came from hydrologic alteration caused by flow regulation for irrigation purposes. Water deficits in quantity and quality associated with uncontrolled water demands seriously affect Mediterranean rivers and represent the main constraint to achieving good ecological status of Spanish rivers, most of them intensively regulated. Proper environmental allocation of in-stream flows would need deep restrictions in agricultural water use which seem to be of very difficult social acceptance. This situation highlights the need to integrate land-use and rural development policies with water resources and river management, and identifies additional difficulties in achieving the WFD objectives and good ecological status of rivers in Mediterranean countries

Keep off the grass?:Cannabis, cognition and addiction

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.In an increasing number of states and countries, cannabis now stands poised to join alcohol and tobacco as a legal drug. Quantifying the relative adverse and beneficial effects of cannabis and its constituent cannabinoids should therefore be prioritized. Whereas newspaper headlines have focused on links between cannabis and psychosis, less attention has been paid to the much more common problem of cannabis addiction. Certain cognitive changes have also been attributed to cannabis use, although their causality and longevity are fiercely debated. Identifying why some individuals are more vulnerable than others to the adverse effects of cannabis is now of paramount importance to public health. Here, we review the current state of knowledge about such vulnerability factors, the variations in types of cannabis, and the relationship between these and cognition and addiction.This work was supported by grants from the US National Institutes of Health to L.H.P. (AA020404, AA006420, AA022249 and AA017447) and by grants from the UK Medical Research Council to H.V.C. and C.J.A.M. (G0800268; MR/K015524/1)

Sediment transport below a small alpine reservoir desilted by controlled flushing: field assessment and one-dimensional numerical simulation

Purpose: Sediment transport and riverbed sedimentation were investigated in an alpine stream below a small hydropower reservoir desilted by a controlled sediment flushing (CSF) operation. The term \u201ccontrolled\u201d refers to the operational tasks implemented to mitigate the downstream environmental impact of the operation. The experimental dataset acquired before, during, and after the CSF was also used to carry out and calibrate a one-dimensional sediment transport model of the monitored event. Materials and methods: The investigated reservoir is located in the central Italian Alps, and its original storage was 160,000 m3, about 30% filled by a mixture of sand and silt/clay before the CSF. Downstream sediment concentration was controlled by releasing clear water from upstream reservoirs and regulating the work of earth-moving equipment in the emptied reservoir. A 3.6-km-long reach with average slope of 0.015 was monitored: concentration and grain size of suspended sediment were measured during the CSF and the riverbed alteration was evaluated by volumetric sampling and measurements of the deposits\u2019 thickness. Sedimentation and River Hydraulics\u2014One Dimensional (SRH-1D) was used to simulate sediment transport during the monitored CSF. Model parameters were calibrated by comparing the computed and the observed amount of sediment deposited along the study reach. Results and discussion: Sediment flushing was carried out in October 2010 for 3 days. Ca. 16,000 m3 of sediment were evacuated, representing approximately 30% silt/clay and 70% sand. 2.4 Mm3 of clear water was released to reduce sediment concentration and increase transport capacity downstream. About 3000 m3 of sand was deposited in the study reach after the CSF, with maximum height up to 0.2 m. Although the riverbed before the CSF was simply set as mono-granular, after calibrating the parameters, good agreement was achieved between the depositional pattern computed by SRH-1D and the one observed, both in terms of deposit thickness and grain size of deposited sediment. The sensitivity analysis revealed a major role of the parameters controlling bed mixing processes in affecting the simulated deposition after the CSF. Conclusions: Sediment below 0.1 mm in diameter was not detected in river deposits after the flushing: the effects on river biota associated with substrate clogging by very fine sediment were therefore minimized. After proper calibration, 1-D sediment transport modeling can effectively support the planning of CSF operations: to minimize the downstream environmental effects, concurrently achieving acceptable flushing efficiency, the analyzed scenarios as well as the model outputs need to be carefully evaluated from a multidisciplinary perspective

Do badlands (always) control sediment yield? Evidence from a small intermittent catchment

The objective of this paper is to analyse the production and the yield of fine sediment in a small mountain catchment (10 km2), characterised by patches of badlands (25% of the catchment area) and drained by intermittent streams. The study area is located in the Southern Central Pyrenees. The study is performed at multiple temporal scales to further highlight: (i) the effect of pulses in the transfer of water and fine sediment; (ii) the contribution of the sediment production from badlands to the sediment yield of the catchment; and (iii) the role of the drainage network as fine sediment source and sink. Significant correlations between meteorological and flow variables were found; specifically, the strongest positive relations were observed between stream flashiness, the duration of the period in which the stream is dry and the suspended sediment concentration. Results indicated that badlands do not always control the export of sediments. At the annual scale badlands supply around 40% of the total catchment sediment yield. Seasonally sediment produced in badlands can be higher than the amount exported at the catchment outlet, suggesting the channel network acts as a sink. In terms of sediment production, badlands represent around of 53% of the total production taking also into account agricultural fields and forest areas. Results emphasise the key role of the channel network on controlling pulses of sediment transfer, in direct relation to the intermittent character of the streams. The frequency and magnitude of such pulses determines the catchment Sediment Delivery Ratio (SDR), depending on whether the drainage network acts as a sediment sink or source