Desigualdades en Salud: La Mortalidad Perinatal e Infantil en España

ResumenSe ha considerado al coeficiente de variación interprovincial (CV) como un indicador objetivo de la dispersión de los valores provinciales de las tasas de mortalidad infantil, neonatal, postneonatal y perinatal. Así, se ha estudiado la evolución de los CV anuales, para las cuatro tasas, desde 1940 hasta 1986, con objeto de identificar la evolución temporal de las diferencias interprovinciales con respecto a dichas tasas de mortalidad. Se observa que en ningún caso los CV muestran una tendencia decreciente en el tiempo, lo que parece indicar que las desigualdades interregionales permanecen inalteradas. La tasa de mortalidad postneonatal es la que mayor dispersión presenta en sus valores provinciales durante el período estudiado (CV entre 23 y 40%), y su evolución es independiente de la de la tasa de mortalidad neonatal, lo que parece indicar que los factores que influyen en ambas son diferentes.SummaryThe interregional variation coefficient (VC)) has been considered as an accurate measure of the dispersion of regional infant, neonatal, postneonatal and perinatal mortality rates. Thus, trends of annual VC have been analyzed, for each rate, from 1940 to 1986, to identify the evolution in time of the regional differences with respect to these mortality rates. None of the four mortality rates showed a decreasing trend in their respective VCs. This may indicate that interregional differences do not change along time. The postneonatal mortality rate has been shown to have the highest VCs during the study period (ranging from 23 to 40%), with an independent evolution with respect to neonatal mortality rate, probably because the factors that influence both rates are clearly different

Estudio de las resistencias a Aminoglicósidos en enterobacterias de origen hospitalario

Se estudia la presencia de enzimas modificantes de antibióticos aminoglicósidos y su origen genético en 97 cepas de enterobacterias resistentes a diversos aminoglicósidos y aisladas en el Hospital Universitario de Granada. La presencia de tales enzimas se detectó en 82 cepas (84,50/0) cuyos determinantes génicos se localizaron en 74 casos (90,2 %) sobre plásmidos conjugativos, y en 8 (9,8 %) en plásmidos que únicamente se pudieron transferir mediante transformación. Se identificaron 4 tipos de enzimas, APH(3'), AAC(3), AAC(6') Y ANT(2") respectivamente según su frecuencia de aparición. Los resultados obtenidos indican la existencia de un estado de resistencia endémica, acentuado en el caso de aquellos antibióticos cuyo uso prácticamente no se controla, y aportan la base de conocimientos necesaria para la determinación de la evolución de las mismas en nuestro hospital con fines epidemiológicos.The aminoglycoside antibiotics modifying enzymes and their genetic properties from 97 entero bacteria strains resistant to several aminoglycoside antibiotics isolated at the Universitary Hospital of Granada were studied. These enzymes were detected in 82 strains (84,5 %) and their genetics determinants were localized in 74 strains (90,2 %) on conjugative plasmids. 8 strains (9,8 %) had their genetics determinant on plasmid transferred only by transformation. Four types of enzymes were found, APH(3'), AAC(3), AAC(6') and ANT(2") in this strains. Our results show a situation of endemic resistance towards those antibiotics without control in this hospital

The Tree Biodiversity Network (BIOTREE-NET): prospects for biodiversity research and conservation in the Neotropics

Biodiversity research and conservation efforts in the tropics are hindered by the lack of knowledge of the assemblages found there, with many species undescribed or poorly known. Our initiative, the Tree Biodiversity Network (BIOTREE-NET), aims to address this problem by assembling georeferenced data from a wide range of sources, making these data easily accessible and easily queried, and promoting data sharing. The database (GIVD ID NA-00-002) currently comprises ca. 50,000 tree records of ca. 5,000 species (230 in the IUCN Red List) from \u3e2,000 forest plots in 11 countries. The focus is on trees because of their pivotal role in tropical forest ecosystems (which contain most of the world\u27s biodiversity) in terms of ecosystem function, carbon storage and effects on other species. BIOTREE-NET currently focuses on southern Mexico and Central America, but we aim to expand coverage to other parts of tropical America. The database is relational, comprising 12 linked data tables. We summarise its structure and contents. Key tables contain data on forest plots (including size, location and date(s) sampled), individual trees (including diameter, when available, and both recorded and standardised species name), species (including biological traits of each species) and the researchers who collected the data. Many types of queries are facilitated and species distribution modelling is enabled. Examining the data in BIOTREE-NET to date, we found an uneven distribution of data in space and across biomes, reflecting the general state of knowledge of the tropics. More than 90% of the data were collected since 1990 and plot size varies widely, but with most less than one hectare in size. A wide range of minimum sizes is used to define a \u27tree\u27. The database helps to identify gaps that need filling by further data collection and collation. The data can be publicly accessed through a web application at http://portal.biotreenet.com. Researchers are invited and encouraged to contribute data to BIOTREE-NET

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

La Red Internacional de Inventarios Forestales (BIOTREE-NET) en Mesoamérica: avances, retos y perspectivas futuras

Conservation efforts in Neotropical regions are often hindered by lack of data, since for many species there is a vacuum of information, and many species have not even been described yet. The International Network of Forest Inventory Plots (BIOTREE-NET) gathers and facilitates access to tree data from forest inventory plots in Mesoamerica, while encouraging data exchange between researchers, managers and conservationists. The information is organised and standardised into a single database that includes spatially explicit data. This article describes the scope and objectives of the network, its progress, and the challenges and future perspectives. The database includes above 50000 tree records of over 5000 species from more than 2000 plots distributed from southern Mexico through to Panama. Information is heterogeneous, both in nature and shape, as well as in the geographical coverage of inventory plots. The database has a relational structure, with 12 inter-connected tables that include information about plots, species names, dbh, and functional attributes of trees. A new system that corrects typographical errors and achieves taxonomic and nomenclatural standardization was developed using The Plant List (http://theplantlist.org/) as reference. Species distribution models have been computed for around 1700 species using different methods, and they will be publicly accessible through the web site in the future (http://portal.biotreenet.com). Although BIOTREE-NET has contributed to the development of improved species distribution models, its main potential lies, in our opinion, in studies at the community level. Finally, we emphasise the need to expand the network and encourage researchers willing to share data and to join the network and contribute to the generation of further knowledge about forest biodiversity in Neotropical regions

Metaanálisis en epidemiología, (segunda parte): métodos cuantitativos

ResumenEl objetivo del presente trabajo es poner al alcance del lector interesado en el tema los principales métodos cuantitativos del metaanáiísis que se han aplicado en el terreno sanitario, haciéndose especial hincapié en los más utilizados. Se ofrece también un pequeño resumen de los métodos más difundidos para determinar la presencia de un sesgo de publicación Se discuten las ventajas e inconvenientes de cada procedimiento detallado.SummaryThe main goal of this paper is to offer an introduction to the quantitative methods of meta-analysis used in epidemiology/public health, emphasizing on the most widespread used. We give also a brief reference of the methods to recognize publication bias. The limitations and advantages of the methods commented on are discussed

Biofertilización de café orgánico en etapa de vivero en Chiapas, México

In Chiapas, coffee seedlings production is conventionally done with chemical fertilizers. Organic coffee production requires see dlings nutrition with biofertilizers and therefore the objective was to evaluate the effect of some of these in coffee seedlings development (Coffee arabica) Bourbon variety in a nursery. The experiment was conducted during 2007 and 2008 in Cacahohatan, Chiapas. Inoculants were a strain of Glomus intraradices Schenck and Smith and strains of PACHAZ08 of Azotobacter and Azospirillum 11B. Factorial designs 23 were used with eight treatments and 100 repetitions per treatment. In inoculated seedlings, 4 samples were made at intervals of 28 days, measuring height, leaves length, root length, dried leaves and roots weight, chlorophyll and nitrogen content, and root colonization by inoculants. Data were subjected to variance analysis and means comparison by Tukey p¿ 0.05. Best morphological and biochemical characteristics of seedlings were obtained with Azospirillum alone or coinoculated with Glomus and Azotobacter and were statistically the best treatments. Azospirillum modified root architecture and stimulated mycorrhization. Diazotrophics were antagonistic, but it was inhibited by Glomus. The three organisms¿ interaction induced abetter use of nutrients, water, photosynthetic capacity and greater accumulation of carbon biomass in seedlings.En Chiapas, la producción de plántulas de café, se realiza convencionalmente con la aplicación de fertilizantes quí­micos. La producción de café orgánico, requiere la nutrición de plántulas con biofertilizantes y por ello el objetivo fue evaluar el efecto de algunos de éstos en el desarrollo de plántulas de café (Coffe arábica) variedad Bourbon en vivero. El experimento se realizó durante 2007 y 2008 en Cacahohatan,Chiapas. Los inoculantes fueron una cepa Glomus intraradices Schenck y Smith, cepas PACHAZ08 de Azotobacter y 11B de Azospirillum. Se utilizó el diseño factorial 23 con ocho tratamientos y 100 repeticiones por tratamiento. En las platulas inoculadas, se efectuaron 4 muestreos con intervalos de 28 dí­as, midiendóse la altura, longitud de hojas, longitud de raí­z, peso seco de hojas y raí­ces, contenido de clorofila y nitrógeno, y colonizacion de raí­z por los inoculantes. Los datos se sometieron al análisis de varianza y comparacion de medias por Tukey p 0.05. Las mejores características morfológicas y bioquímicas de las plántulas, se obtuvieron con Azospirillum sóla o coinoculada con Glomus y Azotobacter y estadísticamente fueron los mejores tratamientos. Azospirillum modificó la arquitectura de la raíz y estimuló la micorrización. Los diazotrofos en conjunto fueron antagónicos pero esta fue inhibida por Glomus. La interacción de los tres microorganismos indujo en las plántulas un mejor aprovechamiento de nutrimentos, agua, capacidad fotosintética y mayor acumulación de biomasa carbonada