Caracterización de los sistemas de captación de agua de los cantones de Hojancha y Nicoya, en Guanacaste, Costa Rica

Capítulo 2 del libro digital: Clima, agua y producción sostenible: Aportes desde la acción académica CEMEDE - HIDROCECEn esta investigación se caracterizaron los sistemas de captación de agua en los cantones de Hojancha y Nicoya, en Guanacaste, Costa Rica. Específicamente, se documentaron las razones que incentivaron a los agricultores a construir estos sistemas. Adicionalmente, se analizó la percepción de los agricultores acerca del estado actual del funcionamiento de estos sistemas, así como, de los beneficios obtenidos durante los meses de aridez estacional. La información fue obtenida por medio de visitas a las fincas, registrando la ubicación espacial de los sistemas, tomando fotografías del estado actual de la infraestructura de los sistemas. Además, se utilizaron encuestas que fueron aplicadas en finca, a los once dueños de sistemas de captación de agua. El diseño colaborativo de la metodología, así como el trabajo de campo, la transcripción de las encuestas y el análisis de la información fue realizada por los estudiantes y académicos de la Universidad Nacional (UNA). Los productores encuestados establecieron que el principal beneficio de los sistemas de captación es que pueden proporcionar el agua necesaria para desarrollar actividades agropecuarias durante la aridez estacional (seis meses). Esta es la temporada más difícil para el desarrollo de la ganadería y la agricultura en estos cantones. Los sistemas de captación de agua les permiten adaptarse a los problemas de escasez hídrica que se han agravado en los últimos diez años. A partir del análisis de los resultados, se identificaron oportunidades para mejorar el diseño técnico de los sistemas, así como, la necesidad de continuar investigando, a fin de, evaluar la eficiencia de la tecnología y las implicaciones de implementar los sistemas de captación de agua, para solventar la disponibilidad hídrica en la región.Centro Mesoamericano de Desarrollo Sostenible del Trópico Seco (CEMEDE-UNA)Universidad Nacional, Costa RicaUniversidad Nacional, Sede Regional Chorotega, Costa RicaCentro Mesoamericano de Desarrollo Sostenible del Trópico Seco (CEMEDE-UNA

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used