Combination of lumped hydrological and remote-sensing models to evaluate water resources in a semi-arid high altitude ungauged watershed of Sierra Nevada (Southern Spain).

Assessing water resources in high mountain semi-arid zones is essential to be able to manage and plan the use of these resources downstream where they are used. However, it is not easy to manage an unknown resource, a situation that is common in the vast majority of high mountain hydrological basins. In the present work, the discharge flow in an ungauged basin is estimated using the hydrological parameters of an HBV (Hydrologiska Byråns Vattenbalansavdelning) model calibrated in a "neighboring gauged basin". The results of the hydrological simulation obtained in terms of average annual discharge are validated using the VI-ETo model. This model relates a simple hydrological balance to the discharge of the basin with the evaporation of the vegetal cover of the soil, and this to the SAVI index, which is obtained remotely by means of satellite images. The results of the modeling for both basins underscore the role of the underground discharge in the total discharge of the hydrological system. This is the result of the deglaciation process suffered by the high mountain areas of the Mediterranean arc. This process increases the infiltration capacity of the terrain, the recharge and therefore the discharge of the aquifers that make up the glacial and periglacial sediments that remain exposed on the surface as witnesses of what was the last glaciation.

Ecological characterization of a tick community across a landscape gradient exhibiting differential anthropogenic disturbance in the Atlantic Forest ecoregion in Argentina.

An ecological analysis of a tick (Ixodida: Ixodidae) community across a landscape gradient presenting differential anthropogenic disturbance in the Atlantic Forest ecoregion in Argentina was performed. Ticks were collected from vegetation and hosts between September 2014 and August 2016. A total of 12 697 free-living ticks and 3347 specimens from hosts were collected, including 317 ticks infesting humans. The values obtained show considerable species diversity in the forest environment accompanied by low equitability. The similarity index derived from a comparison of forest and agricultural environments was higher than that calculated by comparing forest and urban environments. The data suggest that although a cycle of one generation per year is apparent in some species, more than one cohort may co-exist within the populations of some of these species. Well-marked patterns of the seasonal distribution of free-living tick species emerged in environments with no anthropic modification. The results indicate that forest environments are more suitable habitats than agricultural and urban environments for many species of native tick, but are unsuitable for exotic species that have successfully established in environments that have been modified by man.

Prevention of intestinal parasites in a tri-border area of Latin America: Children perceptions and an integral health education strategy.

To investigate knowledge of school-aged children and their perception on intestinal parasites, and to assess knowledge reconstruction on prevention practices after specific training in the subject. We performed an activity package that included the analysis of children's drawings of intestinal parasites, and information and communication technologies (ITCs) to transfer knowledge about these pathogens and prevention measures. Retrieval learning activities were performed to fixation of general and specific prevention and control measures.Overall, we found that there is a knowledge gap in many aspects of parasite biology and ecology, and therefore on the risk of infection and acquisition mechanisms. After ITCs, the children improved their knowledge over non-trained children.The approaches used to transfer knowledge and for learning, fixation were valuable tools for incorporating changes in misconceptions and in the deep-rooted habits that favour entero-parasitic diseases. This has important implications for the specific design of future education materials and campaigns. Understanding of perceptions helps to provide justifications and knowledge to achieve changes in unhealthy habits, and it constitutes the basis for the transformation of many risky practices.

Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental, controlled, multi-centre study.

BACKGROUND: Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain). METHODS: Quasi-experimental, controlled, non-randomised, multi-centre study on the population receiving home care services comparing the outcomes of the new model, which included nurse-led case management, versus the conventional one. Primary endpoints: functional status, satisfaction and use of healthcare resources. Secondary endpoints: recruitment and caregiver burden, mortality, institutionalisation, quality of life and family function. Analyses were performed at base-line, and at two, six and twelve months. A bivariate analysis was conducted with the Student's t-test, Mann-Whitney's U, and the chi squared test. Kaplan-Meier and log-rank tests were performed to compare survival and institutionalisation. A multivariate analysis was performed to pinpoint factors that impact on improvement of functional ability. RESULTS: Base-line differences in functional capacity - significantly lower in the intervention group (RR: 1.52 95%CI: 1.05-2.21; p = 0.0016) - disappeared at six months (RR: 1.31 95%CI: 0.87-1.98; p = 0.178). At six months, caregiver burden showed a slight reduction in the intervention group, whereas it increased notably in the control group (base-line Zarit Test: 57.06 95%CI: 54.77-59.34 vs. 60.50 95%CI: 53.63-67.37; p = 0.264), (Zarit Test at six months: 53.79 95%CI: 49.67-57.92 vs. 66.26 95%CI: 60.66-71.86 p = 0.002). Patients in the intervention group received more physiotherapy (7.92 CI95%: 5.22-10.62 vs. 3.24 95%CI: 1.37-5.310; p = 0.0001) and, on average, required fewer home care visits (9.40 95%CI: 7.89-10.92 vs.11.30 95%CI: 9.10-14.54). No differences were found in terms of frequency of visits to A&E or hospital re-admissions. Furthermore, patients in the control group perceived higher levels of satisfaction (16.88; 95%CI: 16.32-17.43; range: 0-21, vs. 14.65 95%CI: 13.61-15.68; p = 0,001). CONCLUSION: A home care service model that includes nurse-led case management streamlines access to healthcare services and resources, while impacting positively on patients' functional ability and caregiver burden, with increased levels of satisfaction. TRIAL REGISTRATION: ISRCTN44054549.

Alpha-fetoprotein and hematopoietic growth factors in amniotic fluid.

OBJECTIVE: To determine whether a relationship exists between alpha-fetoprotein (AFP) and hematopoietic growth factors in amniotic fluid. METHODS: Forty-one women at 15 weeks' gestation were included in the study. Gestational age was assessed by obtaining a reliable menstrual history and scanning. Amniocentesis was performed, and each woman subsequently delivered anatomically and chromosomally normal infants. The level of AFP was determined using a standard automated procedure. The concentrations of stem cell factor, interleukin 3, interleukin 6, erythropoietin, and granulocyte colony-stimulating factor (G-CSF) were measured using a commercially available immunoassay. The relationships between AFP and the studied cytokines were evaluated using the Pearson linear correlation test. Significant correlations were studied further by linear and nonlinear regression to obtain the best predictive model. RESULTS: There was a significant correlation between AFP and stem cell factor (r =.47, P =.002). No significant correlations between AFP and the rest of the studied cytokines were found (r = -.07, r =.02, r = -.02, and r = -.11 for erythropoietin, G-CSF, interleukin 3, and interleukin 6, respectively). CONCLUSION: Alpha-fetoprotein is significantly correlated with stem cell factor in early pregnancy and might play a role in fetal hematopoiesis.

Umbilical blood flow and neonatal morphometry: a multivariate analysis.

OBJECTIVE: To study the relation between the state of umbilical blood flow and neonatal morphometry. STUDY DESIGN: We have recorded data from 460 pregnant women. Umbilical systolic to diastolic ratio was measured within the 3 days prior to the birth. Weight, height, head and chest circumferences, ponderal and head to chest circumferences ratio were considered for the study. RESULTS: In a univariate analysis, the best correlated variable to S/D ratio was the weight (r=-0.35). However, a forward stepwise multiple regression analysis demonstrated that the best predictors of S/D ratio were height and ponderal index. Small-for-gestational-age fetuses with placental insufficiency (n=20) had a significant more pronounced decrease of weight, height, head circumference and chest circumference than those with normal placental perfusion (n=31). The degree of decrease of ponderal index and HC/TC was similar in both groups. CONCLUSIONS: Umbilical blood flow is one important factor determining newborn morphometry. If only one growth variable is considered, the best correlation with umbilical S/D ratio is found to be the weight. The multivariate regression analysis concluded that the two most influential factors by umbilical blood flow are height and ponderal index and the rest of the morphometric parameters lost their significant correlations when adjusted by these variables. The impairment on neonatal morphometry in small-for-gestational-age fetuses associated to placental insufficiency is more severe than that with normal placental perfusion. However, it does not have a more pronounced decrease of ponderal index than the rest of causes of small-for-gestational-age fetuses.

Third-trimester maternal serum beta-HCG level and umbilical blood flow in fetal growth retardation.

OBJECTIVE: To determine the relationship between maternal serum beta-HCG level and umbilical artery systolic/diastolic ratio in fetal growth retardation. METHODS: Maternal serum beta-HCG was measured in 57 pregnant women in the third trimester, 31 with a fetal growth retardation and 26 with a normal growth. The systolic/diastolic ratio was measured in a midsection of the umbilical cord the same day of the biochemical determination. RESULTS: The serum beta-HCG level was statistically significant higher in pregnant women with a fetal growth retardation associated with a high systolic/diastolic ratio (n = 9) (P < 0.001). There were no differences between the fetuses with a normal growth (n = 26) and those with an intrauterine growth retardation and a normal systolic/diastolic ratio (n = 22). There was a significant positive correlation between maternal serum beta-HCG level and umbilical artery systolic/diastolic ratio (P < 0.01). CONCLUSION: Fetal growth retardation due to Doppler-defined vascular placental insufficiency is associated with a higher maternal serum beta-HCG level.