Examining Factors Associated with Cannabis Use Among Sexual and Gender Minority and Cisgender Heterosexual Emerging Adults in California.

Purpose: We explored correlates of cannabis risk and examined differences between sexual and gender minority (SGM) and cisgender heterosexual emerging adults (ages 18-29) in California. Methods: We recruited 1491 participants aged 18-29 years for a cross-sectional online survey. Ordinal logistic regressions assessed associations between minority stress (discrimination and internalized homophobia [IH]), social support (perceived social support and lesbian, gay, bisexual, transgender, and queer+ [LGBTQ+] community connectedness), and cannabis risk scores (low, medium, and high risk of developing problems related to their cannabis use). We also explored differences in cannabis risk scores by sexual orientation and gender identity (SOGI). Results: Higher everyday discrimination scores were associated with increased odds of self-scoring in a higher cannabis risk range (adjusted odds ratio = 1.53, 95% confidence interval [CI] = 1.31-1.79). We found no significant associations for IH, LGBTQ+ community connectedness, or social support on cannabis risk scores. There were also no statistically significant differences by SOGI groups; however, SOGI did moderate the relationship between IH and cannabis risk score such that the slope for IH was 0.43 units higher for cisgender sexual minority women compared to cisgender sexual minority men (95% CI = 0.05-0.81). Conclusion: Our findings suggest that experiences of everyday discrimination are important contributors to developing cannabis-related problems and IH may have more pronounced effects for sexual minority women compared to sexual minority men. More research is needed to better understand risk and protective factors of cannabis risk to inform the development of culturally tailored interventions for SGM emerging adults.

"You'll Be Chased Away": Sources, Experiences, and Effects of Violence and Stigma among Gay and Bisexual Men in Kenya.

Gay and bisexual men in Kenya face extreme socio-political stigma which manifests in widespread violence and discrimination across socio-ecological levels. We conducted individual in-depth interviews with 60 gay and bisexual men in western and central Kenya. Interview transcripts were thematically analyzed using an inductive, phenomenological approach to qualitatively examine experiences of stigma and violence at the interpersonal and institutional levels. A total of seven primary themes and four sub-themes emerged from the data. At the interpersonal level, participants described stigma and violence from family, friends, and romantic/sexual partners with sub-themes for gay-baiting violence, blackmail, intimate partner violence, and commitment phobia. At the institutional level, participants described stigma and violence from religious, employment, educational, and healthcare institutions. This stigma and violence severely impacted the lives of participants including their mental health, physical health, sexual health, socioeconomic status, and ability to access health-promoting services. These data identify sources of stigma and describe how this stigma manifests in the everyday lives of gay and bisexual men in Kenya. Study findings and quotes from participants highlight the severity of violence, stigma, and discrimination faced by this community and emphasize the need for decriminalization of same-sex sexualities as well as interventions to support health and wellbeing.

Experiences of Violence and Mental Health Concerns Among Sexual and Gender Minority Adults in Western Kenya.

Purpose: Sexual and gender minority (SGM) populations throughout Kenya as well as other sub-Saharan African countries face systemic discrimination and substantial human rights violations, yet scant literature documents the potentially harmful mental health effects of these experiences. This study sought to understand the relationship among experiences of violence, social support, and mental health among SGM adults in Kenya. Methods: Members of a local LGBT community-based organization collected survey data in Western Kenya from October 2017 to April 2018, recruiting 527 SGM participants through an array of community outreach methods. Respondents in this cross-sectional study completed a survey regarding their mental health and other psychosocial factors. Multiple linear regression analyses were conducted to assess associations between experiences of violence (SGM violence and intimate partner violence [IPV]) and mental health outcomes (depressive symptoms and post-traumatic stress symptoms [PTSSs]) and to examine the potential moderating effect of social support on these relationships. Results: Relative to those who had never faced violence, participants who experienced IPV and/or violence based on their sexual orientation, gender identity, or gender expression (SGM violence) reported significantly higher levels of depressive symptoms and PTSSs. Emotional support was associated with lower levels of PTSSs. Social support did not moderate the relationship between SGM violence and mental health symptoms. Conclusions: These findings suggest that there may be a relationship between experiences of violence and poor mental health among SGM Kenyans. More studies are needed to better understand SGM-specific risk factors for poor mental well-being among SGM people in Kenya and the types of interventions that may help mitigate these challenges.

The addition of echocardiographic parameters to PESI risk score improves mortality prediction in patients with acute pulmonary embolism: PESI-Echo score.

AIMS: Pulmonary embolism severity index (PESI) has been developed to help physicians make decisions about the treatment of patients with pulmonary embolism (PE). The combination of echocardiographic parameters could potentially improve PESI's mortality prediction. To assess the additional prognostic value of tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) when combined with the PESI score in patients with PE to predict short-term mortality. METHODS AND RESULTS: A multicentric prospective study database of patients admitted with PE in 75 academic centres in Argentina between 2016 and 2017 was analysed. Patients with an echocardiogram at admission with simultaneous measurement of TAPSE and PASP were included. PESI risk score was calculated blindly and prospectively, and in-hospital all-cause mortality was assessed. Of 684 patients, 91% had an echocardiogram, PASP and TAPSE could be estimated simultaneously in 355 (57%). All-cause in-hospital mortality was 11%. The receiver operating characteristic analysis showed an area under the curve (AUC) [95% confidence interval (CI)] of 0.76 (0.72-0.81), 0.74 (0.69-0.79), and 0.71 (0.62-0.79), for the PESI score, PASP, and TAPSE parameters, respectively. When PESI score was combined with the echocardiogram parameters (PESI + PASP-TAPSE = PESI-Echo), an AUC of 0.82 (0.77-0.86) was achieved (P = 0.007). A PESI-Echo score ≥128 was the optimal cut-off point for predicting hospital mortality: sensitivity 82% (95% CI 67-90%), specificity 69% (95% CI 64-74%). The global net reclassification improvement was 9.9%. CONCLUSIONS: PESI-Echo score is a novel tool for assessing mortality risk in patients with acute PE. The addition of echocardiographic parameters to a validated clinical score improved the prediction of hospital mortality.

[External validation of prognostic scores for in-hospital and 30-day mortality in patients with pulmonary embolism in Argentina]. / Validación externa de puntajes pronósticos para mortalidad hospitalaria y a treinta días en pacientes con tromboembolismo pulmonar en Argentina.

Prognostic models have been developed to help make decisions in the treatment of pulmonary embolism (PE). Among them, the Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI), however they have not been validated in our setting. The objective was to evaluate PESI and sPESI scores ability to predict in-hospital mortality in patients with PE in Argentina. We analyzed a database of 75 academic centers in Argentina that included consecutive patients with PE from 2016 to 2017. The scores were prospectively calculated, and in-hospital and 30 days mortality were assessed. The validation of the models was assessed through discrimination using the area under the ROC curve (AUC), and calibration with the Hosmer-Lemeshow (HL) test. The cohort included 684 patients. In-hospital mortality was 12% and at 30 days an additional 3.2% mortality was registered. The AUC (95% CI) for in-hospital mortality was 0.75 (0.69-0.81) for PESI and 0.77 (0.71-0.82) for sPESI (p = 0.2 between scores). AUC of 30-day mortality 0.75 (0.68-0.8) and 0.78 (0.74-0.83) for PESI and sPESI (p = 0.2 between scores). Both models presented good calibration. The PESI and sPESI risk scores demonstrated similar performance and good accuracy in predicting hospital and 30-day mortality. Both scores can be established as simple prediction tools for PE patients in Argentina.

Se han desarrollado modelos pronósticos para guiar el tratamiento del tromboembolismo pulmonar agudo (TEP), entre ellos el Pulmonary Embolism Severity Index (PESI) y PESI simplificado (sPESI), los cuales no han sido validados en nuestro país. El objetivo fue evaluar la capacidad de los puntajes de riesgo PESI y sPESI para predecir mortalidad hospitalaria en pacientes con TEP en Argentina. Analizamos una base de datos de 75 centros académicos de Argentina que incluyeron pacientes consecutivos con TEP desde el 2016 al 2017. Las puntuaciones se calcularon de forma prospectiva y se evaluó la mortalidad hospitalaria y a 30 días. La validación de los modelos se realizó a través de discriminación mediante área bajo la curva ROC (AUC) y calibración con la prueba de Hosmer-Lemeshow (HL). La cohorte total incluyó 684 pacientes. La mortalidad hospitalaria fue 12% y a los 30 días se registró un 3.2% adicional de mortalidad. El AUC (IC 95%) para la mortalidad hospitalaria fue de 0.75 (0.69-0.81) para PESI y 0.77 (0.71-0.82) para sPESI (p = 0.25 entre puntajes). El AUC de mortalidad a los 30 días fue de 0.75 (0.68-0.8) y 0.78 (0.74-0.83) para PESI y sPESI (p = 0.2 entre puntajes). Ambos modelos presentaron buena calibración y demostraron un desempeño similar para predecir mortalidad hospitalaria y a 30 días, por lo que pueden establecerse como herramientas de predicción simples para pacientes con TEP en Argentina.

Validación externa de puntajes pronósticos para mortalidad hospitalaria y a treinta días en pacientes con tromboembolismo pulmonar en Argentina / External validation of prognostic scores for in-hospital and 30-day mortality in patients with pulmonary embolism in Argentina

Resumen Se han desarrollado modelos pronósticos para guiar el tratamiento del tromboembolismo pulmonar agudo (TEP), entre ellos el Pulmonary Embolism Severity Index (PESI) y PESI simplificado (sPESI), los cuales no han sido validados en nuestro país. El objetivo fue evaluar la capacidad de los puntajes de riesgo PESI y sPESI para predecir mortalidad hospitalaria en pacientes con TEP en Argentina. Analizamos una base de datos de 75 centros académicos de Argentina que incluyeron pacientes consecutivos con TEP desde el 2016 al 2017. Las puntuaciones se calcularon de forma prospectiva y se evaluó la mortalidad hospitalaria y a 30 días. La validación de los modelos se realizó a través de discriminación mediante área bajo la curva ROC (AUC) y calibración con la prueba de Hosmer-Lemeshow (HL). La cohorte total incluyó 684 pacientes. La mortalidad hospitalaria fue 12% y a los 30 días se registró un 3.2% adicional de mortalidad. El AUC (IC 95%) para la mortalidad hospitalaria fue de 0.75 (0.69-0.81) para PESI y 0.77 (0.71-0.82) para sPESI (p = 0.25 entre puntajes). El AUC de mortalidad a los 30 días fue de 0.75 (0.68-0.8) y 0.78 (0.74-0.83) para PESI y sPESI (p = 0.2 entre puntajes). Ambos modelos presentaron buena calibración y demostraron un desempeño similar para predecir mortalidad hospitalaria y a 30 días, por lo que pueden establecerse como herramientas de predicción simples para pacientes con TEP en Argentina.

Abstract Prognostic models have been developed to help make decisions in the treatment of pulmonary embolism (PE). Among them, the Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI), however they have not been validated in our setting. The objective was to evaluate PESI and sPESI scores ability to predict in-hospital mortality in patients with PE in Argentina. We analyzed a database of 75 academic centers in Argentina that included consecutive patients with PE from 2016 to 2017. The scores were prospectively calculated, and in-hospital and 30 days mortality were assessed. The validation of the models was assessed through discrimination using the area under the ROC curve (AUC), and calibration with the Hosmer-Lemeshow (HL) test. The cohort included 684 patients. In-hospital mortality was 12% and at 30 days an additional 3.2% mortality was registered. The AUC (95% CI) for in-hospital mortality was 0.75 (0.69-0.81) for PESI and 0.77 (0.71-0.82) for sPESI (p = 0.2 between scores). AUC of 30-day mortality 0.75 (0.68-0.8) and 0.78 (0.74-0.83) for PESI and sPESI (p = 0.2 between scores). Both models presented good calibration. The PESI and sPESI risk scores demonstrated similar performance and good accuracy in predicting hospital and 30-day mortality. Both scores can be established as simple prediction tools for PE patients in Argentina.

[Scholia about the pandemia urbi et orbi et orbe generate by de COVID-19 disease.] / Escolios sobre la planetaria pandemia urbi et orbi provocada por la enfermedad debida al COVID-19.

The Goddess of Health had two daughters, Panacea and Higinia, the fruit of the first is diagnosis, prognosis and treatment, and the fruit of the second is health management, prevention, and statistics. Humanbeings are unexpectedly subjected to:1. Happenings: they belong to the plane of the personality, crisis, the Age of the virus appears that had already been announced. The ideological support is not sustained, causing a bankruptcy in the system of our life. The subject acts unconsciously, does not believe in the advent of the catastrophe, does not follow logical rules, is unable to transcend, fear-anguish appears and this requires a lot of protection. Those who remain free from personal decomposition skewer him and put a project called "person" with his sense of life, his lifestyle and life project, which is the conjunction of body and spirit, which with the agony struggles against life itself.2. Events: they belong to the plane of nature, catastrophes. The use of the word catastrophe is not synonymou swith unavoidable natural disaster, accident, although it is used by the health authorities this can have a great impact on those affected by the virus. This word has the final nuance of Greek tragedies. False arrogance appears, true madness. In the case of the Covid-19 there is something else, a dialectical position with oneself. They lived and we lived on a volcano. The example of the Apocalypse and its three plagues, epidemics and post-war neuroses, etc. The most striking neuropsychiatricsymptomatology is the appearance of "ageusia" and "anosmia", abruptly and totally, which disappears slowly, as well as sleep disturbances with ignagogic images post-traumatic stress charts appear.

La Diosa salud tenía dos hijas, Panaceae Higinia, fruto de la primera es el diagnóstico, el pronóstico y tratamiento y fruto de la segunda es la gestión sanitaria, la prevención y la estadística. Los seres humanos están sometidos inesperadamente a: 1. Acontecimientos: pertenecen al plano de la personalidad, crisis, aparece la Edad del virus que ya se venía anunciada. El soporte ideológico no se sostiene, provocando una quiebra en el sistema de nuestra vida. El sujeto actúa inconscientemente, no cree en el advenimiento de la catástrofe, no sigue normas lógicas es incapaz de transcender, aparece el miedo-angustia y esto exige mucho amparo. Los que se mantienen libres de la descomposición personal lo ensartan y le ponen un proyecto que se llama "persona" con su sentido de vida, su estilo de vida y proyecto de vida, que es la conjunción del cuerpo y el espíritu, que con la agonía lucha contra la vida misma.2. Sucesos: pertenecen al plano de la naturaleza, catástrofes. El uso de la palabra catástrofe no es sinónimo de desastre natural inevitable, accidente, aunque se utilice por las autoridades sanitarias esto puede tener una gran repercusión en los damnificados por el virus. Esta palabra tiene el matiz final de las tragedias griegas. Aparece la falsa arrogancia, la locura verdadera. En el caso del Covid-19 hay algo mas, una posición dialéctica con uno mismo. Vivieron y vivimos en un volcán. El ejemplo del Apocalipsis y sus tres plagas, epidemias y neurosis de la post guerra, etc. La sintomatología neuropsiquiatrica más llamativa es la aparición de la "ageusia" y "anosmia", de forma brusca y total que desaparece lentamente, así como las alteraciones del sueño con imágenes ignagogicas, aparecen cuadros de estrés post traumático.

Escolios sobre la planetaria pandemia urbi et orbi provocada por la enfermedad debida al COVID-19 / Scholia about the pandemia urbi et orbi et orbe generate by de COVID-19 disease

La Diosa salud tenía dos hijas, Panacea e Higinia, fruto de la primera es el diagnóstico, el pronostico y tratamiento y fruto de la segunda es la gestión sanitaria, la prevención y la estadística. Los seres humanos están sometidos inesperadamente a: 1. Acontecimientos: pertenecen al plano de la personalidad, crisis, aparece la Edad del virus que ya se venía anunciada. El soporte ideológico no se sostiene, provocando una quiebra en el sistema de nuestra vida. El sujeto actúa inconscientemente, no cree en el advenimiento de la catástrofe, no sigue normas lógicas es incapaz de transcender, aparece el miedo-angustia y esto exige mucho amparo. Los que se mantienen libres de la descomposición personal lo ensartan y le ponen un proyecto que se llama "persona" con su sentido de vida, su estilo de vida y proyecto de vida, que es la conjunción del cuerpo y el espíritu, que con la agonía lucha contra la vida misma. 2. Sucesos: pertenecen al plano de la naturaleza, catástrofes. El uso de la palabra catástrofe no es sinónimo de desastre natural inevitable, accidente, aunque se utilice por las autoridades sanitarias esto puede tener una gran repercusión en los damnificados por el virus. Esta palabra tiene el matiz final de las tragedias griegas.Aparece la falsa arrogancia, la locura verdadera. En el caso del Covid-19 hay algo más, una posición dialéctica con uno mismo. Vivieron y vivimos en un volcán. El ejemplo del Apocalipsis y sus tres plagas, epidemias y neurosis de la post guerra, etc. La sintomatología neuropsiquiátrica más llamativa es la aparición de la "ageusia" y "anosmia", de forma brusca y total que desaparece lentamente, así como, las alteraciones del sueño con imágenes ignagógicas, aparecen cuadros de estrés post traumático

The Goddess of Health had two daughters, Panacea and Higinia, the fruit of the first is diagnosis, prognosis and treatment, and the fruit of the second is health management, prevention, and statistics. Human beings are unexpectedly subjected to: 1. Happenings: they belong to the plane of the personality, crisis, the Age of the virus appears that had already been announced. The ideological support is not sustained, causing a bankruptcy in the system of our life. The subject acts unconsciously, does not believe in the advent of the catastrophe, does not follow logical rules, is unable to transcend, fear-anguish appears and this requires a lot of protection. Those who remain free from personal decomposition skewer him and put a project called "person" with his sense of life, his lifestyle and life project, which is the conjunction of body and spirit, which with the agony struggles against life itself. 2. Events: they belong to the plane of nature, catastrophes. The use of the word catastrophe is not synonymous with unavoidable natural disaster, accident, although it is used by the health authorities this can have a great impact on those affected by the virus. This word has the final nuance of Greek tragedies. False arrogance appears, true madness. In the case of the Covid-19 there is something else, a dialectical position with oneself. They lived and we lived on a volcano. The example of the Apocalypse and its three plagues, epidemics and post-war neuroses, etc. The most striking neuropsychiatric symptomatology is the appearance of "ageusia" and "anosmia", abruptly and totally, which disappears slowly, as well as sleep disturbances with ignagogic images post-traumatic stress charts appear

Tromboembolismo pulmonar agudo en la Argentina. Registro CONAREC XX / Acute Pulmonary Embolism in Argentina. XX CONAREC Registry

RESUMEN Introducción: El tromboembolismo de pulmón agudo (TEP) representa la tercera causa de mortalidad cardiovascular. Sin embargo, existen pocos datos de esta patología en nuestro país. Nuestro objetivo fue describir las características basales, evolución y tratamiento implementado en pacientes con tromboembolismo de pulmón agudo en Argentina. Material y métodos: Se trata de un registro multicéntrico prospectivo que incorporó pacientes con diagnóstico de tromboembolismo de pulmón agudo internados en centros con residencia de cardiología desde octubre de 2016 a noviembre de 2017. Se realizó un análisis convencional para estadística descriptiva y comparativa. Se consideró significativo un valor de p < 0,05. Se realizó una auditoría cruzada al 20% de los centros participantes. Resultados: Se incluyeron 684 pacientes consecutivos de 75 centros, con un promedio de edad de 63,8 años; 388 (57%) eran de sexo femenino. El TEP fue el motivo de internación en 484 (71%) de los casos. Los factores predisponentes más frecuentes fueron obesidad, hospitalización reciente, reposo transitorio y cáncer activo. Se indicó anticoagulación durante la internación en 661 (97%) pacientes y terapia de reperfusión en 91 (13%). Sin embargo, solo 50 de los 102 pacientes que se presentaron con inestabilidad hemodinámica recibieron alguna terapia de reperfusión (49%). La mortalidad hospitalaria fue del 12%, principalmente relacionada con el tromboembolismo de pulmón agudo (51%). Conclusiones: El tromboembolismo de pulmón agudo en nuestro medio constituye una patología con elevada mortalidad en la internación atribuible principalmente al evento embólico. Se observó una baja utilización de terapias de reperfusión en pacientes con inestabilidad hemodinámica.

ABSTRACT Background: Acute pulmonary embolism (PE) represents the third cause of cardiovascular mortality. However, there is lack of information about this entity in our country. Our aim was to describe baseline characteristics, clinical evolution and treatment of patients with acute PE in Argentina. Methods: This was a prospective multicenter registry including patients with acute PE hospitalized in centers with cardiology residency from October 2016 to November 2017. Conventional analysis was performed for descriptive and comparative statistics. A value of p<0.05 was considered significant. Cross audit was performed to 20% of participating centers. Results: We included 684 consecutive patients from 75 centers with an average age of 63.8 years and 388 (57%) women. Hospital admission was due to PE in 484 (71%) cases. The most frequent predisposing factors were obesity, recent hospitalization, transient rest and active cancer. Anticoagulation was indicated in 661 patients (97%) and reperfusion therapy was performed in 91 (13%). However, only 50 of the 102 patients who presented with hemodynamic instability received reperfusion therapy (49%). Global in-hospital mortality was 12%, mainly associated with acute PE (51%). Conclusions: Acute pulmonary embolism presents with high in-hospital mortality in our setting, mainly related to the embolic event. We observed a low use of reperfusion therapies in patients with hemodynamic instability.

Development of a measure to assess vaccine confidence among men who have sex with men.

BACKGROUND: Recent serogroup C meningococcal disease outbreaks led to meningococcal vaccine recommendations for Southern California men who have sex with men (MSM). Assessment of vaccine confidence is critical to improving vaccine coverage in the context of disease outbreaks wherein immunization(s) are recommended. METHODS: We surveyed MSM using venue-based sampling and began development of the vaccine confidence index (VCI) with 30 survey items corresponding to trust- and safety-related perceptions. We performed exploratory factor analyses and computed the Cronbach's alpha coefficient to assess internal consistency of the VCI. We created a categorical confidence variable (low, medium, and high confidence) and conducted bivariate and multivariate analyses to evaluate associations with reported confidence and immunization uptake. RESULTS: Ten survey items were included in the final VCI and formed the confidence measure. Participants with low confidence had the lowest levels of reported uptake for both meningococcal vaccines. Confidence differed significantly (p ≤ 0.05) between MSM who indicated they received vaccines recommended within the context of the outbreak and those who did not. CONCLUSIONS: Our VCI is sensitive to a number of issues that may influence vaccine confidence. It is useful for assessing MSM trust and acceptance of recommended immunizations and may be used to inform intervention development.

Alcohol Use and HIV Risk Within Social Networks of MSM Sex Workers in the Dominican Republic.

To examine how alcohol-related HIV risk behaviors within MSM sex workers' social networks (SN) may be associated with individual risk behaviors, respondent-driven and venue-based sampling were used to collect demographic, behavioral and SN characteristics among MSM sex workers in Santo Domingo and Boca Chica (N = 220). The majority of participants reported problem drinking (71.0%) or alcohol use at their last sexual encounter (71.4%). Self-reported problem drinking was associated with SN characteristics (at least one member who recently got drunk aOR = 7.5, no religious/spiritual adviser aOR = 3.0, non-sexual network density aOR = 0.9), while self-reported alcohol use at last sex was associated with individual (drug use at last sex aOR = 4.4) and SN characteristics (at least one member with previous HIV/STI testing aOR = 4.7). Dominican MSM sex workers reported high alcohol use, which may increase their risk for HIV. A better understanding of SN factors associated with individual risk behaviors can help guide appropriate intervention development.

Season-dependent and independent responses of Mediterranean scrub to light conditions.

Semi-arid plant species cope with excess of solar radiation with morphological and physiological adaptations that assure their survival when other abiotic stressors interact. At the leaf level, sun and shade plants may differ in the set of traits that regulate environmental stressors. Here, we evaluated if leaf-level physiological seasonal response of Mediterranean scrub species (Myrtus communis, Halimium halimifolium, Rosmarinus officinalis, and Cistus salvifolius) depended on light availability conditions. We aimed to determine which of these responses prevailed independently of the marked seasonality of Mediterranean climate, to define a leaf-level strategy in the scrub community. Thirty six leaf response variables - involving gas exchange, water status, photosystem II photochemical efficiency, photosynthetic pigments and leaf structure - were seasonally measured in sun exposed and shaded plants under field conditions. Physiological responses showed a common pattern throughout the year, in spite of the marked seasonality of the Mediterranean climate and of species-specific differences in the response to light intensity. Variables related to light use, CO2 assimilation, leaf pigment content, and LMA (leaf mass area) presented differences that were consistent throughout the year, although autumn was the season with greater contrast between sun and shade plants. Our data suggest that in Mediterranean scrub shade plants the lutein pool could have an important role in the photoprotection of the photosynthetic tissues. There was a negative linear correlation between the ratio lutein/total chlorophylls and the majority of leaf level variables. The combined effect of abiotic stress factors (light and drought or light and cold) was variable-specific, in some cases enhancing differences between sun and shade plants, while in others leading to unified strategies in all scrub species.

Climatic conditions and herbivory effects on morphological plasticity of Argania spinosa.

The main objective of this paper was to look into the morphological differentiation patterns and phenotypic plasticity in four populations of Argania spinosa with environmentally contrasted conditions. Mean response, magnitude and pattern of morphological intra- and inter-population plasticity indexes were measured and analyzed in order to identify which characters contribute the most to the acclimation of this species. Populations growing in the ecological optimum of the species presented the lowest plasticity, while those growing in the most stressed habitats showed an increased morphological variability. The study of four populations showed that human pressure seems to play an important function in the regulation of morphological characters. However, climatic conditions seem to play a significant role in the increase of morphological plasticity.

Germination success and seedling development of Argania spinosa under different climatic conditions and browsing intensity.

The present study assesses whether the germination and establishment success of Argania spinosa seeds are affected by the environmental conditions under which the mother plant has grown. Seeds from three populations with different climatic conditions and herbivory intensity were collected and sown in the laboratory after different treatments. Our study suggests that the seed germination process and initial stages of seedling growth are adaptive. Seeds from the population of Agadir with the highest herbivory pressure and high air relative humidity in summer (due to the proximity to the sea) were stimulated by acid treatment, and showed a lower root/stem ratio, which allows them to take advantage of the atmospheric water resources. Seeds from the Mountain population, where the most arid environmental conditions were found, produced early-germinating seeds with the highest root/stem ratio that would facilitate seedling establishment when the harshest environmental conditions appear in summer.

A highly sensitive sandwich ELISA for the determination of glycomacropeptide to detect liquid whey in raw milk.

Milk processing industries and distributors have problems with adulteration of liquid milk by the addition of bovine cheese whey. Recently, the detection of fraudulent manipulation of milk with whey has focused on the identification of glycomacropeptide (GMP). Current non-immunological methods to detect GMP in dairy products are expensive and time-consuming or have low sensitivity. In this study, a novel sandwich enzyme-linked immunosorbent assay (ELISA) for the detection and quantification of whey in raw milk was developed, using a polyclonal rabbit anti-GMP antibody. Calibration curves were constructed by analyzing raw milk standards containing different known concentrations of liquid cheese whey (0.02-20%). The method had a detection limit of 0.047% (v/v) and a quantification limit of 0.14% (v/v). The antibody showed high specificity and no cross-reaction with milk components (other than κ-casein) and was successful in detecting GMP in dairy commercial products. The recovery ratio was between 95.62% and 113.88% for all matrices tested. The intra-assay and interassay coefficients of variation were <6% and <7%, respectively. Finally, it can be stored for 3 months in the form of a ready-to-use kit, while maintaining its accuracy and reproducibility.

[Delayed diagnosis of HIV infection in the Spanish VACH cohort [1997-2002]]. / Diagnóstico tardío de la infección por el virus de la inmunodeficiencia humana en la Cohorte VACH (1997-2002).

OBJECTIVE: To study the prevalence of delayed diagnosis of HIV infection and associated factors. METHODS: A cross sectional study of patients included in the Spanish VACH cohort who had been diagnosed with HIV infection between 1997 and 2002 was performed. Delayed diagnosis was defined as patients diagnosed with HIV infection and AIDS simultaneously or within the first month after the first positive serologic test, or those with a first CD4+ cell count below 200/ml. The epidemiological characteristics of these patients were compared with those of the remaining patients RESULTS: Of 2,820 new cases of HIV infection, delayed diagnosis was found in 506 (18%). These patients differed from the remaining patients in their lower mean age and higher HIV viral load, as well as in their distribution by sex (higher proportion of males), occupational status, history of incarceration in prison, and HIV-risk transmission group. The median survival during follow-up was significantly lower among AIDS patients with a delayed diagnosis. CONCLUSIONS: Delayed diagnosis remains a cause for concern in our environment, due to its magnitude and its association with mortality. Some epidemiological characteristics provide clues to guide future programs directed at increasing information and improving prevention.

Diagnóstico tardío de la infección por el virus de la inmunodeficiencia humana en la Cohorte VACH (1997-2002) / Delayed diagnosis of HIV infection in the Spanish VACH cohort [1997-2002]

Objetivo: Estudiar la prevalencia del diagnóstico tardío (DT) de la infección por el virus de la inmunodeficiencia humana (VIH) y sus factores asociados. Métodos: Estudio transversal sobre los pacientes incluidos en la cohorte VACH cuya infección por el VIH hubiese sido diagnosticada entre 1997 y 2002. Consideramos DT los casos diagnosticados de sida concomitantemente o dentro del primer mes desde la primera serología positiva, o con recuento de CD4+ < 200/ml. Comparamos sus características epidemiológicas con las de los demás pacientes. Resultados: De 2.820 nuevos casos de infección por el VIH, 506 (18%) tuvieron DT. Éstos difirieron del resto en su menor edad media, mayor carga viral y en su distribución por sexos (mayor proporción de hombres), situación laboral, antecedentes penitenciarios y grupo de riesgo. La mediana de supervivencia durante el seguimiento fue menor en el grupo de DT. Conclusiones: El DT continúa siendo un problema preocupante por su magnitud y asociación con la mortalidad. Algunas características epidemiológicas proporcionan indicios para orientar futuros programas de información y prevención

Objective: To study the prevalence of delayed diagnosis of HIV infection and associated factors. Methods: A cross sectional study of patients included in the Spanish VACH cohort who had been diagnosed with HIV infection between 1997 and 2002 was performed. Delayed diagnosis was defined as patients diagnosed with HIV infection and AIDS simultaneously or within the first month after the first positive serologic test, or those with a first CD4+ cell count below 200/ml. The epidemiological characteristics of these patients were compared with those of the remaining patients Results: Of 2,820 new cases of HIV infection, delayed diagnosis was found in 506 (18%). These patients differed from the remaining patients in their lower mean age and higher HIV viral load, as well as in their distribution by sex (higher proportion of males), occupational status, history of incarceration in prison, and HIV-risk transmission group. The median survival during follow-up was significantly lower among AIDS patients with a delayed diagnosis. Conclusions: Delayed diagnosis remains a cause for concern in our environment, due to its magnitude and its association with mortality. Some epidemiological characteristics provide clues to guide future programs directed at increasing information and improving prevention

Microsomal transformation of organophosphorus pesticides by white rot fungi.

The enzymatic mechanism for the transformation of organophosphorus pesticides (OPPs) by different white-rot fungi strains was studied. With the exception of Ganoderma applanatum 8168, all strains from a collection of 17 different fungi cultures were able to deplete parathion. Three strains showing the highest activities were selected for further studies: Bjerkandera adusta 8258, Pleurotus ostreatus 7989 and Phanerochaete chrysosporium 3641. These strains depleted 50 to 96% of terbufos, azinphos-methyl, phosmet and tribufos after four-days exposure to the pesticides. In order to identify the cellular localization of the transformation activity, the extracellular and microsomal fractions of Pleuronts ostreatus 7989 were evaluated in vitro. While the activities of ligninolytic enzymes (lignin peroxidase, manganese peroxidase and laccase) were detected in the extracellular fraction, no enzymatic modification of any of the five pesticides tested could be found, suggesting the intracellular origin of the transformation activity. In accordance with this observation the microsomal fraction was found able to transform three OPPs with the following rates: 10 micromol mg prot(-1) h(-1) for phosmet, 5.7 micromol mg prot(-1) h(-1) for terbufos, and 2.2 micromol mg prot(-1) h(-1) for azinphos-methyl. The products from these reactions and from the transformation of trichlorfon and malathion, were identified by mass-spectrometry. These results, supported by specific inhibition experiments and the stringent requirement for NADPH during the in vitro assays suggest the involvement of a cytochrome P450.

[Retrospective epidemiological study on the durability of the treatment of HIV infection or AIDS in Spain]. / Estudio epidemiológico retrospectivo sobre la duración del tratamiento de la infección por el virus de la inmunodeficiencia humana en España.

BACKGROUND AND OBJECTIVE: To know the durability of consecutive regimens of antiretroviral treatment is important to design a long-term therapy, but there is not much information about this subject. PATIENTS AND METHOD: Retrospective epidemiological study of a sample of 401 patients who began antiretroviral treatment between January 1997 and April 2000 at ten Spanish hospitals. The duration of each consecutive antiretroviral regimen was calculated and the reasons for modification and discontinuation were described. RESULTS: In the 3 years and 3 months covered by the study, 48.6% of the patients received more than one regimen of therapy. Seventy five of the initial prescribed combinations included protease inhibitors. Median duration of consecutive lines of therapy was decreasing: 560, 360, 330 and 202 days for the first, second, third and fourth regimens, respectively. The main reason to modification was intolerance or toxicity (46.2, 49.1 and 47.1% for the first, second and third modification). A fifth of changes was originated by difficulties to follow the therapy. Virological failure was the reason for modification in 21.8, 24.5 and 26.5% of first, second and third changes. CONCLUSIONS: Duration of consecutive antiretroviral regimens progressively decreases. Intolerance or drug toxicity were the main reasons conditioning the change of treatment.