Macroecology of rocky intertidal benthic communities along the southwestern Atlantic: Patterns of spatial variation and associations with natural and anthropogenic variables.

Assessing spatial variability in biodiversity and its relationships with potential drivers is necessary for understanding and predicting changes in ecosystems. Here, we evaluated spatial patterns in sessile macrobenthic communities in rocky intertidal habitats along the southwestern Atlantic (SE Brazil), spanning over 500 km of coastline. We applied a rapid-survey approach focusing on the main space occupiers and habitat-forming taxa. We partitioned community variance into spatial scales ranging from metres to hundreds of kilometres and assessed whether community patterns were associated with variation in shore topography, nearshore ocean, and human influence. The communities from the mid-midlittoral level exhibited equivalent variation (31-35%) at the scales of quadrats (metres), sites (kilometres), and sub-regions (tens of kilometres). For the communities from the low-midlittoral and infralittoral fringe levels, most variability occurred at the scales of quadrats and sites (30-42%), followed by sub-regions (22%). Wave fetch, sea surface temperature (SST), and shore inclination were the variables that best explained community structure at the mid-midlittoral. At the low-midlittoral and infralittoral fringe, the most influential variables were related to oceanic forcing (SST, total suspended solids, particulate organic carbon, chlorophyll-a concentration) and human influence. Univariate analyses also revealed strong associations between the abundance of the main components of the communities and the predictor variables evaluated. Our results suggest that urbanised estuarine bays and coastal upwelling regimes have a strong influence on adjacent benthic communities, driving macroecological patterns in the study area. This study advances the knowledge in macroecology and biogeography of rocky shores in an understudied coastline and globally and provides valuable insights for future assessments of ecological changes resulting from unfolding human impacts.

Marine fish and benthic biota before the 2019 oil spill: A baseline dataset for monitoring programs and impact assessments at Rio Grande Norte state, Northeastern Brazil.

In 2019 an oil spill spread over more than 4000 km of the Brazilian coastline. Monitoring programs that allow for the evaluation of potential impacts on communities and ecosystems and their recovery through time are needed and rely on baseline information previous to the oil spill. Here we compiled qualitative and quantitative data available from 8 studies on fish and benthic species from different habitats of Rio Grande do Norte (RN) from 2007 to 2018. We assessed the number of species from different locations and compiled information on conservation status and human use. We mapped the study areas and habitats and overlapped them with those affected by the oil spill. The RN state has a high diversity of fish (175 species) and benthic species (285 species), of which more than half of fish (52%) and 2% of benthic species are threatened and 72,8% of fish and 7,9% of benthic species are of commercial interest. Information of most habitats is still poorly known (i.e.majority ofthe available data are from unique and punctual sampling), which may weaken future evaluations of the real impact of the oil spill. Nonetheless, it is possible to design reliable monitoring based on our dataset, persistent contamination and future loss of diversity.

Variations in benthic fluxes of sediments near pier pilings and natural rocky reefs.

Marine artificial structures such as pilings are replacing natural habitats, and modifying surrounding areas, often resulting in local decreases in species diversity and facilitation of bioinvasion. Most research on the impacts of artificial structures in marine ecosystems has primarily focused on rocky bottom habitats and biodiversity, overlooking the effects of these structures on the functioning of nearby sedimentary habitats. Here we compared, for the first time, benthic metabolism (O2 fluxes) and sediment-water nutrient (inorganic nitrogen, phosphate, and dissolved organic nitrogen) fluxes in shallow water sediments adjacent to pilings and natural reefs. We also measured sediment properties (grain size, total organic carbon, total nitrogen, C:N ratio and chlorophyll-a content). We found that sediments near pilings were generally finer with greater C:N ratios than those near reefs, while differences in other sediment properties between types of habitats were dependent on the site. We found significant differences in the oxygen consumption, primary productivity, and net ecosystem metabolism in sediments around pilings compared to sediments near natural reefs, but these patterns differed by site. Net nutrient fluxes were similar in sediments near pilings and reefs at both sites. This study showed that although pilings can be associated with changes in the functioning of sedimentary habitats, patterns and the direction of change seem to vary depending on local conditions.

When One Health Meets the United Nations Ocean Decade: Global Agendas as a Pathway to Promote Collaborative Interdisciplinary Research on Human-Nature Relationships.

Strong evidence shows that exposure and engagement with the natural world not only improve human wellbeing but can also help promote environmentally friendly behaviors. Human-nature relationships are at the heart of global agendas promoted by international organizations including the World Health Organization's (WHO) "One Health" and the United Nations (UN) "Ocean Decade." These agendas demand collaborative multisector interdisciplinary efforts at local, national, and global levels. However, while global agendas highlight global goals for a sustainable world, developing science that directly addresses these agendas from design through to delivery and outputs does not come without its challenges. In this article, we present the outcomes of international meetings between researchers, stakeholders, and policymakers from the United Kingdom and Brazil. We propose a model for interdisciplinary work under such global agendas, particularly the interface between One Health and the UN Ocean Decade and identify three priority research areas closely linked to each other: human-nature connection, conservation-human behavior, and implementation strategies (bringing stakeholders together). We also discuss a number of recommendations for moving forward.

Reviewing the effects of contamination on the biota of Brazilian coastal ecosystems: Scientific challenges for a developing country in a changing world.

Pollution is a major worldwide problem that is increasing with urban growth, mainly along coastal areas. Pollution is often worse, governance is poorer and managerial strategies to improve environmental quality are less advanced in developing than developed countries. Here, we present an overview of the current scientific knowledge of the impacts of contamination on the biota of coastal ecosystems of Brazil and evaluate the scientific challenges to provide baseline information for local managerial purposes. We compiled data from 323 peer-reviewed published papers from the extensive Brazilian coast. We critically evaluated the produced knowledge (target contaminants, sources, ecosystems, taxa, response variables) and the science behind it (rigour and setting) within its socioenvironmental context (land occupation, use of the coast, sanitation status, contamination history). Research was driven largely by environmental outcomes of industrial development with a focus on the single effects of metals on the biota. The current knowledge derives mainly from laboratory manipulative experiments or from correlative field studies of changes in the biota with varying levels of contamination. Of these, 70% had problems in their experimental design. Environmental impacts have mainly been assessed using standard indicators of populations, mostly in ecotoxicological studies. Benthic assemblages have mostly been studied using structural indicators in field studies. Future assessments of impacts should expand research to more taxonomic groups and ecosystem compartments, adding combined functional and structural responses. Furthermore, further investigations need to consider the interactive effects of contaminants and other environmental stressors. By doing so, researchers would deliver more robust and effective results to solve problems of pollution.

Impacts of copper contamination on a rocky intertidal predator-prey interaction.

Metal contamination can change ecological interactions with potential effects on community dynamics. However, understanding real effects of metals on biota relies on studies undertaken in natural conditions. Through a field experiment, we investigated the effects of copper contamination on the responses of a barnacle prey and its predator, the dogwhelk, and explicitly their interaction. Contamination increased barnacle mortality and reduced predation with no effects on interaction strength. This was because the higher mortality of the prey compensated for the lower consumption of the predator. Despite not affecting the interaction strength, these results suggest a decrease in energy flow in the trophic chain that may lead to important changes in community structure and ecosystem functioning. This study shows the importance of manipulative experiments designed to provide mechanistic insights into ecological interactions to better clarify the effect of stressors on the structure and dynamic of communities.

Functional responses of filter feeders increase with elevated metal contamination: Are these good or bad signs of environmental health?

Fast urbanization in coastal areas has increased the load of contaminants entering estuaries worldwide, threatening the diversity and provision of services by these important systems. Contamination causes structural changes in ecosystems, but the consequences for their functioning are still overlooked. Here we investigated filtration and biodeposition rates of the mussel Mytilaster solisianus across different concentrations of metals, nutrients and suspended material, and levels of urbanization. As expected, filtration rates increased with the number of particles in the water column. However, in areas with low particle concentration, filtering increased in mussels with higher metal concentrations (Cu/Zn/Ni), which were, in turn, related to high urbanization. Similarly, biodeposition rates were positively related to metal concentration in mussels. The increased functional responses observed here is likely a symptom of stress, caused by potential compensatory mechanisms to the energetic costs of cell maintenance and body detoxification of mussels, rather than an indication of healthy systems/organisms. CAPSULE: Increased functional responses of mussels can be a sign of environmental stress.

Guía de práctica clínica para el manejo del lupus eritematoso sistémico propuesta por el Colegio Mexicano de Reumatología / Clinical practice guidelines for the treatment of systemic lupus erythematosus by the Mexican College of Rheumatology

Existen varias guías de práctica clínica tanto nacionales como internacionales para el tratamiento del lupus eritematoso sistémico. No obstante, la mayoría de las guías disponibles no están diseñadas para población mexicana o solamente son para el manejo de manifestaciones específicas como nefritis lúpica o para algún estado fisiológico como el embarazo. El Colegio Mexicano de Reumatología se propuso elaborar unas guías de práctica clínica que conjuntaran la mayor parte de las manifestaciones de la enfermedad y que incluyeran adicionalmente pautas en situaciones controversiales como lo son la vacunación y el periodo perioperatorio. En el presente documento se presenta la «Guía de práctica clínica para el manejo del lupus eritematoso sistémico» propuesta por el Colegio Mexicano de Reumatología, que puede ser de utilidad principalmente a médicos no reumatólogos que se ven en la necesidad de tratar a pacientes con lupus eritematoso sistémico sin tener la formación de especialistas en reumatología. En esta guía se presentan recomendaciones sobre el manejo de manifestaciones generales, articulares, renales, cardiovasculares, pulmonares, neurológicas, hematológicas, gastrointestinales, respecto a la vacunación y al manejo perioperatorio

There are national and international clinical practice guidelines for systemic lupus erythematosus treatment. Nonetheless, most of them are not designed for the Mexican population or are devoted only to the treatment of certain disease manifestations, like lupus nephritis, or are designed for some physiological state like pregnancy. The Mexican College of Rheumatology aimed to create clinical practice guidelines that included the majority of the manifestations of systemic lupus erythematosus, and also incorporated guidelines in controversial situations like vaccination and the perioperative period. The present document introduces the «Clinical Practice Guidelines for the Treatment of Systemic Lupus Erythematosus» proposed by the Mexican College of Rheumatology, which could be useful mostly for non-rheumatologist physicians who need to treat patients with systemic lupus erythematosus without having the appropriate training in the field of rheumatology. In these guidelines, the reader will find recommendations on the management of general, articular, kidney, cardiovascular, pulmonary, neurological, hematologic and gastrointestinal manifestations, and recommendations on vaccination and treatment management during the perioperative period

Clinical practice guidelines for the treatment of systemic lupus erythematosus by the Mexican College of Rheumatology. / Guía de práctica clínica para el manejo del lupus eritematoso sistémico propuesta por el Colegio Mexicano de Reumatología.

There are national and international clinical practice guidelines for systemic lupus erythematosus treatment. Nonetheless, most of them are not designed for the Mexican population or are devoted only to the treatment of certain disease manifestations, like lupus nephritis, or are designed for some physiological state like pregnancy. The Mexican College of Rheumatology aimed to create clinical practice guidelines that included the majority of the manifestations of systemic lupus erythematosus, and also incorporated guidelines in controversial situations like vaccination and the perioperative period. The present document introduces the «Clinical Practice Guidelines for the Treatment of Systemic Lupus Erythematosus¼ proposed by the Mexican College of Rheumatology, which could be useful mostly for non-rheumatologist physicians who need to treat patients with systemic lupus erythematosus without having the appropriate training in the field of rheumatology. In these guidelines, the reader will find recommendations on the management of general, articular, kidney, cardiovascular, pulmonary, neurological, hematologic and gastrointestinal manifestations, and recommendations on vaccination and treatment management during the perioperative period.

Can transplanting enhance mobile marine invertebrates in ecologically engineered rock pools?

The field of eco-engineering has burgeoned in recent years in response to the proliferation of artificial structures. Adding water-retaining features to seawalls has been successful in increasing biodiversity relative to the surrounding structure. Artificial rock pools may not, however, completely mimic natural rock pools. Here, we compared natural colonisation, through dispersal and recruitment, of intertidal mobile species to water-retaining flowerpots on seawalls with that into rock pools. This represents the more usual 'passive' approach to eco-engineering where features are built to enhance biodiversity and are allowed to colonise naturally, as opposed to seeding or transplanting organisms to features. While flowerpots supported some mobile species not found on the seawall, other species common on natural shores did not recruit to flowerpots. Thus, in a second experiment we tested the effectiveness of an 'active' approach through transplanting mobile organisms to flowerpots to expedite the colonisation process. For the species examined, however, most individuals did not stay in the flowerpots for more than 24 h after being transplanted. Further understanding of the processes (e.g. dispersal distances, recruitment) influencing colonisation of eco-engineered habitats is needed to effectively inform management of marine infrastructure, particularly for projects targeted at restoration rather than enhancement.

Incorporating in situ habitat patchiness in site selection models reveals that site fidelity is not always a consequence of animal choice.

Understanding site fidelity is important in animal ecology, but evidence is lacking that this behaviour is due to an animal choosing a specific location. To discern site selection behaviour, it is necessary to consider the spatial distribution of habitats that animals can occupy within a landscape. Tracking animals and defining clear habitat boundaries, however, is often difficult. We use in situ habitat distribution data and animal movement simulations to investigate behavioural choice in site fidelity patterns. We resolved the difficulty of gathering data by working with intertidal rock pool systems, which are of manageable size and where boundaries are easy to define. Movements of the intertidal starfish Parvulastra exigua were quantified to test the hypotheses that (1) this species displays fidelity to a particular rock pool and that (2) rock pool fidelity is due to site selection behaviour. Observed patterns of individuals (n = 10 starfish) returning to a previously occupied rock pool (n = 5 pools per location) were tested against an expected null distribution generated through simulations of random movements within their natural patchy environment. Starfish exhibited site selection behaviour at only one location even though site fidelity was high (av. 7·4 starfish out of 10 found in test pools) in two of the three locations. The random chance of a starfish returning to a pool increased 67% for each metre further a rock pool was from the original pool, and 120% for each square metre increase in surface area of an original pool. The decision of returning to an original rock pool was influenced by food availability. When microalgal cover was >60%, there was a c. 50% chance of animals staying faithful to that pool. Our results show the importance to consider spatial distribution of habitats in understanding patterns of animal movement associated with animal choices and site fidelity. Returning to a particular place does not necessarily mean that an animal is homing; it may be the only place to go.

[Profile of the elderly individual dependent on home care in low socioeconomic level communities in Porto Alegre in the state of Rio Grande do Sul]. / Perfil do idoso dependente de cuidado domiciliar em comunidades de baixo nível socioeconômico de Porto Alegre, Rio Grande do Sul.

The scope of this study was to estimate the prevalence of home care and to identify the demographic, socioeconomic, behavioral and health profile of dependent elderly individuals. The cross-sectional and representative delineation of the communities of Restinga and Extremo Sul in Porto Alegre in the State of Rio Grande do Sul included 638 elderly individuals. Home care was defined as a positive answer to the following question: "Do you have someone here in your home to take care of you?" The prevalence of home care was 49.5% (95% CI: 44.5; 54.5). Children and spouses were responsible for the majority of home care (40.7% and 37%, respectively). Men, unaccompanied and physically inactive individuals, of advanced age, lower educational level, higher economic level, functionally disabled and who had been hospitalized in the last year characterized the profile of the dependent elderly individual. The high prevalence of home care can serve as input for health services for the elderly. Among all the characteristics, functional disability was the one most closely associated with home care.

Perfil do idoso dependente de cuidado domiciliar em comunidades de baixo nível socioeconômico de Porto Alegre, Rio Grande do Sul / Profile of the elderly individual dependent on home care in low socioeconomic level communities in Porto Alegre in the state of Rio Grande do Sul

O estudo estimou a prevalência de cuidado domiciliar e identificou o perfil demográfico, socioeconômico, comportamental e de saúde dos idosos dependentes. O delineamento transversal e representativo das comunidades Restinga e Extremo Sul, de Porto Alegre (RS), incluiu 638 idosos. O cuidado domiciliar foi definido pela resposta positiva à questão: "O(a) Sr.(a) tem alguém aqui na sua casa para cuidar do(a) Sr(a)?". A prevalência de cuidado domiciliar encontrada foi de 25,4% (IC95%: 22,0; 28,8). Filhos(as) e esposos(as) foram responsáveis pela maioria do cuidado domiciliar prestado a idosos (40,7% e 37,0%, respectivamente). Homens, indivíduos sem companheiro(a), fisicamente inativos, com idade avançada, menor escolaridade e maior nível econômico, incapacidade funcional e que foram hospitalizados no último ano caracterizaram o perfil do idoso dependente. A alta prevalência de cuidado domiciliar serve de subsídio para políticas públicas destinadas a idosos. Dentre todas as características avaliadas, a incapacidade funcional, esteve mais fortemente associada ao cuidado domiciliar.

The scope of this study was to estimate the prevalence of home care and to identify the demographic, socioeconomic, behavioral and health profile of dependent elderly individuals. The cross-sectional and representative delineation of the communities of Restinga and Extremo Sul in Porto Alegre in the State of Rio Grande do Sul included 638 elderly individuals. Home care was defined as a positive answer to the following question: "Do you have someone here in your home to take care of you?" The prevalence of home care was 49.5% (95% CI: 44.5; 54.5). Children and spouses were responsible for the majority of home care (40.7% and 37%, respectively). Men, unaccompanied and physically inactive individuals, of advanced age, lower educational level, higher economic level, functionally disabled and who had been hospitalized in the last year characterized the profile of the dependent elderly individual. The high prevalence of home care can serve as input for health services for the elderly. Among all the characteristics, functional disability was the one most closely associated with home care.

A SCN9A gene-encoded dorsal root ganglia sodium channel polymorphism associated with severe fibromyalgia.

BACKGROUND: A consistent line of investigation suggests that autonomic nervous system dysfunction may explain the multi-system features of fibromyalgia (FM); and that FM is a sympathetically maintained neuropathic pain syndrome. Dorsal root ganglia (DRG) are key sympathetic-nociceptive short-circuit sites. Sodium channels located in DRG (particularly Nav1.7) act as molecular gatekeepers for pain detection. Nav1.7 is encoded in gene SCN9A of chromosome 2q24.3 and is predominantly expressed in the DRG pain-sensing neurons and sympathetic ganglia neurons. Several SCN9A sodium channelopathies have been recognized as the cause of rare painful dysautonomic syndromes such as paroxysmal extreme pain disorder and primary erythromelalgia. The aim of this study was to search for an association between fibromyalgia and several SCN9A sodium channels gene polymorphisms. METHODS: We studied 73 Mexican women suffering from FM and 48 age-matched women who considered themselves healthy. All participants filled out the Fibromyalgia Impact Questionnaire (FIQ). Genomic DNA from whole blood containing EDTA was extracted by standard techniques. The following SCN9A single-nucleotide polymorphisms (SNP) were determined by 5' exonuclease TaqMan assays: rs4371369; rs4387806; rs4453709; rs4597545; rs6746030; rs6754031; rs7607967; rs12620053; rs12994338; and rs13017637. RESULTS: The frequency of the rs6754031 polymorphism was significantly different in both groups (P = 0.036) mostly due to an absence of the GG genotype in controls. Interestingly; patients with this rs6754031 GG genotype had higher FIQ scores (median = 80; percentile 25/75 = 69/88) than patients with the GT genotype (median = 63; percentile 25/75 = 58/73; P = 0.002) and the TT genotype (median = 71; percentile 25/75 = 64/77; P = 0.001). CONCLUSION: In this ethnic group; a disabling form of FM is associated to a particular SCN9A sodium channel gene variant. These preliminary results raise the possibility that some patients with severe FM may have a dorsal root ganglia sodium channelopathy.

Nocturnal heart rate variability parameters as potential fibromyalgia biomarker: correlation with symptoms severity.

INTRODUCTION: At present, there is neither a laboratory test nor an imaging technique able to differentiate people with fibromyalgia (FM) from healthy controls. This lack of an objective biomarker has hampered FM recognition and research. Heart rate variability (HRV) analyses provide a quantitative marker of autonomic nervous system activity. Nighttime is a stable period in which most people are resting. Sleep is modulated by autonomic activity. Sleeping problems are prominent in FM. The objectives of this study are: 1) to explore different nocturnal HRV parameters as potential FM biomarkers and 2) to seek correlation between such HRV parameters and diverse FM symptoms. METHODS: We studied 22 women suffering from FM and 22 age-matched controls. All participants filled out several questionnaires related to FM symptoms. All participants used a Holter monitor over 24 hours while undertaking their routine activities during the day and while sleeping at their homes at night. Time-domain HRV parameters analyzed from 0000 to 0600 hours included, among others: mean normal-normal interbeat intervals (mean NN), standard deviation of the NN intervals (SDNN), and standard deviation of the successive NN differences (SDSD). RESULTS: Nocturnal SDNN of less than 114 ms had the greatest predictive value to set apart patients from controls with an odds ratio of 13.6 (95% confidence interval: 3.9 to 47.8). In patients, decreased nighttime HRV markers indicative of sympathetic predominance had significant correlations with several FM symptoms: SDSD was associated with pain intensity (r = -0.65, P = 0.001). SDNN correlated with constipation (r = -0.53, P = 0.001), and mean NN with depression (r = -0.53, P = 0.001). Controls displayed an opposite behavior. For them, increased nighttime SDNN correlated with Fibromyalgia Impact Questionnaire scores (r = 0.69, P = 0.001) and with other FM symptoms. CONCLUSIONS: Nocturnal HRV indices indicative of sympathetic predominance are significantly different in FM women when compared to healthy individuals. In FM patients, these HRV parameters correlated with several symptoms including pain severity. Opposite associations were seen in controls. FM may not be just one end of a continuous spectrum of common symptoms. Nocturnal HRV analyses are potential FM biomarkers.

Association of adrenergic receptor gene polymorphisms with different fibromyalgia syndrome domains.

OBJECTIVE: Fibromyalgia (FM) patients have signs of relentless sympathetic hyperactivity associated with hyporeactivity to stress. Adrenergic receptors (ARs) are parts of the sympathetic nervous system that are fundamental for maintenance of homeostasis. We undertook this study to correlate alpha-AR and beta-AR gene polymorphisms with the presence of FM and with different domains of the FM syndrome as measured by the Fibromyalgia Impact Questionnaire (FIQ). METHODS: We studied 78 Mexican FM patients and 48 age-matched controls as well as 78 Spanish FM patients and 71 controls. All subjects studied were women. Single-nucleotide polymorphisms (SNPs) of alpha(1A)-AR (rs574584, rs1383914, rs1048101, and rs573542), beta(2)-AR (rs1042713 and rs1042714), and beta(3)-AR (rs4994) were analyzed by 5' exonuclease TaqMan polymerase chain reaction. Polymorphic haplotypes were constructed after linkage disequilibrium analysis. RESULTS: The beta(2)-AR AC haplotype was a risk factor for the presence of FM. This haplotype had an increased frequency in Mexican patients compared with Mexican controls (42.1% versus 30.5%; P = 0.04). Similarly, 50.4% of Spanish patients had this haplotype compared with 40.0% of Spanish controls (P = 0.05). In Spanish patients, the alpha(1A)-AR SNP rs1383914 was associated with the presence of FM (P = 0.01), and the alpha(1A)-AR SNP rs1048101 was linked with FIQ disability (P = 0.02). Mexican patients with the rs574584 GG genotype presented the highest FIQ score compared with Mexican patients with other genotypes (P = 0.01), and in Mexicans SNP rs574584 was associated with FIQ morning stiffness (P = 0.04) and with FIQ tiredness upon awakening (P = 0.02). CONCLUSION: AR gene polymorphisms are related to the risk of developing FM and are also linked to different domains of the FM syndrome.

Autonomic dysfunction in fibromyalgia assessed by the Composite Autonomic Symptoms Scale (COMPASS).

BACKGROUND: It has been suggested that autonomic nervous system dysfunction may explain all of fibromyalgia (FM) multisystem features. Such proposal is based mostly on the results of diverse heart rate variability analyses. The Composite Autonomic Symptom Scale (COMPASS) is a different validated method to recognize dysautonomia. OBJECTIVES: The main objective of our study was to investigate symptoms of autonomic dysfunction in FM patients by means of COMPASS. A secondary objective was to define whether there is a correlation between COMPASS and Fibromyalgia Impact Questionnaire (FIQ) scores in FM patients. METHODS: Design, analytical cross-sectional study. Our study population included 3 different groups of women: 30 patients with FM, 30 patients with rheumatoid arthritis, and 30 women who considered themselves healthy. All participants filled out COMPASS and FIQ questionnaires. RESULTS: FM patients had significantly higher values in all COMPASS domains. COMPASS total score (54.6 +/- 20.9; mean +/- standard deviation) clearly differentiated FM patients from the other 2 groups (21.6 +/- 16.5 and 9.5 +/- 10.2, respectively). P < 0.0001. The majority of FM patients gave affirmative answers to questions related to orthostatic, digestive, sleep, sudomotor, or mucosal dysfunction. There was a significant correlation between COMPASS and FIQ scores (Spearman r = 0.5, P < 0.005). CONCLUSIONS: Patients with FM have multiple nonpain symptoms related to different expressions of autonomic dysfunction. There is a correlation between a questionnaire that measures FM severity (FIQ) and an autonomic dysfunction questionnaire (COMPASS). Such correlation suggests that autonomic dysfunction is inherent to FM.