Operationalizing Integrated Water Resource Management in Latin America: Insights from Application of the Freshwater Health Index.

Water crises in Latin America are more a consequence of poor management than resource scarcity. Addressing water management issues through better coordination, identification of problems and solutions, and agreement on common objectives to operationalize integrated water resources management (IWRM) could greatly improve water governance in the region. Composite indices have great potential to help overcome capacity and information challenges while supporting better IWRM. We applied one such index, the Freshwater Health Index (FHI) in three river basins in Latin America (Alto Mayo, Perú; Bogotá, Colombia; and Guandu, Brazil) to assess freshwater ecosystem vitality, ecosystem services, and the water governance system in place. The approach included convening management agencies, water utilities, planning authorities, local NGOs and industries, community groups and researchers to co-implement the FHI. The results provide detailed information on the ecological integrity of each basin and the sustainability of the ecosystem services being provided. All three basins show very low scores for governance and stakeholder engagement, thus improving both in the region should be a priority. The results also shed light on how the FHI framework can help inform decision-making to improve IWRM implementation by facilitating stakeholder engagement while contributing to coordination, identification of problems and solutions as well as agreement on common objectives. Because implementation of IWRM is part of the solution for the United Nations Sustainable Development Goal (SDG) 6.5 ("By 2030, implement IWRM at all levels, including through transboundary cooperation as appropriate"), our case studies can serve as examples to other Latin American countries to achieve SDG 6.5.

Identification of undiagnosed dementia cases using a web-based pre-screening tool: The MOPEAD project.

INTRODUCTION: Innovative patient engagement models are required to identify people with prodromal and mild Alzheimer's disease who are "hidden" in their communities and not normally found in a memory clinic setting. METHODS: A marketing campaign and a web-based pre-screening tool were used to identify individuals at risk of dementia in five European countries. Harmonized clinical evaluation of these patients was performed in participating memory clinics within the MOPEAD project. RESULTS: A total of 1487 individuals completed the pre-screening, with 547 of them found to be at risk of dementia (36.8%). Among the subset of 91 patients with a positive pre-screening result that underwent full clinical evaluation, 49 (53.8%) were diagnosed with either mild cognitive impairment or Alzheimer's disease. CONCLUSION: This novel web-based pre-screening tool showed to be a valid strategy to identify undiagnosed people with cognitive impairment.

Social Representation of Dementia: An Analysis of 5,792 Consecutive Cases Evaluated in a Memory Clinic.

BACKGROUND: Different interpretations of cognitive impairment and dementia due to differences in health structures, such as cultural differences could affect the diagnosis and treatment of the condition. it is reasonable to expect that the social and family impact of the disease and coping strategies will differ among societies. OBJECTIVE: The general aim of this study is to understand the social representations of dementia, its associated practices, and the effects they imply. METHODS: People diagnosed with clinical dementia and their families were assessed from 2005 to 2015 in the memory clinic of the Fundació ACE, Institut Català de Neurociències Aplicades in Barcelona, Spain. RESULTS: 9,898 people were examined and 5,792 were diagnosed with dementia. For those with a caregiver (71%), the decision-making fell on the person with dementia in 16.2% of the cases; and for those without a caregiver, in 26.4% of the cases the family did not perceive the deficits as a disease, which led to multiple risk situations (74.6%). CONCLUSIONS: The recognition of dementia as part of aging is common among families. Consequently, risk situations may arise and diagnosis and access to treatment may be delayed. The incorporation of a social appraisal to the diagnostic process is a necessity to evaluate these situations.

Long-Term Evolution of Patients Treated for Paroxysmal Atrial Fibrillation with First and Second Generation Cryoballoon Catheter Ablation with a Prospective Protocol Guided by Complete Bidirectional Left Atrium-Pulmonary Veins Disconnection after Adenosine as Main Target end Point to achieved. Seven Years Follow-up of Patients with a rough estimation profile of Low ALARMEc Score. A Single Center Report.

INTRODUCTION: Cryoballoon ablation (CB) has proven effective for treating patients with paroxysmal atrial fibrillation (PAF). We analyzed our seven year follow-up of patients, treated for PAF with first (CB1) and second generation (CB2), with demonstration of LA-PV disconnection with bidirectional block (BB) after adenosine (AD). METHODS: Since November 2008 to May 2015, 128 patients, 97 male (58±7 years), without heart disease, highly symptomatic, refractory to antiarrhythmic drugs (AAD) were treated, and follow-up (1411 ±727 days). Left atrial size: 37±6 mm. RESULTS: A total of 439 PV were successfully isolated (91.9%). Acute reconduction: 44 PV (9%): 16 after CB; 16 unmasked by AD; 12 extrapulmonary muscular connections (EMC). Main complication was phrenic nerve palsy (PNP): 9 (7 %). On follow-up, 114 patients (89%) remain asymptomatic in sinus rhythm (SR), free of medication. Fourteen patients (11%) had arrhythmia recurrence: 12 male (52±8 years). Early recurrences occurred in 9 male. Late recurrences presented 3 male at 24, 27 and 60 months, and 2 female at 7 and 40 months respectively. All recurrence patients were Redo, and remain in SR without medication during follow-up. CONCLUSIONS: CB alone is very effective and safe for the definitive treatment of patients suffering PAF with 72.6% success rate, increasing up to 89.1% when this protocol is applied in a single procedure. After Redo, all population group (100%), remain in sinus rhythm, freedom of arrhythmia, without AAD, in this very long term follow-up. Checking for BB, AD protocol, and ruling out EMC allowed-us to identified 14.8% of patients with underlying substrate for potential arrhythmia recurrence. CB2 applications entail a highest risk of PNP. Patients with a rough estimated profile of low ALARMEc score (≤ 1) have an excellent long term outcome, being this series the largest follow-up described so far, for patients treated for PAF with CB.

Concordance between Subjective and Objective Memory Impairment in Volunteer Subjects.

BACKGROUND: Subjective memory impairment (SMI) refers to subjective awareness of initial memory decline undetectable with existing standardized cognitive tests. The Face Name Associative Memory Exam (FNAME) was created to detect memory deficits in individuals with preclinical Alzheimer's disease (AD). We reported normative data of a Spanish version of FNAME (S-FNAME) in cognitively normal (CN) Spanish-speaking subjects >49. OBJECTIVE: To determine whether higher SMI [a modification of Memory Failures Everyday (MFE-30)] was related to worse memory performance (S-FNAME) or associated with greater affective symptoms in subjects >49; and whether MFE-30 and FNAME were able to discriminate between CN and mild cognitive impairment (MCI) subjects. METHODS: 317 subjects (CN = 196, MCI = 121) were included in the analysis because they attended the annual "Open House Initiative" at Memory Clinic Fundació ACE, were >49 years, literate, received S-FNAME, MFE-30, and Hospital Anxiety and Depression Scale, had Mini-Mental State Examination scores ≥27, and returned to complete a comprehensive diagnostic assessment. RESULTS: MFE-30 scores were associated with affective symptoms but not with S-FNAME performance. S-FNAME scores were related to performance on memory variables of NBACE (neuropsychological battery used in Fundació ACE). Although the MCI group showed significantly higher MFE-30 and worse S-FNAME scores than the CN group, their discriminability values were similar (Sensitivity: 49.6 versus 52.9; Specificity: 85.1 versus 83.6, respectively). CONCLUSIONS: SMI was more related to depressive symptoms than to S-FNAME memory performance; and S-FNAME scores were related to other episodic memory test performances, but neither to affective symptoms nor to SMI. MFE-30 and S-FNAME are not optimal for discriminating between CN and MCI groups. Longitudinal follow-up will determine if lower S-FNAME and higher SMI are related to increased risk of AD.

Subjective Cognitive Decline in Older Adults: An Overview of Self-Report Measures Used Across 19 International Research Studies.

Research increasingly suggests that subjective cognitive decline (SCD) in older adults, in the absence of objective cognitive dysfunction or depression, may be a harbinger of non-normative cognitive decline and eventual progression to dementia. Little is known, however, about the key features of self-report measures currently used to assess SCD. The Subjective Cognitive Decline Initiative (SCD-I) Working Group is an international consortium established to develop a conceptual framework and research criteria for SCD (Jessen et al., 2014, Alzheimers Dement 10, 844-852). In the current study we systematically compared cognitive self-report items used by 19 SCD-I Working Group studies, representing 8 countries and 5 languages. We identified 34 self-report measures comprising 640 cognitive self-report items. There was little overlap among measures- approximately 75% of measures were used by only one study. Wide variation existed in response options and item content. Items pertaining to the memory domain predominated, accounting for about 60% of items surveyed, followed by executive function and attention, with 16% and 11% of the items, respectively. Items relating to memory for the names of people and the placement of common objects were represented on the greatest percentage of measures (56% each). Working group members reported that instrument selection decisions were often based on practical considerations beyond the study of SCD specifically, such as availability and brevity of measures. Results document the heterogeneity of approaches across studies to the emerging construct of SCD. We offer preliminary recommendations for instrument selection and future research directions including identifying items and measure formats associated with important clinical outcomes.

Validation of the Spanish Version of the Face Name Associative Memory Exam (S-FNAME) in Cognitively Normal Older Individuals.

The Face Name Associative Memory Exam (FNAME) is a paired associative memory test that has demonstrated sensitivity to amyloid burden in cognitively normal individuals, a biomarker of preclinical Alzheimer's disease. Normative data adjusted for age were reported in American healthy individuals older than 57. We aimed to report the psychometric characteristics of a Spanish version of FNAME (S-FNAME) when administered to Spanish-speaking people. We sought to investigate convergent validity of S-FNAME with another memory measure and to identify which demographic characteristics might be associated with performance on S-FNAME. We administered the S-FNAME to 110 literate, cognitively normal, Spanish individuals older than 49 years from the Memory Clinic Fundació ACE. Construct validity of S-FNAME showed 2 components: face-name and face-occupation. A significant correlation between S-FNAME and Word List from the WMS-III supported convergent validity. The S-FNAME was also associated with age and gender. Thus, we provide normative data for age and gender.

Evaluation of Candidate Genes Related to Neuronal Apoptosis in Late-Onset Alzheimer's Disease.

The objective of this study was to identify genetic variation in genes encoding death receptors and signals that modulate their activity. After conducting a meta-analysis with five previous genome-wide association studies and aggregated data, the most significant signals, (TNF locus: rs2395488, rs2534672, and rs9267445; and FASLG locus: rs730278), were replicated in 1,046 cases and 372 controls. The rs2395488 and rs2534672 markers showed a modest protective effect (OR = 0.849, p = 0.49780;OR= 0.687, p = 0.11335), in contrast to rs730278 marker (OR = 1.146, p = 0.17212), which did not follow the previous effect direction; in any case it reached the significance level. Final meta-analysis, adding the replication sample, confirmed these observations. We concluded that FASLG marker is not etiologically linked to Alzheimer's disease. However, single nucleotide polymorphisms around TNF locus require further analyses in order to explain the association between Alzheimer's disease and human leukocyte antigen.

The unintended consequences of sex education: an ethnography of a development intervention in Latin America.

This paper is an ethnography of a four-year, multi-disciplinary adolescent sexual and reproductive health intervention in Bolivia, Nicaragua and Ecuador. An important goal of the intervention--and of the larger global field of adolescent sexual and reproductive health--is to create more open parent-to-teen communication. This paper analyzes the project's efforts to foster such communication and how social actors variously interpreted, responded to, and repurposed the intervention's language and practices. While the intervention emphasized the goal of 'open communication,' its participants more often used the term 'confianza' (trust). This norm was defined in ways that might--or might not--include revealing information about sexual activity. Questioning public health assumptions about parent-teen communication on sex, in and of itself, is key to healthy sexual behavior, the paper explores a pragmatics of communication on sex that includes silence, implied expectations, gendered conflicts, and temporally delayed knowledge.

Bifocal nummular headache: a series of 6 new cases.

OBJECTIVE: We aimed to report 6 new cases of bifocal nummular headache (NH), showing their clinical characteristics and comparing them with those formerly described. BACKGROUND: NH is a focal head pain felt in a small, well-circumscribed, coin-shaped area. Among all the reported cases (over 200), 6 patients localized their pain in 2 or more separate areas. METHODS: We reviewed all patients diagnosed with NH at the headache clinics of 2 tertiary hospitals, searching for cases with head pain in 2 different areas. RESULTS: Six patients (4 female, 2 male; age at onset 40.8 ± 19.1, range 24-69 years) presented with bifocal NH. The shape and size of both painful areas were identical in each patient. They were located at symmetrical points of either side in 3 patients, while 2 patients had both symptomatic areas on the same side of the head. The chronological pattern was synchronous in 2 patients, and the other 4 showed an additive pattern with onset intervals between the 2 areas ranging from 2 months to 30 years. Pain intensity was slightly different in each area in 4 of the cases. Four patients were treated with a preventive (gabapentin or carbamazepine) with good clinical response. CONCLUSION: Although not frequently found, some patients may have bifocal or multifocal NH.

Pacientes ingresados con formas graves de enfermedad tipo influenza en una unidad de cuidados intensivos, octubre a diciembre 2009 / Patients admitted in an Intensive Care Unit with severe clinical manifestations of Influenza, october december 2009

Se realizó un estudio descriptivo de serie de casos, donde se incluyeron 109 pacientes, el total de los admitidos en una de nuestras Unidades de Cuidados Intensivos (UCIQ), habilitada para esos fines durante la reciente pandemia, con el diagnóstico de formas graves de una enfermedad tipo influenza (ETI) y que ingresaron durante el período comprendido entre el 1 de octubre y el 31 de diciembre de 2009. Se presentan los principales resultados, que arrojaron que 62 eran mujeres (56,9 por ciento), de las cuales 19 estaban embarazadas o eran puérperas (17,4 por ciento). Los síntomas predominantes fueron: tos en 93 pacientes (85,3 por ciento), disnea en 86 (78,9 por ciento), fiebre en 76 (68,8 por ciento) y síntomas generales de astenia y anorexia, también en 76 (68,8 por ciento). Al examen físico, los signos más frecuentes fueron: polipnea en 86 (78,9 por ciento) y estertores húmedos en 65 (59,6 por ciento(AU)

A descriptive study of a series of cases was carried out, where 109 patients with the presumptive diagnosis of severe clinical pictures of Influenza were included, the total of them admitted in one of our Intensive Care Units (ICU), prepared for that purpose during the recent pandemic, during the period comprised between October 1 and December 31, 2009. There were 62 women (56,9 percent), of which 19 were pregnant or postpartum women (17,4 percent). The mean age of the sick persons of this serie was of 52,53 ± 22,54 years. The beginning of symptoms before the time of admission revealed an average of 4,90 ± 4,37 days. The predominant symptoms were: cough in 93 patients (85,3 percent), dyspnea in 86 (78,9 percent), fever in 76 (68,8 percent) and general symptoms of asthenia and anorexia in 76 (68,8 percent). In the physical exam, the most frequent signs were: polypnea in 86 (78,9 percent) and wet rales in 65 (59,6 percent(AU)

Síndrome de Twiddler en un paciente portador de desfibrilador automático implantable: ¿una complicación evitable? / Twiddler's syndrome in a patient with an implantable cardioverter defibrillator: an avoidable complication?

El síndrome de Twiddler es una complicación poco frecuente en pacientes portadores de desfibrilador implantable, pero que puede provocar graves problemas en estos enfermos. La identificación de vicios posturales repetitivos y el seguimiento radiológico periódico en pacientes predispuestos pueden ser útiles en la prevención primaria de este síndrome (AU)

Estudio de la incidencia de portadores de meningococo en un colectivo de estudiantes universitarios / Study of the incidence of meningococus host in a group of university students

Se seleccionó, dentro de un colectivo de estudiantes universitarios, una muestra de 284 alumnos, cifras que representa el 50.9 porciento. Se realizó 3 exudados de orofaringe en busca de portadores de meningococo, siendo sembrados en medio de Thayer Martin y mediando entre cada toma de muestra una semana. De los 284 alumnos, 83 resultaron positivos, para un 29.2 porciento de positividad. Después de 5 meses de habérsele tomado las muestras a estos casos y no habiendo recibido tratamiento, se les realizó 3 exudados más, descubriéndose que de los 83 portadores, continuaban siéndolo 38; mientras un 54.2 porciento de los mismos dejó de serlo. Las diferentes cepas encontradas se clasificaron serológicamente predominando el serogrupo B. Se realizó prueba de sensibilidad a la Rifampicina y Metaciclina por el método de dilución, detectándose una menor sensibilidad de las cepas estudiadas a la Rifampicina que a la Metaciclina. En el presente trabajo se pone de manifiesto que el número de portadores aumenta al utilizarse tres exudados seriados en lugar de uno

Estudio de la incidencia de portadores de meningococo en un colectivo de estudiantes universitarios / Study of the incidence of meningococus host in a group of university students

Se seleccionó, dentro de un colectivo de estudiantes universitarios, una muestra de 284 alumnos, cifras que representa el 50.9 porciento. Se realizó 3 exudados de orofaringe en busca de portadores de meningococo, siendo sembrados en medio de Thayer Martin y mediando entre cada toma de muestra una semana. De los 284 alumnos, 83 resultaron positivos, para un 29.2 porciento de positividad. Después de 5 meses de habérsele tomado las muestras a estos casos y no habiendo recibido tratamiento, se les realizó 3 exudados más, descubriéndose que de los 83 portadores, continuaban siéndolo 38; mientras un 54.2 porciento de los mismos dejó de serlo. Las diferentes cepas encontradas se clasificaron serológicamente predominando el serogrupo B. Se realizó prueba de sensibilidad a la Rifampicina y Metaciclina por el método de dilución, detectándose una menor sensibilidad de las cepas estudiadas a la Rifampicina que a la Metaciclina. En el presente trabajo se pone de manifiesto que el número de portadores aumenta al utilizarse tres exudados seriados en lugar de uno(AU)