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Elderly patients are increasingly enrolled in dialysis programs and present a series of special characteristics due to their high morbidity and mortality. Objective:To describe the characteristics of incident dialysis patients aged >75 years, their comorbidities and their admissions, with a view to determining the factors that influence their course and mortality. Patients and Methods: The study included all patients aged >75 years who started dialysis in our center since January 2000. The mean duration of follow-up was 3.3 ± 2.2 years. Data were collected on incident comorbidity, admissions and their causes. A total of 139 patients were included, with a mean age of 78.6 ± 2.6 years (67.6% males, 33.8% diabetic and 7.9% on peritoneal dialysis). Three groups were established according to age: 75–79, 80–85 and >85 years. The most frequent comorbidities were chronic obstructive pulmonary disease (25.9%), ischemic heart disease (25.2%), heart failure (25.9%), neoplasms (23.7%), peripheral vascular disease (23.7%), cerebrovascular disease (18.7%) and arterial hypertension (81%). The Charlson index was calculated, not adjusted for age, and comorbidity tertiles were established. Results: During follow-up, the patients presented 0.82 ± 0.99 admissions/patient/year, with a duration of 12.1 ± 20.6 days/patient/year. The main causes of admission were infection (33%), vascular access problems (27%) and peripheral vascular events (14%). A total of 61 patients died (44%), and 4 underwent kidney transplantation (2.9%). The mean duration of follow-up of the transplanted patients was 3.6 ± 1.8 years. The main causes of death were infection (32%), cardiovascular problems (28.3%) and neoplastic disease (11.3%). The global survival rate was 90, 82 and 53% after 1, 2 and 5 years, respectively. No significant differences in survival or annual admission rate were found in relation to age group and dialysis technique. In contrast, the annual admission rate and days of admission were directly correlated to the Charlson index (p = 0.009 and p = 0.032, respectively). No significant differences in the Charlson index were found between the patients on hemodialysis and those subjected to peritoneal dialysis. In the univariate model, the factors associated to mortality were diabetes, chronic obstructive pulmonary disease, heart failure and the Charlson index. In the multivariate model, only the Charlson index remained as an independent predictive factor (p = 0.006). Conclusions: Unlike the general population, age does not influence mortality or admissions in elderly patients on dialysis. Incident comorbidity is the factor exerting the greatest influence upon mortality and admissions. Advanced age in itself should not be regarded as an excluding factor for starting dialysis. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This paper provides an overview of the last 40 years of use, and in many cases abuse, of the natural resources in Catalonia, a country that is representative of European countries in general, and especially those in the Mediterranean region. It analyses the use of natural resources made by mining, agriculture, livestock, logging, fishing, nature tourism, and energy production and consumption. This use results in an ecological footprint, i.e., the productive land and sea surface required to generate the consumed resources and absorb the resulting waste, which is about seven times the amount available, a very high number but very similar to other European countries. This overexploitation of natural resources has a huge impact on land and its different forms of cover, air, and water. For the last 25 years, forests and urban areas have each gained almost 3% more of the territory at the expense of agricultural land; those municipalities bordering the sea have increased their number of inhabitants and activity, and although they only occupy 6.7% of the total surface area, they account for 43.3% of the population; air quality has stabilized since the turn of the century, and there has been some improvement in the state of aquatic ecosystems, but still only 36% are in good condition, while the remainder have suffered morphological changes and different forms of nonpoint source pollution; meanwhile the biodiversity of flora and fauna remains still under threat. Environmental policies do not go far enough so there is a need for revision of the legislation related to environmental impact and the protection of natural areas, flora, and fauna. The promotion of environmental research must be accompanied by environmental education to foster a society which is more knowledgeable, has more control and influence over the decisions that deeply affect it. Indeed, nature conservation goes hand in hand with other social and economic challenges that require a more sustainable vision. Today’s problems with nature derive from the current economic model, which is environmentally unsustainable in that it does not take into account environmental impacts. Lastly, we propose a series of reasonable and feasible priority measures and actions related to each use made of the country’s natural resources, to the impacts they have had, and to their management, in the hope that these can contribute to improving the conservation and management of the environment and biodiversity and move towards sustainability.

Este trabajo presenta las principales conclusiones del Programa de tutorización para el cambio de clase (PTCC) iniciado por la Federación Catalana de Vela (FCV) en el 2001. Se trata de un proyecto inédito a nivel internacional, que pretende conocer e incidir en la mejora continua del paso de los regatistas infantiles a las clases juveniles. En vela de competición, el tiempo final en la clase Optimist, la elección de una nueva clase y las primeras experiencias en la escogida son momentos clave de la vida deportiva de los regatistas. Después de un periodo piloto, en el 2003 se inició un proceso de 10 años durante el que se han llevado a cabo tres estudios (2003, 2008 y 2013) de seguimiento e intervención de las flotas infantiles y juveniles de la FCV. Mediante cuestionarios creados para este proyecto se han recogido impresiones de 370 regatistas infantiles, 231 juveniles y de 170 padres y madres. Vista la extensión de los resultados, el artículo se centra en las tendencias que más informan sobre la evolución de los regatistas, especialmente en el estudio de 2013, a la vez que presenta el PTCC como un posible modelo para el seguimiento de flotas aplicable a otras organizaciones relacionadas con la vela de competición.

En el presente trabajo se simula la introducción de diferentes métodos de reparto del agua en la agricultura, y se aplican a una zona de regadío del valle central del Ebro. En concreto, se han escogido tres métodos diferentes de asignación con el fin de comparar su eficiencia económica. Además del actual sistema proporcional y el sistema de mercado, se simulará la introducción de la regla de reparto uniforme, desarrollada en la teoría de la elección social. Los resultados permiten concluir que aunque el mercado de agua conduzca a mejores resultados globales en todos los casos, la regla uniforme puede resultar una alternativa interesante cuando las dotaciones de agua se encuentran en el intervalo habitual, mientras que en situaciones de escasez severa de agua, el mercado presenta una ventaja más clara con respecto a cualquier otro sistema de asignación. Asimismo, los resultados demuestran que los niveles superiores de heterogeneidad entre los usuarios y altos precios administrativos del agua representan situaciones más ventajosas para la aplicación de la regla de asignación uniforme en comparación con el actual sistema proporcional.

Este trabalho relata os estudos do esôfago através da abreugrafia, de chagásicos do projeto Mambaí no período de 25 anos. Cada indivíduo realizou duas abreugrafias, em quatro períodos (1975-1976, 1980-1982, 1988-1991 e 1998-2000). A primeira abreugrafia foi realizada em posição obliqua anterior direita imediatamente após a ingestão de 75ml de sulfato de bário e a segunda um minuto após. Em todos os períodos foi utilizada a mesma metodologia, as abreugrafias foram lidas pelo mesmo pesquisador e os megaesôfagos foram classificadas em quatro grupos, segundo os critérios de Rezende e colaboradores. A prevalência de megaesôfago foi 5,2%; 5%; 18,6% e 13,9% em 1975-1976, 1980-1982, 1988-1991 e 1998-2000, respectivamente. A incidência de megaesôfago no período de 1975 a 2000 foi 11,5% (51/445). Durante 25 anos, 394 (84,2%) chagásicos permaneceram com o esofagograma normal, 11 (2,3%) diagnosticados com megaesôfago em 1975-1976, não progrediram, 61 (13%) que eram normais, duvidosos ou já tinham megaesôfago em 1975-1976, progrediram e 2 (0,4%) tiveram regressão do megaesôfago grupo I, diagnosticado em estudos anteriores.This work describes radiography studies of the esophagus in chagasic patients of the Mambaí project over a 25 year period. Each person realized two radiographs in four different periods (1975-1976, 1980-1982, 1988-1991 and 1998-2000). The first radiograph was realized in the right anterior oblique position after swallowing 75ml of barium sulphate solution and another 60 seconds later. In all periods the same methodology was used. The radiographs were read by the same researcher, and the megaesophagus was classified in four groups according to Rezende and colleagues. The prevalence of megaesophagus was 5.2%; 5.0%; 18.6% and 13.9% in 1975-1976, 1980-1982, 1988-1991 and 1998-2000 respectively. The incidence of megaesophagus from 1975 to 2000 was 11.5% (51/445). During 25 year, 394 (84.2%) patients presented radiographs normal of esophagus, 11 (2.3%) diagnosed as megaesophagus in 1975-1976 did not progress, 61 (13%) that were normal, doubtful or already presented megaesophagus in 1975-1976, progressed and 2 (0.4%) presented regression of group I megaesophagus, diagnosed in previous studies.

Reações cutâneas de hipersensibilidade tardia ao antígeno T12E foram identificadas em 35,7% da amostra de 842 indivíduos do município de Mambaí, Goiás. Suas especificidade e sensibilidade foram comparadas com aquelas dos exames sorológicos. Em 94 pacientes chagásicos comprovados pelo xenodiagnóstico, o teste cutâneo foi positivo em 98,7% dos casos, a imunofluorescência em 97,8% e afixação do complemento em 80,6%. A hemaglutinação foi positiva em todos esses casos. O índice de 0,897 mostrou a estreita relação entre os percentuais positivos dos exames de hemaglutinação e de imunofluorescência com o teste cutâneo, nos chagásicos sem comprovaçãoparasitológica. Esse dado indica que em aproximadamente 90% dos casos os resultados desses três exames são concordantes. A quantidade de 50µg do antígeno T12E empregada no teste cutâneo não apresentou efeitos colaterais e não produziu conversão das provas imunológicas, mesmo quando foi repetido cinco vezes em voluntários sadios, em intervalos de 15 dias. A potência do antígeno permaneceu inalterada após a estocagem a -10ºC, durante 24 meses.

The megaesophagus and megacolon endemic in South America are related , to Chagas' disease. These mega conditions are found in patients with chronic Chagas's infection, when the parasite is not demonstrable in the lesions. These are characterized by depopulation of parasympathetic ganglion cells, dilation and hypertrophy of the viscera. In the experiments described here we deminstrate a selective affinity and adherence of Trypanosoma cruzi-immune lymphocytes to myenteric, parasympathetic ganglion cells, leading to neuronolysis. None of these features are observed when non-immune lymphocytes from control rabbits are used, or when the immune lymphocytes are allowed to react with CNS neurons. This demonstration is an indication of the high degree of specificity of the destruction of parasympathetic neurons in Chagas' disease. We postulate that the T. cruzi-immune lymphocyte rejection of parasympathetic neurons, but not of CNS neurons, might be related to recognition of a cross-reacting antigenic determinant secreted only by the target neurons. In favor of this interpretation is the observation of lymphocytic infiltrates and parasympathetic ganglion cell destruction in chronic Chagas' infection in the absence of encephalitis.O megaesôfago e o megacolon endêmicos na América do Sul estão relacionados á doença de Chagas. Estas condições clínicas são encontradas em pacientes com infecção chagásica crônica, quando o parasito não é demonstrado nas lesões caracterizadas por povoamento de células neuronais parassimpáticas. Nos experimentos descritos aqui nós demonstramos uma afinidade seletiva de linfócitos imunes, sensibilizados pelo T. cruzi, para neurônios de gânglios mioentéricos. Os linfócitos imunes citotóxicos aderem nas células ganglionares, produzindo neuronólise. Isto não se observa quando linfócitos não-imunes são usados, ou quando os linfócitos imunes são colocados na presença de neurônios do sistema nervoso central. Esta é uma demonstração do alto grau de especificidade da destruição de neurônios parassimpáticos na doença de Chagas. Postulamos que a rejeição de neurônios parassimpáticos deve estar relacionada ao conhecimento de um determinante antigênico de reação cruzada, o qual seria secretado exclusivamente pelos neurônios parassimpáticos. Em favor desta interpretação temos a observação de infiltrados linfocitários com destruição de células ganglionares parassimpáticas em pacientes com infecção chagástica crônica, na ausência de encefalite.