Appraising biocultural approaches to sustainability in the scientific literature in Spanish

Biocultural approaches that acknowledge the multiple and dynamic relationships between the diversity of cultures and nature are growing in popularity in sustainability research. Scientific contributions to biocultural approaches written in Spanish are numerous, including influential work on biocultural memory, biocultural heritage and biocultural ethics. However, despite linguistic diversity being considered essential in knowledge production for assuring broad and balanced evidence to successfully cope with sustainability challenges, non-English literature is rarely reviewed and taken into account in English-language scientific knowledge production and publications. This review assesses how the scientific literature in Spanish conceptualizes and applies biocultural approaches, showing their richness beyond the Anglophone predominance in academic knowledge production and communication. The results suggest that insights from Spanish-language scientific literature could contribute alternative methodological and theoretical pathways for biocultural approaches that might foster transformations for more sustainable human-nature relationships. We conclude by highlighting avenues that could bring more plural biocultural studies.

Landscape products for sustainable agricultural landscapes

Landscape products link to low-input practices and traditional ecological knowledge, and have multiple functions supporting human well-being and sustainability. Here we explore seven landscape products worldwide to identify these multiple functions in the context of food commodification and landscape sustainability. We show that a landscape products lens can improve food systems by fostering sustainability strategies and standards that are place-sensitive, and as such can mitigate conflicts related to food production, social justice and the environment. Co-management strategies and information policies, such as certification, labelling, product information and raising of awareness could accelerate, incentivize and catalyse actions to support landscape products in the context of sustainability strategies.

Mapping Adolescents' Sense of Place and Perceptions of Change in an Urban-Rural Transition Area

Landscapes are changing, with rural areas becoming increasingly urbanized. Children and adolescents are underrepresented in the sense-of-place literature. Our study aimed to understand how adolescent residents of a rural-urban transition area perceive and value their urbanizing landscape by examining sense of place and perceptions of landscape change. A Public Participation GIS approach, accompanied by a questionnaire survey, was applied to elicit responses from a sample of 747 students aged 12-18 in Colmenar Viejo, Madrid (Spain). Respondents' sense of "self-in-place" or home range was small, around 1 km, although valued places were identified up to around 17 km away, and occasionally further afield. Most responses were associated with urban land, with clear difference between the urban core, strongly associated with emotions, and the suburbs, with activities. Functional locations (i.e. sports facilities) and places which were valued for their social meaning (i.e. shopping malls), could be differentiated. Students were perceptive about change processes in the urban area, but not about those on the peripheral semi-natural land. Younger children were less aware than older children of spaces outside of the town and carried out fewer activities there. Females carried out fewer outdoor activities than male adolescents. In contrast to the adult population, students were more strongly focused on urban areas than on their surrounding rural landscapes. Here, awareness-raising and incentives are needed, particularly those encouraging females into the use of areas beyond the urban land. Our results suggest a lack of meaningful integration between the core city and the periphery, with lessons for urban planners.

Driver dependent factors and the risk of causing a collision for two wheeled motor vehicles

OBJECTIVE

To assess the effect of driver dependent factors on the risk of causing a collision for two wheeled motor vehicles (TWMVs).

DESIGN

Case control study.

SETTING

Spain, from 1993 to 2002.

SUBJECTS

All drivers of TWMVs involved in the 181 551 collisions between two vehicles recorded in the Spanish registry which did not involve pedestrians, and in which at least one of the vehicles was a TWMV and only one driver had committed a driving infraction. The infractor and non-infractor drivers constituted the case and control groups, respectively.

MAIN OUTCOME MEASURES

Logistic regression analyses were used to obtain crude and adjusted odds ratio estimates for each of the driver related factors recorded in the registry (age, sex, nationality, psychophysical factors, and speeding infractions, among others).

RESULTS

Inappropriate speed was the variable with the greatest influence on the risk of causing a collision, followed by excessive speed and driving under the influence of alcohol. Younger and older drivers, foreign drivers, and driving without a valid license were also associated with a higher risk of causing a collision. In contrast, helmet use, female sex, and longer time in possession of a driving license were associated with a lower risk.

CONCLUSIONS

Although the main driver dependent factors related to the risk of causing a collision for a TWMV were similar to those documented for four wheeled vehicles, several differences in the pattern of associations support the need to study moped and motorcycle crashes separately from crashes involving other types of vehicles.

Risk compensation theory and voluntary helmet use by cyclists in Spain

OBJECTIVE

To obtain empirical data that might support or refute the existence of a risk compensation mechanism in connection with voluntary helmet use by Spanish cyclists.

DESIGN

A retrospective case series.

SETTING

Spain, from 1990 to 1999.

SUBJECTS

All 22 814 cyclists involved in traffic crashes with victims, recorded in the Spanish Register of Traffic Crashes with Victims, for whom information regarding helmet use was available.

MAIN OUTCOME MEASURES

Crude and adjusted odds ratios for the relation between committing a traffic violation and using a helmet.

RESULTS

Fifty four percent of the cyclists committed a traffic violation other than a speeding infraction. Committing a traffic violation was associated with a lower frequency of helmet use (adjusted odds ratio (aOR) 0.63, 95% confidence interval (CI) 0.58 to 0.69). Cycling at excessive or dangerous speed, a violation observed in 4.5% of the sample, was not significantly associated with helmet use either alone (aOR 0.95, 95% CI 0.56 to 1.61) or in combination with any other violation (aOR 0.97, 95% CI 0.79 to 1.20).

CONCLUSIONS

The results suggest that the subgroup of cyclists with a higher risk of suffering a traffic crash are also those in which the health consequences of the crash will probably be higher. Although the findings do not support the existence of a strong risk compensation mechanism among helmeted cyclists, this possibility cannot be ruled out.

Proportion of hospital deaths potentially attributable to nosocomial infection

OBJECTIVE

To determine the fraction of hospital deaths potentially associated with nosocomial infection (NI).

DESIGN

A matched (1:1) case-control study.

SETTING

An 800-bed, tertiary-care, teaching hospital.

PATIENTS

All patients older than 14 years who were admitted to the hospital between January 1, 1990, and January 1, 1991, were eligible. All 524 consecutive deaths that occurred in the hospital comprised the case group. For each case, a control patient was matched for primary admission diagnosis and admission date.

OUTCOME MEASURES

The proportion of hospital deaths potentially associated with NI was estimated from the population attributable risk (PAR) adjusted for age, gender, service, severity of illness, length of stay, and quality of the medical record.

RESULTS

For stays longer than 48 hours, the PAR for all NIs was estimated to be 21.3% (95% confidence interval [CI95], 16.8%-30.5%). The greatest proportion of deaths potentially associated with NIs was observed in patients with only one infection (PAR, 15.0%; CI95, 10.9%-22.6%) and bacteremia or sepsis (PAR, 7.7%; CI95, 4.6%-11.6%).

CONCLUSIONS

NIs are associated with a large proportion of intrahospital deaths. This information may help clinicians and healthcare managers to assess the impact of programs for the prevention and control of NIs on intrahospital death.

Application of the induced exposure method to compare risks of traffic crashes among different types of drivers under different environmental conditions

The authors used the induced exposure method to compare risks of traffic crashes among different types of Spanish drivers under different environmental conditions. The authors analyzed traffic crashes recorded by the Spanish Dirección General de Tráfico for the years 1991 and 1992 to compare proportions of drivers in different age/sex categories who were involved in single-vehicle and multivehicle crashes under different psychological and physical conditions. Crash risk was 1.42- to 2.35-fold greater in men than in women, depending on driver category and environmental factors. Risk was also significantly higher in the 18- to 24-year-old age group (1.75- to 2.87-fold greater than in drivers aged 25-49 years) and under abnormal psychological-physical conditions (1.69- to 4.10-fold greater among drivers under the influence of alcohol). Twilight and night driving, driving in urban areas, and driving on weekends and legal holidays were also associated, though nonsignificantly, with a slightly higher traffic crash risk. These findings are consistent with earlier reports, and they support the usefulness of the induced exposure method as an easy and economical tool with which to analyze data contained in traffic crash records.

Predictive value of a screen for gestational diabetes mellitus: influence of associated risk factors

BACKGROUND

There is a need for solid evidence of the relative advantages of universal vs. selective screening for gestational diabetes mellitus. Our study of a broad obstetric population determines the positive predictive value of the 50-g oral glucose challenge test for screening in the presence and absence of classical gestational diabetes risk factors.

METHODS

A retrospective cohort study was carried out with a total of 2,574 pregnant women. Clinical information was obtained from hospital records and each patient's medical history, and gestational diabetes risk factors were quantified for each pregnant woman. The positive predictive value of a screen was determined with respect to the number of risk factors.

RESULTS

Age 30 or over, family history of diabetes, obesity (BMI > or =27) and previous fetal macrosomia were established as the most frequent risk factors. Just over half (54.2%) of our population presented one or more risk factors. Screening covered 75% of the population, and was positive in 15% of the cases. Diagnosis was confirmed in 64 cases, 57 of them at risk, and seven with no risk factors. We obtained an overall positive predictive value of 21.8% (CI 17.3-27.0). This figure increases with the number of risk factors, from 12% for the women with no risk factors, to 40% for those presenting three or more risk factors.

CONCLUSIONS

A selective screening program that takes into account the clinical background and characteristics of each pregnant woman allows a high yield of true positives while reducing the possible undesirable effects associated with false positives.

Changes in serum cholesterol in employees after three years of multifactorial intervention

BACKGROUND

To assess long-term effectiveness of a multifactorial intervention at the work-site on serum cholesterol levels.

METHODS

Individualized face-to-face counseling was given to 1,555 employees (76.7% male; mean age = 42.3 years) by occupational physicians at four work-sites. After 3 years, a blinded assessment of the adequacy of the intervention was done. Implementation of the intended intervention by physicians was assessed as adequate in two work-sites (927 employees) and inadequate in the other two (628 employees). Observed changes in serum cholesterol were analyzed in the followed-up individuals. Follow-up rates at each work-site were 78.6% and 44.5% for the adequate intervention, and 85.5% and 60.4% for the inadequate intervention. Changes in serum cholesterol were controlled for potential confounding factors (pre-test levels of risk factors, age, sex, body mass index, educational level, marital status, physical activity and alcohol consumption) by multiple linear regression procedures.

RESULTS

When the intervention was adequately performed, serum cholesterol was significantly lowered with a mean reduction of 14.3 mg/dl (95% C.I.: 11.0 to 17.6) in those employees with baseline levels > or = 200 mg/dl.

CONCLUSIONS

Adequacy of implementation of work-site programs determines their long-term effectiveness in reducing mean serum cholesterol levels.

Proportion of hospital deaths associated with adverse events

OBJECTIVES

To determine the fraction of hospital deaths potentially associated with the occurrence of adverse events (AE).

DESIGN

A paired (1:1) case-control study.

SETTING

An 800-bed, teaching tertiary care hospital.

PATIENTS

All patients older than 14 years admitted to the hospital between January 1, 1990, and January 1, 1991, were eligible. All 524 consecutive deaths (death rate of 3.74%) that occurred in the hospital comprised the case group. For each case, a control patient was matched for both primary diagnosis on admission and admission date.

MEASUREMENTS

The proportion of hospital deaths associated with adverse events (defined as problems of any nature and seriousness faced by the patient during hospitalization, and potentially traceable to clinical or administrative management) was estimated from attributable risks adjusted for age, sex, service, severity of illness, length of stay, and quality of the medical record.

RESULTS

For stays longer than 48 hours, the adjusted attributable risk for all adverse events was estimated to be 0.51 (0.40-0.61). When the data were stratified according to the category of adverse event, the attributable risks remained significant except for administrative problems. The greatest proportion of deaths associated with adverse events was observed for surgical adverse events [0.56 (0.38-0.71)] and nosocomial infection [0.22 (0.14-0.28)].

CONCLUSIONS

A significant proportion of intrahospital deaths were associated with AE. These results suggest the need to consider programs focused on the prevention of mortality from AE.

Effects of heavy water on hepatic intracellular pH and phosphatidylcholine turnover. A 31P NMR study

The short term effect of heavy water (2H2O) in intracellular pH (pHi) and phosphatidylcholine (PtdCho) turnover have been studied by 31P NMR spectroscopy in the perfused mouse liver metabolizing alanine. Hepatic pHi decreased from 7.19 +/- 0.01 (n = 10) to 7.01 +/- 0.03 (n = 4) after the addition of 6 mM alanine to Krebs Ringer bicarbonate (KRB) perfusion medium. Replacement of 50% of the KRB water with 2H2O during alanine perfusion inhibited the intracellular acidification induced by alanine and caused i) a decrease in the hepatic content of PtdCho, and ii) increases in phosphocholine and glycerophosphocholine, respectively. Amiloride (1 mM) of 5-(N-ethyl-N-isopropyl)-amiloride (10 microM), two previously reported inhibitors of the Na+/H+ exchangers, mimicked the effects produced by 2H2O on pHi and PtdCho turnover. Replacement of 50% of the KRB water with 2H2O or the addition of 1mM amiloride to KRB only, did not modify pHi nor increase the levels of phosphocholine of glycerophosphocholine. Thus, the observed increases are the result of alanine perfusion in the presence of 2H2O or amiloride. These results suggest that 2H2O behaves similarly to previously reported inhibitors of Na+/H+ exchange, disclosing also a novel role for PtdCho metabolism in the regulation on hepatic pHi.

[Surveillance of hospital infections: validity of a selective system based on risk markers]

BACKGROUND

In order to achieve simultaneously a higher quality of hospital care and cost-containment, an objective assessment of alternative systems for surveillance of hospital infections is needed in our country. This assessment will allow to make a rational choice of the system to be used at each hospital.

METHODS

719 patients admitted to a Vascular Surgery ward were studied. Sensitivity, specificity, and predictive values for a selective system of surveillance of nosocomial infection (NI) were assessed. This selective system attempted to contain costs by means of limiting the revision of records to those patients who presented fever, prescription of antibiotics after admission or who required laboratory cultures. In this selective method charts revision was retrospectively performed by nurses.

RESULTS

A low sensitivity (50.9%) and acceptable values for specificity and predictive values were found.

CONCLUSIONS

Although this selective method requires only 20% of the reference method's time, its association with an important reduction in sensitivity precludes its systematic use and confines it eventually to low risk wards.

Exposure to pesticides and cryptorchidism: geographical evidence of a possible association

Synthetic hormone-disrupting chemicals may play a role in the increased frequency of cryptorchidism observed in some studies. We used a spatial ecological design to search for variations in orchidopexy rates in the province of Granada in Spain and to search for relationships between these differences and geographical variations in exposure to pesticides. Orchidopexy rates were estimated for the period from 1980 to 1991 in all municipalities and health care districts served by the University of Granada Hospital. A random sample of males of the same age (1-16 years) admitted for any reason during the same period was used to estimate inpatient control rates. Each municipality was assigned to one of four levels of pesticide use. We used Poisson homogeneity tests to detect significant differences in rates of orchidopexy between districts and between levels of pesticide use. Poisson and logistic regression models were also used to estimate the strength of association between orchidopexy and level of pesticide use. Orchidopexy rates tended to be higher in districts near the Mediterranean coast where intensive farming is widespread. The city of Granada, where the reference hospital is located, also had higher figures both for orchidopexy and inpatient control rates. Regression models showed that the strength of association between orchidopexy and level of pesticide use tended to increase with higher levels of use, with the exception of level 0 (mainly in the city of Granada). Our results are compatible with a hypothetical association between exposure to hormone-disruptive chemicals and the induction of cryptorchidism. Several methodological limitations in the design make it necessary to evaluate the results with caution.

Exposure to pesticides and cryptorchidism: geographical evidence of a possible association

Synthetic hormone-disrupting chemicals may play a role in the increased frequency of cryptorchidism observed in some studies. We used a spatial ecological design to search for variations in orchidopexy rates in the province of Granada in Spain and to search for relationships between these differences and geographical variations in exposure to pesticides. Orchidopexy rates were estimated for the period from 1980 to 1991 in all municipalities and health care districts served by the University of Granada Hospital. A random sample of males of the same age (1-16 years) admitted for any reason during the same period was used to estimate inpatient control rates. Each municipality was assigned to one of four levels of pesticide use. We used Poisson homogeneity tests to detect significant differences in rates of orchidopexy between districts and between levels of pesticide use. Poisson and logistic regression models were also used to estimate the strength of association between orchidopexy and level of pesticide use. Orchidopexy rates tended to be higher in districts near the Mediterranean coast where intensive farming is widespread. The city of Granada, where the reference hospital is located, also had higher figures both for orchidopexy and inpatient control rates. Regression models showed that the strength of association between orchidopexy and level of pesticide use tended to increase with higher levels of use, with the exception of level 0 (mainly in the city of Granada). Our results are compatible with a hypothetical association between exposure to hormone-disruptive chemicals and the induction of cryptorchidism. Several methodological limitations in the design make it necessary to evaluate the results with caution.

Recall bias in a case-control study of low birth weight

The role of report/recall bias in case-control studies of low birth weight (LBW) was investigated in women who gave birth at a tertiary hospital. Prenatal exposure information reported at the postpartum interview was compared with that documented during pregnancy in obstetric records. 169 cases of LBW and 198 controls were selected. The two sets of information on case mothers and control mothers were compared, using the medical record as a reference. Kappa values were estimated. No trend was observed to increase/decrease the sensitivity and specificity of recall. Agreement on alcohol use was very low (kappa = 0.11 for case mothers and 0.03 for control mothers): on obstetrical records, only 12 mothers of cases reported habitual alcohol intake at the first prenatal care visit, whereas in the interview 69 said yes to the same question; in control mothers, the figures were 4 and 89 respectively. Odds ratios (ORs) of exposure estimated from the two sets of data did not differ importantly in 8 variables. Interview data yielded ORs for hypertension (8.39 versus 4.63), anemia (0.44 versus 0.99) that were farther from the null, and ORs in the opposite direction for alcohol (0.83 versus 1.61) and any drug (0.64 versus 1.42). In conclusion, given that OR figures are similar for most variables and no trend is observed in sensitivity/specificity, mothers of normal births can be an adequate reference group, using personal interviews to obtain information on lifestyle, and medical records for conditions.

The effect of completeness of medical records on the determination of appropriateness of hospital days

Although the Appropriateness Evaluation Protocol (AEP) has been widely used during the past decade, several methodological concerns have not yet been properly resolved, including the possible influence of low completeness of the medical records on the results yielded by the AEP in retrospective studies. We examined medical records for a random sample of 345 patient-days with the AEP, according to a protocol that included several variables potentially related to inappropriateness. The completeness of physician and nursing notes was also assessed. The proportion of inappropriate days of hospitalization was 36.2%. In the crude analysis, significantly higher proportions of inappropriateness were found for lower values of completeness. Factors related to the inappropriateness of stay were summer season, elective admission, no previous admissions, surgical and medical-surgical service in charge, and the day sampled falling within the last third of the hospital stay. Adjustment for the completeness level of medical records did not substantially change the strength of the association between these factors and the inappropriateness of hospital stay. Completeness level itself did not show any significant association with the proportion of inappropriate days in the adjusted analysis.

Epidemiology, therapy and costs of nosocomial infection

In the current climate of cost containment and quality control, nosocomial infection is a worrisome adverse event in hospital care. Hospitalised patients require care for increasingly severe illnesses, and are therefore more susceptible to infection, especially by opportunistic micro-organisms. It is thus necessary to accurately assess and adjust for the severity of the underlying illness in studies of risk factors involved in nosocomial infections. The appearance of new diagnostic and therapeutic techniques provides novel opportunities for infection control and represents a constant challenge to hospital systems. The continuous selection of resistant flora, together with the identification of new pathogens, calls for a reconsideration of hospital policies regarding the dispensation of antibiotics. Epidemiological surveillance continues to be the most important aspect of attempts to monitor infection control programmes, and to identify changes in risk factors that may increase the infection rate. Among the major challenges now facing the infection control practitioner is the use of nosocomial infection rates as an indicator of quality of care. Awareness of infection statistics would serve as a stimulus to the prevention and control of infection, but would be useless if not accompanied by adequate systems to guarantee the comparability of data from different studies and centres. Suitably sensitive and specific surveillance systems should be developed, and the use of site-specific and procedure-specific infection rates adjusted for the patient's intrinsic risk should be encouraged.

Haemopoietic phagocytes in the early differentiating avian retina

The existence of specialised phagocytic cells is described in regions of the retinal neuroepithelium undergoing intense cell death during early differentiation of the avian embryo retina (2.5-5 days of incubation). These results were obtained using routine techniques for light microscopy, acid phosphatase histochemistry and immunocytochemical staining with antibodies MB-1 and QH-1, both specific for quail endothelial cells and all blood cells except mature erythrocytes. Specialised phagocytes were distinguishable from neuroepithelial cells on the basis of morphological criteria: in the former, the nucleus was not oval in shape and was not oriented perpendicular to basement membrane neuroepithelium. The cytoplasm of the specialised phagocytes was often filled with dead cell fragments. In contrast to neuroepithelial cells, the specialised phagocytes showed acid phosphatase activity and were labelled with both MB-1 and QH-1 antibodies in normal quail embryos and chick----quail yolk sac chimeras. Moreover, some acid phosphatase positive and MB-1/QH-1 positive cells also appeared in the presumptive vitreous body, at the edges of the optic cup and in the surrounding mesenchyme. As the vitreal cells and the specialised phagocytes of the neural retina were immunolabelled in chick----quail yolk sac chimeras, we conclude that they are derived from haemopoietic cells in the yolk sac. Some images suggest that these cells enter the vitreous body from the surrounding mesenchyme and traverse the basement membrane of the neuroepithelium in the optic disc region to give rise to the specialised phagocytes of the retinal neuroepithelium.