Geomorphology applied to landscape analysis for planning and management of natural spaces. Case study: Las Batuecas-S. de Francia and Quilamas natural parks, (Salamanca, Spain)

Geomorphology is fundamental to landscape analysis, as it represents the main parameter that determines the land spatial configuration and facilitates reliefs classification. The goal of this article is the elaboration of thematic maps that enable the determination of different landscape units and elaboration of quality and vulnerability synthetic maps for landscape fragility assessment prior to planning human activities. For two natural spaces, the final synthetic maps were created with direct (visual-perceptual features) and indirect (cartographic models and 3D simulations) methods from thematic maps with GIS technique. This enabled the creation of intrinsic and extrinsic landscape quality maps showing sectors needing most preservation, as well as intrinsic and extrinsic landscape fragility maps (environment response capacity or vulnerability towards human actions). The resulting map shows absorption capacity for areas of maximum and/or minimum human intervention. Sectors of high absorption capacity (minimum need for preservation) are found where the incidence of human intervention is minimum: escarpment bottoms, fitted rivers, sinuous high lands with thick vegetation coverage and valley interiors, or those areas with high landscape quality, low fragility and high absorption capacity, whose average values are found across lower hillsides of some valleys, and sectors with low absorption capacity (areas needing most preservation) found mainly in the inner parts of natural spaces: peaks and upper hillsides, synclines flanks and scattered areas. For the integral analysis of landscape, a mapping methodology has been set. It comprises a valid criterion for rational and sustainable planning, management and protection of natural spaces.

Body mass index and mortality in patients with acute venous thromboembolism: findings from the RIETE registry

BACKGROUND

There is little information on the influence of body mass index (BMI) on mortality in patients with acute venous thromboembolism (VTE).

PATIENTS AND METHODS

RIETE is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute VTE. We examined the association between BMI and mortality during the first 3 months of therapy.

RESULTS

Of the 10 114 patients enrolled as of March 2007: 153 (1.5%) were underweight (BMI < 18.5); 2882 (28%) had a normal weight (BMI 18.5-24.9); 4327 (43%) were overweight (BMI 25.0-30); and 2752 (27%) were obese (BMI > 30). The overweight and obese patients were significantly older, and were less likely to have had cancer, recent immobility or renal insufficiency. After 3 months of therapy their death rates were 28%, 12%, 6.2% and 4.2%, respectively. In multivariate analysis, the relative risks for death after adjusting for confounding variables including age, cancer, renal insufficiency or idiopathic VTE were: 2.1 (95% CI, 1.5-2.7); 1.0 (reference); 0.6 (95% CI, 0.5-0.7); and 0.5 (95% CI, 0.4-0.6), respectively. The rates of fatal pulmonary embolism (2.0%, 2.1%, 1.2% and 0.8%, respectively) also decreased with BMI. There were no differences in the rate of fatal bleeding, but patients who were underweight had an increased incidence of major bleeding complications (7.2% vs. 2.7%; odds ratio, 2.7; 95% CI, 1.4-5.1).

CONCLUSIONS

Obese patients with acute VTE have less than half the mortality rate when compared with normal BMI patients. This reduction in mortality rates was consistent among all subgroups and persisted after multivariate adjustment.

Plasma prolactin/oestradiol ratio at 38 weeks gestation predicts the duration of lactational amenorrhoea

BACKGROUND

Fully breastfeeding women experience an amenorrhoea of variable duration. Our aim was to identify in pregnancy, endocrine markers that could predict the duration of subsequent lactational amenorrhoea.

METHODS

We studied 17 healthy women at 34 and 38 weeks gestation, and 1 and 3 months post-partum. The women fully breastfed until 6 months post-partum. During pregnancy, prolactin (PRL), oestrogens (total oestradiol, unconjugated oestrone, unconjugated oestriol), sex hormone binding globulin (SHBG), dehydroepiandrosterone sulphate (DHEA-S), progesterone and placental lactogen, and during post-partum PRL, oestrogens and SHBG, were measured. Free oestradiol in pregnancy and post-partum was calculated.

RESULTS

Ten women experienced long (>6 months) and seven experienced short (<6 months) lactational amenorrhoea. At 38 weeks gestation, the women who experienced a long lactational amenorrhoea had twice as much PRL, about half the total oestradiol, lower SHBG concentration (P < 0.05, Student's t-test, Bonferroni modification) and similar free oestradiol concentration, compared with those who experienced short lactational amenorrhoea. The difference in PRL concentration persisted in post-partum postsuckling samples.

CONCLUSION

At 38 weeks gestation, the ratio PRL/oestradiol identified all individual women according to the subsequent duration of their lactational amenorrhoea, suggesting that duration of lactational amenorrhoea is conditioned during pregnancy.

The efficacy of the lactational amenorrhea method (LAM) among working women

The purpose of this study was to assess the efficacy of the lactational amenorrhea method (LAM) for family planning among mothers who are separated from their infants by work. The study population, 170 urban middle class women who planned to return to work before 120 days postpartum, were interviewed monthly for 6 months postpartum and contacted at 12 months. The study population received clinical support for expressing their milk and exclusively breast-milk feeding the infants and for the use of LAM for birth spacing. The cumulative life table pregnancy rate by 6-month was 5.2%, with 3 pregnancies, one at each of months 4, 5, and 6. LAM for working women, as described in this article, might be associated with a higher pregnancy risk than LAM use among non-working women. Therefore, women using LAM should be informed that separation from the infant might increase their risk of pregnancy.

[Typing habitats of Aedes albopictus in Cuba and their association with other species of Culicidae, 1995-1998]

A typing of the habitats of Aedes albopictus in Cuba was made after its detection in 1995. It was observed in suburban areas of the Boyeros Municipality, in Havana City, where a study was conducted from October, 1995, to July, 1998. Most of the positive repositories were found outside the houses. Tins, tires, trees and plants were the places preferred for its breeding. It was found in the breeding places associated with Aedes mediovittatus and Culex quinquefasciatus, dominant species in these places. It was also observed a trend towards an increase of the number of repositories colonized only by the species under study. Reference was made to the phenomenon of competence between this species and the indigenous species present in such places.

Clinical support can make the difference in exclusive breastfeeding success among working women

Exclusive breastfeeding has generally been considered incompatible with working separated from the infant. This prospective, controlled intervention trial shows that breastfeeding support, including anticipatory counseling and monthly clinical follow-up of the mother and infant, can significantly increase the percentage of infants exclusively fed with breastmilk at the end of 6 months of life. Over 80 per cent of women from control and intervention groups expressed a desire to breastfeed for more than 6 months and more than 50 per cent thought it was best for the infant to be exclusively breastfed for 6 months. Only 6 per cent of women in the control group were able to complete 6 months of exclusive breastmilk feeding compared to 53 per cent of those in the intervention group. The most important difference between the strategies used by both groups of mothers for maintaining exclusive breastmilk feeding after returning to work was that only 23 per cent of the control group practiced milk expression compared to 66 per cent in the intervention group. All women from the supported group stated that they would advise a friend to combine exclusive breastfeeding and work and that they would like to do so again with another child.

[The ecological succession of mosquito species in the town of Boyeros, Ciudad de la Habana 1994-1996]

An analysis was made on the incidence of Culicidae in Boyeros municipality, City of Havana from 1994 to 1996 based on the requirements of the national program for eradication of Aedes aegypti. A total of 13 species was detected in which Aedes mediovittatus predominated during 3 years of study, followed by Culex quinquefasciatus whereas for the first time Aedes albopictus species was found in the territory. People's Councils Wajay, Santiago de las Vegas and Armada exhibited the highest values of infestation by Culicidae in the municipality, therefore, they required that anti-Aedes program, operators paid more attention to this situation. It was found that depots preferred by Culicidae for breeding were larval traps followed by low tanks in 1994 and 1995 and by other reservoirs in 1996. A mediovittatus preferred larval traps whereas Cx. quinquefasciatus preferred low tanks except in 1996 when this species was mostly found in other tanks. 93% of all test-positive reservoirs found were colonized by only one species, whereas 7% presented larvae from 2 species or more. A. mediovittatus and C. quinquefasciatus were the most related, above all in low tanks.

[Entomological surveillance over Aedes (S) aegypti and other culicids in Ciudad de La Habana, Cuba 1991-1996]

The results of the entomologic surveillance carried out from 1991 to 1996 in Boyeros municipality, City of Havana within the Program for Eradication of Aedes aegypti were analyzed. Data on mosquitoes fauna collected in the municipality by various sampling methods, larval survey, human bait, capture at rest and larval traps. Culex quinquefasciatus, Aedes mediovittatus and Aedes aegypti species were the most found by the different methods. It was proved that water tanks, man-made deposits, other kinds of tanks and low tanks were the most exploited resources by mosquitoes for their breeding in this municipality whereas larval surveys were the most sensitive method for detecting species since it contributed a greater variety of species. Reference is made to the search for a mechanism that help estimate adult populations from larval indices provided by surveys and the method of capture at rest is stressed as the most sensitive method for adult mosquitoes, particularly for dengue vector within the surveillance system aimed at this species.

Does prenatal breastfeeding skills group education increase the effectiveness of a comprehensive breastfeeding promotion program?

A control/intervention study carried out in Santiago, Chile assessed the impact of five interventions on breastfeeding patterns and duration, and demonstrated a significant increase in full breastfeeding at six months (32 percent to 67 percent). Fifty-nine of 422 post-intervention women were included in a sixth intervention: prenatal group educational sessions emphasizing the skills necessary to initiate and maintain breastfeeding past the neonatal period. A significantly higher percentage of this subset of women were fully breastfeeding at six months compared to those who received only the five basic interventions (80 percent and 65 percent, respectively). The effect was greater among primiparous women. We conclude that prenatal group education with hands-on skills reinforcement is a significant and additive component of breastfeeding support, especially among those who have no previous breastfeeding experience.

The effects on professional practices of a three-day course on breastfeeding

This study assessed reported changes in clinical breastfeeding support practices following a three-day (approximately 24 hour) course. The course, presented at the Catholic University in Santiago, Chile, included the physiology of lactation and lactational infertility, related policy, clinical skills, the Lactational Amenorrhea Method (LAM), and program-related findings. A questionnaire was sent to all participants and an additional systematic sample was telephoned to assure a statistically valid sample. Sixty-nine percent of respondents reported changes in clinical practices resulting from attendance at the course. The results support the concept, now being advanced by the Baby-Friendly Hospital Initiative, that an 18-24 hour course can change clinical practices.

[Cryptococcosis with exclusive cutaneous presentation in a patient with AIDS]

We report an exclusively cutaneous case of cryptococcosis, which is exceptional. He was a 33 years old patient with the acquired immunodeficiency syndrome who presented with an ulcer-necrotic lesion at the nasal wings with a long and torpid evolution. Finally, culture and biopsy were diagnostic of cryptococcosis. We ruled out affection of other organs and the cryptococcal antigen was negative in serum and cerebrospinal fluid. The patient was treated with fluconazole and had a good clinical course. Its emphasized the scarcity of this form of presentation as well as the lack of specificity of its lesions and the necessity of ruling out other locations once the fungus is isolated in the skin. Diagnosis is simple through skin biopsy and culture. Its important to determine the cryptococcal antigen. We comment on the current approaches to treatment during acute and maintenance phases, after the appearance of the new imidazolic compounds such as fluconazole.

The impact of a hospital and clinic-based breastfeeding promotion programme in a middle class urban environment

Hospital interventions in support of breastfeeding have been highly successful in areas where the indigenous population has a well established environment of breastfeeding. However, programmes designed to improve breastfeeding patterns in urban populations have met with mixed success. This paper presents a prospective intervention study with a control group in which a health system-based breastfeeding promotion programme was initiated to support optimal breastfeeding for both child health and child spacing. Following collection of control data, a four-step intervention programme (Breastfeeding Promotion Program) was instituted. This paper reports the process of the development of the intervention programme as well as the comparison of the control and study populations. Major findings include significant increases in duration of full breastfeeding from 31.6 per cent at 6 months in the control group to 66.8 per cent in the intervention group. The duration of lactational amenorrhea was similarly increased: 22 per cent of the control mothers and 56 per cent of the intervention group women were in amenorrhoea at 180 days. The cost-effectiveness of the hospital changes is illustrated.

Santiago Breastfeeding Promotion Program: preliminary results of an intervention study

A prospective intervention study was undertaken in Santiago, Chile, to assess the impact of a breastfeeding promotion program and the acceptance and use of the lactational amenorrhea method for natural child spacing. The intervention study significantly increased the duration of exclusive breastfeeding and amenorrhea. In addition, the use of the lactational amenorrhea method proved highly efficacious, with an unplanned pregnancy rate of less than 0.5% by 6-month cumulative life table. Total family planning coverage at 6 months was increased in the intervention group.