THE EFFECT OF CAFFEINE CONSUMPTION ON MORTALITY IN HYPERTENSIVE INDIVIDUALS

The effect of caffeine consumption on mortality was evaluated in a historical cohort study of 10064 hypertensive individuals participating in the Hypertension Detection and Follow-Up Program (HDFP) from 1973 to 1979. The study cohort was stratified into caffeine consumption groups (none, low, medium and high) based on their total level of caffeine intake from beverages (coffee and tea) and certain medications at the One-year follow-up home visit. Stratification was also made by sex, race, type of care and age. The total relative risks (RRs) when computed across strata for each caffeine consumer group (low, medium and high) were not significantly different when compared to the noncaffeine consumer group for all-cause or cause-specific mortality rates. The point estimates and 95 per cent confidence intervals for relative risks of all-cause mortality when compared to nonconsumers were as follows: Low = 0.82 (0.65-1.03), Medium: = 0.82 (0.62-1.82) and High = 0.90 (0.63-1.28). For all sex, race combinations there was an increase in the per cent of current smokers within each caffeine consumer group as the level of caffeine consumption increased. Cigarette smoking was an important confounder correlated with caffeine consumption and associated with mortality in this cohort. When confounding by cigarette smoking was adjusted for in the analysis, no association was found between the level of caffeine consumption and all-cause or cause-specific mortality. ^

Spatial analysis of cardiovascular disease mortality and air pollution in Harris County, Texas

The association between fine particulate matter air pollution (PM2.5) and cardiovascular disease (CVD) mortality was spatially analyzed for Harris County, Texas, at the census tract level. The objective was to assess how increased PM2.5 exposure related to CVD mortality in this area while controlling for race, income, education, and age. An estimated exposure raster was created for Harris County using Kriging to estimate the PM2.5 exposure at the census tract level. The PM2.5 exposure and the CVD mortality rates were analyzed in an Ordinary Least Squares (OLS) regression model and the residuals were subsequently assessed for spatial autocorrelation. Race, median household income, and age were all found to be significant (p<0.05) predictors in the model. This study found that for every one μg/m3 increase in PM2.5 exposure, holding age and education variables constant, an increase of 16.57 CVD deaths per 100,000 would be predicted for increased minimum exposure values and an increase of 14.47 CVD deaths per 100,000 would be predicted for increased maximum exposure values. This finding supports previous studies associating PM2.5 exposure with CVD mortality. This study further identified the areas of greatest PM2.5 exposure in Harris County as being the geographical locations of populations with the highest risk of CVD (i.e., predominantly older, low-income populations with a predominance of African Americans). The magnitude of the effect of PM2.5 exposure on CVD mortality rates in the study region indicates a need for further community-level studies in Harris County, and suggests that reducing excess PM2.5 exposure would reduce CVD mortality.^

Systematic review of current trends of cardiovascular disease (CVD) and association between health insurance coverage and CVD mortality among women aged 60--65 in Texas in 2000--2011

Cardiovascular disease (CVD) is highly preventable, yet it is a leading cause of death among women in Texas. The primary goals of this research were to examine past and current trends of CVD, as well as identify whether there is an association between the insurance coverage and mortality from CVD among women aged 60–65 in Texas between 2000 and 2011. ^ The systematic review of the research is based on the guidelines and recommendations set by the Centre for Reviews and Dissemination for conducting reviews in health care. Over 47 citations of peer-reviewed articles from Ovid MEDLINE and PubMed databases and five websites were identified, of which 7 studies met inclusion criteria for the first systematic review to examine the trends of CVD in Texas. Ten citations of peer-reviewed articles from Ovid MEDLINE and PubMed databases and five web sites were reviewed for the second systematic review (to study the association between insurance coverage and cardiovascular health among Texas women 60–64 years of age), of which 3 studies met inclusion criteria and were included in the research. The results of the study highlighted key gaps in the existing literature and important areas for the further research, as well as determined directions for future public health CVD prevention programs in Texas. ^ Based on the conducted research, the major determinants of premature mortality among women attributed to cardiovascular disease are based on individual level characteristics, more specifically sex, age, race/ethnicity, and education. The results indicate that African American and non-Hispanic white women are more likely to have higher CVD mortality rates than Hispanic women due to higher prevalence of cardiac risk factors. The data also shows higher levels of mortality from CVD in the southeastern United States, with Texas ranking as the third state with the highest prevalence of CVD among women. According to the Texas Department of State Health Services, there are approximately 56,000 deaths caused by CVD annually in Texas, which represents about one death every ten minutes. Coronary artery disease and stroke were the causes of 31.2 percent of all female deaths in Texas in 2009, meaning that approximately 68 women die from any form of cardiac disease in Texas each day. ^ The data of the reviewed studies indicate that women' lack of health insurance was significantly associated with a higher prevalence of cardiovascular disease. The uninsured women were more likely to be unaware of their risk factors and more likely to have undiagnosed diabetes—a co-morbidity factor of CVD. One of the studies also reports strong correlation between state rates of uninsured and lower rates of preventive care. Given these strong correlations, those who were chronically uninsured were at a higher risk of mortality than the insured, due to prolonged periods of time without basic access to preventive and medical care. ^ Suggested recommendations to decrease CVD mortality rates in Texas are consistent with the existing literature and include state policy development that addresses elimination of health disparities, consideration of potential benefits of universal health coverage by the legislative policymakers, and maintenance of solid partnerships between public health agencies and hospitals to educate on, diagnose, and treat CVD among the female population in Texas. ^

The Relationship of Provincial Economic Level and Child Injury Mortality in Thailand: A Cross-Sectional Analysis in a Middle Income Country

The objective of this cross-sectional study was to examine the relationship of provincial economic development indices with incidences of child injury mortality in Thailand from 1999 - 2001. All injury deaths among children age 1-14 years were included. The independent variables included gross provincial product per capita (GPP/c), poverty and inequality indices, material and social deprivation indices, population in rural/ urban areas, and migration. Due to multicollinearity of such variables, the 76 provinces were categorized by GPP/c quartile, and means of overall injury, drowning, and transport-related mortality rates were compared among quartile groups. Spearman’s rho correlation between GPP/c and injury mortality rates was also performed. Finally, factor analysis was employed to create a set of factors to be treated as uncorrelated variables and stepwise multiple regression was carried out for the effects of the factors on injury mortality rates. A significant direct relationship was observed between GPP/c and overall injury mortality among children age 1-4 years, and 10-14 year-olds of both genders. Drowning was the main cause of this relationship among children age 1-4 years, and transport-related injury was the principle cause among children age 10-14 years. Conversely, provinces with lower GPP/c experienced higher injury mortality rates among school-age children 5-9 years old for both genders, mostly due to drowning. Factor analysis, and multiple regression results confirmed the relationships between economic development and injury mortality rates. These findings revealed that economic development had an adverse impact on injury-related mortality among children 1 to 4 and 10 to14 in Thailand.

Fasting blood glucose and 8-year mortality in the hypertension detection follow-up program population

This study analyzed the relationship between fasting blood glucose (FBG) and 8-year mortality in the Hypertension Detection Follow-up Program (HDFP) population. Fasting blood glucose (FBG) was examined both as a continuous variable and by specified FBG strata: Normal (FBG 60–100 mg/dL), Impaired (FBG ≥100 and ≤125 mg/dL), and Diabetic (FBG>125 mg/dL or pre-existing diabetes) subgroups. The relationship between type 2 diabetes was examined with all-cause mortality. This thesis described and compared the characteristics of fasting blood glucose strata by recognized glucose cut-points; described the mortality rates in the various fasting blood glucose strata using Kaplan-Meier mortality curves, and compared the mortality risk of various strata using Cox Regression analysis. Overall, mortality was significantly greater among Referred Care (RC) participants compared to Stepped Care (SC) {HR = 1.17; 95% CI (1.052,1.309); p-value = 0.004}, as reported by the HDFP investigators in 1979. Compared with SC participants, the RC mortality rate was significantly higher for the Normal FBG group {HR = 1.18; 95% CI (1.029,1.363); p-value = 0.019} and the Impaired FBG group, {HR = 1.34; 95% CI (1.036,1.734); p-value = 0.026,}. However, for the diabetic group, 8-year mortality did not differ significantly between the RC and SC groups after adjusting for race, gender, age, smoking status among Diabetic individuals {HR = 1.03; 95% CI (0.816,1.303); p-value = 0.798}. This latter finding is possibly due to a lack of a treatment difference of hypertension among Diabetic participants in both RC and SC groups. The largest difference in mortality between RC and SC was in the Impaired subgroup, suggesting that hypertensive patients with FBG between 100 and 125 mg/dL would benefit from aggressive antihypertensive therapy.^

Regression with autocorrelated data: A study of time trend of global infant mortality rate

The infant mortality rate (IMR) is considered to be one of the most important indices of a country's well-being. Countries around the world and other health organizations like the World Health Organization are dedicating their resources, knowledge and energy to reduce the infant mortality rates. The well-known Millennium Development Goal 4 (MDG 4), whose aim is to archive a two thirds reduction of the under-five mortality rate between 1990 and 2015, is an example of the commitment. ^ In this study our goal is to model the trends of IMR between the 1950s to 2010s for selected countries. We would like to know how the IMR is changing overtime and how it differs across countries. ^ IMR data collected over time forms a time series. The repeated observations of IMR time series are not statistically independent. So in modeling the trend of IMR, it is necessary to account for these correlations. We proposed to use the generalized least squares method in general linear models setting to deal with the variance-covariance structure in our model. In order to estimate the variance-covariance matrix, we referred to the time-series models, especially the autoregressive and moving average models. Furthermore, we will compared results from general linear model with correlation structure to that from ordinary least squares method without taking into account the correlation structure to check how significantly the estimates change.^

Indigent care and infant mortality in Texas

Infant Mortality has been made a point of emphasis by the Department of Health and Human Services in the Healthy People 2000, 2010, and 2020 priorities. This study used the Behavioral Model for Vulnerable Populations to consider a number of factors which impact infant mortality in the indigent populations in the State of Texas. The primary focus of this study was the enabling factor of community resources, specifically the program used by each county to provide care to their indigent population. The Legislature of the State of Texas requires that each state have a program set up within a Hospital District, Public Hospital or develop a County Indigent Health Care Program (CIHCP) in order to provide the basic health care needs of their most vulnerable residents. We sought to determine whether the development of a CICHP without an appointed hospital to provide the care would have an adverse effect on residents seeking care and increase infant mortality. A Poisson Regression Analysis was used to analyze incidence rate ratios adjusting for race/ethnicity and wealth/poverty variables. Our study showed that counties using a CIHCP had significantly lower infant mortality rates when compared to counties using a hospital district and were statistically equivalent to counties using a public hospital program or a combination of service programs. This relationship was maintained when adjusted incidence rate ratios were calculated. This may give evidence that counties struggling to fund a public hospital or hospital district may be able to find a more cost-effective alternative in the CIHCP without adversely affecting the health status of their residents. More cost-benefit analysis and controlling analysis must be done to further characterize this relationship. ^

Epidemiology of perinatal mortality: Birthweight, crown -heel length, gestational age, and weight -for -height

Studies suggest that slim infants (low weight-for-height) experienced higher mortality rates than average or high weight-for-height infants (Miller and Hassanein, 1973; Hoffman, Meirik, and Bakketeig, 1984). In this study, the 1980 National Natality Survey and the National Fetal Mortality Survey were used to examine the association of weight, height and perinatal mortality. All singleton births to white married mothers, between 18 and 34 years of age and of parity less than 4, for whom both mother's and hospital questionnaires were completed in those two surveys (3796 live births and 2043 fetal deaths) were selected for analysis. Overall, low weight and height infants had excess mortality rates. However, after adjustment for low birthweight and preterm birth status, low weight and height infants had only slightly higher mortality rates than their medium or high weight and height counterparts. The current study consists of relatively well-educated white married mothers of optimal reproductive age and low parity. Therefore, lower than expected mortality rates for slim infants may be attributed to these favorable demographic factors in this sample as compared with previous studies, or because of advances in perinatal medicine, slim infants may be prevented from achieving the high mortality seen in earlier studies. ^

Experiment: summer mortality phenomena in pacific oysters

Mass mortalities of Pacific oysters Crassostrea gigas occur regularly when temperatures are high. Elevated temperatures facilitate the proliferation and spread of pathogens and simultaneously impose physiological stress on the host. Additionally, periods of high temperatures coincide with the oyster spawning season. Spawning is energetically costly and can further compromise oyster immunity. Most studies monitoring the underlying factors of oyster summer mortality in the field, point to the involvement of abiotic and biotic factors including low salinities, high temperatures, pollutants, toxic algae blooms, pathogen exposure and physical stress in conjunction with maturation. However, studies addressing more than two factors experi- mentally are missing thus far. Therefore, we investigated the combination of three main factors including abiotic as well as internal and external biotic stressors by conducting controlled infection experiments on pre-and post-spawning as well as on gravid oysters with opportunistic Vibrio sp. at two different tempera- tures. Based on mortality rates, infection intensity and cellular immune parameters, we provide experimental evidence that all three factors (i.e. reproductive investment, elevated temperatures and infection with oppor- tunistic Vibrio sp.) act additively to the phenomenon of oyster summer mortality, leaving post-spawning oyster more susceptible to SMS than pre-spawning and gravid oysters. While previous studies found that post-spawning oysters have a lower thermal tolerance and a reduced ability to withstand pathogen infec- tions, our study now allows to separate the relative contribution of different causative agents to oyster sum- mer mortality and pinpoint to infection with pathogenic Vibrio sp. being of highest importance. In addition we can add a mechanistic understanding for the higher losses after spawning during which the phagocytic ability of hemocytes was strongly impeded resulting in insufficient clearance of pathogens.

Ingestion and clearance rates of Copepods

Feeding activity, selective grazing and the potential grazing impact of two dominant grazers of the Polar Frontal Zone, Calanus simillimus and Rhincalanus gigas, and of copepods < 2 mm were investigated with incubation experiments in the course of an iron fertilized diatom bloom in November 2000. All grazers were already actively feeding in the low chlorophyll waters prior to the onset of the bloom. C. simillimus maintained constant clearance rates and fed predominantly on diatoms. R. gigas and the small copepods strongly increased clearance and ingestion of diatoms in response to their enhanced availability. All grazers preyed on microzooplankton, most steadily on ciliates, confirming the view that pure herbivory appears to be the exception rather than the rule in copepod feeding. The grazers exhibited differences in feeding behavior based on selectivity indices. C. simillimus and R. gigas showed prey switching from dinoflagellates to diatoms in response to the phytoplankton bloom. All grazers most efficiently grazed on large diatoms leading to differences in daily losses for large and small species, e.g. Corethron sp. or Thalassionema nitzschioides. Species-specific diatom mortality rates due to grazing suggest that the high feeding activity of C. simillimus prior to and during the bloom played a role in shaping diatom population dynamics

Carbon allocation in north-western Amazon forests (Colombia)

Los estudios sobre la asignación del carbono en los ecosistemas forestales proporcionan información esencial para la comprensión de las diferencias espaciales y temporales en el ciclo del carbono de tal forma que pueden aportar información a los modelos y, así predecir las posibles respuestas de los bosques a los cambios en el clima. Dentro de este contexto, los bosques Amazónicos desempeñan un papel particularmente importante en el balance global del carbono; no obstante, existen grandes incertidumbres en cuanto a los controles abióticos en las tasas de la producción primaria neta (PPN), la asignación de los productos de la fotosíntesis a los diferentes componentes o compartimentos del ecosistema (aéreo y subterráneo) y, cómo estos componentes de la asignación del carbono responden a eventos climáticos extremos. El objetivo general de esta tesis es analizar los componentes de la asignación del carbono en bosques tropicales maduros sobre suelos contrastantes, que crecen bajo condiciones climáticas similares en dos sitios ubicados en la Amazonia noroccidental (Colombia): el Parque Natural Nacional Amacayacu y la Estación Biológica Zafire. Con este objetivo, realicé mediciones de los componentes de la asignación del carbono (biomasa, productividad primaria neta, y su fraccionamiento) a nivel ecosistémico y de la dinámica forestal (tasas anuales de mortalidad y reclutamiento), a lo largo de ocho años (20042012) en seis parcelas permanentes de 1 hectárea establecidas en cinco tipos de bosques sobre suelos diferentes (arcilloso, franco-arcilloso, franco-arcilloso-arenoso, franco-arenoso y arena-francosa). Toda esta información me permitió abordar preguntas específicas que detallo a continuación. En el Capítulo 2 evalúe la hipótesis de que a medida que aumenta la fertilidad del suelo disminuye la cantidad del carbono asignado a la producción subterránea (raíces finas con diámetro <2 mm). Y para esto, realicé mediciones de la masa y la producción de raíces finas usando dos métodos: (1) el de los cilindros de crecimiento y, (2) el de los cilindros de extracción secuencial. El monitoreo se realizó durante 2.2 años en los bosques con suelos más contrastantes: arcilla y arena-francosa. Encontré diferencias significativas en la masa de raíces finas y su producción entre los bosques y, también con respecto a la profundidad del suelo (010 y 1020 cm). El bosque sobre arena-francosa asignó más carbono a las raíces finas que el bosque sobre arcillas. La producción de raíces finas en el bosque sobre arena-francosa fue dos veces más alta (media ± error estándar = 2.98 ± 0.36 y 3.33 ± 0.69 Mg C ha1 año1, con el método 1 y 2, respectivamente), que para el bosque sobre arcillas, el suelo más fértil (1.51 ± 0.14, método 1, y desde 1.03 ± 0.31 a 1.36 ± 0.23 Mg C ha1 año1, método 2). Del mismo modo, el promedio de la masa de raíces finas fue tres veces mayor en el bosque sobre arena-francosa (5.47 ± 0.17 Mg C ha1) que en el suelo más fértil (de 1.52 ± 0.08 a 1.82 ± 0.09 Mg C ha1). La masa de las raíces finas también mostró un patrón temporal relacionado con la lluvia, mostrando que la producción de raíces finas disminuyó sustancialmente en el período seco del año 2005. Estos resultados sugieren que los recursos del suelo pueden desempeñar un papel importante en los patrones de la asignación del carbono entre los componentes aéreo y subterráneo de los bosques tropicales; y que el suelo no sólo influye en las diferencias en la masa de raíces finas y su producción, sino que también, en conjunto con la lluvia, sobre la estacionalidad de la producción. En el Capítulo 3 estimé y analicé los tres componentes de la asignación del carbono a nivel del ecosistema: la biomasa, la productividad primaria neta PPN, y su fraccionamiento, en los mismos bosques del Capítulo 2 (el bosque sobre arcillas y el bosque sobre arena-francosa). Encontré diferencias significativas en los patrones de la asignación del carbono entre los bosques; el bosque sobre arcillas presentó una mayor biomasa total y aérea, así como una PPN, que el bosque sobre arena-francosa. Sin embargo, la diferencia entre los dos bosques en términos de la productividad primaria neta total fue menor en comparación con las diferencias entre la biomasa total de los bosques, como consecuencia de las diferentes estrategias en la asignación del carbono a los componentes aéreo y subterráneo del bosque. La proporción o fracción de la PPN asignada a la nueva producción de follaje fue relativamente similar entre los dos bosques. Nuestros resultados de los incrementos de la biomasa aérea sugieren una posible compensación entre la asignación del carbono al crecimiento de las raíces finas versus el de la madera, a diferencia de la compensación comúnmente asumida entre la parte aérea y la subterránea en general. A pesar de estas diferencias entre los bosques en términos de los componentes de la asignación del carbono, el índice de área foliar fue relativamente similar entre ellos, lo que sugiere que el índice de área foliar es más un indicador de la PPN total que de la asignación de carbono entre componentes. En el Capítulo 4 evalué la variación espacial y temporal de los componentes de la asignación del carbono y la dinámica forestal de cinco tipos e bosques amazónicos y sus respuestas a fluctuaciones en la precipitación, lo cual es completamente relevante en el ciclo global del carbono y los procesos biogeoquímicos en general. Estas variaciones son así mismo importantes para evaluar los efectos de la sequía o eventos extremos sobre la dinámica natural de los bosques amazónicos. Evalué la variación interanual y la estacionalidad de los componentes de la asignación del carbono y la dinámica forestal durante el periodo 2004−2012, en cinco bosques maduros sobre diferentes suelos (arcilloso, franco-arcilloso, franco-arcilloso-arenoso, franco-arenoso y arena-francosa), todos bajo el mismo régimen local de precipitación en la Amazonia noroccidental (Colombia). Quería examinar sí estos bosques responden de forma similar a las fluctuaciones en la precipitación, tal y como pronostican muchos modelos. Consideré las siguientes preguntas: (i) ¿Existe una correlación entre los componentes de la asignación del carbono y la dinámica forestal con la precipitación? (ii) ¿Existe correlación entre los bosques? (iii) ¿Es el índice de área foliar (LAI) un indicador de las variaciones en la producción aérea o es un reflejo de los cambios en los patrones de la asignación del carbono entre bosques?. En general, la correlación entre los componentes aéreo y subterráneo de la asignación del carbono con la precipitación sugiere que los suelos juegan un papel importante en las diferencias espaciales y temporales de las respuestas de estos bosques a las variaciones en la precipitación. Por un lado, la mayoría de los bosques mostraron que los componentes aéreos de la asignación del carbono son susceptibles a las fluctuaciones en la precipitación; sin embargo, el bosque sobre arena-francosa solamente presentó correlación con la lluvia con el componente subterráneo (raíces finas). Por otra parte, a pesar de que el noroeste Amazónico es considerado sin una estación seca propiamente (definida como <100 mm meses −1), la hojarasca y la masa de raíces finas mostraron una alta variabilidad y estacionalidad, especialmente marcada durante la sequía del 2005. Además, los bosques del grupo de suelos francos mostraron que la hojarasca responde a retrasos en la precipitación, al igual que la masa de raíces finas del bosque sobre arena-francosa. En cuanto a la dinámica forestal, sólo la tasa de mortalidad del bosque sobre arena-francosa estuvo correlacionada con la precipitación (ρ = 0.77, P <0.1). La variabilidad interanual en los incrementos en el tallo y la biomasa de los individuos resalta la importancia de la mortalidad en la variación de los incrementos en la biomasa aérea. Sin embargo, las tasas de mortalidad y las proporciones de individuos muertos por categoría de muerte (en pie, caído de raíz, partido y desaparecido), no mostraron tendencias claras relacionadas con la sequía. Curiosamente, la hojarasca, el incremento en la biomasa aérea y las tasas de reclutamiento mostraron una alta correlación entre los bosques, en particular dentro del grupo de los bosques con suelos francos. Sin embargo, el índice de área foliar estimado para los bosques con suelos más contrastantes (arcilla y arena-francosa), no presentó correlación significativa con la lluvia; no obstante, estuvo muy correlacionado entre bosques; índice de área foliar no reflejó las diferencias en la asignación de los componentes del carbono, y su respuesta a la precipitación en estos bosques. Por último, los bosques estudiados muestran que el noroeste amazónico es susceptible a fenómenos climáticos, contrario a lo propuesto anteriormente debido a la ausencia de una estación seca propiamente dicha. ABSTRACT Studies of carbon allocation in forests provide essential information for understanding spatial and temporal differences in carbon cycling that can inform models and predict possible responses to changes in climate. Amazon forests play a particularly significant role in the global carbon balance, but there are still large uncertainties regarding abiotic controls on the rates of net primary production (NPP) and the allocation of photosynthetic products to different ecosystem components; and how the carbon allocation components of Amazon forests respond to extreme climate events. The overall objective of this thesis is to examine the carbon allocation components in old-growth tropical forests on contrasting soils, and under similar climatic conditions in two sites at the Amacayacu National Natural Park and the Zafire Biological Station, located in the north-western Amazon (Colombia). Measurements of above- and below-ground carbon allocation components (biomass, net primary production, and its partitioning) at the ecosystem level, and dynamics of tree mortality and recruitment were done along eight years (20042012) in six 1-ha plots established in five Amazon forest types on different soils (clay, clay-loam, sandy-clay-loam, sandy-loam and loamy-sand) to address specific questions detailed in the next paragraphs. In Chapter 2, I evaluated the hypothesis that as soil fertility increases the amount of carbon allocated to below-ground production (fine-roots) should decrease. To address this hypothesis the standing crop mass and production of fine-roots (<2 mm) were estimated by two methods: (1) ingrowth cores and, (2) sequential soil coring, during 2.2 years in the most contrasting forests: the clay-soil forest and the loamy-sand forest. We found that the standing crop fine-root mass and its production were significantly different between forests and also between soil depths (0–10 and 10–20 cm). The loamysand forest allocated more carbon to fine-roots than the clay-soil forest, with fine-root production in the loamy-sand forest twice (mean ± standard error = 2.98 ± 0.36 and 3.33 ± 0.69 Mg C ha −1 yr −1, method 1 and 2, respectively) as much as for the more fertile claysoil forest (1.51 ± 0.14, method 1, and from 1.03 ± 0.31 to 1.36 ± 0.23 Mg C ha −1 yr −1, method 2). Similarly, the average of standing crop fine-root mass was three times higher in the loamy-sand forest (5.47 ± 0.17 Mg C ha1) than in the more fertile soil (from 1.52 ± 0.08 a 1.82 ± 0.09 Mg C ha1). The standing crop fine-root mass also showed a temporal pattern related to rainfall, with the production of fine-roots decreasing substantially in the dry period of the year 2005. These results suggest that soil resources may play an important role in patterns of carbon allocation of below-ground components, not only driven the differences in the biomass and its production, but also in the time when it is produced. In Chapter 3, I assessed the three components of stand-level carbon allocation (biomass, NPP, and its partitioning) for the same forests evaluated in Chapter 2 (clay-soil forest and loamy-sand forest). We found differences in carbon allocation patterns between these two forests, showing that the forest on clay-soil had a higher aboveground and total biomass as well as a higher above-ground NPP than the loamy-sand forest. However, differences between the two types of forests in terms of stand-level NPP were smaller, as a consequence of different strategies in the carbon allocation of above- and below-ground components. The proportional allocation of NPP to new foliage production was relatively similar between the two forests. Our results of aboveground biomass increments and fine-root production suggest a possible trade-off between carbon allocation to fine-roots versus wood growth (as it has been reported by other authors), as opposed to the most commonly assumed trade-off between total above- and below-ground production. Despite these differences among forests in terms of carbon allocation components, the leaf area index showed differences between forests like total NPP, suggesting that the leaf area index is more indicative of total NPP than carbon allocation. In Chapter 4, I evaluated the spatial and temporal variation of carbon allocation components and forest dynamics of Amazon forests as well as their responses to climatic fluctuations. I evaluated the intra- and inter-annual variation of carbon allocation components and forest dynamics during the period 2004−2012 in five forests on different soils (clay, clay-loam, sandy-clay-loam, sandy-loam and loamy-sand), but growing under the same local precipitation regime in north-western Amazonia (Colombia). We were interested in examining if these forests respond similarly to rainfall fluctuations as many models predict, considering the following questions: (i) Is there a correlation in carbon allocation components and forest dynamics with precipitation? (ii) Is there a correlation among forests? (iii) Are temporal responses in leaf area index (LAI) indicative of variations of above-ground production or a reflection of changes in carbon allocation patterns among forests?. Overall, the correlation of above- and below-ground carbon allocation components with rainfall suggests that soils play an important role in the spatial and temporal differences of responses of these forests to rainfall fluctuations. On the one hand, most forests showed that the above-ground components are susceptible to rainfall fluctuations; however, there was a forest on loamy-sand that only showed a correlation with the below-ground component (fine-roots). On the other hand, despite the fact that north-western Amazonia is considered without a conspicuous dry season (defined as <100 mm month−1), litterfall and fine-root mass showed high seasonality and variability, particularly marked during the drought of 2005. Additionally, forests of the loam-soil group showed that litterfall respond to time-lags in rainfall as well as and the fine-root mass of the loamy-sand forest. With regard to forest dynamics, only the mortality rate of the loamy-sand forest was significantly correlated with rainfall (77%). The observed inter-annual variability of stem and biomass increments of individuals highlighted the importance of the mortality in the above-ground biomass increment. However, mortality rates and death type proportion did not show clear trends related to droughts. Interestingly, litterfall, above-ground biomass increment and recruitment rates of forests showed high correlation among forests, particularly within the loam-soil forests group. Nonetheless, LAI measured in the most contrasting forests (clay-soil and loamysand) was poorly correlated with rainfall but highly correlated between forests; LAI did not reflect the differences in the carbon allocation components, and their response to rainfall on these forests. Finally, the forests studied highlight that north-western Amazon forests are also susceptible to climate fluctuations, contrary to what has been proposed previously due to their lack of a pronounced dry season.

La transición sanitaria en España desde 1900 a 1990

Fundamento: El concepto de transición sanitaria trata de explicar, desde un enfoque plural, los cambios en las condiciones de salud que contribuyeron al descenso de la mortalidad que acompaño a la transición demográfica. El objetivo de este trabajo es analizar la transición sanitaria en España a lo largo del presente siglo ( 1900- 1990). Método: El estudio de los distinto componentes de la transición sanitaria (transición epidemiológica, transición de riesgos y transición de la atención sanitaria) se ha basado en las series históricas disponibles procedentes de los Movimientos Naturales de la Población, Anuarios Estadísticas y Censos de viviendas. Resultados: La evolución de las tasas de mortalidad general y mortalidad infantil refleja una tendencia descendente que se manifiesta a lo largo de todo el periodo: la mortalidad general se ha reducido un 70%. mientras que la infantil lo ha hecho en un 96%. Respecto a la esperanza de vida al nacer, la ganancia ha sido de 43 años entre 1900 (35 años) y 1990 (77 años), lo que en términos relativos supone un aumento del 130%. Conclusiones: El nuevo perfil epidemiológico que fue emergiendo durante el período considerado, aparece relacionado con mejoras en las infraestructuras sanitarias, con el aumento del gasto y de las prestaciones sanitarias. pero también con la aparición de nuevos problemas de salud relacionados con las condiciones de trabajo, el crecimiento masivo del medio urbano (a partir, sobre todo, de la década de los 60) o las modificaciones en los patrones de vida.

Trends and Disparities in Mortality Among Spanish-Born and Foreign-Born Populations Residing in Spain, 1999–2008

Spain’s immigrant population has increased 380 % in the last decade, accounting for 13.1 % of the total population. This fact has led her to become during 2009 the eighth recipient country of international immigrants in the world. The aim of this article is to describe the evolution of mortality and the main causes of death among the Spanish-born and foreign-born populations residing in Spain between 1999 and 2008. Age-standardised mortality rates (ASRs), average age and comparative mortality ratios among foreign-born and Spanish-born populations residing in Spain were computed for every year and sub-period by sex, cause of death and place of birth as well as by the ASR percentage change. During 1999–2008 the ASR showed a progressive decrease in the risk of death in the Spanish-born population (−17.8 % for men and −16.6 % for women) as well as in the foreign-born one (−45.9 % for men and −35.7 % for women). ASR also showed a progressive decrease for practically all the causes of death, in both populations. It has been observed that the risk of death due to neoplasms and respiratory diseases among immigrants is lower than that of their Spanish-born counterparts, but risk due to external causes is higher. Places of birth with the greater decreases are Northern Europe, Eastern Europe, Western Europe, Southern Europe, and Latin America and the Caribbean. The research shows the differences in the reduction of death risk between Spanish-born and immigrant inhabitants between 1999 and 2008. These results could contribute to the ability of central and local governments to create effective health policy. Further research is necessary to examine changes in mortality trends among immigrant populations as a consequence of the economic crisis and the reforms in the Spanish health system. Spanish data sources should incorporate into their records information that enables them to find out the immigrant duration of permanence and the possible impact of this on mortality indicators.

Growth, survival, gene expression, microbiota and tryptic activity during feeding of Scophthalmus maximus first feeding larvae with beta-glucan (MacroGard)

Reflecting the natural biology of mass spawning fish aquaculture production of fish larvae is often hampered by high and unpredictable mortality rates. The present study aimed to enhance larval performance and immunity via the oral administration of an immunomodulator, beta-glucan (MacroGard®) in turbot (Scophthalmus maximus). Rotifers (Brachionus plicatilis) were incubated with or without yeast beta-1,3/1,6-glucan in form of MacroGard® at a concentration of 0.5 g/L. Rotifers were fed to first feeding turbot larvae once a day. From day 13 dph onwards all tanks were additionally fed untreated Artemia sp. nauplii (1 nauplius ml/L). Daily mortality was monitored and larvae were sampled at 11 and 24 dph for expression of 30 genes, trypsin activity and size measurements. Along with the feeding of beta-glucan daily mortality was significantly reduced by ca. 15% and an alteration of the larval microbiota was observed. At 11 dph gene expression of trypsin and chymotrypsin was elevated in the MacroGard® fed fish, which resulted in heightened tryptic enzyme activity. No effect on genes encoding antioxidative proteins was observed, whilst the immune response was clearly modulated by beta-glucan. At 11 dph complement component c3 was elevated whilst cytokines, antimicrobial peptides, toll like receptor 3 and heat shock protein 70 were not affected. At the later time point (24 dph) an anti-inflammatory effect in form of a down-regulation of hsp 70, tnf-alpha and il-1beta was observed. We conclude that the administration of beta-glucan induced an immunomodulatory response and could be used as an effective measure to increase survival in rearing of turbot.

Estimating Baselines and Identifying Anomalies in Beached Bird Patterns on the Outer Coasts of Washington and Oregon, USA

Thesis (Master's)--University of Washington, 2016-06