The Association of H1N1 Pandemic Influenza with Congenital Anomaly Prevalence in Europe: An Ecological Time Series Study.

BACKGROUND: In the context of the European Surveillance of Congenital Anomalies (EUROCAT) surveillance response to the 2009 influenza pandemic, we sought to establish whether there was a detectable increase of congenital anomaly prevalence among pregnancies exposed to influenza seasons in general, and whether any increase was greater during the 2009 pandemic than during other seasons. METHODS: We performed an ecologic time series analysis based on 26,967 pregnancies with nonchromosomal congenital anomaly conceived from January 2007 to March 2011, reported by 15 EUROCAT registries. Analysis was performed for EUROCAT-defined anomaly subgroups, divided by whether there was a prior hypothesis of association with influenza. Influenza season exposure was based on World Health Organization data. Prevalence rate ratios were calculated comparing pregnancies exposed to influenza season during the congenital anomaly-specific critical period for embryo-fetal development to nonexposed pregnancies. RESULTS: There was no evidence for an increased overall prevalence of congenital anomalies among pregnancies exposed to influenza season. We detected an increased prevalence of ventricular septal defect and tricuspid atresia and stenosis during pandemic influenza season 2009, but not during 2007-2011 influenza seasons. For congenital anomalies, where there was no prior hypothesis, the prevalence of tetralogy of Fallot was strongly reduced during influenza seasons. CONCLUSIONS: Our data do not suggest an overall association of pandemic or seasonal influenza with congenital anomaly prevalence. One interpretation is that apparent influenza effects found in previous individual-based studies were confounded by or interacting with other risk factors. The associations of heart anomalies with pandemic influenza could be strain specific.

How institutions shaped the last major evolutionary transition to large-scale human societies.

What drove the transition from small-scale human societies centred on kinship and personal exchange, to large-scale societies comprising cooperation and division of labour among untold numbers of unrelated individuals? We propose that the unique human capacity to negotiate institutional rules that coordinate social actions was a key driver of this transition. By creating institutions, humans have been able to move from the default 'Hobbesian' rules of the 'game of life', determined by physical/environmental constraints, into self-created rules of social organization where cooperation can be individually advantageous even in large groups of unrelated individuals. Examples include rules of food sharing in hunter-gatherers, rules for the usage of irrigation systems in agriculturalists, property rights and systems for sharing reputation between mediaeval traders. Successful institutions create rules of interaction that are self-enforcing, providing direct benefits both to individuals that follow them, and to individuals that sanction rule breakers. Forming institutions requires shared intentionality, language and other cognitive abilities largely absent in other primates. We explain how cooperative breeding likely selected for these abilities early in the Homo lineage. This allowed anatomically modern humans to create institutions that transformed the self-reliance of our primate ancestors into the division of labour of large-scale human social organization.

Hospitalisation du proche : fatigue et coping du proche aidant à l'occasion de cette transition

Le processus de vieillissement entraîne une augmentation et une complexification des besoins de soins. Or, la proportion de personnes vieillissantes dans le monde et en Suisse s'accroit. Les professionnels de la santé ne disposent pas des moyens économiques et humains pour couvrir l'ensemble des besoins de soins. Les proches aidants contribuent de manière importante à la couverture des besoins. Cette contribution devient un élément central de la politique du maintien à domicile. Cependant, l'engagement à long terme des proches aidants auprès de leur parent peut influencer négativement leur état de santé. Pour une même classe d'âge, la population des proches aidants déclare un niveau de fatigue plus élevée que le reste de la population. Dans ce contexte, la fatigue est définie comme le résultat de l'ambivalence entre la demande en soins et les ressources dont dispose le proche aidant. L'hospitalisation du parent, qu'elle soit ou non liée à la fatigue, constitue un moment de crise pour le proche aidant. Face à cette crise, l'aidant mettra en oeuvre des stratégies de coping telles que conceptualisées dans la théorie transactionnelle du stress. Dans le cadre de la théorique intermédiaire de la transition de Meleis, le coping est un indicateur de processus de la transition qui doit permettre d'appréhender la transition vécue par l'aidant à l'occasion de l'hospitalisation du parent. Avec un devis corrélationnel descriptif, cette étude décrit les caractéristiques de l'échantillon de proches aidants, et du rôle qu'ils assument. Elle décrit le degré de fatigue et les styles de coping utilisés, et explore la relation entre la fatigue et le coping du proche aidant à l'occasion de l'hospitalisation du parent. Deux questionnaires auto-administrés ont été complétés par 33 participants. Cette étude a permis de dégager les résultats suivants : le score moyen de fatigue dans cet échantillon indique une fatigue légère selon la classification établie par Piper. Les participants mettent en avant l'influence du rôle d'aidant sur leur fatigue, ainsi que l'influence de leur propre santé et des contraintes économicoprofessionnelles. Le score moyen de fatigue varie en fonction de la nature de l'aide fournie. Il est significativement plus élevé lorsque le proche aidant soutient son parent dans les activités de la vie quotidienne (AVQ). Le style de coping mobilisé préférentiellement dans cet échantillon est le coping centré sur le problème, suivi du coping centré sur la recherche du soutien social, et enfin le coping centré sur l'émotion. Les aidants soutenant leur proche dans les AVQ mobilisent plus le coping centré sur l'émotion que ceux qui n'offrent pas ce type d'aide. Les principales sources de stress nommées par les participants sont l'état de santé du parent, son hospitalisation, et la rencontre avec le système de santé. Dans cet échantillon, nous n'avons pas observé de corrélation entre le degré de fatigue et les trois styles de coping. Des limites liées à la petite taille de l'échantillon amènent à la prudence quant à la généralisation des résultats de cette étude.

Transition of young people with chronic conditions: a cross-sectional study of patient perceptions before and after transfer from pediatric to adult health care.

UNLABELLED: The aim of this study was to compare perceived barriers to and the most preferred age for successful transition to adult health care between young people with chronic disorders who had not yet transferred from pediatric to adult health care (pre-transfer) and those who had already transferred (post-transfer). In a cross-sectional study, we compared 283 pre-transfer with 89 post-transfer young people, using a 28-item questionnaire that focused on perceived barriers to transition and beliefs about the most preferred age to transfer. Feeling at ease with the pediatrician was the most important barrier to successful transition in both groups, but was rated significantly higher in the pre-transfer compared to the post-transfer group (OR = 2.03, 95 %CI 1.12-3.71). Anxiety and lack of information were the next most important barriers, rated equally highly by the two groups (OR = 0.67, 95 %CI 0.35-1.28 and OR = 0.71, 95 %CI 0.36-1.38, respectively). More than 80 % of the respondents in both groups reported that 16-19 years was the most preferred age to transfer; more than half of all the respondents reported 18-19 years and older as the most preferred age. CONCLUSION: Better transition planning through the provision of regular and more detailed information about adult health-care providers and the transition process could reduce anxiety and contribute to a more positive attitude to overcome perceived barriers to transition from young people's perspective. Young people's preferences about transferring to adult health care provide a challenge to those children's hospitals that transfer to adult health care at a younger age.

The health of adolescents around a world in transition.

Since several years, the health of adolescents is on the agenda of ministers, decision makers and health professionals. Around the world, while there has been a steady decrease of the death rates among young children, this is not the case for young people. This is mainly linked with the fact that mortality and morbidity during this period of life is largely linked with non communicable diseases and conditions, including deaths from injuries, suicide, homicides and drug abuse. Unplanned pregnancies, illegal abortions, newly acquired HIV infections are also situations that have short and long term consequences. This paper reviews the epidemiological data pertaining to adolescent health and disease. It proposes evidence-informed avenues as how to address these issues in the field of health care (e.g. adolescent friendly services) and of prevention and health promotion. It also stresses the importance of creating safe environments for the development and well-being of young people and thus, of an interdisciplinary and inter sectorial approach to their complex health problems and challenges.

Tackling Societal Challenges Related to Ageing and Transport Transition: An Introduction to Philosophical Principles of Causation Adapted to the Biopsychosocial Model

In geriatrics, driving cessation is addressed within the biopsychosocial model. This has broadened the scope of practitioners, not only in terms of assessing fitness to drive, but also by helping to maintain social engagements and provide support for transport transition. Causes can be addressed at different levels by adapting medication, improving physical health, modifying behaviour, adapting lifestyle, or bringing changes to the environment. This transdisciplinary approach requires an understanding of how different disciplines are linked to each other. This article reviews the philosophical principles of causality between fields and provides a framework for understanding causality within the biopsychosocial model. Understanding interlevel constraints should help practitioners overcome their differences, and favor transversal approaches to driving cessation.

Transición a la vida adulta de jóvenes con discapacidad intelectual. La opinión de los profesionales de servicios escolares y postescolares = Transition to adulthood of young people with intellectual disabilities. Views of professionals from school and postschool services

La transición a la edad adulta y vida activa es un proceso extremadamente complejo para los jóvenes con discapacidad. Para plantear propuestas de actuación que mejoren sus oportunidades de conseguir objetivos relacionados con la inclusión laboral y social en la vida adulta es imprescindible el diagnóstico en profundidad del contexto en que se construyen y desarrollan los procesos de transición. En este artículo se presenta un estudio en el que se ha aplicado el método Delphi con el propósito de obtener datos sobre la adecuación de los servicios o dispositivos que trabajan con jóvenes con discapacidad a lo largo de su proceso de transición a la edad adulta y vida activa, tanto en el escenario escolar como en el postescolar. Se han constituido dos paneles de expertos, uno con profesionales del ámbito educativo y otro con profesionales que trabajan en servicios postescolares. En ambos casos, los ejes temáticos son: visión del proceso de transición, aspectos curriculares y organizativos de los servicios, existencia de itinerarios de apoyo sistematizados, trabajo colaborativo entre profesionales, acciones de orientación con familias, adecuación de las alternativas postescolares, la formación de los profesionales, y coordinación de servicios. El análisis de los cuestionarios permite constatar las principales dificultades percibidas por los expertos en cada uno de los ámbitos y establece líneas básicas de actuación para mejorar los procesos de tránsito, entre las cuales destaca la necesidad de reforzar el papel de los equipos multiprofesionales en la articulación de redes de trabajo interprofesional

Vulnerability of stream biota to climate change in mediterranean climate regions: a synthesis of ecological responses and conservation challenges

Freshwater species worldwide are experiencing dramatic declines partly attributable to ongoing climate change. It is expected that the future effects of climate change could be particularly severe in mediterranean climate (med-) regions, which host many endemic species already under great stress from the high level of human development. In this article, we review the climate and climate-induced changes in streams of med-regions and the responses of stream biota, focusing on both observed and anticipated ecological responses. We also discuss current knowledge gaps and conservation challenges. Expected climate alterations have already been observed in the last decades, and include: increased annual average air temperatures; decreased annual average precipitation; hydrologic alterations; and an increase in frequency, intensity and duration of extreme events, such as floods, droughts and fires. Recent observations, which are concordant with forecasts built, show stream biota of med-regions when facing climate changes tend to be displaced towards higher elevations and upper latitudes, communities tend to change their composition and homogenize, while some life-history traits seem to provide biota with resilience and resistance to adapt to the new conditions (as being short-lived, small, and resistant to low streamflow and desiccation). Nevertheless, such responses may be insufficient to cope with current and future environmental changes. Accurate forecasts of biotic changes and possible adaptations are difficult to obtain in med-regions mainly because of the difficulty of distinguishing disturbances due to natural variability from the effects of climate change, particularly regarding hydrology. Long-term studies are needed to disentangle such variability and improve knowledge regarding the ecological responses and the detection of early warning signals to climate change. Investments should focus on taxa beyond fish and macroinvertebrates, and in covering the less studied regions of Chile and South Africa. Scientists, policy makers and water managers must be involved in the climate change dialogue because the freshwater conservation concerns are huge.

Ecological change predicts population dynamics and genetic diversity over 120 000 years.

While ecological effects on short-term population dynamics are well understood, their effects over millennia are difficult to demonstrate and convincing evidence is scant. Using coalescent methods, we analysed past population dynamics of three lizard species (Psammodromus hispanicus, P. edwardsianus, P. occidentalis) and linked the results with climate change data covering the same temporal horizon (120 000 years). An increase in population size over time was observed in two species, and in P. occidentalis, no change was observed. Temporal changes in temperature seasonality and the maximum temperature of the warmest month were congruent with changes in population dynamics observed for the three species and both variables affected population density, either directly or indirectly (via a life-history trait). These results constitute the first solid link between ecological change and long-term population dynamics. The results moreover suggest that ecological change leaves genetic signatures that can be retrospectively traced, providing evidence that ecological change is a crucial driver of genetic diversity and speciation.

Sticky income inequality in the Spanish transition (1973-1990)

This paper investigates the evolution of income inequality in Spain during its transition to democracy, suggesting a method for the correction of under-reporting of earnings and profits in the Household Budget Surveys’ data. The contribution is twofold: the methodological proposal, based on income expenditure discrepancy and scaling-up to National Accounts, improves on previous work, and can be convenient for similar historical sources in other countries. Secondly, its application results in an alternative history of the distribution of income in this case, changing the levels and also the observed trend. Previous literature asserted a substantial equalization, related to the democratization process, while after the adjustment inequality in disposable income is shown to have been quite persistent.

Cultural Diffusion Was the Main Driving Mechanism of the Neolithic Transition in Southern Africa

It is well known that the Neolithic transition spread across Europe at a speed of about 1 km/yr. This result has been previously interpreted as a range expansion of the Neolithic driven mainly by demic diffusion (whereas cultural diffusion played a secondary role). However, a long-standing problem is whether this value (1 km/yr) and its interpretation (mainly demic diffusion) are characteristic only of Europe or universal (i.e. intrinsic features of Neolithic transitions all over the world). So far Neolithic spread rates outside Europe have been barely measured, and Neolithic spread rates substantially faster than 1 km/yr have not been previously reported. Here we show that the transition from hunting and gathering into herding in southern Africa spread at a rate of about 2.4 km/yr, i.e. about twice faster than the European Neolithic transition. Thus the value 1 km/yr is not a universal feature of Neolithic transitions in the world. Resorting to a recent demic-cultural wave-of-advance model, we also find that the main mechanism at work in the southern African Neolithic spread was cultural diffusion (whereas demic diffusion played a secondary role). This is in sharp contrast to the European Neolithic. Our results further suggest that Neolithic spread rates could be mainly driven by cultural diffusion in cases where the final state of this transition is herding/pastoralism (such as in southern Africa) rather than farming and stockbreeding (as in Europe)

Ecological and physiological variance in T-cell mediated immune response in Cory's shearwaters

T-cell mediated immune response (CMI) hasbeen widely studied in relation to individual andfitness components in birds. However, few studieshave simultaneously examined individual and socialfactors and habitat-mediated variance in theimmunity of chicks and adults from the samepopulation and in the same breeding season. Weinvestigated ecological and physiological variancein CMI of male and female nestlings and adults in abreeding population of Cory's Shearwaters(Calonectrisdiomedea) in theMediterranean Sea. Explanatory variables includedindividual traits (body condition, carbon andnitrogen stable isotope ratios, plasma totalproteins, triglycerides, uric acid, osmolarity,β-hydroxy-butyrate, erythrocyte meancorpuscular diameter, hematocrit, andhemoglobin) and burrow traits(temperature, isolation, and physicalstructure). During incubation, immune responseof adult males was significantly greater than thatof females. Nestlings exhibited a lower immuneresponse than adults. Ecological and physiologicalfactors affecting immune response differed betweenadults and nestlings. General linear models showedthat immune response in adult males was positivelyassociated with burrow isolation, suggesting thatmales breeding at higher densities suffer immunesystem suppression. In contrast, immune response inchicks was positively associated with bodycondition and plasma triglyceride levels.Therefore, adult immune response appears to beassociated with social stress, whereas a trade-offbetween immune function and fasting capability mayexist for nestlings. Our results, and those fromprevious studies, provide support for anasymmetrical influence of ecological andphysiological factors on the health of differentage and sex groups within a population, and for theimportance of simultaneously considering individualand population characteristics in intraspecificstudies of immune response.