Prevalence of pulmonary hypertension in COPD patients living at high altitude

BACKGROUND

Pulmonary hypertension (PH) is associated with poor prognosis for patients with chronic obstructive pulmonary disease (COPD). Most of the knowledge about PH in COPD has been generated at sea level, with limited information associated with high altitude (HA).

OBJECTIVES

To assess the prevalence and severity of PH in COPD patients living in a HA city (2,640 m).

METHODS

Cross-sectional study in COPD patients with forced expiratory volume in the first second / forced vital capacity ratio (FEV1/FVC) post-bronchodilator <0,7. Transthoracic echocardiography (TTE), spirometry, carbon monoxide diffusing capacity, and arterial blood gasses tests were performed. Patients were classified according to the severity of airflow limitation. PH was defined by TTE as an estimated systolic pulmonary artery pressure (sPAP) > 36 mmHg or indirect PH signs; severe PH as sPAP > 60 mmHg; and disproportionate PH as an sPAP > 60 mmHg with non-severe airflow limitation (FEV1 > 50% predicted).

RESULTS

We included 176 COPD patients. The overall estimated prevalence of PH was 56.3% and the likelihood of having PH increased according to airflow-limitation severity: mild (31.6%), moderate (54.9%), severe (59.6%) and very severe (77.8%) (p = 0.038). The PH was severe in 7.3% and disproportionate in 3.4% of patients.

CONCLUSIONS

The estimated prevalence of PH in patients with COPD at HA is high, particularly in patients with mild to moderate airflow limitation, and greater than that described for COPD patients at low altitude. These results suggest a higher risk of developing PH for COPD patients living at HA compared to COPD patients with similar airflow limitation living at low altitude.

Association between Increased Risk of Pneumonia with ICS in COPD: A Continuous Variable Analysis of Patient Factors from the IMPACT Study

INTRODUCTION

Despite the proven benefits of inhaled corticosteroid (ICS)-containing triple therapy for chronic obstructive pulmonary disease (COPD), clinicians limit patient exposure to ICS due to the risk of pneumonia. However, there are multiple factors associated with the risk of pneumonia in patients with COPD. This post hoc analysis of IMPACT trial data aims to set the risks associated with ICS into a context of specific patient-related factors that contribute to the risk of pneumonia.

METHODS

The 52-week, double-blind IMPACT trial randomized patients with symptomatic COPD and ≥1 exacerbation in the prior year 2:2:1 to once-daily fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI), FF/VI or UMEC/VI. Annual rate of on-treatment pneumonias in the intent-to-treat population associated with age, body mass index (BMI), percent predicted forced expiratory volume in 1 s (FEV1) and blood eosinophil count (BEC) was evaluated.

RESULTS

This analysis revealed that the annual rate of pneumonia showed the lowest risk at the age of 50 years. The 95% confidence intervals (CI) between ICS-containing and non-ICS containing treatments diverged in ages > 63 years, suggesting a significantly increased ICS-related risk in older patients. In contrast, the annual rate of pneumonia rose in both groups below BMI of 22.5 kg/m2, but above that, there was no relationship to pneumonia rate and no differential effect between the two groups. The relationship between BEC and pneumonia was flat up to > 300/µL cells with ICS-containing treatment and then rose. In contrast, the rate of pneumonia with non-ICS containing treatment appeared to increase at a lower level of BEC (~ 200/µL).

CONCLUSIONS

There was little evidence of a differential effect of older age, lower BMI, lower FEV1 and BEC on the pneumonia rate between ICS-containing and non-ICS containing treatments. This analysis points to the need for a balanced approach to risk versus benefit in the use of ICS-containing treatments in COPD.

CLINICAL TRIAL REGISTRATION

IMPACT ClinicalTrials.gov number, NCT02164513.

Underlying and proximate drivers of biodiversity changes in Mesoamerican biosphere reserves

Protected areas are of paramount relevance to conserving wildlife and ecosystem contributions to people. Yet, their conservation success is increasingly threatened by human activities including habitat loss, climate change, pollution, and species overexploitation. Thus, understanding the underlying and proximate drivers of anthropogenic threats is urgently needed to improve protected areas' effectiveness, especially in the biodiversity-rich tropics. We addressed this issue by analyzing expert-provided data on long-term biodiversity change (last three decades) over 14 biosphere reserves from the Mesoamerican Biodiversity Hotspot. Using multivariate analyses and structural equation modeling, we tested the influence of major socioeconomic drivers (demographic, economic, and political factors), spatial indicators of human activities (agriculture expansion and road extension), and forest landscape modifications (forest loss and isolation) as drivers of biodiversity change. We uncovered a significant proliferation of disturbance-tolerant guilds and the loss or decline of disturbance-sensitive guilds within reserves causing a "winner and loser" species replacement over time. Guild change was directly related to forest spatial changes promoted by the expansion of agriculture and roads within reserves. High human population density and low nonfarming occupation were identified as the main underlying drivers of biodiversity change. Our findings suggest that to mitigate anthropogenic threats to biodiversity within biosphere reserves, fostering human population well-being via sustainable, nonfarming livelihood opportunities around reserves is imperative.

Knowledge of Vaccination Against Influenza and Pneumococcus in Patients with Chronic Obstructive Pulmonary Disease in an Integrated Care Program

Purpose

To compare the level of knowledge in vaccination against influenza and pneumococcus of patients with chronic obstructive pulmonary disease (COPD) who are managed in an Integrated Care Program (ICP) with those who receive usual care (UC).

Methods

A telephone survey of patients diagnosed with COPD registered in public care networks or private institutions was done. A descriptive and comparative analysis of the characteristics of the ICP and UC groups was carried out. The relationship between belonging to an ICP and the level of knowledge about vaccination was evaluated using Propensity Score Matching (PSM) and multivariate logistic and ordinal regression models.

Results

Of 674 study participants, 27.2% were from the ICP group. ICP patients were older, more frequently men, from a higher socioeconomic stratum and a higher educational level (p<0.05). 75.5% of the patients in the ICP group had a high level of vaccination knowledge compared to 42.7% in the UC group (p<0.001). In the multivariate analysis, adjusting for sociodemographic variables, years of COPD diagnosis, and comorbidities, belonging to the ICP was associated with a higher probability of answering questions about vaccination correctly and having a high level of knowledge (OR 3.397, IC 95% 2.058-5.608, p<0.001).

Conclusion

Patients with COPD managed in an ICP have a higher level of knowledge in vaccination against influenza and pneumococcus, compared to patients in usual care.

Agri-silvicultures of Mexican Arid America

BACKGROUND

Agri-silvicultures (ASC) are biocultural practices procuring either the maintenance of wild diversity in predominantly agricultural spaces or introducing agrobiodiversity into forests. In the Mesoamerican region, ASC contribute to food sovereignty and territorial conservation and provide strategies for dealing with global changes. Previous inventories of ASC identified gaps in information about these systems in the Mexican Arid America region. This article raises the general question: How have human interactions between cultural, wild, and domesticated biodiversity in this territory? The particular questions in this paper are: (i) How have historical processes shaped human interactions between wild and domesticated biodiversity in the region? and (ii) What types of agri-silvicultures have emerged in Mexican Arid America since these relationships?

METHODS

We trace a methodological border where archaeologists have identified the Mesoamerican region to define our study area as Arid America northern of this line in Mexico. We analyzed agriculturalization processes in Arid America through a historical review. Then, we carry out an inventory of Arid America ASC based on academic papers and other documented experiences. We constructed a spatial database and a typology to understand what kinds of agri-silviculture occur in the region.

RESULTS

We identified several pre-Hispanic agri-silvicultural practices in the region, like hunting, fishing, terraces, gathering, and irrigation systems. The cultivation of native species of maize, beans, and squash even was registered. The Spanish colonization forced the agriculturization in arid northern Mexico, where itinerant hunting-gathering patterns predominated. In the twentieth century, the Green Revolution adopted this area as the principal setting for industrialized agriculture. The industrialized irrigated systems expansion and other political strategies provoked the simplification of productive landscapes. The practices that integrate wild and agricultural diversity systems were marginalized and invisibilized in such a context. Our research group proposes seven types of agri-silvicultural systems (natives agrisilvicultures, the oases agroforestry, Mesquite and Huisache ASC, homegardens and other traditional forms of agroforestry or agri-silvicultures). These agri-silvicultures provide food, medicine, fodder, and other contributions, as income to the families that practice them and protect native and exotic species.

DISCUSSION AND CONCLUSION

The agriculturization of the arid environments initiated during Spanish colonization and the subsequent modernizing projects shaped dominant actors and ideologies in the arid north of Mexico. However, aridity has favored ancestral and agroecological relationships between cultures and biodiversity, emerging and subsisting Arid American agri-silvicultures. These agri-silvicultures deserve to be understood, adopted, and adapted to new contexts. They could be essential alternatives in the context of environmental changes.

Multiple domestication events explain the origin of Gossypium hirsutum landraces in Mexico

Several Mesoamerican crops constitute wild-to-domesticated complexes generated by multiple initial domestication events, and continuous gene flow among crop populations and between these populations and their wild relatives. It has been suggested that the domestication of cotton (Gossypium hirsutum) started in the northwest of the Yucatán Peninsula, from where it spread to other regions inside and outside of Mexico. We tested this hypothesis by assembling chloroplast genomes of 23 wild, landraces, and breeding lines (transgene-introgressed and conventional). The phylogenetic analysis showed that the evolutionary history of cotton in Mexico involves multiple events of introgression and genetic divergence. From this, we conclude that Mexican landraces arose from multiple wild populations. Our results also revealed that their structural and functional chloroplast organizations had been preserved. However, genetic diversity decreases as a consequence of domestication, mainly in transgene-introgressed (TI) individuals (π = 0.00020, 0.00001, 0.00016, 0, and 0, of wild, TI-wild, landraces, TI-landraces, and breeding lines, respectively). We identified homologous regions that differentiate wild from domesticated plants and indicate a relationship among the samples. A decrease in genetic diversity associated with transgene introgression in cotton was identified for the first time, and our outcomes are therefore relevant to both biosecurity and agrobiodiversity conservation.

Risk factors for persistent tomographic abnormalities at 6 months of follow-up in a cohort of hospitalized patients with moderate and severe COVID-19 living at high altitude

Introduction

After COVID-19, functional and tomographic lung alterations may occur, but there are no studies at high altitude where, due to lower barometric pressure, there are lower levels of arterial oxygen pressure and saturation in both normal subjects and patients with respiratory disease. In this study, we evaluated the computed tomographic (CT), clinical, and functional involvement at 3 and 6 months post-hospitalization in survivors with moderate-severe COVID-19, as well the risk factors associated with abnormal lung computed tomography (ALCT) at 6 months of follow-up.

Materials and methods

Prospective cohort, after hospitalization for COVID-19, of patients older than 18 years residing at high altitude. Follow-up at 3 and 6 months with lung CT, spirometry, diffusing capacity of the lung for carbon monoxide (DLCO), six-minute walk test (6MWT), and oxygen saturation (SpO₂). Comparisons between ALCT and normal lung computed tomography (NLCT) groups with X² and Mann-Whitney U test, and paired test for changes between 3 and 6 months. A multivariate analysis was performed to evaluate the variables associated with ALCT at 6-month follow-up.

Results

We included 158 patients, 22.2% hospitalized in intensive care unit (ICU), 92.4% with typical COVID CT scan (peripheral, bilateral, or multifocal ground glass, with or without consolidation or findings of organizing pneumonia), and median hospitalization of 7 days. At 6 months, 53 patients (33.5%) had ALCT. There were no differences between ALCT and NLCT groups in symptoms or comorbidities on admission. ALCT patients were older and more frequently men, smokers and hospitalized in ICU. At 3 months, ALCT patients had more frequently a reduced forced vital capacity (< 80%), and lower meters walked (6MWT) and SpO₂. At 6 months, all patients improved lung function with no differences between groups, but there were more dyspnea and lower exercise SpO₂ in ALCT group. The variables associated with ALCT at 6 months were age, sex, ICU stay, and typical CT scan.

Conclusion

At 6-month follow-up, 33.5% of patients with moderate and severe COVID had ALCT. These patients had more dyspnea and lower SpO₂ in exercise. Regardless of the persistence of tomographic abnormalities, lung function and 6MWT improved. We identified the variables associated with ALCT.

Disappearance and survival of fermented beverages in the biosphere reserve Tehuacán-Cuicatlán, Mexico: The cases of Tolonche and Lapo

Traditional fermented products are disappearing from the local foodscapes due to social pressures and ecological changes that affect their production; it is therefore crucial to document local knowledge, which is crucial to maintain and recover local biocultural heritage and to contribute to food security. This study aims to document and foster the production of local traditional beverages by registering recipes of fermented beverages in the Tehuacán-Cuicatlán biosphere reserve in central Mexico, a region recognized for its great biocultural diversity. We conducted a search of peer-reviewed literature. Additionally, we included ethnographic research and participatory methods to engage residents in different steps of the production process. We identified five main fermented beverages in the research area, the most common beverages are those produced by agave species which include, mescal, pulque and an almost extinct beverage known as lapo which involves sugar cane as main substrate. We also identified a fermented beverage produced with several cacti fruits known as nochoctli and a traditional a fermented beverage produced with fruits of Schinus molle known as tolonche. We highlight the production of lapo and tolonche since these involved the incorporation of foreign substrates into the region after the Spaniard conquest and to their restricted distribution and almost extinction. The beverages tolonche and lapo are nowadays almost lost and only a few producers still prepare them to follow modified versions of the original recipe. Lapo and tolonche were once important in the research area but almost became extinct until local people started to recently recover them. Traditional fermented beverages in Mexico play an important role in cultural identity and contribute to the local diet; nevertheless, several fermented beverages have not been recorded and have even become extinct. This work is an effort to promote and conserve traditional fermented beverages as valuable biocultural heritage by empowering people to make decisions about the use of locally available resources, which is crucial in times when food systems are highly vulnerable.

Alternatives for mushroom poisoning timely care in Mexico and Central America

BACKGROUND

In countries where the consumption of mushrooms is common, hundreds of mushroom poisonings occur every year, which represents a public health problem. In Mexico, mushroom poisoning is classified as a non-bacterial gastrointestinal poisoning, which prevents timely care.

OBJECTIVE

To create a free-access platform that synthesizes and standardizes the information on mycetism cases and offers tools for diagnosis and timely treatment.

MATERIAL AND METHODS

In locations where cases of mycetism have occurred, information was obtained on the fungi involved, the poisonings that occurred, care protocols, and sample processing.

RESULTS

Records were generated that synthesize and describe the types of mycetism with the highest probability of occurrence in Mexico. Therein, the biological characteristics of fungi, the symptoms they cause and their treatment are described. A protocol proposal for patient care and for the processing of biological samples is presented. Finally, a form is included to collect information on cases of poisoning.

CONCLUSIONS

Systematized and analyzed information on mycetism allows to simplify its diagnosis, attention and treatment. The protocols for clinical care and sample processing are the basis for generating strategies that prevent deaths due to mycetism.

Prospection and identification of backcrossings of traditional-heritage peruvian grapevine cultivars (Vitis vinifera L.) from Ica and Cañete Valleys

La vid (Vitis vinifera L.) fue introducida en Sudamérica durante el siglo XVI. En los valles de Ica y Cañete, los nombres "Quebranta Mollar", "Mollar" y "Prieta Mollar" son comúnmente utilizados en referencia a los diferentes colores de las bayas de estas variedades dentro de un mismo racimo. Esta heterogeneidad en cuanto al color de las bayas, sumada a los antecedentes históricos, sugieren que otras variedades, además de Quebranta y Mollar Cano, podrían estar implicadas en esta denominación genérica "Mollar". En este trabajo se identificaron diferentes fenotipos correspondientes a algunas variedades utilizadas en la elaboración de vino y Pisco. Para ello, 10 accesiones fueron recolectadas en 9 viñedos diferentes (valles de Ica y Cañete), y analizadas utilizando 20 marcadores moleculares y 25 descriptores morfológicos según la OIV. Nuestros resultados mostraron que las muestras recolectadas correspondieron a 5 genotipos, tres cultivares tradicionales y dos genotipos desconocidos no registrados previamente. Los tres cultivares conocidos fueron Listan Prieto, Quebranta y Mollar Cano. Las dos accesiones correspondientes a variedades no conocidas previamente fueron Mollar de Ica y Prieta Mollar, generadas a partir de retrocruzamientos entre Quebranta y sus progenitores. También se identificaron diferentes variaciones fenotípicas de Quebranta, lo cual enriquece la diversidad vitícola peruana.

Neonatal infrared thermography images in the hypothermic ruminant model: Anatomical-morphological-physiological aspects and mechanisms for thermoregulation

Hypothermia is one factor associated with mortality in newborn ruminants due to the drastic temperature change upon exposure to the extrauterine environment in the first hours after birth. Ruminants are precocial whose mechanisms for generating heat or preventing heat loss involve genetic characteristics, the degree of neurodevelopment at birth and environmental aspects. These elements combine to form a more efficient mechanism than those found in altricial species. Although the degree of neurodevelopment is an important advantage for these species, their greater mobility helps them to search for the udder and consume colostrum after birth. However, anatomical differences such as the distribution of adipose tissue or the presence of type II muscle fibers could lead to the understanding that these species use their energy resources more efficiently for heat production. The introduction of unconventional ruminant species, such as the water buffalo, has led to rethinking other characteristics like the skin thickness or the coat type that could intervene in the thermoregulation capacity of the newborn. Implementing tools to analyze species-specific characteristics that help prevent a critical decline in temperature is deemed a fundamental strategy for avoiding the adverse effects of a compromised thermoregulatory function. Although thermography is a non-invasive method to assess superficial temperature in several non-human animal species, in newborn ruminants there is limited information about its application, making it necessary to discuss the usefulness of this tool. This review aims to analyze the effects of hypothermia in newborn ruminants, their thermoregulation mechanisms that compensate for this condition, and the application of infrared thermography (IRT) to identify cases with hypothermia.

The role of attentional shifting in the relation between error monitoring and anxiety in youth

The error-related negativity (ERN), a well-established neural marker of anxiety, reflects enhanced attention to internal threat signals. While attention to threat plays a crucial role in the development and maintenance of anxiety, it is unclear how attentional control influences the ERN-anxiety association. To address this, 37 youths (M_age = 10.89 years) completed self-report measures of attentional control and anxiety symptoms. To obtain ERN amplitude, youth completed a flanker task while simultaneous EEG was collected. Attentional control, specifically attentional shifting rather than focusing, moderated the relation between ERN amplitude and anxiety. Youth who displayed smaller neural responses to making an error and higher ability to shift attention experienced lower levels of anxiety, relative to those who exhibited larger neural responses to making an error or lower attention-shifting ability. These findings highlight that response magnitude to internal threat and ability to flexibly shift attention may jointly contribute to anxiety in youth.

Adaptation and biocultural conservation of traditional agroforestry systems in the Tehuacán Valley: access to resources and livelihoods strategies

Traditional agroforestry systems (TAFS) are important areas for conserving biodiversity, ecosystems benefits and biocultural heritage, outstandingly local knowledge, management techniques, and domestication processes. These systems have adapted to environmental, social, technological, and cultural changes throughout history. However, contemporary drastic socio-environmental changes as climate variability, economic inequality, migration, among others, have caused a productive crisis, with several consequences as productive land abandonment, threaten the sustainability of TAFS and vulnerating livelihoods. In such context, the question arises of what kind of adaptations are needed to face these changes, and how access to water and land, should be managed to improve adaptation of TAFS? The study analyzes TAFS in the Tehuacán Valley, a region with high biological and cultural diversity and early signs of agriculture in Mexico, where TAFS have remained active until present. The study analyzes the capacity of TAFS to conserve biodiversity and sustain local livelihoods, despite socio-environmental threats. It is based on a political ecology approach, which proposes that socio-ecological systems degradation is linked to unequal access to land and natural resources. Looking for an integral study of adaptations of TAFS to socio-environmental changes, this study combines qualitative and historical research methodology with quantitative methods evaluating plant diversity and spatial analysis. The study findings show that differentiated access to resources, water, land, and forest, is a key factor that limits adaptation of TAFS, impacting livelihood strategies, changing management patterns, and constraining social capacities for coping with socio-environmental changes. TAFS have significantly higher species richness than forests but lower diversity. The main contribution of the study is the methodological approach looking for an integral analysis of natural resources management and biocultural conservation in agroecosystems, and the identification of the unequal access to resources, as a keystone to understand and act for improving adaptive strategies of TAFS to socio-environmental changes.

•Traditional agroforestry systems (TAFS) are dynamic and highly adaptable to maintain biodiversity and peoples' livelihood.

•Access to natural resources is key to understand and act for agroecosystems analysis.

•Differentiated access to water and land drastically limits social adaptation.

•Integral assessment of social and environmental factors limiting TAFS is needed to understand their adaptation capacity.

•TAFS play a crucial role in sustainable food production and deserve strong actions for their conservation.

P-331 The female upper reproductive tract of fertile women harbour endogenous microbial profiles

Study question

Do the Fallopian Tubes from fertile women harbor microbial communities and are they similar to the endometrial microbiome?

Summary answer

Fallopian tubes have their own microbiome which is greatly shared with endometrial microbial profiles of the same women.

What is known already

The vaginal milieu is known to have an active microbiome (&gt;90% of Lactobacillus), but the microbial composition of the upper reproductive tract is not well established, especially in the Fallopian tubes. The first studies on the Fallopian tubes from women diagnosed with a benign disease or for prophylaxis suggest that this site supports an endogenous microbiome (Pelzer ES et al  Oncotarget 2018; Miles SM et al Fertil Steril 2017). However, today we lack the knowledge of the microbial composition in Fallopian tubes in the non-diseased conditions (as biopsing these sites may hamper the tissue and future fertility).

Study design, size, duration

A pilot-study with 6 fertile women with benign uterine pathology submitted to abdominal hysterectomy or tubal ligation at Hospital Universitario Virgen de Arrixaca Murcia were included into the study. The samples were collected between January and July 2019.

Participants/materials, setting, methods

Fallopian tubes and endometrial samples were collected as previously described (Canha-Gouveia A et al Int J Mol Sci 2019) from women submitted to abdominal hysterectomy and women submitted a tubal ligation. After DNA extraction “Ion 16S Metagenomics Kit” (Ion Torrent) was used to exploit the V5 to V9 regions of the 16S rRNA gene. Primary data analysis was performed with Torrent Suite™ Software v5.12.1 and advanced analysis using Ion Reporter™ software v5.18.0.2.

Main results and the role of chance

In our study, distinct microbial community profiles in the Fallopian tubes confirm that this genital tract site harbors an endogenous microbiome and in big part is shared with the endometrial microbial profile (over 60% of the detected taxa). Since in humans the intramural portion of the uterine tube does not allow a real physical separation between the fallopian tube and uterine environments, the obtained results were expected. Nevertheless, 43 bacterial taxa were exclusively detected in the Fallopian tubes (FDR&lt;0.05) that included Abiotrophia, Aeromonas, Aggregatibacter Weissella, Wolinella, and Zoogloea among others.

Limitations, reasons for caution

This is a pilot study with a limited number of samples, and more studies with a bigger sample size are warranted.

Wider implications of the findings

Distinct microbial community profiles in the Fallopian tubes from the uterus suggest that this upper reproductive site supports an endogenous microbiome, which can play a role in the fertilization process.

Trial registration number

not applicable

Ecological Knowledge and Management of Fauna Among the Mexicatl of the Sierra Negra, México: An Interpretive Approach

Generally motivated by the relevance of animals in human subsistence, the management of fauna has taken different shapes throughout the world. This study aims to analyse a typology of management forms, exploring their relationship with the motivation to maintain coexistence and use of fauna and mitigate negative human-fauna interactions by the Mexicatl (Nahua) people in Central Mexico. We generally expected to find a broad spectrum of management types in a gradient of interactions intensity. This is because we hypothesised that the more meaningful these interactions due to the magnitude of benefit or damage, philias, or phobias among other positive or negative perceptions, and ecological aspects and management viability, the more actions and practices might be motivated to maintain or mitigate them. We conducted a qualitative research based on interpretivist approaches, mixing qualitative and quantitative analyses, to register the Mexicatl names of fauna present in the area and recognised by locals and to analyse the influence of local ecological knowledge (LEK) and natural history as perceived by people on the use, conflicts, and management practices regarding local fauna. In order to gather such information, in 2018 and 2019 we generated 356 free lists of fauna and 20 sessions of group interviews about the presence of animals in the area, the Mexicatl name, information on distribution, diet, use, management, and other facts. We used visual stimuli with children and young people from schools of basic and intermediate levels in five rural communities and the municipal head of Coyomeapan, Puebla. We also generated free lists and in-depth interviews with 18 persons older than 16 years. People recognised 114 animal items, the most salient being 11 domestic and 14 wild animals including deer, medium and small mammals, snakes, and birds. For both domestic and wild fauna, people reported 18 use categories and three types of damage (crop losses, predation of domestic animals, and damages to health). LEK interacted with traditional celebrations, religious beliefs, land tenure, and migration to define preferences and management types of fauna. Bushmeat demand, especially for Mazama temama and Cuniculus paca, was related to a perception of healthy nutrition properties. Management actions included husbandry of domestic animals, extraction of wild animals for supply, or to avoid damages, captivity, tolerance to damage, protection of seeds and domestic animals threatened by wild fauna, regulations for extraction of wild fauna, and agreements to prevent conflicts. Mixed quantitative and qualitative approaches allowed the interpretation of the human-fauna interactions related to subsistence, coexistence, and the high relevance of LEK, perceptions, religious beliefs, ecosystem, socio-demographic factors, and animal behaviour and habits, which are crucial factors that influence the shaping of management practices. Local management strategies of fauna were diverse and contribute to biocultural conservation and theoretical construction on domestication.

Constructing Micro-Landscapes: Management and Selection Practices on Microbial Communities in a Traditional Fermented Beverage

Colonche is a traditional beverage produced in Mexico by the fermentation of fruits of several cacti species. In the Meridional Central Plateau region of Mexico, where this study was conducted, it is mainly produced with fruits of Opuntia streptacantha; there, the producers perform spontaneous fermentation and/or fermentations through inoculums. Several factors can change the microbial community structure and dynamics through the fermentation process, but little attention has been directed to evaluate what type and extent of change the human practices have over the microbial communities. This study aims to assess the microbiota under spontaneous and inoculated fermentation techniques, the microorganisms present in the inoculums and containers, and the changes of microbiota during the process of producing colonche with different techniques. We used next-generation sequencing of the V3-V4 regions of the 16S rRNA gene and the ITS2, to characterize bacterial and fungal diversity associated with the different fermentation techniques. We identified 701 bacterial and 203 fungal amplicon sequence variants (ASVs) belonging to 173 bacterial and 187 fungal genera. The alpha and beta diversity analysis confirmed that both types of fermentation practices displayed differences in richness, diversity, and community structure. Richness of bacteria in spontaneous fermentation (0D = 136 ± 0.433) was higher than in the inoculated samples (0D = 128 ± 0.929), while fungal richness in the inoculated samples (0D = 32 ± 0.539) was higher than in spontaneous samples (0D = 19 ± 0.917). We identified bacterial groups like Lactobacillus, Leuconostoc, Pediococcus and the Saccharomyces yeast shared in ferments managed with different practices; these organisms are commonly related to the quality of the fermentation process. We identified that clay pots, where spontaneous fermentation is carried out, have an outstanding diversity of fungal and bacterial richness involved in fermentation, being valuable reservoirs of microorganisms for future fermentations. The inoculums displayed the lowest richness and diversity of bacterial and fungal communities suggesting unconscious selection on specific microbial consortia. The beta diversity analysis identified an overlap in microbial communities for both types of fermentation practices, which might reflect a shared composition of microorganisms occurring in the Opuntia streptacantha substrate. The variation in the spontaneous bacterial community is consistent with alpha diversity data, while fungal communities showed less differences among treatments, probably due to the high abundance and dominance of Saccharomyces. This information illustrates how traditional management guides selection and may drive changes in the microbial consortia to produce unique fermented beverages through specific fermentation practices. Although further studies are needed to analyze more specifically the advantages of each fermentation type over the quality of the product, our current analysis supports the role of traditional knowledge driving it and the relevance of plans for its conservation.

Experimental Applications and Factors Involved in Validating Thermal Windows Using Infrared Thermography to Assess the Health and Thermostability of Laboratory Animals

Evaluating laboratory animals' health and thermostability are fundamental components of all experimental designs. Alterations in either one of these parameters have been shown to trigger physiological changes that can compromise the welfare of the species and the replicability and robustness of the results obtained. Due to the nature and complexity of evaluating and managing the species involved in research protocols, non-invasive tools such as infrared thermography (IRT) have been adopted to quantify these parameters without altering them or inducing stress responses in the animals. IRT technology makes it possible to quantify changes in surface temperatures that are derived from alterations in blood flow that can result from inflammatory, stressful, or pathological processes; changes can be measured in diverse regions, called thermal windows, according to their specific characteristics. The principal body regions that were employed for this purpose in laboratory animals were the orbital zone (regio orbitalis), auricular pavilion (regio auricularis), tail (cauda), and the interscapular area (regio scapularis). However, depending on the species and certain external factors, the sensitivity and specificity of these windows are still subject to controversy due to contradictory results published in the available literature. For these reasons, the objectives of the present review are to discuss the neurophysiological mechanisms involved in vasomotor responses and thermogenesis via BAT in laboratory animals and to evaluate the scientific usefulness of IRT and the thermal windows that are currently used in research involving laboratory animals.

Current Advances in Assessment of Dog's Emotions, Facial Expressions, and Their Use for Clinical Recognition of Pain

Animals' facial expressions are involuntary responses that serve to communicate the emotions that individuals feel. Due to their close co-existence with humans, broad attention has been given to identifying these expressions in certain species, especially dogs. This review aims to analyze and discuss the advances in identifying the facial expressions of domestic dogs and their clinical utility in recognizing pain as a method to improve daily practice and, in an accessible and effective way, assess the health outcome of dogs. This study focuses on aspects related to the anatomy and physiology of facial expressions in dogs, their emotions, and evaluations of their eyebrows, eyes, lips, and ear positions as changes that reflect pain or nociception. In this regard, research has found that dogs have anatomical configurations that allow them to generate changes in their expressions that similar canids-wolves, for example-cannot produce. Additionally, dogs can perceive emotions similar to those of their human tutors due to close human-animal interaction. This phenomenon-called "emotional contagion"-is triggered precisely by the dog's capacity to identify their owners' gestures and then react by emitting responses with either similar or opposed expressions that correspond to positive or negative stimuli, respectively. In conclusion, facial expressions are essential to maintaining social interaction between dogs and other species, as in their bond with humans. Moreover, this provides valuable information on emotions and the perception of pain, so in dogs, they can serve as valuable elements for recognizing and evaluating pain in clinical settings.

The Taming of Psidium guajava: Natural and Cultural History of a Neotropical Fruit

Guava (Psidium guajava L., Myrtaceae) is a Neotropical fruit that is widely consumed around the world. However, its evolutionary history and domestication process are unknown. Here we examine available ecological, taxonomic, genetic, archeological, and historical evidence about guava. Guava needs full sunlight, warm temperatures, and well-distributed rainfall throughout the year to grow, but tolerates drought. Zoochory and anthropochory are the main forms of dispersal. Guava's phylogenetic relationships with other species of the genus Psidium are unclear. A group of six species that share several morphological characteristics are tentatively accepted as the Psidium guajava complex. DNA analyses are limited to the characterization of crop genetic diversity within localities and do not account for possible evolutionary and domestication scenarios. A significant amount of archeological information exists, with a greater number and older records in South America than in Mesoamerica, where there are also numerous historical records. From this information, we propose that: (1) the guava ancestor may have originated during the Middle or Late Miocene, and the savannas and semi-deciduous forests of South America formed during the Late Pleistocene would have been the most appropriate ecosystems for its growth, (2) the megafauna were important dispersers for guava, (3) dispersal by humans during the Holocene expanded guava's geographic range, including to the southwestern Amazonian lowlands, (4) where its domestication may have started, and (5) with the European conquest of the Neotropics, accompanied by their domestic animals, new contact routes between previously remote guava populations were established. These proposals could direct future research on the evolutionary and domestication process of guava.

Clinical Applications and Factors Involved in Validating Thermal Windows Used in Infrared Thermography in Cattle and River Buffalo to Assess Health and Productivity

Infrared thermography (IRT) is a non-ionizing, non-invasive technique that permits evaluating the comfort levels of animals, a topic of concern due to the growing interest in determining the state of health and welfare of production animals. The operating principle of IRT is detecting the heat irradiated in anatomical regions characterized by a high density of near-surface blood vessels that can regulate temperature gain or loss from/to the environment by modifying blood flow. This is essential for understanding the various vascular thermoregulation mechanisms of different species, such as rodents and ruminants' tails. The usefulness of ocular, nasal, and vulvar thermal windows in the orbital (regio orbitalis), nasal (regio nasalis), and urogenital (regio urogenitalis) regions, respectively, has been demonstrated in cattle. However, recent evidence for the river buffalo has detected discrepancies in the data gathered from distinct thermal regions in these large ruminants, suggesting a limited sensitivity and specificity when used with this species due to various factors: the presence of hair, ambient temperature, and anatomical features, such as skin thickness and variations in blood supplies to different regions. In this review, a literature search was conducted in Scopus, Web of Science, ScienceDirect, and PubMed, using keyword combinations that included "infrared thermography", "water buffalo", "river buffalo" "thermoregulation", "microvascular changes", "lacrimal caruncle", "udder", "mastitis", and "nostril". We discuss recent findings on four thermal windows-the orbital and nasal regions, mammary gland in the udder region (regio uberis), and vulvar in the urogenital region (regio urogenitalis)-to elucidate the factors that modulate and intervene in validating thermal windows and interpreting the information they provide, as it relates to the clinical usefulness of IRT for cattle (Bos) and the river buffalo (Bubalus bubalis).

Physical Activity Levels and Associated Factors in a Latin American COPD Population of Patients. The LASSYC Study

Reduced physical activity (PA) is an independent risk factor for lung function decline, hospitalization and mortality in chronic obstructive pulmonary disease (COPD) and affects a large proportion of patients from Europe and the United States. However, little is known of the level of PA of COPD patients in Latin America. The aim of this study was to provide information of the level of PA and its determinants in COPD patients in Latin America. This is an observational, cross-sectional study on patients with COPD in seven Latin American countries. PA level was evaluated with the short version of the International Physical Activity Questionnaire (IPAQ) and the association between PA and other variables was investigated. Complete information of PA level was obtained in 734 COPD patients consecutively recruited from specialized outpatient clinics; 448 (61%) were men, with a mean age of 69.6 years (standard deviation [SD] = 8.7) and a mean FEV₁ (% predicted) = 49.1% (17.5%). In 37.9% the level of PA was low, and the average sitting time was 36.1 h per week. Patients with low levels of PA were older, with higher levels of dyspnea and higher CAT scores. Additionally, we found that patients with low level of PA presented more symptoms during the day. Low levels of PA have been observed in a large proportion of COPD patients of Latin America, which is higher in women and older patients and it is related with worse functional and clinical characteristics.

Natural and Cultural Processes Influencing Gene Flow Among Wild (atoq papa), Weedy (araq papa and k’ipa papa), and Crop Potatoes in the Andean Region of Southern Peru

The Andean region is one of the areas with the earliest signs of food production systems and highest agrobiodiversity of the world, which resulted from millennia of domestication in a context of high ecosystem heterogeneity and human cultures valuing diversity for risk management. FAO has reported nearly 4000 varieties of cultivated potatoes still grown in the Andes, 3000 of them currently occurring in Peru. Such diversity has enormous sources of variation in wild (atoq papa) and weedy (araq papa and k’ipa papa) potatoes that coexist with crops, but their variation, interactions and mechanisms influencing diversification processes still require studies. In order to have a panorama of the variation and mechanisms influencing it in a regional setting, we studied biocultural factors favoring potatoes diversity in communities of Cusco and Apurimac, Peru. Our study documented the regional variation of wild, weedy, and cultivated potatoes recognized by local Quechua people and conducted semi-structured interviews to document their use, cultural value, and strategies of gene flow management implemented. We also studied their phenology, floral biology, flower visitors, and conducted experimental crosses between the wild S. candolleanum and 30 varieties of cultivated potatoes. We identified the wild potatoes S. acaule, S. brevicaule and S. candolleanum and 53 varieties of araq papa used and managed by local people. The latter provide nearly one third of the annual consumption of tubers by people interviewed and are, therefore, highly valued, maintained and managed in crop fields (chacras). People recognized that crosses between wild, weedy, and cultivated potatoes occur, and identified flower visitors and frugivores consuming their berries. Overlap of blooming periods and flower visitors of wild, weedy, and cultivated potatoes was recorded. Almost all flower visitors are shared among the different potato species and varieties, the bumble bees being particularly relevant in pollination of all taxa studied. We recorded seed production in nearly 35% of the experimental crosses. K’ipa papas are sets of mixtures of plants resulting from remaining tubers of cultivated potatoes, but also those from seeds that may result from hybridization of wild, weedy, and cultivated potatoes. Since local people commonly use k’ipa papa varieties and some of them are kept for planting in chacras, sexual reproduction in k’ipa papas is possibly one main mechanism of variation and source of new varieties of crops. Maintaining wild and weedy potatoes, and the natural and cultural mechanisms of gene flow is crucial for in situ conservation and generation of potato variation.

Nahua biocultural richness: an ethnoherpetological perspective

BACKGROUND

Mexico harbours one of the greatest biocultural diversities of the world, where multiple social and natural elements and systems form complex networks of interactions in which both culture and nature are mutually influenced. Biocultural states and processes are studied by ethnosciences, among them ethnoherpetology, which seeks understanding material and non-material expressions of the interactions between humans, amphibians, and reptiles. Herpetofauna has been part of the magic-religious world and source of goods for Mesoamerican cultures. This study aims to document and analyse the complex body of knowledge, beliefs, and practices on these vertebrates in the Nahua culture, the factors that have influenced progressive risk and loss of culture, habitat, and species, and the potential contribution of contemporary Nahua knowledge to biocultural conservation.

METHODS

Through 15 workshops with children and young people, and 16 semi-structured interviews to people 27 to 74 years old, we documented the contemporary Nahua knowledge in the communities of Aticpac and Xaltepec in the Sierra Negra, Puebla, central Mexico. Biological and ecological knowledge, use, management practices, legends, and perceptions on herpetofauna were emphasised in the study.

RESULTS

We obtained an ethnoherpetological checklist, grouping species into four general classificatory categories: kohuatl (serpents), kalatl (frogs and toads), ayotsi (turtles), and ketzo (lizards and salamanders), which included 21, 10, 1, and 11 ethnocategories respectively, based on the local Nahua knowledge of herpetofauna. Serpents, used as medicine, are the most culturally relevant. Due to perceptions of danger, beliefs, and actual snake bites, the main interaction with serpents is their elimination; however, some snakes are tolerated and maintained in captivity. The remaining species of local herpetofauna recorded are tolerated. Cultural aspects of reptiles and amphibians in the Nahua worldview were documented to influence the regulation of interactions of people with these vertebrates, but for younger generations, such aspects are less frequent or absent.

CONCLUSIONS

Interactions and cultural relationships between the Nahua people, amphibians and reptiles are complex, maintaining some aspects of the local worldview but also influenced by external factors and being constantly recreated and re-signified. Documenting and understanding the contemporary relations is essential to generate strategies in biocultural conservation of herpetofauna.

Integral Projection Models and Sustainable Forest Management of Agave inaequidens in Western Mexico

In México, at least 37 Agave species are extracted from wild populations for producing distilled spirits. This activity involves harvesting mature agaves just before producing their inflorescences, which cancels sexual reproduction of plants used. The increasing demand of agaves spirits in national and international markets is determining a strong pressure on wild populations, most of them lacking adequate management. In addition, the dynamics of agave populations may be affected by natural phenomena like oscillation of rainfall regimes, which affects the recruitment of agave seedlings, or the scarcity of pollinators that may affect seed production and general population dynamics. We studied the demography of wild populations of Agave inaequidens to analyze critical conditions for populations recovery, modelling the effects of rainfall trends on the demographic performance of this species, and exploring response of populations to hypothetical extraction regimes and reforestation efforts. Our study was performed in four well-conserved wild populations in Central Western Mexico, each population was sampled in a plot of about one hectare composed by 10 subplots 50 x 5 m (2500 m²). Populations were monitored yearly between 2011 and 2013, measuring plant size, reproductive individuals, and fecundity. Data were analyzed through integral projection models by using the IPMpack for R, to perform prospective analyses. We in addition constructed stochastic models to explore the possible influence of rainfall variation on species demography, using data for the drier and wetter years of the study period. Population growth varied from λ=1.003 to λ=0.899 among populations and years, and exceptionally λ=0.559 after a fire event. Low rainfall decreases λ values, indicating especial limitations to harvesting agaves during dry years whose frequency most probably will increase. In general, extraction rates from 10% to 30% of mature individuals are viable to maintain λ above 1, and these rates may be higher if new plants are introduced in populations. Depending on levels of extraction, our models suggest that it is necessary to carry out actions of reforestation, and in situ management according to the trends found in each site. This is one indispensable condition to maintain λ close to or greater than 1. Sustainable extraction of wild agaves is possible, some communities are already carrying out a repertoire of goods practices in this direction, but together with ecological criteria and good management techniques, strict regulations and social organization are needed to achieve it.

Time-domain induced polarization as a tool to image clogging in treatment wetlands

During the last decade, treatment (artificial) wetlands have flourished all over Europe for the treatment of sewages from small communities thanks to their low cost of operation. The clogging of the filter of these wetlands is an issue affecting their efficiency and considered as their main operational problem. The present work shows the results of the application of a geophysical method called time-domain induced polarization. It is used to non-intrusively image, in 3D, the clogging of the gravel filters in a quick and efficient way. Induced polarization characterizes the ability of a porous material to reversibly store electrical charges when submitted to an electrical field. The material property characterizing this ability is called normalized chargeability. A set of laboratory experiments allows to determine an empirical relationship between the normalized chargeability and the weight amount of clogging. Induced polarization measurements have been performed in the field over a treatment wetland to get a 3D reconstructed image (tomography) of the normalized chargeability. From this tomography and the previously defined relationship, we are able to image in 3D the distribution of clogging and where it is concentrated in the filter. We can therefore identify the areas requiring preventive measures to minimize this clogging issue.

Environmental interactions between people and birds in semiarid lands of the Zapotitlán Valley, Central Mexico

BACKGROUND

Birds have been among the most important element in lives of humans around the world, due to their presence and abundance in practically all ecosystems. Zapotitlán Salinas, a community of the Tehuacán Valley, has been a site of interest for studying ecology of bird communities, but no previous studies addressing the relationship between humans and birds have been conducted in the area. Based on their local knowledge, people of the area shape the use and conservation of local bird fauna diversity, which is being maintained or lost under the influence of factors like commerce, tourism, agriculture intensification or abandonment, public policies for conservation, environmental changes, among others. This study aims to analyze the patterns of interactions between humans and birds in a context of high biocultural diversity with a long history and facing the environmental and social challenges of semiarid areas.

METHODS

Ecological sampling for documenting bird species richness was conducted from November 2015 to May 2017 in three transects that included agroforestry systems, forests, and fallow agricultural land. The method of counting by fixed radius points at 16 points within the study systems was used. Thirty in-depth interviews were conducted with local people who own land in the study areas by random sampling and choosing experts of Zapotitlán Salinas, Puebla, a semiarid natural protected area and, since 2019, recognized as Mixed World Heritage. Some visitor guides of the Helia Bravo Hollis Botanical Garden who are member of the community and local people who dedicated part of their time to catching birds were considered as local experts. They have experience in identifying birds through bird watching and listening to bird songs, as well as their knowledge on behavior and habits of the bird species occurring in their locality. We in addition conducted free listing of bird species recognized by people and interviews on ecological aspects, forms of use, and management of birds using a photographic catalog as visual stimulus. The following aspects were addressed with local people: (i) the bird species of Zapotitlán recognized by them; (ii) the biological, ecological, and behavioral knowledge about these species; (iii) the description of practices of use and management of these animals; (iv) the perceived changes regarding presence and abundance of the wild birds recognized; and (v) the regulations of these practices and uses.

RESULTS

Through the ecological sampling, we identified 89 bird species, a number representing nearly 68% of all species reported for the Zapotitlán Valley. The species recorded belong to 61 genera, 26 families, and 11 orders. Local people interviewed recognized 62 morphospecies occurring in their territory, and designated them with 50 local names. The interactions of local people with birds and the knowledge related to habitats and habits varied according to people's daily life activities and the ways of inter-generational transmission of knowledge. The interactions identified respond to several motivations. The most intense are those of utilitarian nature (three types of use are recognized: nutritional, medicinal, and ornamental), while other less notorious but equally relevant are those related to the awareness and conservation of biological diversity, and aesthetic appreciation of nature. Also relevant are those interactions shaped by the people's worldview since some species are interpreted as climatic environmental predictors, amulets, or omens.

CONCLUSIONS

To understand the various human-bird environmental interactions, it is necessary not only to address the utilitarian assessment that species have in a specific place but also those associated with cultural expressions and the connection between these aspects. Lifestyles, traditions, and beliefs model intangible forms of use, such as the interpretation of climate predictors. Ancient roles of birds in local culture are ongoing, and new demand of ornamental birds from cities influences catching activities but local and regional regulations have contributed to maintain them below a critical level.

Physical, Chemical, and Microbiological Characteristics of Pulque: Management of a Fermented Beverage in Michoacán, Mexico

Pulque is a beverage that has been prepared in Mexico since pre-Hispanic times from the fermented sap of more than 30 species of wild and domesticated agaves. We conducted studies in two communities of the state of Michoacán, in central-western Mexico, where we documented its traditional preparation and analyzed the relationship between preparation conditions and the composition and dynamics of microbiological communities, as well as the physical and chemical characteristics of the beverage. In one of the communities, Santiago Undameo (SU), people boil the sap before inoculating it with pulque inoculum; this action causes this local pulque to be sweeter, less acidic, and poorer in bacteria and yeast diversity than in the other community, Tarimbaro (T), where the agave sap is not boiled and where the pulque has more diversity of microorganisms than in SU. Fermentation management, particularly boiling of the agave sap, influences the dynamics and diversity of microbial communities in the beverage.

Use and management of wild fauna by people of the Tehuacán-Cuicatlán Valley and surrounding areas, Mexico

BACKGROUND

Interactions between humans and fauna lay in the heart of the history of human subsistence. In Mesoamerica, the Tehuacán-Cuicatlán Valley (TCV) harbours a high biodiversity with archaeological and ethnoecological evidence of its use by people inhabiting the area since at least 12,000 B.P. It is recognized as one of the most ancient areas of agriculture in the Americas, and a broad spectrum of management practices aimed to ensure the availability of desirable plants has been documented, but it has not been analysed for animals. This study aimed to investigate the use and management practices directed to wild animals along current settlements within the TCV and neighbouring areas.

METHODS

We conducted an extensive search, review and analysis of documental sources for the period between 1967 and 2018. We found 38 documents providing information about the presence of animal species and 15 describing their use and/or management. We included our own observations from four case studies among the Ixcatec, Cuicatec, Nahua and Mestizo people, as well as from regional studies of biodiversity. We used unconstrained multivariate data analysis to describe the management typology of the animals in the region.

RESULTS

Hitherto, 652 vertebrate species and 765 species of insects have been recorded in this area; and until present, 107 wild animal species have been reported to be used in 11 use-type categories, mostly for food (65.42%), ornamental (27.52%) and medicinal (21.10%) purposes by the Nahua, Cuicatec, Popolocan, Ixcatec, Mazatec and Mestizo people. Their extraction entails manual capture and gathering as well as hunting and trapping strategies, some of them involving planning in time or space and communitarian regulations; in addition, relocation actions and care in captivity were recorded. Nearly 178 of the species distributed in the region with no reports of local use are used in other localities of Mesoamerica. Ethnozoological information is still lacking for the Mixtec, Chinantec and Chocholtec people in the area.

CONCLUSIONS

Wild fauna is still a valuable resource for the inhabitants of the TCV. Animals are obtained through extractive practices, which vary from one another in their qualitative attributes. With this work, we provide a context for further research priorities on fauna management in a region of high biocultural significance.

Management, morphological and genetic diversity of domesticated agaves in Michoacán, México

BACKGROUND

Pulque is a fermented beverage prepared with sap of Agave species in Mexico. Management of agaves for this purpose has motivated domestication of some species and high phenotypic variation that commonly causes uncertainty about the taxonomic identity of varieties traditionally managed by people. This study assumed that varieties of crop species continually arise from mutations, sexual reproduction and hybridization, among other processes, and some of them are favoured and maintained by humans. Identifying these varieties may be difficult and a challenging issue for botanists and evolutionary biologists studying processes of domestication. Through a case study, we analysed the traditional varieties of agaves used to produce pulque in Michoacán, Mexico. We aimed at identifying the varieties, analysing the relatedness among them and developing a methodological approach that could help solve taxonomic problems and study variation under domestication of this and other plant groups. We documented (1) the traditional varieties of agave used and their identity, (2) how these varieties are perceived, used and managed by the local people and (3) how management influences phenotypic and genetic variation among varieties.

METHODS

We interviewed pulque producers in two localities of the state of Michoacán, Mexico, where we recorded management practices of agaves, the traditional varieties used, the attributes characterizing those varieties, the varieties preferred by people, and features and mechanisms of selection. We conducted multivariate analyses of morphological features of the agave varieties, as well as genetic diversity and genetic distance studies among agave varieties through 11 nuclear microsatellites.

RESULTS

Seven traditional varieties of Agave were recorded in the study area. Multivariate analyses of morphology identified varieties belonging to the species A. salmiana, A. mapisaga and, presumably, A. americana. The preferred varieties have morphological features selected to make easier their management and produce higher sap yields. Genetic diversities (H_E = 0. 470 to 0.594) were high compared with other Agave species with similar life history traits and use. Genetic distance analyses grouped the varieties "Verde" and "Negro" (identified as A. salmiana), whereas the varieties "Tarímbaro" and "Listoncillo" (identified as A. mapisaga) formed another group. The varieties "Blanco" and "Carrizaleño" (most probably being A. americana) clustered with varieties of A. salmiana, whereas the variety "Cenizo" appeared as a distinct group. Bayesian analysis indicated that most individuals of varieties of A. salmiana form a group and those of the varieties of A. mapisaga form another, whereas individuals of the varieties putatively belonging to A. americana clustered in similar proportions with both groups.

CONCLUSIONS

The traditional pulque production in the study area is an ongoing practice. It is still an important source of products for direct consumption by households and generation of economic incomes and as part of the cultural identity of local people. The most used traditional variety exhibited a marked gigantism, and although these agaves are mainly asexually propagated, populations have high genetic diversity. The local producers promote the maintenance of different traditional varieties. Our study shows the value of an integral research approach including ethnobiological, morphological and genetic information to clarify the state of variation influenced by humans on agaves, but it would be helpful to study other organisms under domestication. In addition, such approach would help to document human and non-human mechanisms generating crop varieties managed by local people.

Traditional management of microorganisms in fermented beverages from cactus fruits in Mexico: an ethnobiological approach

BACKGROUND

Fermentation is an ancient technique for preserving and improving the qualities of food and beverages throughout the world. Microbial communities, not seen by the producers of fermented goods, are the actors involved in the fermentation process and are selected upon through different management processes in order to achieve a final product with culturally accepted features. This study documented the preparation of "colonche" which is a type of traditionally fermented beverages made with the fruits from several cactus species in two main producing regions of Mexico, the Altiplano and the Tehuacán Valley. We documented the selection processes of the cactus species used and the practices that could influence microbial community composition, as well as, how the producers reach the desirable sensorial attributes of the beverages.

METHODS

We conducted 53 semi-structured interviews and participatory observations with colonche producers in 7 communities of the Altiplano and the Tehuacán Valley in order to characterize the practices and processes involved in the elaboration of the beverage. Opuntia and columnar cacti species used in colonche production were collected during fieldwork and identified. Selected sensorial attributes of Opuntia colonches were characterized by a ranking table and visualized by principal component analysis in order to distinguish differences of this beverage in the Altiplano localities.

RESULTS

Thirteen cactus species are used for colonche production in both regions studied. In the Altiplano, the most commonly used fruit is Opuntia streptacantha because it contributes to the preferred attributes of the beverage in this region. Selection of substrates by producers depends on their preference and the availability of fruits of O. streptacantha and other species. Fermentation is mainly conducted in clay pots which is perceived to be the best type of vessel contributing to the preferred sensorial properties of colonche. The two main differences in colonche preparation between the villages are the practice of boiling the fruit juice and the use of pulque (fermented sap of Agave species) as inoculum. The most contrasting sensorial attributes selected between localities are the alcohol content and sweetness, which might be in accordance with the practices used for obtaining the final product. Colonche is produced mainly for direct consumption and secondarily used as a commercialized good to be sold for economic gains contributing to the general subsistence of households. The preparation methods are passed on by close relatives, mainly women.

CONCLUSIONS

Traditional producers of colonche use several techniques in order to reach specific sensorial attributes of the final product. The production of colonche has been upheld for generations but fermentation practices are divided into two categories; (1) the use of an inoculum (either from pulque, or from colonche saved from the previous year), and (2) the use of "spontaneous" fermentation. The differing practices documented reflect the contrasts in the preferred sensorial attributes between regions. Colonche is a beverage that contributes to regional pride, cultural identity and is appreciated because of its gastronomic value. Here, we argue that there is a clear relationship of human knowledge in the management of microbiota composition in order to produce this beverage. In-depth documentation of the microbiota composition and dynamics in colonche will contribute to the preservation of this valuable biocultural heritage.

Cuicatec ethnozoology: traditional knowledge, use, and management of fauna by people of San Lorenzo Pápalo, Oaxaca, Mexico

BACKGROUND

The Tehuacán-Cuicatlán Valley is a region of outstanding biocultural diversity, harboring eight indigenous ethnic groups and a remarkable biodiversity in a territory 10,000 km² extent. Ethnobotanical studies of the region are among the most complete in Mexico; contrarily, ethnozoological studies are still limited. But information on both flora and fauna use and management is relevant for understanding local cultural and ecological issues, and for planning integral strategies of biodiversity conservation. Our study focused on analyzing knowledge and use of animals and their relationship with faunistic management by the Cuicatec, an ancient human culture whose distribution is restricted to the region. We hypothesized that wild animals still have significant contributions to diet, medicine, and spiritual life of the Cuicatec people. In addition, we expected to find a gradient of interactions, from simple gathering and hunting to communitarian regulations of use, specialized management techniques and care, nurturing, and domestication of animals. Such gradient of management interactions would be influenced proportionally with cultural and economic values, viability maintenance, and scarcity of animals.

METHODS

Our study was carried out in San Lorenzo Pápalo, Oaxaca. We conducted surveys and semi-structured and open interviews to people to document the Cuicatec nomenclature, classification, use, and management of fauna, as well as their perceptions about abundance, risks of disappearance, and availability of wild animals. We used images of animal species reported for the area as communication stimuli for confirming their local presence. Also, we recorded skins and skulls used as trophies and ornamental objects, pawprints, and excretes. Through free listing, we identified the most meaningful species of different animal groups. Whenever possible, we evaluated amounts of animals obtained from the wild, and for some species, we compared this information with data on their distribution and abundance evaluated through ecological sampling, to explore indicators on their sustainable use.

RESULTS

The Cuicatec name all animals through the term i-ti and classify them in several groups of vertebrates, arthropods, and mollusks, some of them coinciding with the formal taxonomy and some others based on their social-cultural role. The most meaningful animals are 23 species of edible organisms, outstandingly the chicatana ants (Atta mexicana) and the cuetla Lepidoptera larvae (Arsenura armida), the lizard Sceloporus grammicus, and among the mammals some squirrels (Sciurus spp.), badgers (Nasua narica), and deer (Odocoileus virginianus). Some species were reported to be used for medicinal purposes, among them opossum (Didelphis spp.) and macaws (Ara militaris), used to ease childbirths, but this use almost disappeared. Local perception of availability of animal resources is associated to forest conservation. Regulations for protecting forests and the most used animal species were recorded; the rules are mainly associated to hunting and gathering seasons, respecting females of vertebrate species, and permits for gathering and hunting given by local authorities. Nurturing of animals was recorded in bird and mammal species, but in no case, their breeding was achieved.

CONCLUSIONS

Animals are important elements of the Cuicatec culture and subsistence, complementing their diet based on agricultural products. Animals used as medicine were still reported but substituted by modern medicine. There is a consensus about the need to conserve forests to ensure the maintenance of animals, which are valued as part of nature, the beauty of their territory, and culture. Communitarian regulations are the main ways for conserving fauna, but local techniques of animal management may help in designing conservation strategies.

Incorporating New Evidence on Inhaled Medications in COPD. The Latin American Chest Association (ALAT) 2019

This document on COPD from the Latin American Chest Association (ALAT-2019) uses PICO methodology to analyze new evidence on inhaled medication and answer clinical questions. The following key points emerged from this analysis: 1) evidence is lacking on the comparison of short-acting vs. long-acting bronchodilators in patients with mild COPD; patients with moderate-to-severe COPD obtain greater benefit from long-acting bronchodilators; 2) the benefits of monotherapy with long-acting antimuscarinic agents (LAMA) and combined therapy with long-acting β₂-agonists and inhaled corticosteroids (LABA/ICS) are similar, although the latter is associated with a greater risk of pneumonia; 3) LABA/LAMA offer greater benefits in terms of lung function and risk of exacerbation than LABA/ICS (the latter involve an increased risk of pneumonia), 4) LAMA/LABA/ICS have greater therapeutic benefits than LABA/LAMA on the risk of moderate-severe exacerbations. With regard to the role of eosinophils in guiding the use of ICS, ICS withdrawal must be considered when the initial indication was wrong or no response is elicited, in patients with side effects such as pneumonia, and in patients with a low risk of exacerbation and an eosinophil blood count of <300 cells/μl. All this evidence, categorized according to the severity of the obstruction, symptoms, and risk of exacerbations, has been used to generate an algorithm for the use of inhaled medication in COPD.

Abstract P5-13-05: Overcoming barriers to achieve a successful breast cancer patient recruitment: Professionals' views

Accurate recruitment in performing clinical trials is crucial to avoid delays in the availability of potential beneficial treatments for patients. However, optimal strategies to improve it remain elusive and highly variable. The aim of this study was to identify the factors affecting recruitment from a multi-professional approach.

Methods: A convergent mixed method study was used, including key informant in-depth interviews (n=13), 5 focus groups (n=40) and a 209-item Likert-scale survey for the measurement of a whole array of variables of interest (i.e. job attitudes, job satisfaction, job stressors and social status). A purposive sample of professionals from thirty-three clinical trial sites in Spain were targeted. Qualitative data were analyzed alongside quantitative data to document patterns and modifiers of recruitment performance. Audio material was recorded, transcribed verbatim and analyzed using the framework method.

Findings: Pattern observed in qualitative data was confirmed in quantitative analysis. A total of 32 key barriers to successful patient recruitment were identified and clustered in three categories. The most commonly reported barriers and facilitators regarding a multifactorial approach were: System/organization: Counting on experienced recruiters and having a strong team-workforce awareness (92,3%); automated recruitment software, scientific culture, recruiting philosophy, adequate workload demands (88%); high stimuli and interprofessional trust (84%). However, lack of time devoted to clinical research in favor of assistance demands, excessive workload and bureaucratic tasks were the most salient stressors to fulfill professional research and recruitment responsibilities (54%). Working team conditions: Insufficient workforce support as well as high employee turnover contributed to emotional exhaustion and depersonalization and to a lower personal accomplishment (15%). Interpersonal relations affected not only motivation and performance but professionalism satisfaction with outcomes. Professional recruiter characteristics: Professionals with a high level of expertise and academic specialization (&gt;5 years), greater active involvement in relevant clinical trials just as interprofessional prestige and recognition showed a greater satisfaction. Consequently, they were prompted to intensify their efforts to fulfill recruitment. The more effective clinical research settings were those better aligned with attributes for becoming high recruiters and with better multi-professional articulation. Suggestions to improve recruitment included providing professionals with devoted time for research, setting up collaborative research agreements, building a clinical research network, collaborative tumor registries, clinical trials data sharing resources, multidisciplinary functional units and committees, flexible staffing models and empowering oncologists/managers leadership.

Conclusions: This study provided useful understanding of how to maximize patient recruitment at clinical research sites. Strong team-workforce and adequate workload were the most important identified factors for achieving it. Results will be used to inform professionals and stakeholders of the next steps needed and to engage them to fulfill accurate recruitment.

Citation Format: Casas A, Gonzàlez X, Capelán M, Morales J, Fabián M, Ciruelos E, Gabriele G. Overcoming barriers to achieve a successful breast cancer patient recruitment: Professionals' views [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-13-05.

Cultural, economic, and ecological factors influencing management of wild plants and mushrooms interchanged in Purépecha markets of Mexico

BACKGROUND

Traditional markets outstandingly contribute to conservation of biocultural diversity, social relations, and cultural values. These markets reflect life strategies and forms people of a region interact with their biodiversity and territories, as well as traditional ecological knowledge and management practices. To understand the factors motivating plant and mushroom management, we analyzed the resources cultural and economic values, their role in people's subsistence, and the relation of these values with the resources spatial and temporal availability. Our study based on the supposition that traditional markets are settings of interchange of resources with the highest importance for people's life in a region. Also, that the cultural, economic, and ecological factors influence values of the resources, and the demand on them determine pressures on the most valuable resources which, when scarce, motivate management innovation, otherwise become extinct.

METHODS

We documented cultural, economic, and ecological aspects, as well as management techniques of wild and weedy plants and mushrooms interchanged in three traditional markets of the Pátzcuaro Lake region, in central-western Mexico. For doing that, from February 2015 to March 2018, we conducted 175 visits to markets and 89 semi-structured interviews to producers, gatherers, and sellers of wild and weedy plants and mushrooms. Based on participant observation and interviews, we identified variables related to culture, economic, and ecological aspects, as well as management regimes of resources and management systems, which were documented and used as indicators for quantitative analyses. Through principal components analyses (PCA), we determined the indexes of cultural and economic importance (ICEI), management intensity (IMI), and ecological risk (IR) of the resources studied. For conducting that, we classified plant and mushroom species according to their cultural, economic, ecological, and technological indicators, respectively. The score of the first principal component was considered as the index for each group of variables, respectively. To identify relations between cultural importance and risk, we performed linear regression analyses between ICEI and IR indexes.

RESULTS

We recorded 57 species of wild and weedy plants used as food, medicine, and ornamental, and 17 species of edible mushrooms. The variables with the highest weight in the ICEI are related to the need of a resource according to people, its recognizing, the number of communities and markets offering it in markets, its explicit preference expressed by people, the effort invested in obtaining it, and the form it is interchanged. Gathering is practiced in all mushrooms and wild and weedy plants from forests and agricultural areas; 11 species in addition receive 1 or more forms of management (enhancing, selective let standing, propagation through seeds or vegetative parts, transplantation, and/or protection). The management intensity and complexity are explained by variables related to management practices and systems. Plants receiving selective management have the higher management intensity. Silvicultural management (in situ management in forests) was recorded in all species of mushrooms, as well as in more than 80% of medicinal, ceremonial and ornamental plants, and in more than 50% of the edible plants. In agricultural systems, people manage more than 90% of the edible plants recorded to be under a management regime, 25% of the managed medicinal plants, and 30.7% of the managed ceremonial and ornamental plants. In homegardens, people manage 41.6% of the medicinal plants recorded and 26.6% of the edible plants, to have them available near home. Nearly 63% of the species interchanged in the markets studied are gathered in forests without any other management form. In this group are included all mushroom species, 61.5% of ceremonial/ornamental plants, 50% of medicinal, and 33.3% of edible plants. The linear regression between ICEI an IER is significantly negative for edible species with high management intensity R² = 0.505 (p = 0.0316), because of their management. But in medicinal and ornamental plants, the risk is high if the cultural importance increases, even when management practices like transplanting and propagation in homegardens are carried out.

CONCLUSIONS

Traditional markets are settings of interchange of products, knowledge, and experiences, where the ongoing factors and processes motivating management innovation can be identified and documented. This approach allows documenting processes occurring at regional level but would be benefited from deeper studies at local level in communities.

Respiratory medication used in COPD patients from seven Latin American countries: the LASSYC study

Background

Limited information is available regarding medication use in COPD patients from Latin America. This study evaluated the type of medication used and the adherence to different inhaled treatments in stable COPD patients from the Latin American region.

Methods

This was an observational, cross-sectional, multinational, and multicenter study in COPD patients attended by specialist doctors from seven Latin American countries. Adherence to inhaled therapy was assessed using the Test of Adherence to Inhalers (TAI) questionnaire. The type of medication was assessed as: short-acting β-agonist (SABA) or short-acting muscarinic antagonist (SAMA) only, long-acting muscarinic antagonist (LAMA), long-acting β-agonist (LABA), LABA/LAMA, inhaled corticosteroid (ICS), ICS/LABA, ICS/LAMA/LABA, or other.

Results

In total, 795 patients were included (59.6% male), with a mean age of 69.5±8.7 years and post-bronchodilator FEV₁ of 50.0%±18.6%. The ICS/LAMA/LABA (32.9%) and ICS/LABA (27.7%) combinations were the most common medications used, followed by LABA/LAMA (11.3%), SABA or SAMA (7.9%), LABA (6.4%), LAMA (5.8%), and ICS (4.3%). The types of medication most commonly used in each Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 category were ICS/LABA (A: 32.7%; B: 19.8%; C: 25.7%; D: 28.2%) and ICS/LAMA/LABA (A: 17.3%; B: 30.2%; C: 33%; D: 41.1%). The use of long-acting bronchodilators showed the highest adherence (good or high adherence >50%) according to the TAI questionnaire.

Conclusion

COPD management in specialist practice in Latin America does not follow the current guideline recommendations and there is an overuse of ICSs in patients with COPD from this region. Treatment regimens including the use of long-acting bronchodilators are associated with the highest adherence.

Psychological impact of multigene cancer panel testing in patients with a clinical suspicion of hereditary cancer across Spain

OBJECTIVE

Patients' psychological reactions to multigene cancer panel testing might differ compared with the single-gene testing reactions because of the complexity and uncertainty associated with the different possible results. Understanding patients' preferences and psychological impact of multigene panel testing is important to adapt the genetic counselling model.

METHODS

One hundred eighty-seven unrelated patients with clinical suspicion of hereditary cancer undergoing a 25-gene panel test completed questionnaires after pretest genetic counselling and at 1 week, 3 months, and 12 months after results to elicit their preferences regarding results disclosure and to measure their cancer worry and testing-specific distress and uncertainty.

RESULTS

A pathogenic variant was identified in 38 patients (34 high penetrance and 4 moderate penetrance variants), and 54 patients had at least one variant of uncertain significance. Overall, cancer panel testing was not associated with an increase in cancer worry after results disclosure (P value = .87). Twelve months after results, carriers of a moderate penetrance variant had higher distress and uncertainty scores compared with carriers of high penetrance variants. Cancer worry prior to genetic testing predicted genetic testing specific distress after results, especially at long term (P value <.001). Most of the patients reported the wish to know all genetic results.

CONCLUSIONS

Our results suggest that patients can psychologically cope with cancer panel testing, but distress and uncertainty observed in carriers of moderate penetrance cancer variants in this cohort warrant further research.

Species delimitation in the Stenocereus griseus (Cactaceae) species complex reveals a new species, S. huastecorum

The Stenocereus griseus species complex (SGSC) has long been considered taxonomically challenging because the number of taxa belonging to the complex and their geographical boundaries remain poorly understood. Bayesian clustering and genetic distance-based methods were used based on nine microsatellite loci in 377 individuals of three main putative species of the complex. The resulting genetic clusters were assessed for ecological niche divergence and areolar morphology, particularly spination patterns. We based our species boundaries on concordance between genetic, ecological, and morphological data, and were able to resolve four species, three of them corresponding to S. pruinosus from central Mexico, S. laevigatus from southern Mexico, and S. griseus from northern South America. A fourth species, previously considered to be S. griseus and commonly misidentified as S. pruinosus in northern Mexico showed significant genetic, ecological, and morphological differentiation suggesting that it should be considered a new species, S. huastecorum, which we describe here. We show that population genetic analyses, ecological niche modeling, and morphological studies are complementary approaches for delimiting species in taxonomically challenging plant groups such as the SGSC.

Ethnoecology of the interchange of wild and weedy plants and mushrooms in Phurépecha markets of Mexico: economic motives of biotic resources management

BACKGROUND

Interactions between societies and nature are regulated by complex systems of beliefs, symbolism, customs, and worldviews (kosmos), ecological knowledge (corpus), and management strategies and practices (praxis), which are constructed as product of experiences and communication of people throughout time. These aspects influence social relations, life strategies, and cultural identity, and all of them in turn influence and are influenced by local and regional patterns of interchange. In this study, we analyze the interchange of wild and weedy plants and mushrooms in traditional markets of the Phurépecha region of Mexico. Particularly, the social relations constructed around the interchange of these products; how knowledge, cultural values, and ecological factors influence and are influenced by interchange; and how all these factors influence the type and intensity of biotic resources management.

METHODS

We studied three main traditional markets of the Phurépecha region of Michoacán, Mexico, through 140 visits to markets and 60 semi-structured interviews to sellers of wild and weedy plants and mushrooms. In nearly 2 years, we carried out 80 visits and 30 interviews in the "Barter Market", 20 visits and 15 interviews in the "Phurépecha Tiánguis", and 40 visits and 15 interviews to the "Municipal Market". We documented information about the spaces of interchange that form the markets, the types of interchange occurring there, the cultural and economic values of the resources studied, the environmental units that are sources of such resources, the activities associated to resources harvesting and, particularly, the management techniques practiced to ensure or increase their availability. We analyzed the relations between the amounts of products interchanged, considered as pressures on the resources; the perception of their abundance or scarcity, considered as the magnitude of risk in relation to the pressures referred to; and the management types as response to pressures and risk.

RESULTS

We recorded 38 species of wild and weedy plants and 15 mushroom species interchanged in the markets. We characterized the spaces of interchange, the interchange types, and social relations among numerous Phurépecha communities which maintain the main features of pre-Columbian markets. The products analyzed are differentially valued according to their role in people's life, particularly food, medicine, rituals, and ornamental purposes. The highest cultural values were identified in multi-purpose plant and mushroom resources and, outstandingly, in ornamental and ritual plants. In markets, women are the main actors and connectors of the regional households' activities of use and management of local resources and ecosystems. The interrelationships between worldviews, knowledge, and practices are visible through the interchange of the products analyzed, including the types of environments comprised in communitarian territories, agricultural calendars, and feasts. Those plants and mushrooms are highly valued but relatively scarce according to the demand on them receiving special attention and management practices directed to ensure or increase their availability. With the exception of most mushrooms and ornamental and ritual plants, which have high economic and cultural values, there are those that are relatively scarce and under high risk, but are obtained through simple gathering from the wild.

CONCLUSIONS

Traditional markets are crucial part of the subsistence strategy of Phurépecha people based on the multiple use of resources and ecosystems at the local and regional levels. The markets influence social relations, cultural identity, and preservation of traditional knowledge and biodiversity. In general, the demand of products in markets enhances innovation and practices for ensuring or increasing their availability, particularly those that are naturally scarce. However, it was notorious that, althoug mushrooms and ritual plants have high demand and value in markets, most of them are obtained by simple gathering.

One-step preparation of novel 1-(N-indolyl)-1,3-butadienes by base-catalysed isomerization of alkynes as an access to 5-(N-indolyl)-naphthoquinones

A series of novel 1-(N-indolyl)-1,3-butadienes, as (1 : 1) mixtures of the (E) and (Z) dienes, was prepared in one step by base-catalysed isomerization of N-alkylindoles with a terminal butyne chain. The reaction conditions are mild, and in all cases the yields were very high (>90%). The (E) and (Z) dienes were separable by preparative TLC and could be fully characterized. This isomerization proceeded readily in the case of a butynyl chain, but didn't take place with a pentynyl chain. A mechanism was proposed for this reaction, based on previous studies on the isomerization of alkynes in basic media, and a key intermediate that supports the proposed mechanism could be isolated and fully characterized. A theoretical study of the proposed mechanism was performed by computational methods and the results validated the proposal. The reactivity of the synthesized dienes was studied in Diels–Alder reactions with p-benzoquinone, to obtain a small library of new 5-(N-indolyl)-1,4-naphthoquinones.The lack of reactivity in the case of the (Z) isomers was explained by calculation of the rotational curves of the central bond of the (Z) and (E) dienes. Finally, the cytotoxicity of the new 5-(N-indolyl)-1,4-naphthoquinones was tested against a panel of three cell lines.

A series of novel 1-(N-indolyl)-1,3-butadienes, was easily prepared in one step and used for the synthesis of 5-(N-indolyl) naphthoquinones.

Prevalence and impact of respiratory symptoms in a population of patients with COPD in Latin America: The LASSYC observational study

BACKGROUND

To analyse the relationship between symptoms at different times during the 24-hour day and outcomes in COPD.

METHODS

Observational cross-sectional study in a patients from 7 Latin American countries. The frequency of symptoms in the morning, at night and during the day was explored by means of standardised and validated questionnaires, and the relationship between symptoms and exacerbations and quality of life were investigated.

RESULTS

734 patients (59.6% male, mean age 69.5 years, mean FEV₁ 50% predicted normal) were recruited. The most frequent symptoms during the day were dyspnea (75% of patients, of which 94% mild-moderate) and cough (72.2%, of which 93.4% mild-moderate). Highly symptomatic patients had a greater impairment in FEV₁, more exacerbations and worse scores in COPD assessment test (CAT) and Body Mass Index, Obstruction, Dyspnoea and Exacerbations (BODEx) index (all p < 0.001). Morning symptoms were more frequent than night-time symptoms, particularly cough and dyspnoea (morning: 50.1% and 45.7%; night-time: 33.2% and 24.4%, respectively), and mostly rated as mild or moderate. Patients with morning or night-time symptoms presented with worse severity of daytime symptoms. There was a strong correlation between intensity of daytime with morning or night-time symptoms, as well as with CAT score (r = 0.715; p < 0.001), but a weak correlation with FEV₁ (r = -0.205; p < 0.001).

CONCLUSION

Morning symptoms were more frequent than night-time symptoms, and having either morning and/or night-time symptoms was associated with worse severity of daytime symptoms. Increased symptoms were strongly associated with worse quality of life and more frequent exacerbations, but weakly associated with airflow limitation.

CLINICAL TRIAL REGISTRATION

NCT02789540.