ENINGOCOCCAL DISEASE caused predominantly by Neisseria meningitidis serogroups A, B, and C occurs predominantly in young children and remains a substantial cause of morbidity and mortality worldwide. 1,2 In addition to causing endemic disease globally, meningococci, unlike other encapsulated bacteria, cause epidemics. Serogroup B epidemics, problematic in Norway and throughout much of Latin America in the 1980s and 1990s, 1 have recently emerged in New Zealand 3 and the United States. [4][5][6] Response to serogroup B epidemics, unlike serogroup A and C epidemics, is difficult because existing serogroup B vaccines have not been shown to be efficacious on an international scale. [7][8][9][10] Quadrivalent meningococcal polysaccharide vaccine is efficacious against meningococcal disease caused by the A, C, W-135, and Y serogroups. [11][12][13] Serogroup B polysaccharide antigen, however, is poorly immunogenic in humans, 14,15 and the elicitation of antibodies to serogroup B polysaccharide antigen is of concern because this antigen is present in human neonatal neural tissue. 16,17 Therefore, alternative Author Affiliations are listed at the end of this article.

Patients' low adherence to medical treatment in chronic illnesses is one of the biggest public health problems. Numerous studies attend to the diverse factors associated with patient adherence. However, little research has been done to explore patients' reasons for non-compliance from their own point of view. In this article, we aim to understand patient non-adherence using dialogical self-theory and qualitative research methods. We interviewed 51 hypertensive patients to explore their anti- and pro-adherence motivations. Results show that most patients adhere and non-adhere to different aspects of treatment programs (medication, exercise, diet) according to the way they construct meaning to those activities. Also, our findings support the notion that patients' non-adherent behavior aims to preserve important values such as self-esteem, autonomy, affiliation, well-being, freedom, and health (or that more adherence is not worth the extra effort). We discuss the therapeutic relevance of empathically understanding patients' worldview and implicit beliefs.

ResumenSe presentan los resultados de un microanálisis de la conversación psicoterapéutica en Episodios de Cambio y de Estancamiento. Se realizó un análisis comparativo de la comunicación verbal en una muestra de 33 Episodios de Cambio y 34 de Estancamiento, correspondientes a 15 procesos terapéuticos, aplicando el Sistema de Codificación de la Actividad Terapéutica. Este sistema distingue cinco niveles de análisis: Formas Básicas, Intenciones Comunicacionales, Técnicas, Dominio y Referencia. Los resultados muestran que los Episodios de Cambio y Estancamiento se distinguen en cuanto a que, en los primeros, predomina un lenguaje más asertivo por parte del terapeuta y más receptivo en el paciente, estando ambos involucrados en la activa construcción de nuevos significados y el paciente centrado en sí mismo. En los segundos se rigidiza el lenguaje, se exacerban algunas técnicas por parte del terapeuta y se tiende a focalizar menos en el paciente como referente del diálogo terapéutico.Palabras clave: Proceso terapéutico, cambio, episodios relevantes, acciones comunicacionales. AbstractResults of a microanalysis of the psychotherapeutic conversation in change and stuck episodes are presented. For the comparison of the verbal communication, the Therapeutic Activity Coding System was applied to a sample of 33 change episodes and 34 stuck episodes, corresponding to 15 therapeutic processes. This system includes five levels of analysis: Basic Forms, Communicative Intentions, Techniques, Domain and Reference. Results show differences in change and stuck episodes. The former are characterized by an assertive speech on the therapists' side, and a more receptive language from the patients, with both actors involved in an active construction of new meanings, and the patients referring to him or herself. In contrast, the language in stuck episodes is less flexible, the use of some therapist techniques is exacerbated and the therapeutic dialogue tends to be less focused on the patient as a reference point. Keywords: therapeutic process, change, relevant episodes, communicative actions.Correspondencia: La correspondencia relativa a este artículo debe ser dirigida a: Olga Fernández, Programa de Doctorado en Psicoterapia, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Macul, Santiago, Chile. E-mail: ofernandezg@uc.cl 1 Los resultados de investigación presentados en este artículo forman parte del Proyecto Fondecyt Nº1080136 (Fondo Nacional para el Desarrollo de la Ciencia y la Tecnología, Ministerio de Educación, Gobierno de Chile), institución a la que agradecemos su apoyo.

On Floreana, the smallest inhabited island in the Galápagos, populations of several species of birds have either been extirpated or, based on anecdotal evidence and small‐scale surveys, are declining. Our objective, therefore, was to conduct a comprehensive survey of landbirds encompassing the entire island during three breeding seasons (2014–2016). We conducted surveys at 59 points in 2014, 257 in 2015, and 295 in 2016. Each survey point was sampled once. We detected 12 species during our surveys. Galápagos Flycatchers, Yellow Warblers, Small and Medium ground‐finches, and Small Tree‐Finches were widely distributed over the entire island. Common Cactus‐Finches and Medium Tree‐Finches had more restricted distributions in the lower or higher parts of the island. Few Dark‐billed Cuckoos (Coccyzus melacoryphus), Paint‐billed Crakes (Neocrex erythrops), Galápagos Doves (Zenaida galapagoensis), and Galápagos Short‐eared Owls (Asio flammeus galapagoensis) were recorded. Small Ground‐Finches and Small Tree‐Finches were found at densities comparable to those on other Galápagos Islands, whereas densities of Galápagos Flycatchers and Yellow Warblers were higher on Floreana than on other islands. Endemic Medium Tree‐Finches were confined to an area of 24 km², mainly in the highlands, but were still widespread and common in their restricted habitat, with the number of territories estimated to be between 3900 and 4700. Of 22 originally occurring landbirds on Floreana, no fewer than 10 species have either been extirpated or are likely to have been extirpated since the arrival of the first human inhabitants. The combined effects of introduced mammals, large‐scale habitat destruction, and direct human persecution were responsible for the extirpation of six species during the 19th century. Three additional species have been extirpated since 1960, likely due to the introduction of the parasitic fly Philornis downsi, and this fly remains a major threat for the remaining bird species. Developing strategies for reducing the impact of these flies on the birds of the Galapagos Islands must be a high priority. In addition, habitat management and restoration, including the control of invasive plants and promotion of native tree species, will be critically important in conserving landbird populations on Floreana.

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Cost-benefit analyses can be integral to the evaluation of interventions in developing countries. The authors compare the potential benefits to the Chilean Ministry of Health, in terms of treatment costs averted, by prevention of Haemophilus influenzae type b (HIB) invasive disease, with the costs of adding HIB conjugate vaccine to the diphtheria-tetanus-pertussis (DTP) immunization routinely administered to infants. In their basecase model, over a 10-year period (1991-2000), vaccination against HIB will prevent 1,229 cases of HIB invasive disease, including 713 cases of meningitis, 107 of whom would suffer severe, long-term sequelae, and between 29 and 116 deaths. Assuming a cost of US$1 for a full three-dose regimen of vaccine, the benefit/cost ratio of 1.66, with a net discounted savings of over $403,225, illustrates that HIB vaccine can be cost-beneficial. Sensitivity analyses which alter each of the variables in the analysis indicate that if the true incidence of HIB disease is twice the published rate, then three doses of vaccine remains cost-beneficial at US#3.

There is a bi-directional relationship between depression and chronic illnesses such as diabetes and hypertension. This comorbidity is associated with higher mortality risk and diminishes the efficacy of interventions. The specific mechanisms of this mutual influence are still not fully understood, and most intervention protocols address these conditions separately. This study aims to improve our understanding of this relationship. We interviewed 18 patients and 24 health care professionals, focusing on understanding the different ways in which depression and chronic illness could influence each other. Our results show a common cyclical pattern and specific situations where the reported bi-directional relationship does not occur. We discuss the importance of opening a space for the patient’s grief process after the chronic illness diagnosis, managing the demands and stress of the patient’s treatment, and how to adjust the treatment to the different needs and possibilities of each person.

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