Quantifying the childhood and adolescent overnutrition attributable to specific risk factors: The Young Lives Study in Peru.

OBJECTIVE: Launching priority actions demand a comprehensive appraisal of the size effect that risk factors have on the burden of overweight and obesity. This study aimed to estimate the incidence of overweight and obesity among children and adolescents, with special emphasis on the role of specific risk factors. MATERIALS AND METHODS: Secondary analysis of data from the younger cohort of the Young Lives Study in Peru (2002-2017). The outcomes were: overweight and obesity, defined by the World Health Organization standards; whereas the exposures included caesarean birth, physical activity levels, sodas and sugar-sweetened beverages consumption, snacks consumption, and maternal body mass index (BMI). We used multilevel Poisson regression models, considering the repetitive nature of data, to estimate incidence rate ratios (IRRs) and population attributable fractions (PAFs). RESULTS: A total of 2052 children, mean age 1 (SD 0.4) year, and 50% girls, were enrolled at baseline. After 14 (SD 0.5) years of follow-up, the incidence of overweight and obesity were 7.9 (95% CI 7.6-8.2) and 2.2 (95% CI 2.0-2.4) per 100 person-year, respectively. Maternal BMI (IRRs 3.51; PAF 31.8%), low physical activity (IRR 1.64; PAF 27.4%), caesarean birth (IRR 1.63; PAF 11.4%), almost daily snack consumption (IRR 1.60; PAF 32.1%), and almost daily consumption of sweetened beverages (IRR 1.47; PAF 26.0%) increased the risk of developing obesity. CONCLUSIONS: This study provides evidence on the risk of overweight and obesity attributable to diet habits, physical activity and the obesogenic niche among children and adolescents in Peru, which may guide the implementation of evidence-based interventions.

A Control-Theoretical System for Modulating Hippocampal Gamma Oscillations Using Stimulation of the Posterior Cingulate Cortex.

Closed-loop stimulation for targeted modulation of brain signals has emerged as a promising strategy for episodic memory restoration. In parallel, closed-loop neuromodulation strategies have been applied to treat brain conditions including drug-resistant depression, Parkinson's Disease, and epilepsy. In this study, we seek to apply control theoretical principles to achieve closed loop modulation of hippocampal oscillatory activity. We focus on hippocampal gamma power, a signal with an established association for episodic memory processing, which may be a promising 'biomarker' for the modulation of memory performance. To develop a closed-loop stimulation paradigm that effectively modulates hippocampal gamma power, we use a novel data-set in which open-loop stimulation was applied to the posterior cingulate cortex and hippocampal gamma power was recorded during the encoding of episodic memories. The dataset was used to design and evaluate a linear quadratic integral (LQI) servo-controller in order to determine its viability for in-vivo use. In our simulation framework, we demonstrate that applying an LQI servo controller based on an autoregressive with exogenous input (ARX) plant model achieves effective control of hippocampal gamma power in 15 out of 17 experimental subjects. We demonstrate that we are able to modulate gamma power using stimulation thresholds that are physiologically safe and on time scales that are reasonable for application in a clinical system. We outline further experimentation to test our proposed system and compare our findings to emerging closed-loop neuromodulation strategies.

Cross-regional phase amplitude coupling supports the encoding of episodic memories.

Phase amplitude coupling (PAC) between theta and gamma oscillations represents a key neurophysiological mechanism that promotes the temporal organization of oscillatory activity. For this reason, PAC has been implicated in item/context integration for episodic processes, including coordinating activity across multiple cortical regions. While data in humans has focused principally on PAC within a single brain region, data in rodents has revealed evidence that the phase of the hippocampal theta oscillation modulates gamma oscillations in the cortex (and vice versa). This pattern, termed cross-regional PAC (xPAC), has not previously been observed in human subjects engaged in mnemonic processing. We use a unique dataset with intracranial electrodes inserted simultaneously into the hippocampus and seven cortical regions across 40 human subjects to (1) test for the presence of significant cross-regional PAC (xPAC), (2) to establish that the magnitude of xPAC predicts memory encoding success, (3) to describe specific frequencies within the broad 2-9 Hz theta range that govern hippocampal-cortical interactions in xPAC, and (4) compare anterior versus posterior hippocampal xPAC patterns. We find that strong functional xPAC occurs principally between the hippocampus and other mesial temporal structures, namely entorhinal and parahippocampal cortices, and that xPAC is overall stronger for posterior hippocampal connections. We also show that our results are not confounded by alternative factors such as inter-regional phase synchrony, local PAC occurring within cortical regions, or artifactual theta oscillatory waveforms.

[Nutritional situation of venezuelan migrant children upon entry into Peru and the actions taken to protect their health and nutrition]. / Situación nutricional de los niños migrantes venezolanos a su ingreso al Perú y las acciones emprendidas para proteger su salud y nutrición.

The high level of Venezuelan migration is a great challenge for Peru due to the healthcare needs of immigrants. Worryingly, children under the age of five are the most vulnerable. In order to know the nutritional status of this group in migratory transit to Peru, a descriptive study was carried out with two rounds of data collection (August 2018 and March 2019) at the Binational Border Healthcare Center in Tumbes. In each round, nutritional status, morbidity and food characteristics were determined for 322 and 619 Venezuelan children under the age of five, as well as any health and nutrition actions implemented upon their entry into Peru. For each round, acute malnutrition affected 3.2% and 3.0%; chronic malnutrition 16.5% and 17.9%; anemia 34.8% and 25.0%; cough or shortness of breath was present in 31.3% and 17.6%; diarrhea in 16.6% and 9.9%. Nearly seven out of ten children under the age of two breastfed the day before. During the migratory journey and for each round, 58.3% and 47.0% of children under two years of age increased their frequency of breastfeeding, the minimum meal frequency (MMF) was met only by 13.9% and 18.0%. While the timely reaction in terms of healthcare and nutrition facing the inflow of migrant population is a good first step, the health system needs to generate the conditions so that health services can provide coverage with adequate quality to the entire population residing in the national territory, under the premise that the right to health is for everybody without any type of exclusion.

La elevada migración venezolana ha mostrado ser un gran desafío para el Perú debido a las necesidades de atención que requieren los inmigrantes. De modo preocupante, los menores de cinco años son quienes se encuentran más vulnerables. A fin de conocer el estado nutricional de este grupo en tránsito migratorio al Perú, se realizó un estudio descriptivo con dos rondas de recolección de datos (agosto de 2018 y marzo de 2019) en el Centro Binacional de Atención Fronteriza de Tumbes. En cada ronda, a 322 y 619 niños venezolanos menores de cinco años se determinó su estado nutricional, morbilidad y características de la alimentación, así como las acciones de salud y nutrición implementadas al momento de su ingreso al Perú. Para cada ronda, la desnutrición aguda afectó al 3,2% y 3,0%, la desnutrición crónica al 16,5% y 17,9%, la anemia al 34,8% y 25,0%, la tos o dificultad para respirar estuvo presente en el 31,3% y 17,6%, las diarreas en el 16,6% y 9,9%. Cerca de siete de cada diez niños menores de dos años lactó el día previo. Durante el viaje migratorio y para cada ronda, el 58,3% y 47,0% de los niños menores de dos años aumentó la frecuencia de lactadas, la frecuencia mínima de alimentación (FMA) fueron alcanzadas sólo por el 13,9% y 18,0%. La reacción oportuna de atención en salud y nutrición frente al ingreso de la población migrante es un buen primer paso, el sistema de salud necesita generar las condiciones para que los servicios de salud puedan brindar la cobertura con la calidad adecuada a toda la población que reside en el territorio nacional, bajo el enfoque de que el derecho a la salud corresponde a todas las personas sin ningún tipo de exclusión.

Situación nutricional de los niños migrantes venezolanos a su ingreso al Perú y las acciones emprendidas para proteger su salud y nutrición / Nutritional situation of venezuelan migrant children upon entry into Peru and the actions taken to protect their health and nutrition

RESUMEN La elevada migración venezolana ha mostrado ser un gran desafío para el Perú debido a las necesidades de atención que requieren los inmigrantes. De modo preocupante, los menores de cinco años son quienes se encuentran más vulnerables. A fin de conocer el estado nutricional de este grupo en tránsito migratorio al Perú, se realizó un estudio descriptivo con dos rondas de recolección de datos (agosto de 2018 y marzo de 2019) en el Centro Binacional de Atención Fronteriza de Tumbes. En cada ronda, a 322 y 619 niños venezolanos menores de cinco años se determinó su estado nutricional, morbilidad y características de la alimentación, así como las acciones de salud y nutrición implementadas al momento de su ingreso al Perú. Para cada ronda, la desnutrición aguda afectó al 3,2% y 3,0%, la desnutrición crónica al 16,5% y 17,9%, la anemia al 34,8% y 25,0%, la tos o dificultad para respirar estuvo presente en el 31,3% y 17,6%, las diarreas en el 16,6% y 9,9%. Cerca de siete de cada diez niños menores de dos años lactó el día previo. Durante el viaje migratorio y para cada ronda, el 58,3% y 47,0% de los niños menores de dos años aumentó la frecuencia de lactadas, la frecuencia mínima de alimentación (FMA) fueron alcanzadas sólo por el 13,9% y 18,0%. La reacción oportuna de atención en salud y nutrición frente al ingreso de la población migrante es un buen primer paso, el sistema de salud necesita generar las condiciones para que los servicios de salud puedan brindar la cobertura con la calidad adecuada a toda la población que reside en el territorio nacional, bajo el enfoque de que el derecho a la salud corresponde a todas las personas sin ningún tipo de exclusión.

ABSTRACT The high level of Venezuelan migration is a great challenge for Peru due to the healthcare needs of immigrants. Worryingly, children under the age of five are the most vulnerable. In order to know the nutritional status of this group in migratory transit to Peru, a descriptive study was carried out with two rounds of data collection (August 2018 and March 2019) at the Binational Border Healthcare Center in Tumbes. In each round, nutritional status, morbidity and food characteristics were determined for 322 and 619 Venezuelan children under the age of five, as well as any health and nutrition actions implemented upon their entry into Peru. For each round, acute malnutrition affected 3.2% and 3.0%; chronic malnutrition 16.5% and 17.9%; anemia 34.8% and 25.0%; cough or shortness of breath was present in 31.3% and 17.6%; diarrhea in 16.6% and 9.9%. Nearly seven out of ten children under the age of two breastfed the day before. During the migratory journey and for each round, 58.3% and 47.0% of children under two years of age increased their frequency of breastfeeding, the minimum meal frequency (MMF) was met only by 13.9% and 18.0%. While the timely reaction in terms of healthcare and nutrition facing the inflow of migrant population is a good first step, the health system needs to generate the conditions so that health services can provide coverage with adequate quality to the entire population residing in the national territory, under the premise that the right to health is for everybody without any type of exclusion.

Subspace Averaging of Auditory Evoked Potentials.

The auditory evoked potential (AEP) is an electric potential generated in the brain in response to auditory stimuli. It has clinical importance in the detection of newborn infant hearing loss, among other applications. The signal-to-noise ratio (SNR) of the AEP is low, so signal averaging is typically employed to estimate it. Often, thousands of trials must be averaged before a sufficiently high SNR estimate is obtained. In this research, we have developed an AEP averaging method called subspace averaging. The subspace averaging method projects onto the signal subspace: the span of the principal eigenvectors of the signal autocorrelation matrix. The signal subspace has low dimensionality and captures the key features of the signal. Also, we introduce a new SNR estimator for AEP trials. Using our estimator, we compare SNR estimates of conventional averaging and subspace averaging. The subspace average has higher SNR compared to the conventional average.

Inestabilidad cronica lateral del tobillo: comparacion entre la reparacion de brostrom-gould y una tecnica artroscopica / Chronic Lateral Ankle Instability: Comparison Between Brostrom-Gould Repair And An Arthroscopic Technique

Introducción La inestabilidad crónica lateral del tobillo es una patología frecuente en las personas que sufren esguinces. El tratamiento inicial es conservador y de no funcionar se recomienda el tratamiento quirúrgico; la técnica descrita por Broström y modificada por Gould es la más utilizada, efectiva y reportada en la actualidad. Con el advenimiento de la cirugía artroscópica, uno de los autores (JBGG) ha desarrollado una técnica mínimamente invasiva que se ha utilizado en la unidad de pie desde hace 8 años. Este trabajo evalúa los resultados funcionales, de dolor y cicatrización de los pacientes tratados con la técnica Artroscópica y la técnica de Broström-Gould abierta. Materiales & Métodos Se evaluaron un total de 111 pacientes, 50 con la técnica abierta y 61 con técnica artroscópica, operados por inestabilidad lateral crónica del tobillo entre enero de 2004 y diciembre de 2011. Se utilizo la escala AOFAS de tobillo y retropié para la medición del dolor, función y alineación, y la escala EVA para la medición del dolor. Resultados El promedio de puntuación final de la escala AOFAS fue de 90 puntos y la inestabilidad se revirtió en el 96% de los casos, para ambos grupo de pacientes. El dolor fue aliviado eficientemente por ambas técnicas. No se observaron diferencias estadísticamente significativas entre los grupos del estudio. Discusión La reparación artroscópica de la inestabilidad crónica lateral del tobillo fue tan efectiva para restablecer la función, estabilidad y eliminar el dolor del tobillo como la técnica abierta y puede tener una menor posibilidad de complicaciones relacionadas con las heridas.

Background Chronic lateral ankle instability is a common condition in people with inversion sprains. Initial treatment is conservative, and if that does not work a surgical approach is recommended, such as that described by Broström and later modified by Gould, and is the most used and effective. With the advent of arthroscopic surgery, one of the authors (JBGG) has recently developed a minimally invasive technique that has been used in the Surgical Foot and Ankle Unit of Imbanaco Medical Centre for 8 years. Therefore, this work aims to determine functional outcomes of patients treated with the arthroscopic technique compared with the open technique of Broström-Gould. Methods A total of 111 patients were evaluated, including 50 with the open method, and 61 with arthroscopic surgery technique for chronic lateral ankle instability between January 2004 and December 2011. The American orthopaedic foot and ankle score (AOFAS) scale for ankle and hindfoot was used for measuring pain, function, and alignment, and a visual analogue scale (VAS) was used to assess the pain. Results The final AOFAS score was 90 points, and instability was reversed in 96% of cases, for both groups of patients. The pain was relieved efficiently by both techniques. There were no statistically significant differences between the study groups. Discussion Arthroscopic repair of chronic lateral ankle instability is an effective tool to restore the function and stability, as well as eliminate ankle pain, and is comparable in effectiveness with the conventional technique. Additionally, there is a lower chance of complications related to wounds.