Development of a crowdsourcing- and gamification-based mobile application to collect epidemiological information and promote healthy lifestyles in Mexico.

We developed a mobile application to promote healthy lifestyles and collect non-communicable disease (NCD) data in Mexico. Its theoretical foundations are supported by a framework-guided literature review. With design sprints, Scrum, Model-View-Controller, and Representational State Transfer architecture, we operationalized evidence-based nutrition/physical activity information into a crowdsourcing- and gamification-based application. The application was piloted for three months to monitor the response of 520 adults. Potential improvements were characterized, considering benchmarking, expert guidance, and standards. Salud Activa (English: Active Health) has two crowdsourcing modules: Nutritional scanner, scanning products' bar codes, providing nutritional data, and allowing new product registry feeding our databases; Surveys, comprising gradually-released NCD questions. Three intervention modules were generated: Drinks diary, a beverage assessment component to receive hydration recommendations; Step counter, monitoring users' steps via Google Fit/Health-iOS; Metabolic Avatar, interconnecting modules and changing as a function of beverage and step records. The 3-month median of Salud Activa use was seven days (IQR = 3-12), up to 35% of participants completed a Survey section, and 157 food products were registered through Nutritional scanner. Better customization might benefit usability and user engagement. Quantitative and qualitative data will enhance Salud Activa's design, user uptake, and efficacy in interventions delivered through this platform.

Mensajes persuasivos en redes sociales de la industria de alimentos y bebidas no saludables.

OBJETIVO: Identificar los mensajes persuasivos usados por la industria de alimentos y bebidas no saludables en las redes sociales más visitadas por niñas, niños y adolescentes mexicanos y determinar a qué grupo de edad estaban dirigidos. Material y métodos. Se analizaron 892 anuncios de los 20 productos y marcas de alimentos y bebidas no saludables más consumidas en México publicados en las cuentas oficiales de dichos productos y marcas en YouTube, Facebook e Instagram. Se determinó el mensaje primario y el público objetivo (niños, adolescentes o ambos) y se clasificó como emocional o racional. RESULTADOS: En Facebook, la proporción de anuncios con mensajes emocionales (50.7%) y mensajes racionales (49.3%) fue similar. En YouTube hubo mayor proporción de mensajes racionales (60.2%). Se encontraron 2.9 más posibilidades de que un mensaje persuasivo emocional se dirija a niños o adolescentes en comparación con mensajes que no tienen publicidad dirigida. Conclusión. La naturaleza de los mensajes persuasivos analizados depende de la red social en la que se presentaron. La industria alimentaria dirige sus mensajes a niños o adolescentes, razón por la que es importante regular la publicidad de alimentos y bebidas no saludables en redes sociales que busca influir en el comportamiento y las decisiones de compra de niñas, niños y adolescentes.

Complicaciones a corto y largo plazo de la cirugía bariátrica

La obesidad afecta sobre todo a hombres y mujeres jóvenes, tanto en países desarrollados como en vías de desarrollo. Los tratamientos farmacológicos han demostrado ser ineficaces, quedando la cirugía como única opción terapéutica. Los procedimientos bariátricos, a pesar de realizarse por cirugía mínimamente invasiva, no están libres de presentar complicaciones posoperatorias. El presente artículo tiene el objetivo de realizar un análisis crítico de las complicaciones posoperatorias a corto y largo plazo de la cirugía bariátrica. Se efectuó una revisión bibliográfica de reportes y series de casos, así como de revisiones bibliográficas; en idioma inglés, español y portugués, publicados desde enero de 2005 hasta a noviembre de 2022, en revistas nacionales e internacionales indexadas en bases de datos reconocidas. Las palabras clave empleadas fueron: cirugía laparoscópica, cirugía bariátrica y complicaciones posoperatorias. Los procedimientos quirúrgicos más realizados y de mayor aceptación son la manga gástrica y el bypass gástrico. Las principales complicaciones a corto plazo son: fuga de la anastomosis, fallo de la línea de grapas, fístulas y sangrado gastrointestinal. Las complicaciones a largo plazo están dadas por: anemia, déficit de vitaminas y minerales, estenosis de la manga gástrica, hernias internas y reganancia del peso corporal.

Obesity affects mostly young men and women, both in developed and developing countries. Pharmacological treatments have proven to be ineffective, leaving surgery as the only therapeutic option. Bariatric procedures, despite being performed by minimally invasive surgery, are not free from presenting postoperative complications. The objective of this article is to carry out a critical analysis of the short and long-term postoperative complications of bariatric surgery. A bibliographic review of case reports and series, as well as bibliographic reviews was carried out; in English, Spanish and Portuguese, published from January 2005 to November 2022, in national and international journals indexed in recognized databases. The keywords used were: laparoscopic surgery, bariatric surgery and postoperative complications. The most widely performed and widely accepted surgical procedures are the gastric sleeve and gastric bypass. The main short-term complications are: anastomotic leakage, staple line failure, fistulas and gastrointestinal bleeding. Long-term complications are given by: anemia, vitamin and mineral deficiency, gastric sleeve stenosis, internal hernias and gain of body weight.

Modelling the impact of sodium intake on cardiovascular disease mortality in Mexico.

BACKGROUND: Cardiovascular diseases (CVD) represent the main cause of death in Mexico, while high blood pressure is suffered by about half of the adult population. Sodium intake is one of the main risk factors for these diseases. The Mexican adult population consumes about 3.1 g/day, an amount that exceeds what is recommended by the World Health Organization (WHO) < 2 g sodium/day. The objective of this study was to estimate the impact of reducing sodium intake on CVD mortality in Mexico using a scenario simulation model. METHODS: The Integrated Model of Preventable Risk (PRIME) was used to estimate the number of deaths prevented or postponed (DPP) due to CVD in the Mexican adult population following the following sodium intake reduction scenarios: (a) according to the WHO recommendations; (b) an "optimistic" reduction of 30%; and (c) an "intermediate" reduction of 10%. RESULTS: The results show that a total of 27,700 CVD deaths could be prevented or postponed for scenario A, 13,900 deaths for scenario B, and 5,800 for scenario C. For all scenarios, the highest percentages of DPP by type of CVD are related to ischemic heart disease, hypertensive disease, and stroke. CONCLUSIONS: The results show that if Mexico considers implementing policies with greater impact to reduce sodium/salt consumption, a significant number of deaths from CVD could be prevented or postponed.

Digital food and beverage marketing appealing to children and adolescents: An emerging challenge in Mexico.

BACKGROUND: Digital food marketing is increasing and has an impact on children's behaviour. Limited research has been performed in Latin America. OBJECTIVES: To determine the extent and nature of Mexican children's and adolescents' exposure to digital food and beverage marketing during recreational internet use. METHODS: A crowdsourcing strategy was used to recruit 347 participants during the COVID-19 lockdown. Participants completed a survey and recorded 45 minutes of their device's screen time using screen-capture software. Food marketing was identified and nutrition information for each marketed product was collected. Healthfulness of products was determined using the Pan-American Health Organization and the Mexican Nutrient Profile Model (NPM). A content analysis was undertaken to assess marketing techniques. RESULTS: Overall, 69.5% of children and adolescents were exposed to digital food marketing. Most frequently marketed foods were ready-made foods. Children and adolescents would typically see a median of 2.7 food marketing exposures per hour, 8 daily exposures during a weekday and 6.7 during a weekend day. We estimated 47.3 food marketing exposures per week (2461 per year). The most used marketing technique was brand characters. Marketing was appealing to children and adolescents yet most of the products were not permitted for marketing to children according to the NPMs (>90%). CONCLUSIONS: Mexican children and adolescents were exposed to unhealthy digital food marketing. The Government should enforce evidence-based mandatory regulations on digital media.

The nature and extent of food marketing on Facebook, Instagram, and YouTube posts in Mexico.

Food and beverage marketing appealing to children and adolescents has an impact on their food preferences, purchases requests, consumption patterns, health outcomes, and obesity. The objective of this study was to assess the nature and extent of food and beverage marketing on Facebook, Instagram, and YouTube posts in Mexico. This was a content analysis that followed the World Health Organization CLICK methodology to comprehend the landscape of digital food marketing campaigns of the top-selling food products and brands and the most popular accounts carried out between September and October 2020. A total of 926 posts from 12 food and beverage products and 8 brands were included. Facebook was the social media platform with the most posts and greatest engagement. The most prevalent marketing techniques were brand logo, image of packaging, image of the product itself, hashtags, and engagement to consume. Fifty percent of the posts were assessed as appealing to children, 66% to adolescents, and 80% to either children or adolescents. Ninety-one percent of products (n = 1250) were classified as unhealthy according to the Mexican warning labels nutrient profile; 93% of the food promoted on posts appealing to either children or adolescents were unhealthy. Hashtags commonly referred to the COVID-19 pandemic. Most of the unhealthy food digital marketing features marketing techniques that appeal to children or adolescents; moreover, the use of the pandemic hashtag reflected brands' responsiveness to the environment at the time of the study. The present data contribute to evidence supporting the strengthening of food marketing regulations in Mexico.

24-hour sodium and potassium excretion in the Americas: a systematic review and meta-analysis.

Objective: To determine the 24-hour urinary sodium and potassium excretions in the Americas. Methods: A systematic review and meta-analysis were performed seeking for studies conducted between 1990 and 2021 in adults living in any sovereign state of the Americas in Medline, Embase, Scopus, SciELO, and Lilacs. The search was first run on October 26th, 2020 and was updated on December 15th, 2021. Of 3 941 abstracts reviewed, 74 studies were included from 14 countries, 72 studies reporting urinary sodium (27 387 adults), and 42 studies reporting urinary potassium (19 610 adults) carried out between 1990 and 2020. Data were pooled using a random-effects meta-analysis model. Results: Mean excretion was 157.29 mmol/24h (95% CI, 151.42-163.16) for sodium and 57.69 mmol/24h (95% CI, 53.35-62.03) for potassium. When only women were considered, mean excretion was 135.81 mmol/24h (95% CI, 130.37-141.25) for sodium and 51.73 mmol/24h (95% CI, 48.77-54.70) for potassium. In men, mean excretion was 169.39 mmol/24h (95% CI, 162.14-176.64) for sodium and 62.67 mmol/24h (95% CI, 55.41-69.93) for potassium. Mean sodium excretion was 150.09 mmol/24h (95% CI, 137.87-162.30) in the 1990s and 159.79 mmol/24h (95% CI, 151.63-167.95) in the 2010s. Mean potassium excretion was 58.64 mmol/24h (95% CI, 52.73-64.55) in the 1990s and 56.33 mmol/24/h (95% CI, 48.65-64.00) in the 2010s. Conclusions: These findings suggest that sodium excretions are almost double the maximum level recommended by the World Health Organization and potassium excretions are 35% lower than the minimum requirement; therefore, major efforts to reduce sodium and to increase potassium intakes should be implemented.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud.

La creciente epidemia de obesidad ha sido uno de los retos más importantes de salud pública en México durante los últimos años. Con apoyo de la Federación Mundial de Obesidad, en 2021 formamos un grupo de profesionales para identificar y resumir las acciones prioritarias en las que puede enfocarse nuestro país para hacer frente a esta epidemia. Al proceso de desarrollo y discusión de este grupo se sumaron más de 1 000 profesionales de la salud para retomar recomendaciones de documentos y guías de alto nivel previamente publicados. En conmemoración del Día Mundial de la Obesidad, en este 2022 se presenta esta postura como insumo para el desarrollo de acciones en el ámbito profesional y de los diferentes sectores, en la que se incluyen 10 recomendaciones de acción, desde la perspectiva poblacional hasta la atención individualizada, y se enfatiza en la importancia de la participación social, de las intervenciones integrales con visión centrada en la persona y de la sostenibilidad planetaria, además de mejorar la educación y las campañas de difusión, propiciar un ambiente promotor de entornos activos y blindar de conflictos de interés los esfuerzos de prevención y control. La postura hace un llamado para abordar la obesidad de manera seria, con base en la evidencia científica, oportuna e integral, con enfoque de curso de vida, de forma ética y sensible, y sin perpetuar las barreras del estigma de peso en la sociedad.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud / Becoming better: the need for immediate action to address obesity. A position statement from health professionals

resumen está disponible en el texto completo

Abstract: In recent decades, the growing obesity epidemic in Mexico has become one of the most important public health challenges faced by the country. With support from the World Obesity Federation, we formed a working group in 2021 to identify and summarize priority actions that Mexico can take to face this epidemic. More than 1 000 health professionals joined the development and discussion process. Recommendations from previously published, high-level documents and guidelines were taken into account. In commemoration of World Obesity Day 2022, this statement is presented as input for health care professionals to develop actions to address obesity. The statement includes 10 recommendations that include population-level and individual-level actions. It emphasizes the importance of social participation, comprehensive interventions with a person- centered perspective, planetary sustainability, on improving education and communication campaigns, as well as fostering a built environment that promotes active living, and shielding prevention and control efforts from conflicts of interest. The statement calls for obesity to be treated seriously, based on scientific evidence, in a timely and comprehensive manner, employing a life-course and ethical approach that does not perpetuate weight stigma in society.

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections: A Randomized Clinical Trial.

Importance: The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. Objective: To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. Design, Setting, and Participants: This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. Interventions: Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or parenteral ertapenem for the comparator group after 4 days. Main Outcomes and Measures: The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. Results: Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to ∞ percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI, -∞ to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). Conclusions and Relevance: This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections. Trial Registration: ClinicalTrials.gov Identifier: NCT02142751.

24-hour sodium and potassium excretion in the Americas: a systematic review and meta-analysis / Excreción de sodio y potasio en 24 horas en la Región de las Américas: revisión sistemática y metanálisis / Excreção de sódio e potássio em 24 horas na Região das Américas: revisão sistemática e meta-análise

ABSTRACT Objective. To determine the 24-hour urinary sodium and potassium excretions in the Americas. Methods. A systematic review and meta-analysis were performed seeking for studies conducted between 1990 and 2021 in adults living in any sovereign state of the Americas in Medline, Embase, Scopus, SciELO, and Lilacs. The search was first run on October 26th, 2020 and was updated on December 15th, 2021. Of 3 941 abstracts reviewed, 74 studies were included from 14 countries, 72 studies reporting urinary sodium (27 387 adults), and 42 studies reporting urinary potassium (19 610 adults) carried out between 1990 and 2020. Data were pooled using a random-effects meta-analysis model. Results. Mean excretion was 157.29 mmol/24h (95% CI, 151.42-163.16) for sodium and 57.69 mmol/24h (95% CI, 53.35-62.03) for potassium. When only women were considered, mean excretion was 135.81 mmol/24h (95% CI, 130.37-141.25) for sodium and 51.73 mmol/24h (95% CI, 48.77-54.70) for potassium. In men, mean excretion was 169.39 mmol/24h (95% CI, 162.14-176.64) for sodium and 62.67 mmol/24h (95% CI, 55.41-69.93) for potassium. Mean sodium excretion was 150.09 mmol/24h (95% CI, 137.87-162.30) in the 1990s and 159.79 mmol/24h (95% CI, 151.63-167.95) in the 2010s. Mean potassium excretion was 58.64 mmol/24h (95% CI, 52.73-64.55) in the 1990s and 56.33 mmol/24/h (95% CI, 48.65-64.00) in the 2010s. Conclusions. These findings suggest that sodium excretions are almost double the maximum level recommended by the World Health Organization and potassium excretions are 35% lower than the minimum requirement; therefore, major efforts to reduce sodium and to increase potassium intakes should be implemented.

RESUMEN Objetivo. Determinar la excreción urinaria de sodio y potasio en 24 horas en la Región de las Américas. Métodos. Se realizaron una revisión sistemática y un metanálisis en busca de estudios realizados entre los años 1990 y 2021 con adultos residentes en cualquier Estado soberano de la Región publicados en Medline, Embase, Scopus, SciELO y Lilacs. La búsqueda se llevó a cabo por primera vez el 26 de octubre del 2020 y se actualizó el 15 de diciembre del 2021. De los 3941 resúmenes revisados, se incluyeron 74 estudios de 14 países, 72 estudios sobre excreción urinaria de sodio (27 387 adultos) y 42 estudios sobre excreción urinaria de potasio (19 610 adultos) realizados entre el 1990 y el 2020. Se agruparon los datos mediante un modelo de metanálisis de efectos aleatorios. Resultados. La excreción media de sodio fue de 157,29 mmol/24h (IC de 95%, 151,42-163,16); la de potasio, de 57,69 mmol/24 h (IC de 95%, 53,35-62,03). En los casos en que se consideraron únicamente mujeres, la excreción media de sodio fue de 135,81 mmol/24h (IC de 95%, 130,37-141,25); la de potasio, de 51,73 mmol/24h (IC de 95%, 48,77-54,70). En varones, la excreción media de sodio fue de 169,39 mmol/24h (IC de 95%, 162,14-176,64); la de potasio, de 62,67 mmol/24h (IC de 95%, 55,41-69,93). La excreción media de sodio fue de 150,09 mmol/24h (IC de 95%, 137,87-162,30) en la década de 1990 y de 159,79 mmol/24 h (IC de 95%, 151,63-167,95) en la década del 2010. La excreción media de potasio fue de 58,64 mmol/24h (IC de 95%, 52,73-64,55) en la década de 1990 y de 56,33 mmol/24h (IC de 95%, 48,65-64,00) en la década del 2010. Conclusiones. Estos resultados sugieren que la excreción de sodio casi duplica el nivel máximo recomendado por la Organización Mundial de la Salud y las excreción de potasio es 35% más baja que el requisito mínimo, por lo que se deben invertir grandes esfuerzos para reducir el consumo de sodio y aumentar la ingesta de potasio.

RESUMO Objetivo. Determinar as excreções urinárias de sódio e potássio em 24 horas na Região das Américas. Métodos. Revisão sistemática e metanálise de estudos realizados entre 1990 e 2021, em adultos vivendo em qualquer estado soberano da região, indexados nos bancos de dados MEDLINE, Embase, Scopus, SciELO e LILACS. A pesquisa foi realizada pela primeira vez em 26 de outubro de 2020 e foi atualizada em 15 de dezembro de 2021. Dos 3.941 resumos revisados, foram incluídos 74 estudos de 14 países, 72 estudos relatando sódio urinário (27.387 adultos) e 42 estudos relatando potássio urinário (19.610 adultos), realizados entre 1990 e 2020. Os dados foram reunidos utilizando um modelo de metanálise de efeitos aleatórios. Resultados. A excreção média foi de 157,29 mmol/24h (IC95% 151,42-163,16) para o sódio e 57,69 mmol/24h (IC95% 53,35-62,03) para o potássio. Quando somente mulheres foram consideradas, a excreção média foi de 135,81 mmol/24h (IC95% 130,37-141,25) para o sódio e 51,73 mmol/24h (IC95% 48,77-54,70) para o potássio. Nos homens, a excreção média foi de 169,39 mmol/24h (IC95% 162,14-176,64) para o sódio e 62,67 mmol/24h (IC95% 55,41-69,93) para o potássio. A excreção média de sódio foi de 150,09 mmol/24h (IC95% 137,87-162,30) na década de 1990 e 159,79 mmol/24h (IC95% 151,63-167,95) na década de 2010. A excreção média de potássio foi de 58,64 mmol/24h (IC95% 52,73-64,55) na década de 1990 e 56,33 mmol/24/h (IC95% 48,65-64,00) na década de 2010. Conclusões. Estes achados sugerem que as excreções de sódio são quase o dobro do nível máximo recomendado pela Organização Mundial da Saúde e as excreções de potássio são 35% menores do que o mínimo exigido; portanto, será necessário envidar esforços importantes para reduzir a ingestão de sódio e aumentar a de potássio.

Combination versus monotherapy as definitive treatment for Pseudomonas aeruginosa bacteraemia: a multicentre retrospective observational cohort study.

BACKGROUND: Pseudomonas aeruginosa bacteraemia is a common and serious infection. No consensus exists regarding whether definitive combination therapy is superior to monotherapy. We aimed to evaluate the impact of combination therapy on mortality. METHODS: This was a multicentre retrospective study (nine countries, 25 centres), including 1277 patients with P. aeruginosa bacteraemia during 2009-15. We evaluated the association between ß-lactam plus aminoglycoside or quinolone combination therapy versus ß-lactam monotherapy and mortality. The primary outcome was 30 day all-cause mortality. Univariate and multivariate Cox regression analyses were conducted, introducing combination as a time-dependent variable. Propensity score was conducted to adjust for confounding for choosing combination therapy over monotherapy. RESULTS: Of 1119 patients included, 843 received definitive monotherapy and 276 received combination therapy (59% aminoglycoside and 41% quinolone). Mortality at 30 days was 16.9% (189/1119) and was similar between combination (45/276; 16.3%) and monotherapy (144/843; 17.1%) groups (P = 0.765). In multivariate Cox regression, combination therapy was not associated with reduced mortality (HR 0.98, 95% CI 0.64-1.53). No advantage in terms of clinical failure, microbiological failure or recurrent/persistent bacteraemia was demonstrated using combination therapy. Likewise, adverse events and resistance development were similar for the two regimens. CONCLUSIONS: In this retrospective cohort, no mortality advantage was demonstrated using combination therapy over monotherapy for P. aeruginosa bacteraemia. Combination therapy did not improve clinical or microbiological failure rates, nor affect adverse events or resistance development. Our finding of no benefit with combination therapy needs confirmation in well-designed randomized controlled trials.

Collaborative Robotic Assistant Platform for Endonasal Surgery: Preliminary In-Vitro Trials.

Endonasal surgery is a minimally invasive approach for the removal of pituitary tumors (sarcomas). In this type of procedure, the surgeon has to complete the surgical maneuvers for sarcoma resection with extreme precision, as there are many vital structures in this area. Therefore, the use of robots for this type of intervention could increase the success of the intervention by providing accurate movements. Research has focused on the development of teleoperated robots to handle a surgical instrument, including the use of virtual fixtures to delimit the working area. This paper aims to go a step further with a platform that includes a teleoperated robot and an autonomous robot dedicated to secondary tasks. In this way, the aim is to reduce the surgeon's workload so that he can concentrate on his main task. Thus, the article focuses on the description and implementation of a navigator that coordinates both robots via a force/position control. Finally, both the navigation and control scheme were validated by in-vitro tests.

How the Language of Instruction Influences Mathematical Thinking Development in the First Years of Bilingual Schoolers.

The present research study focuses on how the language of instruction has an impact on the mathematical thinking development as a consequence of using a language of instruction different from the students' mother tongue. In CLIL (Content and Language Integrated Learning) academic content and a foreign language are leant at the same time, a methodology that is widely used in the schools in the present times. It is, therefore, our main aim to study if the language of instruction in second language immersion programs influences the development of the first formal mathematical concepts. More specifically, if the learning of mathematical concepts in the early ages develops in a similar way if it is taught in the students' mother tongue and is not influenced by the language used for teaching. Or else, if it can influence the development of the first skills only in the students' general performance or in certain areas. The results of both the analysis of variance and multiple regression confirm how influencing the language of instruction is when mathematical thinking is developed teaching formal contents in a non-coincidence language. The second language is affecting the resolution of daily life problems, being more competent those students in 1st grades whose language of instruction matched with their mother tongue.

An Overview of Social Media Use in the Field of Public Health Nutrition: Benefits, Scope, Limitations, and a Latin American Experience.

Social media platforms are low-cost tools that can be used to address issues in public health nutrition, especially in countries where health-related institutions experience economic limitations. We aimed to emphasize the benefits of using social media to promote health that have been documented to date. To show social media's positive impact on population health literacy, we briefly describe an inexpensive systematic communication strategy implemented in our research center through 2 social media platforms, the lessons learned, and the strategy's short-term results. Because social media use in public health is a new field of study, this perspective also focuses on the current limitations and gaps in evidence that need to be addressed to translate the best practices into policy recommendations. In conclusion, the perspective highlights the role that health actors and governments should take to maximize the benefits of social media use.

A Constructivist Intervention Program for the Improvement of Mathematical Performance Based on Empiric Developmental Results (PEIM).

Teaching mathematics and improving mathematics competence are pending subjects within our educational system. The PEIM (Programa Evolutivo Instruccional para Matemáticas), a constructivist intervention program for the improvement of mathematical performance, affects the different agents involved in math learning, guaranteeing a significant improvement in students' performance. The program is based on the following pillars: (a) students become the main agents of their learning by constructing their own knowledge; (b) the teacher must be the guide to facilitate and guarantee such a construction by being a great connoisseur of the fundamental aspects of the development of the child's mathematical thinking; (c) the mathematical contents must be sequenced in terms of the complexity and significance for the student as well as contextualized at all times; and (d) the classroom must have a constructivist climate highlighting cooperative work among students. The implementation of PEIM along with the empirical evaluation conducted in several centers in Madrid and Zaragoza (Spain) confirm how students improve their mathematical competence. Both first- and second-grade students in elementary education were far more effective in solving problems, highlighting the use of more advanced strategies in their resolution and a lower incidence of conceptual errors. Moreover, it was possible to verify how the students proving greater difficulty, experienced an evolution in learning similarly to those who did not present it. The program provides customized education to allow the teacher to know at all times how he should be more influential on the students' learning through mathematical profiles. Both teaching practice and teachers were observed, being that of the experimental group more prone to analyzing processes and allowing the construction of knowledge by students, due to their psycho-developmental training. As a result, we found several improvements through the implementation of the program that may serve, for upcoming years, as a basis for the necessary changes in the teaching of mathematics.

Ceftazidime, Carbapenems, or Piperacillin-tazobactam as Single Definitive Therapy for Pseudomonas aeruginosa Bloodstream Infection: A Multisite Retrospective Study.

BACKGROUND: The optimal antibiotic regimen for Pseudomonas aeruginosa bacteremia is controversial. Although ß-lactam monotherapy is common, data to guide the choice between antibiotics are scarce. We aimed to compare ceftazidime, carbapenems, and piperacillin-tazobactam as definitive monotherapy. METHODS: A multinational retrospective study (9 countries, 25 centers) including 767 hospitalized patients with P. aeruginosa bacteremia treated with ß-lactam monotherapy during 2009-2015. The primary outcome was 30-day all-cause mortality. Univariate and multivariate, including propensity-adjusted, analyses were conducted introducing monotherapy type as an independent variable. RESULTS: Thirty-day mortality was 37/213 (17.4%), 42/210 (20%), and 55/344 (16%) in the ceftazidime, carbapenem, and piperacillin-tazobactam groups, respectively. Type of monotherapy was not significantly associated with mortality in either univariate, multivariate, or propensity-adjusted analyses (odds ratio [OR], 1.14; 95% confidence interval [CI], 0.52-2.46, for ceftazidime; OR, 1.3; 95% CI, 0.67-2.51, for piperacillin-tazobactam, with carbapenems as reference in propensity adjusted multivariate analysis; 542 patients). No significant difference between antibiotics was demonstrated for clinical failure, microbiological failure, or adverse events. Isolation of P. aeruginosa with new resistance to antipseudomonal drugs was significantly more frequent with carbapenems (36/206 [17.5%]) versus ceftazidime (25/201 [12.4%]) and piperacillin-tazobactam (28/332 [8.4%] (P = .007). CONCLUSIONS: No significant difference in mortality, clinical, and microbiological outcomes or adverse events was demonstrated between ceftazidime, carbapenems, and piperacillin-tazobactam as definitive treatment of P. aeruginosa bacteremia. Higher rates of resistant P. aeruginosa after patients were treated with carbapenems, along with the general preference for carbapenem-sparing regimens, suggests using ceftazidime or piperacillin-tazobactam for treating susceptible infection.

Emotional Intelligence as an Evolutive Factor on Adult With ADHD.

Objective: ADHD adults exhibit deficits in emotion recognition, regulation, and expression. Emotional intelligence (EI) correlates with better life performance and is considered a skill that can be learned and developed. The aim of this study was to assess EI development as ability in ADHD adults, considering the effect of comorbid psychiatric disorders and previous diagnosis of ADHD. Method: Participants (n = 116) were distributed in four groups attending to current comorbidities and previous ADHD diagnosis, and administered the Mayer-Salovey-Caruso Emotional Intelligence Test version 2.0 to assess their EI level. Results: ADHD adults with comorbidity with no previous diagnosis had lower EI development than healthy controls and the rest of ADHD groups. In addition, ADHD severity in childhood or in adulthood did not influence the current EI level. Conclusion: EI development as a therapeutic approach could be of use in ADHD patients with comorbidities.

Risk factors for mortality among patients with Pseudomonas aeruginosa bacteraemia: a retrospective multicentre study.

This study aimed to evaluate risk factors for 30-day mortality among hospitalised patients with Pseudomonas aeruginosa bacteraemia, a highly fatal condition. A retrospective study was conducted between 1 January 2009 and 31 October 2015 in 25 centres (9 countries) including 2396 patients. Univariable and multivariable analyses of risk factors were conducted for the entire cohort and for patients surviving ≥48 h. A propensity score for predictors of appropriate empirical therapy was introduced into the analysis. Of the 2396 patients, 636 (26.5%) died within 30 days. Significant predictors (odds ratio and 95% confidence interval) of mortality in the multivariable analysis included patient-related factors: age (1.02, 1.01-1.03); female sex (1.34, 1.03-1.77); bedridden functional capacity (1.99, 1.24-3.21); recent hospitalisation (1.43, 1.07-1.92); concomitant corticosteroids (1.33, 1.02-1.73); and Charlson comorbidity index (1.05, 1.01-1.93). Infection-related factors were multidrug-resistant Pseudomonas (1.52, 1.15-2.1), non-urinary source (2.44, 1.54-3.85) and Sequential Organ Failure Assessment (SOFA) score (1.27, 1.18-1.36). Inappropriate empirical therapy was not associated with increased mortality (0.81, 0.49-1.33). Among 2135 patients surviving ≥48 h, hospital-acquired infection (1.59, 1.21-2.09), baseline endotracheal tube (1.63, 1.13-2.36) and ICU admission (1.53, 1.02-2.28) were additional risk factors. Risk factors for mortality among patients with P. aeruginosa were mostly irreversible. Early appropriate empirical therapy was not associated with reduced mortality. Further research should be conducted to explore subgroups that may not benefit from broad-spectrum antipseudomonal empirical therapy. Efforts should focus on prevention of infection, mainly hospital-acquired infection and multidrug-resistant pseudomonal infection.

[Contrast-enhanced ultrasound at a rare bilateral renal carcinoma with secondary inflammation and necrosis in a cat]. / Kontrastmittelsonografie bei einem seltenen bilateralen renalen Karzinom mit sekundärer Entzündung und Nekrose bei einer Katze.

A 17-year-old male neutered domestic short hair cat was presented because of anorexia. The clinical examination revealed no abnormalities. Using sonography, mainly hypoechoic mass lesions at the level of the cortex and capsule were detected in both kidneys. The severity of the renal lesions could be clearly demonstrated using contrast-enhanced ultrasound and contrast-enhanced computed tomography. Under general anesthesia, fine needle aspirations of the lesions were taken. Part of the lesions were sampled from dorsal, an unusual practice for small animal medicine. Cytology revealed a bilateral renal carcinoma with secondary inflammation and necrosis. The cat improved under medical symptomatic treatment, but was euthanized 2 weeks later.