Assessment of an intervention for preventing pediatric overweight and obesity through the World Café technique: A qualitative study.

PURPOSE: To evaluate the self-reported perspectives of participants involved in the Previene Cádiz intervention for preventing pediatric overweight and obesity. DESIGN AND METHODS: This qualitative study collected information through the World Café technique. A purposive sample of 40 participants was used, of which 14 were schoolchildren, 12 were teachers, and 14 were parent volunteers. The data were segmented, and concepts were created and grouped into dimensions and categories. RESULTS: The participants confirmed they had learned new information and behaviors about healthy habits. Parental awareness was considered a crucial and necessary element in changing family habits; therefore, increasing the motivation of family members was deemed a critical task in public health interventions conducted in school settings. DISCUSSION: Despite the suitability of qualitative methodology to evaluate the perceptions of the main players in an educational intervention, scientific literature is scarce. Obtaining information from the educational community about an intervention is not always easy, so the perspectives of teachers, students, and families about the Previene Cádiz intervention through the World Café approach is considered a relevant contribution. CONCLUSIONS: The participants considered the intervention positive in terms of learning and fostering increased knowledge, awareness, and healthy behaviors. PRACTICE IMPLICATIONS: Future interventions should encourage the active participation of all social groups involved, integrating dynamic and collaborative training activities that are acceptable to all participants.

Hepatitis B virus reactivation after ibrutinib treatment.

New immunosuppressive and antineoplastic drugs are becoming both more numerous and more widely used, even during several years. Most of them present a low-moderate risk of hepatitis B virus (HBV) reactivation in HBsAg-negative and anti-HBc-positive patients. However, their reactivation capacity has not been clearly studied. We present the clinical case of a patient with these serological characteristics who, after 5 years of treatment with ibrutinib for chronic lymphocytic leukaemia, developed VHB reactivation, which was controlled with tenofovir. The occurrence of this event with drugs such as ibrutinib may lead to changes in HBV reactivation prophylaxis.

Lethality risk markers by sex and age-group for COVID-19 in Mexico: a cross-sectional study based on machine learning approach.

BACKGROUND: Mexico ranks fifth worldwide in the number of deaths due to COVID-19. Identifying risk markers through easily accessible clinical data could help in the initial triage of COVID-19 patients and anticipate a fatal outcome, especially in the most socioeconomically disadvantaged regions. This study aims to identify markers that increase lethality risk in patients diagnosed with COVID-19, based on machine learning (ML) methods. Markers were differentiated by sex and age-group. METHODS: A total of 11,564 cases of COVID-19 in Mexico were extracted from the Epidemiological Surveillance System for Viral Respiratory Disease. Four ML classification methods were trained to predict lethality, and an interpretability approach was used to identify those markers. RESULTS: Models based on Extreme Gradient Boosting (XGBoost) yielded the best performance in a test set. This model achieved a sensitivity of 0.91, a specificity of 0.69, a positive predictive value of 0.344, and a negative predictive value of 0.965. For female patients, the leading markers are diabetes and arthralgia. For males, the main markers are chronic kidney disease (CKD) and chest pain. Dyspnea, hypertension, and polypnea increased the risk of death in both sexes. CONCLUSIONS: ML-based models using an interpretability approach successfully identified risk markers for lethality by sex and age. Our results indicate that age is the strongest demographic factor for a fatal outcome, while all other markers were consistent with previous clinical trials conducted in a Mexican population. The markers identified here could be used as an initial triage, especially in geographic areas with limited resources.

Economic burden of Cardiac Arrest in Spain: analyzing healthcare costs drivers and treatment strategies cost-effectiveness.

BACKGROUND: Cardiac arrest is a major public health issue in Europe. Cardiac arrest seems to be associated with a large socioeconomic burden in terms of resource utilization and health care costs. The aim of this study is the analysis of the economic burden of cardiac arrest in Spain and a cost-effectiveness analysis of the key intervention identified, especially in relation to neurological outcome at discharge. METHODS: The data comes from the information provided by 115 intensive care and cardiology units from Spain, including information on the care of patients with out-of-hospital cardiac arrest who had a return of spontaneous circulation. The information reported by theses 115 units was collected by a nationwide survey conducted between March and September 2020. Along with number of patients (2631), we also collect information about the structure of the units, temperature management, and prognostication assessments. In this study we analyze the potential association of several factors with neurological outcome at discharge, and the cost associated with the different factors. The cost-effectiveness of using servo-control for temperature management is analyzed by means of a decision model, based on the results of the survey and data collected in the literature, for a one-year and a lifetime time horizon. RESULTS: A total of 109 cardiology units provided results on neurological outcome at discharge as evaluated with the cerebral performance category (CPC). The most relevant factor associated with neurological outcome at discharge was 'servo-control use', showing a 12.8% decrease in patients with unfavorable neurological outcomes (i.e., CPC3-4 vs. CPC1-2). The total cost per patient (2020 Euros) was €73,502. Only "servo-control use" was associated with an increased mean total cost per hospital. Patients treated with servo-control for temperature management gained in the short term (1 year) an average of 0.039 QALYs over those who were treated with other methods at an increased cost of €70.8, leading to an incremental cost-effectiveness ratio of 1,808 euros. For a lifetime time horizon, the use of servo-control is both more effective and less costly than the alternative. CONCLUSIONS: Our results suggest the implementation of servo-control techniques in all the units that are involved in managing the cardiac arrest patient from admission until discharge from hospital to minimize the neurological damage to patients and to reduce costs to the health and social security system.

Effectiveness of exercise versus arthroscopic partial meniscectomy plus exercise in the management of degenerative meniscal tears at 5-year follow-up: a systematic review and meta-analysis.

INTRODUCTION: There are no meta-analytical data in the long term for comparing surgery and exercise for meniscal tear. The aim of this study is to compare the effectiveness of exercise versus arthroscopic partial meniscectomy (APM) plus exercise for degenerative meniscal tears (DMT) in knee function at 5-year follow-up. MATERIALS AND METHODS: A systematic search of Medline, EMBASE, Web of Science, SciELO, SPORTDiscus, Scopus, and Cochrane Library was performed. The studies were included if they were randomized controlled trials performed in patients aged ≥ 18 years with DMT, that compared physical therapy to APM at 5-year follow-up, and reported at least one outcome measure of knee function/disability. Risk of bias was analyzed with the Cochrane RoB-2 tool and certainty of evidence with GRADE recommendations. A random effects model meta-analysis was performed. RESULTS: 3743 articles were identified and 4 met the criteria. Three had low risk of bias and one had some concerns. There were no significant between-group differences, in within-group changes from baseline to 5-year, on the Knee Injury and Osteoarthritis Outcome Score pain (- 2.28; 95% CI - 5.41 to 0.84), symptoms (- 0.24; 95% CI - 4.13 to 3.64), activities of daily living (- 2.16; 95% CI - 6.16 to 1.83) and quality of life (- 3.98; 95% CI - 9.05 to 1.10). There was a significant difference in support of APM plus exercise for sport/recreation (- 9.28; 95% CI - 18.28 to - 0.29). Leave-one-out sensitivity analysis revealed a non-significant difference in sport/recreation (- 5.05; 95% CI - 12.04 to 1.94). There were no differences in other patient-reported outcome measures. CONCLUSION: Moderate certainty of evidence suggests that the addition of APM to an exercise program adds no benefits in knee function at 5-year follow-up.

Bioremediation of an agricultural saline soil contaminated with endosulfan and Escherichia coli by an active surface agent induced in a Penicillium crustosum culture.

This study evaluates the production of a biological active surface agent (BASA) through its surface tension (ST) and emulsifying activity (E24) for endosulfan degradation (ED) and Escherichia coli growth inhibition (EcGI) in an agricultural saline soil. The fungus, identified as Penicillium crustosum was isolated from the Citrus sinensis peel (CsP), then the surface properties were evaluated in 9 culture media through a Taguchi L9 experimental design. The culture conditions included: stirring speed, pH, carbon (C) and nitrogen (N) sources; being glucose, NH4N03, 120 rpm and pH of 5, the most significant parameters in the BASA production. The BASA identified as a lipopeptide type, showed a ST = 38 mN m-1 and E24=71%. Both properties were stable at 80 °C, while ST presented stability in the pH range of 2 - 12, and a saline concentration of 200 g L-1; E24 was also stable at a pH between 8-12. Further application of BASA and fungal inoculum to a contaminated agricultural saline soil presented an EcGI of 99.8% on the 8th day, and ED of 92.9 ± 4.7% in 30 days, respectively; being the first report that uses this fungus for pesticide and bacteria elimination from an agricultural saline soil.

Behavior of the Uptake of Ibuprofen in Five Varieties of Horticultural Crops Irrigated with Regenerated Water.

The current use of regenerated water in agriculture has led to the emergence of new forms of pollutants, such as pharmaceutical compounds (PCs) which are not fully eliminated in wastewater treatment plants (WWTPs). Therefore, if the effluents of such WWTPs are to be used for agricultural irrigation, the presence of PCs must be analysed and their concentrations determined. The main objective of this study was to evaluate the uptake of ibuprofen (IBP) in horticultural crops irrigated with WWTP effluents and its subsequent effect on human health due to their incorporation into the food chain. The study involved five varieties of crops (lettuce, parsley, cabbage, zucchini and broccoli) grown in a greenhouse and irrigated with WWTP effluent water, in which IBP was analysed. Of the varieties of regenerated water-irrigated horticultural crops, only the leaves of mini-romaine lettuce presented detectable levels of IBP, but without meaning any risk to human health.

Information Theory and Symbolic Analysis: Theory and Applications.

Symbolic analysis has been developed and used successfully in very diverse fields [...].

Selection of Embedding Dimension and Delay Time in Phase Space Reconstruction via Symbolic Dynamics.

The modeling and prediction of chaotic time series require proper reconstruction of the state space from the available data in order to successfully estimate invariant properties of the embedded attractor. Thus, one must choose appropriate time delay τ∗ and embedding dimension p for phase space reconstruction. The value of τ∗ can be estimated from the Mutual Information, but this method is rather cumbersome computationally. Additionally, some researchers have recommended that τ∗ should be chosen to be dependent on the embedding dimension p by means of an appropriate value for the time delay τw=(p-1)τ∗, which is the optimal time delay for independence of the time series. The C-C method, based on Correlation Integral, is a method simpler than Mutual Information and has been proposed to select optimally τw and τ∗. In this paper, we suggest a simple method for estimating τ∗ and τw based on symbolic analysis and symbolic entropy. As in the C-C method, τ∗ is estimated as the first local optimal time delay and τw as the time delay for independence of the time series. The method is applied to several chaotic time series that are the base of comparison for several techniques. The numerical simulations for these systems verify that the proposed symbolic-based method is useful for practitioners and, according to the studied models, has a better performance than the C-C method for the choice of the time delay and embedding dimension. In addition, the method is applied to EEG data in order to study and compare some dynamic characteristics of brain activity under epileptic episodes.

Predicting the uptake of emerging organic contaminants in vegetables irrigated with treated wastewater - Implications for food safety assessment.

Emerging organic contaminants (EOCs) undergoing incomplete removal during wastewater treatment may be found in treated wastewater (TWW) used for irrigation of agricultural products. Following uptake into edible plant parts, EOCs may eventually enter in the food chain, with associated human exposure. In the present study, we used a newly developed steady-state plant uptake model with added phloem transport to predict the uptake of four EOCs (carbamazepine, ibuprofen, ketoprofen and naproxen) into three varieties of lettuce. Input data were derived from an experimental study with vegetables grown in greenhouse and irrigated with TWW spiked with CBZ at 0, 30, 60, 120 and 210 µg/L in each variety of lettuce. Predicted carbamazepine concentrations in leaves were on average 82% higher than in roots, with good agreement between measured and calculated data. We subsequently predicted the uptake of anti-inflammatory compounds ibuprofen, ketoprofen and naproxen, for which the chemical analysis could not provide concentrations above detection limit. These three substances are weak acids and predicted concentrations in roots were higher than in the edible leaves, mainly due to phloem transport downwards. The daily dietary intake of all four EOCs was estimated for consumption of leafy vegetables, being far below usual therapeutic doses.

Symbolic recurrence plots to analyze dynamical systems.

This paper, based on the concept of symbolic correlation integral, introduces a set of symbolic recurrence plots and associated invariant measures, which are independent of the distance parameter, serving as a tool for quantifying the dynamic structure. These new measures allow the study of transient behavior, coexistence of attractors, bifurcations, and structural change. The final user does not have to choose the free distance parameter. An empirical application to electrocardiography data illustrates the use of symbolic recurrence measures.

Efficacy and safety of home-based exercises versus individualized supervised outpatient physical therapy programs after total knee arthroplasty: a systematic review and meta-analysis.

PURPOSE: The aim of the present study was to evaluate the efficacy and safety of non-supervised home-based exercise versus individualized and supervised programs delivered in clinic-based settings for the functional recovery immediately after discharge from a primary TKA. METHODS: Medline, Embase, Cochrane, and PEDro databases were screened, from inception to April 2015, in search for randomized clinical trials (RCT) of home-based exercise interventions versus individualized and supervised outpatient physical therapy after primary TKA. Target outcomes were: knee range of motion (ROM), patient-reported pain and function, functional performance, and safety. Risk of bias was assessed with the PEDro scale. After assessing homogeneity, data were combined using random effects meta-analysis and reported as standardized mean differences or mean differences. We set a non-inferiority margin of four points in mean differences. RESULTS: The search and selection process identified 11 RCT of moderate quality and small sample sizes. ROM active extension data suitable for meta-analysis was available from seven studies with 707 patients, and ROM active flexion from nine studies with 983 patients. Most studies showed no difference between groups. Pooled differences were within the non-inferiority margin. Most meta-analyses showed significant statistical heterogeneity. CONCLUSION: Short-term improvements in physical function and knee ROM do not clearly differ between outpatient physiotherapy and home-based exercise regimes in patients after primary TKA; however, this conclusion is based on a meta-analysis with high heterogeneity. LEVEL OF EVIDENCE: I.

The elimination of siloxanes from the biogas of a wastewater treatment plant by means of an adsorption process.

Siloxanes present in the biogas produced during anaerobic digestion in wastewater treatment plants (WWTPs) can damage the mechanism of cogeneration heat engines and obstruct the process of energy valorization. The objective of this research is to detect the presence of siloxanes in the biogas and evaluate a procedure for their elimination. A breakthrough curve of a synthetic decamethylcyclopentasiloxane on an experimental bed of activated carbon was modeled and the theoretical mathematical model of the adsorption process was adjusted. As a result, the constants of the model were obtained: the mass transfer constant, Henry's equilibrium constant, and the Eddy diffusion. The procedure developed allows the adsorption equilibrium of siloxanes on activated carbon to be predicted, and makes it possible to lay the basis for the design of an appropriate activated carbon module for the elimination of siloxanes in a WWTP.

Selection of Temporal Lags When Modeling Economic and Financial Processes.

This paper suggests new nonparametric statistical tools and procedures for modeling linear and nonlinear univariate economic and financial processes. In particular, the tools presented help in selecting relevant lags in the model description of a general linear or nonlinear time series; that is, nonlinear models are not a restriction. The tests seem to be robust to the selection of free parameters. We also show that the test can be used as a diagnostic tool for well-defined models.

Biodegradation behaviour of pharmaceutical compounds and selected metabolites in activated sludge. A forecasting decision system approach.

Society's support upon chemicals over the last few decades has led to their increased production, application and discharge into the environment. Wastewater treatment plants (WWTPs) contain a multitude of these chemicals such us; pharmaceutical compounds (PCs). Often, their biodegradability by activated sludge microorganisms is significant for their elimination during wastewater treatment. In this paper the focus is laid on two PCs carbamazepine (CBZ) and diclofenac (DCF) and their main transformation products (TPs). Laboratory degradation tests with these two pharmaceuticals using activated sludge as inoculum under aerobic conditions were performed and microbial metabolites were analyzed by liquid chromatography-mass spectrometry (LC/MS-MS). In two different Mixed liquid Suspended Solids (MLSS) concentrations the biodegradability by activated sludge of CBZ and DCF were evaluated. Also, this article proposes a decision support system to optimize the prediction process of this type of pharmacological compounds. A study and analysis of the techniques of Support Vector Machine, Random Forest, Decision Trees and Multilayer Perceptron Network is carried out to select the most reliable and accurate predictor for the decision system. There are not significant differences in the removal of DCF with 30 mg MLSS/L and 60 mg MLSS/L. DCF was better removed than CBZ in all experiments studied. The TP detected in the samples were mainly 4-OH-DCF for DCF and 10, 11 EPOXICBZ for CBZ. The results show that the best models are obtained with Random Forest and Multilayer Perceptron Network techniques, with a model fit of more than 95% for both carbamazepine and diclofenac metabolites. Obtaining a root means square errors of 0.80 µg/L for the metabolite 4-OH-DCF for DCF with the technique Random Forest and a root means square errors of 1.13 µg/L for the metabolite 10, 11 EPOXICBZ for CBZ with the Multilayer Perceptron Network technique. Supplementary Information: The online version contains supplementary material available at 10.1007/s40201-023-00890-x.

[What do we need to work with community orientation in Primary Health Care? Twenty-five measures for management and teams]. / ¿Qué necesitamos para «hacer comunitaria¼? Veinticinco medidas prácticas para gerencias y equipos de atención primaria.

OBJECTIVE: Identify and clarify what practical organizational measures would promote the development of level 2 (community-oriented group health education) and level 3 (community action) community activities in Primary Health Care (PHC) from the perspective of medical professionals with training and experience in this area. METHOD: Exploratory, descriptive and cross-sectional study carried out using qualitative methodology using two techniques: 3 focus groups (24 participants) and 12 open questionnaires (12 participants). RESULTS: 25 measures are defined to promote the development of these activities that are the responsibility of management and Primary Care Teams (PCT). The most notable proposals are: enhance training in community health, incorporate community activity into the work agendas of professionals, political prioritization and support from management, ensure the job stability of the teams, strengthen the recognition of activities community, resize the patient population of professionals, strengthen multidisciplinary work, cohesion and an autonomous and flexible organization in the PCT, and have the support of the coordinations-directions of the PCT. CONCLUSIONS: Three proposals have been considered fundamental to promote the development of level 2 and level 3 community activities in PHC: 1) promote training in community health; 2) incorporate community activity into the work agendas of professionals; 3) political prioritization and support from management for the development of these two levels of work in PHC. Six other proposals have been recognized as being of special importance.

[Proposals for the community orientation of primary health care: to identify key agents for training]. / Propuestas para la orientación comunitaria de la atención primaria: identificar agentes clave para la formación.

OBJECTIVE: To identify the strengths available for the community orientation of primary health care (PHC) in the context of the evaluation of the piloting of a training program in Community Health for Resident Internal Specialists in Andalusia (Spain). METHOD: We will conduct a qualitative, phenomenologically-oriented, explanatory research in which the opinion of the participants is analyzed. Sixty-seven professionals from six PHC Districts of Andalusia which were part of the training program called Project to Support the Revitalization of Primary Care Assets for Community Health (PARAC) were interviewed. RESULTS: There is consensus in giving training a key weight in the community orientation of PHC. For this reason, those agents linked to training are identified as assets: general practice (GP) trainers, young professionals in training who bring updated perspectives and approaches to accredited PHC training centers, whose professionals must respond to the needs of their GP trainees, the multi-professional teaching units responsible for the GP trainees training and a medium and long-term health system thinking along with structures that coordinate and support the community work at the PHC centers. CONCLUSIONS: The community orientation of PHC is an objective that requires the participation of all levels of the health system. Knowing its assets and working with them can contribute to provide proposals to advance towards a community-oriented PHC system.

[Community health. Innovating in the training of family and community medicine residents]. / Salud comunitaria. Innovando en la formación de residentes de medicina familiar y comunitaria.

OBJECTIVE: To know the opinions of the agents involved in the training of family and community medicine residents in order to improve the training process of the «Project to Support the Revitalization of Primary Care; Assets for Community Health¼ (PARAC) taking into account its adequacy, contextualization and the methodologies used. METHOD: Qualitative interpretative-explanatory study of phenomenological orientation, multilevel and multicenter, in which the opinion of the participants is analyzed. Between 2018 and 2020, 12 focus groups and 24 semi-structured interviews were carried out, with the participation of sixty-seven professionals from six health districts of Andalusia (Spain), who were involved in the PARAC training process. RESULTS: The participants consider it necessary to broaden training in community health for residents. To this end, they consider it necessary to make changes in the training plan of the specialty, giving more importance to primary health care than to hospital rotations. They value positively the methodologies used in the PARAC training process, which they consider «novel¼, and the choice of young teachers to serve as references. In order for their interventions in the territory to be carried out with quality and safety for the population, they ask that specific times and spaces be guaranteed for community health, as well as adequate supervision to help ensure the coherence and continuity of their interventions. CONCLUSIONS: Training in community health for family and community medicine residents requires a pedagogical, didactic and curricular effort that prepares them for work with the community, as well as the guarantee of organizational conditions that allow this work.

[Once upon a time there was a place where we learned to listen. The Other Front line_voices for social justice]. / Había una vez un lugar donde aprendimos a escuchar. The Other Front line_voces por la justicia social.

Government responses to the COVID-19 pandemic generated a new wave of social inequalities for communities around the world living in unjust circumstances . Lockdowns and health measures overlooked housing conditions, transitions to virtual schooling, ignoring homes and families without the technological infrastructure and skills to access education, as well as overlooking the availability of an economic remainder. informal employment. The experiences of various communities around the world, from racialized/ethnic communities, homeless, migrants, elderly to young populations, were not reflected in the knowledge that guided the Government's responses; in fact, their experiences were involuntarily silenced . As a result of all this, it was necessary to create alliances with communities that lived in vulnerable conditions and that bore the great burden of the pandemic, to ensure that their voices were included in Public Health policies and practices.

Las respuestas de los gobiernos a la pandemia de la COVID-19 generaron una nueva ola de desigualdades sociales para las comunidades de todo el mundo que vivían en circunstancias injustas . Los confinamientos y las medidas sanitarias pasaron por alto las condiciones de vivienda, las transiciones a la escolarización virtual, ignorando los hogares y las familias sin las infraestructuras tecnológicas y habilidades para acceder a la educación, así como la disponibilidad de un remanente económico pasó por alto el empleo informal. Las experiencias de varias comunidades en todo el mundo, desde comunidades racializadas/étnicas, personas sin hogar, migrantes, ancianos hasta poblaciones jóvenes, no se reflejaron en el conocimiento que orientó las respuestas del Gobierno; de hecho, sus experiencias fueron silenciadas involuntariamente . A consecuencia de todo ello, fue necesario generar alianzas con las comunidades que vivían en condiciones de vulnerabilidad y que soportaban la gran carga de la pandemia, para garantizar así que sus voces se incluyeran en las políticas y prácticas de Salud Pública.

Content reporting and effectiveness of therapeutic exercise in the management of massive rotator cuff tears: A systematic review with 490 patients.

Background: Massive rotator cuff tears (MRCT) account for a substantial fraction of tears above the age of 60 years. However, there are no clear criteria for prescription parameters within therapeutic exercise treatments. The aim of this study was to evaluate the effects and characteristics of therapeutic exercise treatments in patients with MRCT. Methods: A systematic search was conducted in MEDLINE/PubMed, Web of Science, SPORTDiscus, SciELO, Scopus and EMBASE from inception to August 2022. Studies were included if they evaluated the effects of exercise on patients with MRCT. The risk of bias was evaluated and the Consensus on Exercise Reporting Template (CERT) was also used. A narrative synthesis without meta-analysis was performed. Results: One randomized controlled trial, two non-randomized studies, six non-controlled studies, one case series and four retrospective studies were included. They ranged from serious to moderate risk of bias. The CERT reflected a poor description of the exercise programmes. Studies showed a pattern of improvements in most patient-reported outcome measures (PROM) surpassing the MCID, and active elevation range of motion. Conclusions: There is limited evidence that exercise and co-interventions are effective in the management of some patients with MRCT, based on a systematic review without meta-analysis. Future research should improve content reporting. Level of evidence: IV.