Patrones de alimentación perceptiva durante la primera infancia en conglomerados urbanos. Argentina, 2018-19 / Responsive feeding patterns during early childhood in urban areas. Argentina, 2018­2019

Introducción. La calidad de la alimentación implica tanto la cantidad y calidad de los alimentos que se ofrecen como la forma en que se ofrecen, el entorno y las respuestas de quien los ofrece. El objetivo de este trabajo fue identificar patrones de comportamiento relacionados a la alimentación perceptiva en niños entre 6 y 23 meses de áreas urbanas de la Argentina en 2018-19. Población y métodos. Análisis secundario de datos de la 2da Encuesta Nacional de Nutrición y Salud 2018-19, de una muestra probabilística polietápica de localidades urbanas de 5000 habitantes y más de Argentina. Se realizó análisis descriptivo y análisis de componentes principales para identificar los patrones de alimentación perceptiva en 4379 niños y niñas de 6 a 23 meses. Resultados. Se identificaron cinco patrones de alimentación perceptiva, las dos primeras dimensiones explicaron el 71,1 % de la inercia (p = 0,013). El patrón donde prevalecía la posibilidad de experimentación, la autonomía, la interacción y la ausencia de pantallas, premios y distracciones se asoció a niños/as mayores de 12 meses, de las regiones del centro y sur (Cuyo, Pampeana, Gran Buenos Aires y Patagonia), mientras que el patrón relacionado con menor autonomía, experimentación y autorregulación correspondió a las regiones Noroeste y Noreste, y a niños/as entre 6 y 11 meses. Conclusión. Se evidencian prácticas de alimentación perceptiva que se corresponden con patrones diferenciados entre sí, asociados a diferentes etapas y a la región donde viven los niños/as.

Introduction. Dietary quality involves both the quantity and quality of food offered, the way and the setting in which it is offered, and the responses of the person offering it. The objective of this study was to identify behavioral patterns related to responsive feeding in children aged 6 to 23 months in urban areas from Argentina in 2018­2019. Population and methods. Secondary analysis based on data from the second National Survey on Nutrition and Health of 2018­2019 conducted in a multistage probability sample from urban areas of 5000 inhabitants or more in Argentina. A descriptive analysis and a principal component analysis were performed to identify responsive feeding patterns in 4379 children aged 6 to 23 months. Results. Five responsive feeding patterns were identified; the first 2 dimensions explained 71.1% of inertia (p = 0.013). The pattern with a prevailing possibility of experimentation, autonomy, interaction, and the absence of screens, rewards and distractions was associated with children older than 12 months from the central and south regions (Cuyo, Pampa, Greater Buenos Aires, and Patagonia), whereas the pattern related to a lower autonomy, experimentation, and self-regulation corresponded to children aged 6 to 11 months from the Northwest and Northeast regions. Conclusion. There is evidence of responsive feeding practices that correspond to distinguishable patterns, associated with different stages of life and with the region where the children live

Is Intraoperative Muscle Motor Evoked Potential Variability due to Fluctuating Lower Motor Neuron Background Excitability?

PURPOSE: This pilot study tests the contribution of fluctuating lower motor neuron excitability to motor evoked potential (MEP) variability. METHODS: In six pediatric patients with idiopathic scoliosis and normal neurologic examination, cascades of 30 intraoperative H-reflexes (HRs) and MEPs were evoked in the soleus muscle using constant-current stimulators and recorded through surface electrodes with a 20-second interstimulus interval. First, HRs were obtained with an intensity capable of evoking the maximum response. Subsequently, MEPs were obtained with double trains and an intensity of 700 to 900 mA. Coefficients of variation (CVs) of amplitude and area under the curve from HRs and MEPs were compared using a paired two-tailed Student t test. Coefficients of correlation between the mean CVs of HR and MEP parameters were also assessed. RESULTS: Pooling the results from the six patients, the mean CV of amplitude from the MEP (24.6 ± 3) was significantly higher than that from the HR (3.5 ± 4.4) (P = 0.000091). The mean CV of the MEP area under the curve (21.8 ± 4.8) was also statistically significantly higher than that from the HR area under the curve (3.4 ± 4.5) (P = 0.00091). The coefficients of correlation of the mean CV of the HR amplitude and area under the curve compared with the corresponding values of the MEP were low (r = 0.29) and very low (r = 0.03), respectively. CONCLUSIONS: Our results suggest that fluctuations in lower motor neuron excitability may be less important than previously thought to explain the magnitude of MEP variability. The efficacy of corticospinal volleys to recruit a larger and more stable lower motor neuron population would be critical to obtain reproducible MEPs.

Variability in Body Mass Index During 2018-2021 for People with Type 1 Diabetes: Real world data from USA, Germany and Australasia.

INTRODUCTION: The COVID-19 pandemic necessitated worldwide lockdowns in 2020 and 2021, with restrictions on physical activity and changes in eating habits. AIMS: To investigate temporal trends in Body Mass Index (BMI) and BMI Standard Deviation Score (SDS) inSDS) in three international T1D registries between 2018-2021. METHODS: Data were extracted from DPV (Germany/Austria/Luxembourg/Switzerland), T1D Exchange Quality Improvement Collaborative (T1DX-QI, US), and Australasian Diabetes Data Network (ADDN, Australia/New Zealand). The period affected by the COVID-19 pandemic was defined as March to December 2020 and March to December 2021 and compared with the respective 9-month periods in 2018 and 2019. Estimated mean BMI (adults ≥ 19 years) and WHO BMI SDS (children and adolescents 54 to < 19 years) were calculated, adjusted for sex, age, HbA1c and diabetes duration. Adjusted mean proportions overweight /obese (BMI ≥ 25 in adults or BMI SDS > 1.282 in children and adolescents 54 to < 19 years) and obese (BMI ≥30kg/m2 or BMI SDS > 2 in children and adolescents 5 to <19 years) were also calculated, adjusted for sex, age, HbA1ce group and diabetes duration. RESULTS: Study population: ADDN (n=14,624, medianan age 15.720.4 years, 510.6% male); DPV (n=62,732, 16.123.1 years, 53.3% male); T1DX-QI (n=229428,970, 17.121.3 years, 52.1% male). In the DPV registry, BMI SDS in children and adolescents and BMI in adults, as well as the mean proportions overweight/obese in children and adolescents increased consistently between 2018 to 2021 (p<0.001). In ADDN and T1DX-QI, variable changes in BMI and BMI-SDS were seen in adults and young people, as well as in mean proportion overweight. Close to 50% of people in all registries were either overweight or obese. Proportions overweight remained relatively stable across the 4 years. The proportion obese increased in children 5-<10 years. CONCLUSIONS: A slight increase in BMI and BMI SDS, in DPV observed before the pandemic continued during the pandemic years. Results were more variable in the other registries without a clear pattern although Tthe proportion of overweight and obesity was overall high. Healthy weight remains a priority for people with type 1 diabetes.

Type 2 diabetes mellitus and neurodegenerative disorders: The mitochondrial connection.

The incidence of type 2 diabetes mellitus (T2DM) has increased in our society in recent decades as the population ages, and this trend is not expected to revert. This is the same for the incidence of the main neurodegenerative disorders, including the two most common ones, which are, Alzheimer's and Parkinson's disease. Currently, no pharmacological therapies have been developed to revert or cure any of these pathologies. Interestingly, in recent years, an increased number of studies have shown a high co-morbidity between T2DM and neurodegeneration, as well as some common molecular pathways that are affected in both types of diseases. For example, while the etiopathology of T2DM and neurodegenerative disorders is highly complex, mitochondrial dysfunction has been broadly described in the early steps of both diseases; accordingly, this dysfunction has emerged as a plausible molecular link between them. In fact, the prominent role played by mitochondria in the mammalian metabolism of glucose places the physiology of the organelle in a central position to regulate many cellular processes that are affected in both T2DM and neurodegenerative disorders. In this collaborative review, we critically describe the relationship between T2DM and neurodegeneration; making a special emphasis on the mitochondrial mechanisms that could link these diseases. A better understanding of the role of mitochondria on the etiopathology of T2DM and neurodegeneration could pave the way for the development of new pharmacological therapies focused on the regulation of the physiology of the organelle. These therapies could, ultimately, contribute to increase healthspan.

Virologic Failure, Clinical Characteristics, and Common Viral Mutations in HIV Patients From Southwestern Colombia: A Nested Case-Control Study.

Introduction Virologic failure due to antiretroviral drug resistance is a threat to efforts to control the human immunodeficiency virus (HIV) epidemic. Understanding the factors that influence the genetic and clinical expression of drug resistance is fundamental for infection control. Methods A nested case-control study was conducted on a cohort of adult HIV patients between 2016 and 2022. The cases were defined as patients with a confirmed diagnosis of virologic failure due to drug resistance, as indicated by a viral genotype result. The control group consisted of patients who had not experienced virologic failure or undergone any documented changes to their antiretroviral treatment. The incidence of virologic failure over a defined period was calculated. The characteristics of each group were documented in frequency tables and measures of central tendency. To identify risk factors, multiple logistic regression models were employed, and post hoc tests were conducted. All calculations were performed with 95% confidence intervals, and p-values less than 0.05 were considered significant. Results The incidence of virologic failure over the seven-year study period was 9.2% (95% CI: 7.5-11.2%). Low CD4 T-lymphocyte count (≤200 cells/mm³) at diagnosis (adjOR 14.2, 95% CI: 3.1-64.5), history of opportunistic infections (adjOR 3.5, 95% CI: 1.9-6.4), and late enrollment into an HIV program after diagnosis (>1 year) (adjOR 9.2, 95% CI: 3.8-22.2) were identified as independent predictors of virologic failure. The drugs with the highest rates of resistance were nevirapine (84.6%), efavirenz (82.4%), emtricitabine (81.3%), lamivudine (81.3%), and atazanavir (6.6%). The most prevalent major mutations identified were K103N, M184V, and M46I/M. Approximately 50% of the secondary mutations were identified in protease regions. Conclusions The incidence of virologic failure was low in the study population. The identified risk characteristics allow for the prediction of the profile of patients susceptible to failure and for the early optimization of treatment regimens.

Translation and cross-cultural adaptation of the Telemedicine Satisfaction Questionnaire for use in Brazil.

OBJECTIVE: To translate, cross-culturally adapt to Brazilian Portuguese, and evaluate the reliability of the Telemedicine Satisfaction Questionnaire (TSQ). METHODS: This cross-sectional study involved patients from the Smoking Prevention and Cessation Center (PrevFumo) who participated in at least four of the eight scheduled remote meetings with the PrevFumo psychologist in 2020, 2021, or 2022. Participants were contacted by telephone and asked to answer the 14 questions of the TSQ three times at intervals of 7 or 10 days. RESULTS: We assessed 53 patients (73.3% women). The mean age was 49.7 ± 10.2 years. The mean smoking history was 35.32 ± 24.8 pack-years. Of the 53 patients evaluated, 30.2% had completed high school or had some higher education, and 32.1% were classified as socioeconomic class B2 (A being the highest and E being the lowest). Forty-nine (92.5%) of the patients attended all eight meetings. The TSQ with only three answer options showed high reliability, with approximately 90% agreement after three applications. Patients were satisfied with telemedicine. CONCLUSIONS: The TSQ is rapidly applied, is easy to complete, and showed high reliability in our patient sample. Patients declared that they were satisfied with their telemedicine experience.

Extragenital self-collection testing for gonorrhea and chlamydia: A feasibility study for expanding STI screening in the Veterans Health Administration.

OBJECTIVES: Rectal and pharyngeal infections with gonorrhea and chlamydia are of concern because they are associated with higher risk of HIV acquisition. Extragenital screening in asymptomatic persons at high risk may have the potential to reduce the incidence of these sexually transmitted infections (STIs). Several testing platforms are available for the testing of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) using nucleic acid amplification tests (NAATs). Self-collected extragenital samples are currently not approved by the US Food and Drug Administration in any NAAT platform. This study compares the analytical performance of self-collected extragenital specimens to that of clinician-collected specimens. METHODS: We performed a multicenter/multiplatform validation study as a National Veterans Health Administration Pathology and Laboratory Medicine quality improvement project, with 9 different participating sites. Self-collected specimens were obtained at the same time as clinician-collected specimens. Clinician-collected specimens were used as the gold standard to evaluate the sensitivity and specificity of self-collection. RESULTS: A total of 2324 individual tests were analyzed (501 rectal and 661 oropharyngeal). The sensitivity was 94.44% for CT and 100% for NG for rectal specimens, whereas it was 100% for CT and 97.22% for NG for oral specimens. Specificity for oral specimens was 99.85% for CT and 99.36% for NG, whereas for rectal specimens, it was 99% for CT and NG. CONCLUSIONS: Self-collected specimens for extragenital CT/NG testing are highly sensitive and specific, with negative predictive values of 100%. Self-collection has the potential to overcome a major barrier for STI screening by providing an accessible, convenient, and patient-centered alternative.

THE ESSENTIAL KINASE TGGSK REGULATES CENTROSOME DIVISION AND ENDODYOGENY IN TOXOPLASMA GONDII.

Intracellular replication is crucial for the success of apicomplexan parasites, including Toxoplasma gondii . Therefore, essential players in parasite replication present potential targets for drug development. In this study, we have characterized TgGSK, a glycogen synthase kinase homolog that plays an important role in Toxoplasma endodyogeny. We have shown that TgGSK has a dynamic localization that is concurrent with the cell cycle. In non-dividing parasites, this kinase is highly concentrated in the nucleus. However, during division, TgGSK displays a cytosolic localization, with concentration foci at the centrosomes, a key organelle involved in parasite division, and the basal end. Conditional knockdown of TgGSK determined that it is essential for the completion of the lytic cycle and proper parasite division. Parasites lacking endogenous protein levels of TgGSK exhibited defects in division synchronicity and the segregation of the nucleus and apicoplast into forming daughter cells. These phenotypes are associated with defects in centrosome duplication and fission. Global phosphoproteomic analysis determined TgGSK-dependent phosphorylation of RNA-processing, basal end, and centrosome proteins. Consistent with the putative regulation of RNA-processing proteins, global transcriptomic analysis suggests that TgGSK is needed for proper splicing. Finally, we show that TgGSK interacts with GCN5b, a well-characterized acetyltransferase with roles in transcriptional control. Conversely, GCN5b chemical inhibition results in specific degradation of TgGSK. Thus, these studies reveal the involvement of TgGSK in various crucial processes, including endodyogeny and splicing, and identify acetylation as a possible mechanism by which this essential kinase is regulated. AUTHOR SUMMARY: Toxoplasma gondii infects nearly a third of the world's human population. While infection is largely asymptomatic in healthy adults, in immunocompromised or immunosuppressed individuals it can lead to brain lesions and even death. Similarly, toxoplasmosis can result in stillbirth, birth defects, and blindness of a developing fetus in the case of a congenital infection. With minimal treatments for Toxoplasmosis available, it is crucial to study parasite-specific processes that could be potential drug targets for the treatment of Toxoplasmosis. In this study, we investigated the protein TgGSK that is essential for parasite survival and proper division. We showed that TgGSK may perform its essential functions through interaction with the centrosome, an organelle that plays a major role in cell division in many organisms. We also show in this study a role for TgGSK in proper processing of messenger RNAs. Taken together, we have performed an in-depth study of the functional role of the essential protein TgGSK in Toxoplasma gondii . Importantly, TgGSK was shown to have more similarity to plant proteins than mammalian proteins which may allow for the possibility of targeting of this protein for therapeutic treatment of toxoplasmosis.

Repeatability and Reproducibility of a Modified Lekholm and Zarb Bone Quality Classification Based on Cone Beam Computed Tomography: An Observatsion Study.

Aim: We propose a modified Lekholm and Zarb classification that considers all possible combinations of cortical and cancellous bone to provide parameters that favor greater repeatability and reproducibility. Materials and Methods: This observational and analytical study consisted of a sample of 50 cone beam computed tomography (CBCT) scans. Two new types (V and VI), three subtypes to type II (II-A, II-B, and II-C), and two subtypes to type III (III-A and III-B) were added to the original bone quality classification. The new types refer to regenerated bone (type V) and bone with some pathology (type VI). The subtypes are described as type II-A: thick cortical surrounding the abundant cancellous bone with sharp trabeculae throughout the image and presence of small and visible medullary spaces; type II-B: thick cortical surrounding the abundant cancellous bone with predominance of diffuse trabeculae in the basal bone and predominant presence of wide and visible medullary spaces; type II-C: thick cortical surrounding the abundant cancellous bone with predominance of very thick and sharp trabeculae in the basal third as well as presence of small and visible medullary spaces; type III-A: thin cortical surrounding the abundant cancellous bone with sharp trabeculae throughout the image and presence of small and visible medullary spaces; type III-B: thin cortical surrounding the abundant cancellous bone with predominance of diffuse trabeculae and presence of diffuse medullary spaces. Five dental specialists were trained in the use of the modified classification and were provided with CBCT-sectioned images of edentulous jaws for classification. Each specialist classified the images twice at a 7-day interval. The strength of intra-examiner and inter-examiner agreement was measured with Cohen's and Fleiss' kappa index, respectively. In addition, the agreement between both classifications was analyzed. All data were analyzed at a 95% confidence level, considering a P-value <0.05. Results: According to the modified Lekholm and Zarb classification, an almost perfect intra-examiner agreement was significant (P < 0.05) in all five specialists, with the kappa index [k] ranging from 0.91 [95% confidence interval (CI): 0.82-0.99) to 0.95 (95% CI: 0.89-1.00). Furthermore, substantial inter-examiner concordance (k=0.76; 95% CI: 0.73-0.79) was significant (P < 0.05). Conclusion: The high repeatability and reproducibility of the modified Lekholm and Zarb classification on CBCT suggest its applicability to distinguish between the various combinations of cortical and cancellous bone and help to define treatment appropriately to optimize results.

Chronic pramipexole and rasagiline treatment enhances dendritic spine structural neuroplasticity in striatal and prefrontal cortex neurons of rats with bilateral intrastriatal 6-hydroxydopamine lesions.

Parkinson's disease manifests as neurological alterations within dendritic spines in the striatal and neocortical brain regions, where their functionality closely correlates with morphology. However, the impact of current pharmacotherapy on dendritic spine neuroplasticity, crucial for novel drug development in neurological and psychiatric disorders, remains unclear. This study investigated the effects of 6-OHDA intrastriatal bilateral lesions in male adult rats on behavior and dendritic spine neuroplasticity in striatal and cortical neurons. Furthermore, it evaluated the influence of chronic co-administration of pramipexole (PPX), a D3 receptor agonist, and rasagiline (Ras), a selective MAO-B inhibitor, on these alterations. Lesioned animals exhibited impaired balance behavior, with no improvement following PPX-Ras treatment. The 6-OHDA lesion decreased dendritic spine density in caudate putamen (CPU) spiny projection neurons (SPNs), a change unaffected by treatment, though PPX-Ras increased mushroom spines and reduced stubby spines in these neurons. In nucleus accumbens (NAcc) SPNs and prefrontal cortex layer 3 (PFC-3) pyramidal cells, dendritic spine density remained unaltered, but PPX-Ras decreased mushroom spines and increased bifurcated spines in the NAcc, while increasing mushroom spines and decreasing stubby spines in PFC-3 in lesioned rats. These findings emphasize the importance of dendritic spines as promising targets for innovative pharmacotherapies for Parkinson's disease.

Chemical inhibition of the integrated stress response impairs the ubiquitin-proteasome system.

Inhibitors of the integrated stress response (ISR) have been used to explore the potential beneficial effects of reducing the activation of this pathway in diseases. As the ISR is in essence a protective response, there is, however, a risk that inhibition may compromise the cell's ability to restore protein homeostasis. Here, we show that the experimental compound ISRIB impairs degradation of proteins by the ubiquitin-proteasome system (UPS) during proteotoxic stress in the cytosolic, but not nuclear, compartment. Accumulation of a UPS reporter substrate that is intercepted by ribosome quality control was comparable to the level observed after blocking the UPS with a proteasome inhibitor. Consistent with impairment of the cytosolic UPS, ISRIB treatment caused an accumulation of polyubiquitylated and detergent insoluble defective ribosome products (DRiPs) in the presence of puromycin. Our data suggest that the persistent protein translation during proteotoxic stress in the absence of a functional ISR increases the pool of DRiPs, thereby hindering the efficient clearance of cytosolic substrates by the UPS.

An Automated Electronic Health Record Score to Estimate Length of Stay and Readmission in Patients Undergoing Radical Cystectomy for Bladder Cancer.

PURPOSE: Patients treated with radical cystectomy experience a high rate of postoperative complications and frequent hospital readmissions. We sought to explore the utility of the Care Assessment Need (CAN) score, derived from electronic health data, to estimate the risk of these adverse clinical outcomes, thereby aiding patient counseling and informed treatment decision-making. MATERIALS AND METHODS: We retrospectively examined data from 982 patients with bladder cancer who underwent radical cystectomy between 2013 and 2018 within the national Veterans Health Administration system. We tested for associations between the preoperative CAN score and length of stay, discharge location, and readmission rates. RESULTS: We observed a correlation between higher CAN scores and longer hospital stays (adjusted relative risk = 1.03 [95% CI: 1.02-1.05]). An increased CAN score was also linked to greater odds of discharge to a skilled nursing facility or death (adjusted odds ratio = 1.16 [95% CI: 1.06-1.26]). Furthermore, the score was associated with hospital readmission at both 30 and 90 days postdischarge (adjusted HR = 1.03 [95% CI: 1.00-1.07] and 1.04 [95% CI: 1.00-1.07], respectively). CONCLUSIONS: The CAN score is associated with length of hospital stay, discharge to a skilled nursing facility, and readmission within 30 and 90 days after radical cystectomy. These findings highlight the potential of health care systems leveraging electronic health records for automatically calculating multidimensional tools, such as the CAN score, to identify patients at risk of adverse clinical outcomes after radical cystectomy.

Biomechanical considerations of chemical structure and biosafety of current ceramic biomaterials for dentistry: review and outlook of the current state of the art.

Biomaterial refers to any material, non-pharmaceutical or combination of substances of synthetic or natural origin used for any period independently or as part of a system for the purpose of healing, assisting the growth or replacement of tissues, organs or functions of the body. It is an unsustainable material that interacts with biological systems. Before being produced a biomaterial goes through a sequence of steps, which includes: 1) the definition of the problem that the material will be called to solve (treatment, replacement of the instrument, aesthetic reasons); 2) design of the device, composition and control of materials (mechanical properties, toxicity, biological response, corrosion resistance, interaction with proteins, cells and tissues), manufacture, sterilization and standardization; 3) control of the device (in experimental animals, in vitro) clinical studies, studies; and 4) monitor its long-term use in vivo, in vitro and in patients. Research for ceramic materials is evolving and because they can be porous or glassy, they find applications in medicine and biotechnology, as they can be used as fillers, covering materials and scaffolds. Therefore, ceramic biomaterials are widely used not only in the field of orthopedic and maxillofacial surgery but also in dentistry as for dental prostheses. Materials monitoring technologies allow us to monitor the three-dimensional development in space, as well as imperfections or micro-cracks in the ceramic.

A deep learning approach to case prioritisation of colorectal biopsies.

AIMS: To create and validate a weakly supervised artificial intelligence (AI) model for detection of abnormal colorectal histology, including dysplasia and cancer, and prioritise biopsies according to clinical significance (severity of diagnosis). MATERIALS AND METHODS: Triagnexia Colorectal, a weakly supervised deep learning model, was developed for the classification of colorectal samples from haematoxylin and eosin (H&E)-stained whole slide images. The model was trained on 24 983 digitised images and assessed by multiple pathologists in a simulated digital pathology environment. The AI application was implemented as part of a point and click graphical user interface to streamline decision-making. Pathologists assessed the accuracy of the AI tool, its value, ease of use and integration into the digital pathology workflow. RESULTS: Validation of the model was conducted on two cohorts: the first, on 100 single-slide cases, achieved micro-average model specificity of 0.984, micro-average model sensitivity of 0.949 and micro-average model F1 score of 0.949 across all classes. A secondary multi-institutional validation cohort, of 101 single-slide cases, achieved micro-average model specificity of 0.978, micro-average model sensitivity of 0.931 and micro-average model F1 score of 0.931 across all classes. Pathologists reflected their positive impressions on the overall accuracy of the AI in detecting colorectal pathology abnormalities. CONCLUSIONS: We have developed a high-performing colorectal biopsy AI triage model that can be integrated into a routine digital pathology workflow to assist pathologists in prioritising cases and identifying cases with dysplasia/cancer versus non-neoplastic biopsies.

[Orphanhood due to COVID-19 in Argentina during 2020-2021]. / Orfandad por COVID-19 en la República Argentina durante 2020 y 2021.

INTRODUCTION: The COVID-19 pandemic has had significant impacts on society, particularly on children and adolescents, who have faced serious social, educational, and health consequences due to the loss of their primary caregivers. MATERIALS AND METHODS: Female fertility rates were analyzed, and estimates of male fertility were made to calculate the number of children under 18 years old by age group. Demographic and mortality information from COVID-19 infection was used to calculate the resulting orphanhood in Argentina during the period 2020-2021, considering the loss of one or both parents or the main caregiver grandparent. RESULTS: A total of 25161 Argentine children and adolescents lost one of their primary caregivers due to COVID-19 during the pandemic. Of these, 22729 were orphaned by mother or father during the analyzed period. The majority of cases (79.5%) were related to the father's death. Specific age groups with higher incidence of orphanhood were identified. The loss of caregiver grandparents was also significant, affecting 2432 children and adolescents. DISCUSSION: The findings underscore the need for specific policies and programs to address the comprehensive needs of children and adolescents affected by orphanhood during the pandemic. Potential long-term impacts on the physical, mental, educational, and socioeconomic health of these children and adolescents are highlighted.

Introducción: La pandemia de COVID-19 ha ejercido impactos significativos en la sociedad, particularmente en niños, niñas y adolescentes (NNA), quienes han enfrentado consecuencias sociales, educativas y de salud graves debido a la pérdida de sus cuidadores principales. Materiales y métodos: Se analizaron las tasas de fertilidad femenina y se realizaron estimaciones sobre la fertilidad masculina a fin de calcular los hijos menores de 18 años por grupo de edad. Se utilizó información demográfica y de mortalidad por infección por COVID-19 para calcular la orfandad resultante en Argentina durante el período 2020-2021, considerando la pérdida de uno o ambos progenitores o del cuidador principal abuelo/a. Resultados: Un total de 25161 NNA argentinos perdieron a uno de sus cuidadores principales por el COVID-19 durante la pandemia. De ellos, 22729 NNA quedaron huérfanos de madre o padre durante el periodo analizado. La mayoría de los casos (79.5%) estuvo relacionada con la muerte del padre. Se identificaron grupos de edad específicos con mayor incidencia de orfandad. La pérdida de abuelos cuidadores también fue significativa, afectando a 2432 NNA. Discusión: Los hallazgos subrayan la necesidad de políticas y programas específicos para abordar las necesidades integrales de los NNA afectados por la orfandad durante la pandemia. Se destacan los posibles impactos a largo plazo en la salud física, mental, educativa y socioeconómica de estos niños y adolescentes.

Function-based risk reduction intervention for lifestyle-related disorders among inactive 40-year-old people: a pilot randomised controlled trial.

BACKGROUND:  Interventions for preventing or reducing the development of lifestyle-related disorders should be investigated as these conditions are becoming increasingly prevalent and having large effects on quality of life and life expectancy globally. The aim of this pilot study was to prepare for a full-scale randomised controlled trial by evaluating the short-term changes resulting from a function-based preventive intervention aimed at lifestyle-related disorders on a small group of physically inactive 40-year-old people. Change in objectively measured physical activity, functional capacity according to a risk profile, and goal attainment were main outcomes. METHODS: Participants (n = 27) underwent functional examinations including tests of fitness, strength, mobility, balance, and posture as well as standard medical examinations including weight measures, blood pressure and blood tests and were randomised to two groups. The intervention group (n = 15) received feedback from all the examinations and lifestyle counselling based on a functional profile. The control group (n = 12) received feedback only from the standard medical examination. Follow-up was at 3-4 months. Changes in physical activity measured with accelerometers, functional levels on the functional profile, goal attainment and subjective assessments of health-related quality of life, motivation, function, and physical activity were examined, as were standard medical parameters. RESULTS: Change in mean time in moderate or more intense physical activity was 9 min higher in the intervention group (95% confidence interval -6.35, 24.51) and change in sedentary time was 42 min lower (-95.24, 11.32). The intervention group showed a higher increase in motivation for change 1.58 on 10-point scale (0.20, 2.97) and indicated more improvement on the functional risk levels concerning fitness (-0.06, 0.90). Correlation between objectively measured and self-assessed physical activity and function increased after the intervention. Most participants in the intervention group achieved some or all of their goals. CONCLUSIONS: This small-scale pilot intervention with functional examinations and lifestyle counselling showed positive tendencies for change in short-term physical activity level. It seemed to lead to better understanding of personal functional capacity and increased motivation for lifestyle changes. Setting and fulfilling meaningful goals for lifestyle-related changes seemed to influence levels on the functional profile in positive directions. Research on larger and more diverse populations will be necessary to better understand the implications of the intervention. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05535296 first posted on 10/09/2022.

Clinical overview of the physiology and pathophysiology of pleural fluid movement: a narrative review.

In physiological conditions, the pleural space couples the lung with the chest wall and contains a small amount of fluid in continuous turnover. The volume of pleural fluid is the result from the balance between the entry of fluid through the pleural capillaries and drainage by the lymphatics in the most dependent areas of the parietal pleura. Fluid filtration is governed by Starling forces, determined by the hydrostatic and oncotic pressures of the capillaries and the pleural space. The reabsorption rate is 28 times greater than the rate of pleural fluid production. The mesothelial layer of the inner lining of the pleural space is metabolically active and also plays a role in the production and reabsorption of pleural fluid. Pleural effusion occurs when the balance between the amount of fluid that enters the pleural space and the amount that is reabsorbed is disrupted. Alterations in hydrostatic or oncotic pressure produce a transudate, but they do not cause any structural damage to the pleura. In contrast, disturbances in fluid flow (increased filtration or decreased reabsorption) produce an exudate via several mechanisms that cause damage to pleural layers. Thus, cellular processes and the inflammatory and immune reactions they induce determine the composition of pleural fluid. Understanding the underlying pathophysiological processes of pleural effusion, especially cellular processes, can be useful in establishing its aetiology.

The intersection of substance use stigma and anti-Black racial stigma: A scoping review.

BACKGROUND: Substance use stigma poses a barrier to treatment and recovery from substance use disorder. Stigma is amplified when intersecting with other stigmatized identities, particularly Black racial identity. Despite increasing attention to the intersecting roles of racial and substance use stigma, it is unknown how these stigmas interact to impact treatment and health outcomes among Black people who use drugs. This scoping review examines empirical research documenting differential impacts of race and racism on substance use stigma. METHODS: We systematically searched PsychInfo and PubMed databases. Eligible studies were conducted in the U.S.; examined a Black sample, subsample, or experimental condition/variable (i.e., in a vignette); and measured substance use stigma (excluding alcohol or nicotine). Qualitative studies describing a theme related to substance use stigma were also included. RESULTS: Of 1431 unique results, 22 articles met inclusion criteria. The most measured substance use stigma type was interpersonal (e.g., discrimination). Most quantitative findings (n = 15) suggested that Black members of the general public endorse less substance use stigma and Black people who use drugs face less substance use stigma relative to their White counterparts. Qualitative studies (n = 7) suggested stigma was a more common and pernicious substance use treatment barrier for Black people compared to White. Across methods, racial prejudice was associated with substance use stigma, supporting hegemonic ideas that substance use is stereotypically characteristic of Black people. CONCLUSIONS: The interaction between substance use stigma and race is complex and varies by in-group and out-group raters as a function of racial identity and identity as a person who uses drugs. Contradictory findings reflect methodological differences, emphasizing the need for more unified measurement of substance use stigma. More research is needed among Black people who use drugs to improve understanding of the impact of these intersecting stigmas on racial inequities in substance use treatment, morbidity, and mortality.

Applying trace element geochemistry of archaeological bone to study the coevolution of environmental change and human health in the Roman Empire.

Technological change has affected human health dating back to at least the Neolithic agricultural revolution. Growing evidence indicates widespread environmental pollution began with metallurgical practices and continues today. Environmental exposures to trace elements released from these practices have the potential to alter human body composition, such as bone mineral chemistry, especially for elements that are not homeostatically regulated. These signals can be used for inferences about human health, particularly when metallotoxins are detected in abundance. Therefore, trace element geochemistry of archaeological bone may provide a means to evaluate human health through time. However, diagenetic factors can hinder attempts to extract this information. Thus, we employed advanced analytical and interpretive methods to carefully distinct groups of European burials over about 1000 years to address questions of potentially toxic trace element exposures. Here, to address our hypothesis that Roman urbanization created one of the earliest urban toxic environment caused by multiple exposures, we present a comprehensive suite of bone trace element compositions of femora from burials spanning three distinct archaeological time periods (Bronze Age, Iron Age, and Roman period). All bone specimens were obtained from the anterior-mid shaft of carefully selected femora and processed using the same analytical techniques designed to mitigate soil contamination. Our data indicate that widespread environmental pollution accelerated in Londinium during the Roman Empire period, leading to conditions where population health would be vulnerable to environmental changes. Specifically, bone lead, silver, vanadium, arsenic, and cadmium concentrations were typically elevated and would likely be associated with multiple toxicities. In addition, bone iron levels were extremely high in some Londinium burials. Our interpretation is that the Romans inhabiting Londinium were not just poisoned by lead exposure as several previous studies show but by several metallotoxins.