Modelling and assessment of glucose-lactate kinetics in youth with overweight, obesity and metabolic dysfunction-associated steatotic liver disease: A pilot study.

AIM: In this study, we investigated glucose and lactate kinetics during a 75 g oral glucose tolerance test (OGTT) in 23 overweight and obese adolescents and assessed putative differences among participants with and without metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS: We enrolled 23 young people (six girls) with obesity [body mass index 33 (29-37)]. Glucose-lactate kinetics parameters (disposal glucose insulin sensitivity, SID; fraction of glucose converted into lactate, fr; fractional lactate clearance rate, kL) and lactate production rate (LPR) were estimated using the oral glucose-lactate minimal model. MASLD presence was assessed using the proton density fat fraction. We analysed glucose, lactate and LPR time to peak, peak values and area under the curve and evaluated differences using the Wilcoxon test. MASLD and no-MASLD participants were compared using the Mann-Whitney test. Correlations between parameters were assessed using the Spearman correlation coefficient (ρ). We also tested the performance of two (4 or 3 h OGTT) protocols in estimating oral glucose-lactate minimal model and LPR parameters. RESULTS: Glucose peaks 30 min earlier than lactate (p = .0019). This pattern was present in the no-MASLD group (p < .001). LPR peaks 30 min later in the MASLD group (p = .02). LPR and kL were higher in MASLD, suggesting higher glycolysis and lactate utilization. SID and fr correlate significantly (ρ = -0.55, p = .008). SID and fr were also correlated with the body mass index, (ρ = -0.45, p = .04; and ρ = 0.45; p = .03). The protocol duration did not influence the estimates of the parameters. DISCUSSION: Youth with MASLD showed a delayed glucose metabolism, possibly because of greater utilization of the underlying substrates. A 3-h OGTT may be used to assess lactate metabolism effectively.

REPRODUCTIVE CYCLE STAGE ASSESSMENT IN THE TWO-TOED SLOTH (CHOLOEPUS HOFFMANNI), PRELIMINARY RESULTS.

The number of two-toed sloths (Choloepus hoffmanni) has significantly decreased in the last years. Deepening the knowledge of this tropical mammal's reproductive physiology is essential to improve captive breeding within conservation programs for this species. However, several aspects of its reproductive biology remain unexplored and have not been described sufficiently. The aim of this work was to describe the estrous cycle and reproductive physiology of two adult female C. hoffmanni by vaginal cytology, appearance of the external genitalia, and behavior. Vaginal cytology assay showed that the average duration of the estrous cycle was 15.1 ± 4.53 d. Positive correlations (P < 0.05) were found between the peak presence of superficial cells (estrous phase) and four parameters: aggressive behavior, pursuing behavior, vulvar swelling, and vaginal discharge. This pilot study, conducted on just two animals, forms a basis for a study design that may be employed for a more comprehensive assessment of the two-toed sloth reproductive physiology and behavior.

Assessment of Adverse Childhood Experiences and Social Determinants of Health: A Survey of Practices in Pediatric Weight Management Programs.

Introduction: Adverse childhood experiences (ACEs) and social determinants of health (SDoH) are associated with increased incidence of pediatric obesity. Recent literature highlights an imperative need to assess ACEs and SDoH among youth and families with obesity to identify those individuals requiring targeted interventions. The primary objective of the present study was to examine the frequency, methodology, and barriers in evaluation of ACEs and SDoH within pediatric weight management programs (PWMPs). Methods: Invitations were e-mailed to a comprehensive directory of 92 PWMPs in the United States with a link to complete an electronic survey. Results: Forty-one PWMPs from 26 states completed the survey. Assessment of one or more ACEs and SDoH was common and typically took place during the initial patient visit by the psychologist or medical practitioner through unstructured conversations. Reported barriers to assessment included lack of time to assess and to follow-up, lack of clinic protocols, and inadequate referral resources. Programs offering bariatric surgery and those with embedded mental health clinicians reported fewer barriers to ACEs/SDoH referral resources, while family-based and healthy lifestyle-focused programs perceived more barriers related to insufficient support staff and time to follow-up with families. Conclusions: Most PWMPs assess a subset of ACEs and SDoH; however, approaches to assessment vary, are often unstructured, and several barriers remain to optimizing assessment and follow-up. Future research should evaluate standardized ACEs/SDoH assessment protocols, ideal workflow, and their impact on obesity treatment and related health outcomes.

Preoperative Risk Factors for Adverse Events in Adults Undergoing Bowel Resection for Inflammatory Bowel Disease: 15-Year Assessment of the American College of Surgeons National Surgical Quality Improvement Program.

INTRODUCTION: Older adults with inflammatory bowel disease (IBD) are at higher risk for postoperative complications as compared to their younger counterparts; however, factors contributing to this are unknown. We assessed risk factors associated with adverse IBD-related surgical outcomes, evaluated trends in emergency surgery, and explored differential risks by age. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified adults ≥18 years of age who underwent an IBD-related intestinal resection from 2005 to 2019. Our primary outcome included a 30-day composite of mortality, readmission, reoperation, and/or major postoperative complication. RESULTS: Overall, 49,746 intestinal resections were performed with 9,390 (18.8%) occurring among older adults with IBD. Nearly 37% of older adults experienced an adverse outcome as compared to 28.1% among younger adults with IBD ( P < 0.01). Among all adults with IBD, the presence of preoperative sepsis (adjusted odds ratio [aOR], 2.08; 95% confidence interval [CI] 1.94-2.24), malnutrition (aOR, 1.22; 95% CI 1.14-1.31), dependent functional status (aOR, 6.92; 95% CI 4.36-11.57), and requiring emergency surgery (aOR, 1.50; 95% CI 1.38-1.64) increased the odds of an adverse postoperative outcome, with similar results observed when stratifying by age. Furthermore, 8.8% of surgeries among older adults were emergent, with no change observed over time ( P = 0.16). DISCUSSION: Preoperative factors contributing to the risk of an adverse surgical outcome are similar between younger and older individuals with IBD, and include elements such as malnutrition and functional status. Incorporating these measures into surgical decision-making can reduce surgical delays in older individuals at low risk and help target interventions in those at high risk, transforming care for thousands of older adults with IBD.

Systematic literature review of digital resources to educate on gender equality.

Violence and discrimination against women are serious problems that affect today's society regardless of culture or social environment. Educational and government programs addressing these gender issues are difficult to scale up, insufficient or, in some cases, nonexistent. Digital resources can contribute to address discrimination against women and different technological initiatives are being carried out around the world. Videogames and digital resources have proven their effectiveness as tools to educate, prevent and raise awareness about social problems. This article presents a systematic literature review of digital resources such as videogames, apps and simulations that address gender issues including violence and stereotypes. Throughout the review, we analyze multiple characteristics of the resources found (development tools, platforms, location, target audience) to classify the studies found. The main goal of this review is to present the status of gender-focused digital resources, their evaluation studies, including the metrics used and samples, as well as the acceptance and impact of their application. Most of the studies reviewed aimed to raise awareness about gender-based violence using serious games targeted at teenagers. For the resources evaluated, pre-post questionnaires were commonly used. However, many of the projects reviewed did not have evaluation studies or the resources were not openly available, thus limiting their massive application and their potential impact on society. We consider that our results provide a starting point to better understand the role of digital resources in raising awareness about gender issues, highlighting their current limitations, and providing recommendations for future research in gender-based digital resources.

How much does it cost to mitigate soil erosion after wildfires?

Wildfires usually increase the hydrological and erosive response of forest areas, carrying high environmental, human, cultural, and financial on- and off-site effects. Post-fire soil erosion control measures have been proven effective at mitigating such responses, especially at the slope scale, but there is a knowledge gap as to how cost-effective these treatments are. In this work, we review the effectiveness of post-fire soil erosion mitigation treatments at reducing erosion rates over the first post-fire year and provide their application costs. This allowed assessing the treatments' cost-effectiveness (CE), expressed as the cost of preventing 1 Mg of soil loss. This assessment involved a total of 63 field study cases, extracted from 26 publications from the USA, Spain, Portugal, and Canada, and focused on the role of treatment types and materials, and countries. Treatments providing a protective ground cover showed the best median CE (895 $ Mg-1), especially agricultural straw mulch (309 $ Mg-1), followed by wood-residue mulch (940 $ Mg-1) and hydromulch (2332 $ Mg-1). Barriers showed a relatively low CE (1386 $ Mg-1), due to their reduced effectiveness and elevated implementation costs. Seeding showed a good CE (260 $ Mg-1), but this reflected its low costs rather than its effectiveness to reduce soil erosion. The present results confirmed that post-fire soil erosion mitigation treatments are cost-effective as long as they are applied in areas where the post-fire erosion rates exceed the tolerable erosion rate thresholds (>1 Mg-1 ha-1 y-1) and are less costly than the loss of on- and off-site values that they are targeted to protect. For this reason, the proper assessment of post-fire soil erosion risk is vital to ensure that the available financial, human and material resources are applied appropriately.

Clinical relevance of timing of assessment of ICU mortality in patients with moderate-to-severe Acute Respiratory Distress Syndrome.

Mortality is a frequently reported outcome in clinical studies of acute respiratory distress syndrome (ARDS). However, timing of mortality assessment has not been well characterized. We aimed to identify a crossing-point between cumulative survival and death in the intensive care unit (ICU) of patients with moderate-to-severe ARDS, beyond which the number of survivors would exceed the number of deaths. We hypothesized that this intersection would occur earlier in a successful clinical trial vs. observational studies of moderate/severe ARDS and predict treatment response. We conducted an ancillary study of 1580 patients with moderate-to-severe ARDS managed with lung-protective ventilation to assess the relevance and timing of measuring ICU mortality rates at different time-points during ICU stay. First, we analyzed 1303 patients from four multicenter, observational cohorts enrolling consecutive patients with moderate/severe ARDS. We assessed cumulative ICU survival from the time of moderate/severe ARDS diagnosis to ventilatory support discontinuation within 7-days, 28-days, 60-days, and at ICU discharge. Then, we compared these findings to those of a successful randomized trial of 277 moderate/severe ARDS patients. In the observational cohorts, ICU mortality (487/1303, 37.4%) and 28-day mortality (425/1102, 38.6%) were similar (p = 0.549). Cumulative proportion of ICU survivors and non-survivors crossed at day-7; after day-7, the number of ICU survivors was progressively higher compared to non-survivors. Measures of oxygenation, lung mechanics, and severity scores were different between survivors and non-survivors at each point-in-time (p < 0.001). In the trial cohort, the cumulative proportion of survivors and non-survivors in the treatment group crossed before day-3 after diagnosis of moderate/severe ARDS. In clinical ARDS studies, 28-day mortality closely approximates and may be used as a surrogate for ICU mortality. For patients with moderate-to-severe ARDS, ICU mortality assessment within the first week of a trial might be an early predictor of treatment response.

Breastfeeding effect on glucose tolerance assessment in women with previous gestational diabetes mellitus: A randomized controlled trial.

AIMS: To test whether breastfeeding during the oral glucose tolerance test (OGTT) affects glucose and insulin outcomes (main outcome: 120 min plasma glucose). METHODS: A randomized crossover trial was conducted in 20 women with prior gestational diabetes mellitus. Each woman undertook two OGTTs in the first 3 months after delivery, breastfeeding the infant in one and avoiding breastfeeding in the other. Glucose and insulin were measured at 0, 30, 60 and 120 min. Statistics included: T-test for paired data, general linear model (GLM) for repeated measures. Analysis of covariance (ANCOVA) was used to adjust for glucose and insulin values at 0 min. Statistical dispersion for GLM and ANCOVA outcomes is expressed as standard error. RESULTS: In the OGTTs with breastfeeding, higher values were observed for overall glucose and insulin concentrations, glucose and insulin peaks and individual time points of glucose (at 0, 30 and 60 min) and insulin (at 0 and 60 min) but without differences at 120 min (glucose 6.7 ± 0.3 vs. 6.9 ± 0.3 mmol/L, p = 0.506). The rate of abnormal tests was not different. ANCOVA confirmed higher postchallenge glucose values in the OGTT with breastfeeding and similar glucose values at 120 min. CONCLUSIONS: According to the results of this randomized trial, we conclude that breastfeeding during the OGTT resulted in similar 120 min glucose concentration and glycaemic status categorization. However, breastfeeding during the OGTT led to clear differences in glucose and insulin values in the first hour, that warrant further studies.

Food insecurity, housing instability, and dietary quality among children with sickle cell disease: Assessment from a single urban center.

BACKGROUND: Food insecurity and housing instability, both social determinants of health (SDoH), disproportionately affect economically unstable, under-resourced US communities in which children with sickle cell disease (SCD) live. Association between these SDoH markers and dietary quality among children with SCD is unknown. PROCEDURES: We assessed a cross-sectional sample of dyadic parent-child patients and young adult patients up to age 21 from one pediatric SCD center. Food insecurity, housing instability, and dietary quality were measured using validated US instruments and a food frequency questionnaire. Better dietary quality was defined using US dietary guidelines. Multivariate regression assessed for associations among dietary quality and food insecurity with or without (±) housing instability and housing instability alone. RESULTS: Of 100 enrolled participants, 53% were Black and 43% Hispanic; mean age 10.6 ± 5.6 years. Overall, 70% reported less than or equal to one economic instability: 40% housing instability alone and 30% both food insecurity and housing instability. Eighty percent received more than or equal to one federal food assistance benefit. Compared to no economic instability, food insecurity ± housing instability was significantly associated with higher intake of higher dairy and pizza, while housing instability alone was significantly associated with higher dairy intake. Food insecurity ± housing instability was significantly associated with lower intake of whole grains compared to housing instability alone. CONCLUSIONS: Our sample reported high frequencies of both food insecurity and housing instability; having more than or equal to one SDoH was associated with elements of poorer diet quality. Screening families of children with SCD for food insecurity and housing instability may identify those with potential nutrition-related social needs.

The Campaign for Universal Free Lunch in New York City: Lessons Learned.

The New York City (NYC) Department of Education is the largest public school system in the United States, with an enrollment of >1.1 million students. Students who participate in school meal programs can have higher dietary quality than nonparticipating students. Historically, family income documentation qualifying students in the NYC Department of Education for free or reduced-price meals reimbursed by the National School Lunch Program perpetuated poverty stigma. Additionally, National School Lunch Program qualification paperwork was a deterrent to many vulnerable families to participate and impeded all eligible children's access to nutritious meals, potentially magnifying food insecurity. The Healthy, Hunger-Free Kids Act of 2010 provided a viable option for schools to serve free meals to all students, regardless of income status, as a universal free lunch (UFL) through a Community Eligibility Provision if ≥40% of students already participated in another means-based program, such as the Supplemental Nutrition Assistance Program. In this case study, we describe the processes of (1) strategic coalition building of the Lunch 4 Learning campaign (a coalition of students, parents, school-based unions, teachers, pediatricians, community leaders, and children's advocacy organizations) to bring UFL to all NYC public schools, (2) building political support, (3) developing a media strategy, and (4) using an evidence-based strategy to overcome political, administrative, and procedural challenges. The Lunch 4 Learning campaign successfully brought UFL to all NYC public schools in 2017. This case study informs further advocacy efforts to expand UFL in other school districts across the country and national UFL advocacy.

Life cycle assessment of volatile fatty acids production from protein- and carbohydrate-rich organic wastes.

Volatile fatty acids (VFAs) are platform molecules with numerous applications. They can be obtained by adjusting the operational conditions of anaerobic digestion to avoid methanogenesis while focusing on fermentative stages. There are gaps in the knowledge of how, from a life-cycle perspective, the fermentative process performs in VFAs production from waste, including environmental consequences of substituting common commodities in the current market. Mass and energy balances of VFAs production from protein-rich microalgal and carbohydrate-rich agro-industrial wastes were used herein as a key source of inventory data for life cycle assessment. Two waste treatment options were considered: (i) VFAs production (anaerobic fermentation) plus anaerobic digestion of the resulting waste after VFAs separation, and (ii) anaerobic digestion of the original waste for bioenergy. Several scenarios were formulated to evaluate their life-cycle performance. VFAs production generally shows a better environmental behaviour than conventional anaerobic digestion, principally due to the substitution of conventional chemicals.

Hispanic Identity and Its Inclusion in the Race Discrimination Discourse in the United States.

As protests against racism occur all over the United States and medical institutions face calls to incorporate antiracism and health equity curricula into professional training and patient care, the antiracism discourse has largely occurred through a Black/African American and White lens. Hispanics, an umbrella category created by the U.S. government to include all people of Spanish-speaking descent, are the largest minority group in the country. Hispanics are considered an ethnic rather than a racial group, although some Hispanics self-identify their race in terms of their ethnicity and/or country of origin while other Hispanics self-identify with any of the 5 racial categories used by the U.S. government (White, Black/African American, American Indian or Alaska Native, Asian, or Native Hawaiian or Other Pacific Islander). Expanding the antiracism discourse in medicine to include Hispanic perspectives and the diversity of histories and health outcomes among Hispanic groups is crucial to addressing inequities and disparities in health and medical training. A lack of inclusion of Hispanics has contributed to a growing shortage of Hispanic physicians and medical school faculty in the United States as well as discrimination against Hispanic physicians, trainees, and patients. To reverse this negative trend and advance a health care equity and antiracist agenda, the authors offer steps that medical schools, academic medical centers, and medical accreditation and licensing bodies must take to increase the representation of Hispanics and foster their engagement in this evolving antiracism discourse.

Artificial Intelligence Algorithm Qualification: A Quality by Design Approach to Apply Artificial Intelligence in Pharma.

Quality is defined by the American Society for Quality (ASQ) as "the totality of features and characteristics of a product or service that bears on its ability to satisfy given needs." Therefore, quality is applicable to processes that supply outcomes with values that can be measured. Statistical control is an effective methodology that provides the outcome of quality of goods, bringing an added value that other methods, like quality by inspection, do not offer. The statistical methods applied to process control have been thoroughly developed, and the mathematics that supports them have been broadly demonstrated. Artificial Intelligence (AI) is a field in which mathematics, statistics, and programming play a joint role, and its results can also be applied to disciplines like quality control. Nevertheless, its utilization is subordinate to the qualification of the implemented algorithms. This research presents a standard procedure to AI algorithms, allowing their usage in regulated environments to ensure the quality of the delivered products or services (e.g., in drugs and medicines manufacturing). The regulated principles are defined by the concept of quality by design (QbD), which is a notion introduced in the pharmaceutical industry as a good practice for process management under multivariate analysis. This study intended to provide guidance for qualifying AI algorithms using QbD guidelines as the foundation for this purpose.

Assessment of different Bacillus coagulans strains for l-lactic acid production from defined media and gardening hydrolysates: Effect of lignocellulosic inhibitors.

Cellulose valorisation has been successfully addressed for years. However, the use of hemicellulosic hydrolysates is limited due to the presence of C5-sugars and inhibitors formed during pretreatment. Bacillus coagulans is one of the few bacteria able to utilize both C6- and C5-sugars to produce l-lactic acid, but its susceptibility to the lignocellulosic inhibitors needs further investigation. For such a purpose, the tolerance of different B. coagulans strains to increasing concentrations of inhibitors is studied. The isolated A162 strain reached the highest l-lactic acid productivity in all cases (up to 2.4 g L-1  h-1), even in presence of 5 g L-1 of furans and phenols. Remarkably, most of furans and phenolic aldehydes were removed from defined media and hemicellulosic gardening hydrolysate after fermentation with A162. Considering the high productivities and the biodetoxifying effect attained, A162 could be pointed out as a great candidate for valorisation of mixed sugars from hemicellulosic hydrolysates with high inhibitors concentration, promoting the implementation of lignocellulosic biorefineries.

Food Insecurity and Sugar-Sweetened Beverage Consumption Among WIC-Enrolled Families in the First 1,000 Days.

OBJECTIVE: Determine the association between household food insecurity and habitual sugar-sweetened beverage (SSB) consumption among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-enrolled families during the first 1,000 days. METHODS: Cross-sectional analysis of pregnant women and mothers of infants aged under 2 years in the WIC was performed. Families recruited sequentially at consecutive visits completed food insecurity and beverage intake questionnaires; estimated logistic regression models controlled for sociodemographic characteristics. RESULTS: Of 394 Hispanic/Latino mothers and 281 infants, 63% had household food insecurity. Food insecurity significantly increased odds of habitual maternal (unadjusted odds ratio (OR), 2.39; 95% CI, 1.27-4.47; P = .01) and infant SSB consumption (OR, 2.05; 95% CI, 1.15-3.65; P = .02), and the relationship was not attenuated by maternal age, education, or foreign-born status. CONCLUSIONS AND IMPLICATIONS: Food insecurity increased odds of habitual SSB consumption in WIC families. Interventions to curb SSB consumption among WIC-enrolled families in the first 1,000 days in the context of household food insecurity are needed.

VOLATILE FATTY ACIDS FROM ORGANIC WASTES AS NOVEL LOW-COST CARBON SOURCE FOR Yarrowia lipolytica.

Microbial oil biosynthesis is envisaged as a promising technology for sustainable production of chemicals and fuels. Sugar-based substrates are the most typical carbon sources used for this purpose where metabolic pathways and stoichiometry are well known. However, the use of low-cost substrates is crucial for the economic viability of the process. Volatile fatty acids (VFAs) are considered to be a novel low-cost carbon source for microbial lipid production. They can be utilized by oleaginous yeasts to produce and store fatty acids in form of intracellular lipid bodies. In this work, Yarrowia lipolytica growth and substrate consumption were evaluated using the major VFAs present in anaerobic effluents. Individual VFAs as well as synthetic mixtures were tested at different concentrations to determine uptake rates and potential toxicity. Increasing VFA chain length resulted in greater biomass yield although, when added individually, 4 g Carbon/L VFA (e.g. 6.45 g/L of caproic and 10 g/L of acetic acid) caused inhibitory effects. Remarkably, biomass growth increased by 2.5-fold on real anaerobic fermentation effluent compared with synthetic mixtures. When real digestate was supplemented with synthetic VFAs up to 26.5 g/L, the inhibitory effect of the acids was counterbalanced. The results provided evidence of robustness of Y. lipolytica towards low-cost fermentation effluents and present this yeast as a promising candidate for the sustainable production of microbial oil using real digestates.

Perceived discrimination and well-being among unauthorized Hispanic immigrants: The moderating role of ethnic/racial group identity centrality.

OBJECTIVES: We investigated the association between perceived ethnic discrimination with psychological well-being and life satisfaction among a community sample of unauthorized Hispanic immigrants in the United States. We also assessed whether ethnic/racial group identity centrality moderated this relationship. METHOD: A community sample of self-reported unauthorized Hispanics (N = 140) completed questionnaires assessing perceived ethnic discrimination, ethnic/racial group identity centrality, psychological well-being, and life satisfaction. RESULTS: Discrimination negatively predicted psychological well-being and life satisfaction, and ethnic/racial group identity centrality moderated these relationships. High ethnic/racial group identity centrality reduced the association of discrimination with psychological well-being and life satisfaction. Ethnic/racial identity centrality lent psychological protection for those who reported higher levels of discrimination. CONCLUSION: Ethnic discrimination is a salient stressor for unauthorized Hispanic immigrants. Yet high ethnic/racial group identity centrality may protect these individuals from the negative effects of discrimination by providing a sense of belonging, acceptance, and social support in the face of rejection. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Energy balance and life cycle assessment of a microalgae-based wastewater treatment plant: A focus on alternative biogas uses.

The techno-environmental performance of a medium-scale wastewater treatment system using high-rate algal ponds was evaluated through mass and energy balances and life cycle assessment. The system involves wastewater primary treatment, microalgae-based secondary treatment, thermal hydrolysis with steam explosion of microalgae, anaerobic co-digestion of pre-treated microalgal biomass and primary sludge, and biogas cogeneration. Furthermore, two scenarios based on alternative biogas uses were considered: (i) biogas for heat and electricity, and (ii) biogas for heat, electricity, and biomethane. Pumping wastewater to the primary settler arose as the main source of electricity consumption. When compared to conventional activated sludge plants, a large decrease in the energy consumption was observed for the secondary treatment. Moreover, a favourable life-cycle performance was generally found for the microalgae-based systems when displacing conventional energy products. Finally, the preference for a specific scenario on biogas use was found to be highly conditioned by the techno-environmental aspects prioritised by decision-makers.

Dual Food and Energy Hardship and Associated Child Behavior Problems.

OBJECTIVE: To examine dual food and energy hardship and internalizing and externalizing behavior problems in 9-year-old children. METHODS: We conducted a cross-sectional analysis of the Fragile Families and Child Wellbeing Study, a prospective national urban birth cohort, when the children were 9 years old. Maternal-reported "food hardship" (ever hungry and/or ever received free food) and "energy hardship" (ever unable to pay utility bill and/or utility shutoff) within the past year, and child behavior using the Child Behavior Checklist for Ages 6-18 were assessed. Multiple logistic regression analyses estimated associations between individual and dual food and energy hardship and child behavior problems, adjusting for a priori covariates (ie, child sex, health insurance, maternal sociodemographic characteristics, poverty, reported health, attention deficit hyperactivity disorder, depressive symptoms, smoking, and substance and alcohol abuse). RESULTS: Approximately 10% of households reported dual food and energy hardship. Children experiencing dual food and energy hardship had 3 times greater odds of withdrawn/depressed behaviors (adjusted odds ratio [AOR], 2.8; 95% confidence interval [CI], 1.4-5.5), threefold greater odds of somatic complaints (AOR, 3.2; 95% CI, 1.5-6.9), and 4 times greater odds of rule-breaking behavior (AOR, 3.7; 95% CI, 1.5-9.2) in the borderline/clinical range than children with no hardship, and had fourfold greater odds of borderline/clinical range somatic complaints (AOR, 4.2; 95% CI, 1.7-10.3) than children with only energy hardship. CONCLUSIONS: Children experiencing dual food and energy hardship have greater odds of coexisting internalizing and externalizing behaviors after controlling for possible confounders. Providers can consider screening and resource referrals for these addressable hardships alongside behavior assessments in the clinical setting.

Impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure. / Impacto de las variables geriátricas en la mortalidad a 30 días de los ancianos atendidos por insuficiencia cardiaca aguda?

OBJETIVE: To study the impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure (AHF). METHODS: Retrospective analysis of cases in the OAK Registry (Older Acute Heart Failure Key Data), a prospectively compiled database of consecutive patients aged 65 years or older treated for AHF in 3 Spanish emergency departments over a 4-month period (November-December 2011 and January-February 2014). The patients underwent a geriatric assessment adapted for emergency department use on weekdays between 8 AM and 10 PM. Demographic, clinical, laboratory, and geriatric assessment variables were recorded. The geriatric variables were concurrent diseases; polypharmacy; frailty; functional, social, and cognitive status at baseline; results of screening for confusional state, cognitive impairment, and depression; and nutritional status. The primary outcome was all-cause mortality at 30 days. RESULTS: We included 565 patients with a mean (SD) age of 83 (7.1) years; 346 (61.6%) were women. Sixty-five (11.5%) died within 30 days. Independent factors associated with 30-day mortality were acute confusional state (adjusted odds ratio [aOR], 2.2; 95% CI, 1.0­4.8; P=.04), acute illness (aOR, 1.8; 95% CI, 0.9­3.4; P=.05), loss of appetite in the past 3 months (aOR, 1.8; 95% CI, 1.0­3.4; P=.04), frailty (aOR, 2.0, 95% CI, 1.0­4.1; P=.05), and severe disability (aOR, 4.4; 95% CI, 1.9­11.4; P=.01). CONCLUSIONS: Certain geriatric variables should be considered when assessing short-term risk in older patients with AHF.

OBJETIVOS: Estudiar el impacto de las variables geriátricas en la mortalidad a 30 días entre los ancianos con insuficiencia cardiaca aguda (ICA). MÉTODO: Análisis retrospectivo del registro Older Acute heart failure Key data (OAK) que incluye prospectivamente a pacientes consecutivos 65 años con ICA en 3 servicios de urgencias españoles durante 4 meses (noviembre-diciembre 2011 y enero-febrero 2014). Se realizó una valoración geriátrica adaptada a urgencias durante los días laborales de 8 am a 10 pm. Se recogieron variables demográficas, clínicas, analíticas y geriátricas (comorbilidad, polifarmacia, fragilidad, situación basal funcional, cognitiva y social, despistaje de síndrome confusional, deterioro cognitivo y depresión, y situación nutricional). La variable de resultado fue la mortalidad por cualquier causa a los 30 días. RESULTADOS: Se incluyeron 565 pacientes con edad media 83 años (DE 7,1), 346 mujeres (61,6%). Sesenta y cinco sujetos (11,5%) fallecieron a los 30 días. La presencia de síndrome confusional agudo (OR ajustada = 2,2; IC95% 1,0-4,8; p = 0,04), de enfermedad aguda (OR ajustada = 1,8; IC95% 0,9-3,4; p = 0,05) o pérdida de apetito (OR ajustada = 1,8; IC95% 1-3,4; p = 0,04) en los últimos 3 meses, y de fragilidad (OR ajustada = 2,0; IC95% 1,0-4,1; p = 0,05) o dependencia funcional grave (OR ajustada = 4,4; IC95% 1,9-11,4; p = 0,01) fueron factores independientes asociados con mortalidad a los 30 días. CONCLUSIONES: Existen ciertas variables geriátricas que debieran contemplarse en la estratificación de riesgo a corto plazo de los pacientes ancianos con ICA.