Health risk assessment in children living in an urban area with hydrofluorosis: San Luis Potosí Mexico case study.

BACKGROUND: Fluoride is an inorganic element, which can be found in high concentrations in groundwater. Its consumption and exposure have consequences on human health. The objective of this study was to evaluate fluoride exposure and develop a health risk assessment in children from an urban area with hydrofluorosis in Mexico. METHODS: Water fluoride levels in active wells were provided by the Water State Agency and divided into three zones: agriculture zone (Zone A), metallurgical zone (Zone B), and industrial zone (Zone C). Urinary fluoride levels were determined by potentiometric method using an ion-selective electrode. Health risk assessment was performed through Monte Carlo model analysis and hazard quotient was calculated. RESULTS: According to fluoride well concentration, all zones have high concentration especially Zone B (2.55 ± 0.98 mg/L). Urinary fluoride concentrations were highest in children in Zone B (1.42 ± 0.8 mg/L). The estimated median daily intake dose of fluoride was 0.084 mg/Kg-day for the children living in zone B. The highest mean HQ value was to Zone B (1.400 ± 0.980), followed by Zone C (0.626 ± 0.443). CONCLUSION: The levels of fluoride exposure registered are a potential risk to generate adverse health effects in children in the San Luis Potosi metropolitan area.

Population pharmacokinetics of intravenous and oral ciprofloxacin in children to optimize dosing regimens.

PURPOSE: This study aimed to characterize pharmacokinetics of intravenous and oral ciprofloxacin in children to optimize dosing scheme. METHODS: Children treated with ciprofloxacin were included. Pharmacokinetics were described using non-linear mixed-effect modelling and validated with an external dataset. Monte Carlo simulations investigated dosing regimens to achieve a target AUC0-24 h/MIC ratio ≥ 125. RESULTS: A total of 189 children (492 concentrations) were included. A two-compartment model with first-order absorption and elimination best described the data. An allometric model was used to describe bodyweight (BW) influence, and effects of estimated glomerular filtration rate (eGFR) and age were significant on ciprofloxacin clearance. CONCLUSION: The recommended IV dose of 10 mg/kg q8h, not exceeding 400 mg q8h, would achieve AUC0-24 h to successfully treat bacteria with MICs ≤ 0.25 (e.g. Salmonella, Escherichia coli, Proteus, Haemophilus, Enterobacter, and Klebsiella). A dose increase to 600 mg q8h in children > 40 kg and to 15 mg/kg q8h (max 400 mg q8h, max 600 mg q8h if augmented renal clearance, i.e., eGFR > 200 mL/min/1.73 m2) in children < 40 kg would be needed for the strains with highest MIC (16% of Pseudomonas aeruginosa and 47% of Staphylococcus aureus). The oral recommended dose of 20 mg/kg q12h (not exceeding 750 mg) would cover bacteria with MICs ≤ 0.125 but may be insufficient for bacteria with higher MIC and a dose increase according bodyweight and eGFR would be needed. These doses should be prospectively confirmed, and a therapeutic drug monitoring could be used to refine them individually.

Assessment of pesticides in soil from obsolete pesticides stores: a Caribbean case study.

The fate of highly hazardous or persistent pesticides in soils and their potential for environmental and health risks depends on the physical and chemical properties of the pesticide, soil properties including biological health and climatic conditions. Assessing the fate and impact of pesticides in soil is complicated in the Caribbean due to the high diversity of soils and duality of climate. The FAO supported national competent authorities from 11 countries in the Caribbean in the assessment of obsolete stocks and potentially contaminated soil. The Environmental Management Tool Kit (EMKT) prioritised Fond Cole and Camden Base as the only critical sites. Preliminary site investigations that utilised the rapid environmental assessment (REA) methodology identified that contamination was restricted to an impervious layer at the Camden site. Pesticide properties varied across groups, with the organochlorides exhibiting greater sorptive capacity and lower leaching potential relative to the organophosphates. All tested soils were non-saline with alkaline pH and notably sandy in texture with low adsorptive capacity. Analysis of pesticide levels revealed low to undetected quantities across contaminated sites. Traces of Endrin and Dieldrin were found in Marienburg, Suriname. Overall, assessment of soil contamination from stored obsolete pesticides revealed minimal contamination, however, detailed assessment considering contamination gradients should be performed where pesticides were identified.

Association between demographics and resilience - a cross-sectional study among nurses in Singapore.

AIM: To give an overview of the level of resilience among nurses in Singapore and to examine associations between various demographics variables and resilience level. BACKGROUND: The World Health Organization reported a global needs-based shortage of over 9 million nurses and midwives in 2013. Building resilience among nurses has been postulated as one of the ways to support and retain nurses in the profession. METHOD: A self-reported questionnaire consisting of questions on demographics and the Connor-Davidson Resilience Scale CD-RISC 10 was used. RESULTS: Univariate analysis identified marital status, age group, years of experience in nursing, highest education qualification and job grade to have significant associations with resilience. During multivariate analysis, only marital status, age group, highest educational qualification and job grade remained significant. A strong association was found between highest educational qualification and resilience level; nurses with bachelor's or postgraduate degree were about three times more likely than nurses with only a general nursing certificate to be of moderate/high resilience. CONCLUSION: The experience of life events (as exemplified by marital status, age and working experience) was associated with higher resilience levels. IMPLICATIONS FOR NURSING POLICY: There is a need for healthcare organizations and nurse leaders to develop programmes focusing on building resilience among younger and less experienced nurses. Nurses should also be supported in their pursuits for higher education, which will in turn lead to higher resilience, and consequently, retention of nurses within the profession and institution.

Mapping unmet supportive care needs, quality-of-life perceptions and current symptoms in cancer survivors across the Asia-Pacific region: results from the International STEP Study.

Background: To assess the supportive care needs, quality of life (QoL) and symptoms of patients with cancer after the end of first-line treatments and into survivorship in Asian countries using Australian data as benchmark. Patients and methods: A cross-sectional survey was carried out in Australia and eight high-income (HICs) and low-/middle-income (LMICs) Asian countries (China, Japan, Hong Kong SAR, South Korea, Myanmar, Thailand, India, Philippines) using validated scales (Cancer Survivors Unmet Needs scale), physical-symptom concerns (Cancer Survivors Survey of Needs subscale) and a single-item measure of global QoL perception. Results: Data were collected from 1873 patients. QoL was highest in Australia and all other countries had significantly lower QoL than Australia (all P < 0.001). One-quarter of the patients reported low QoL (scores 1-3/10). The most frequently reported symptoms were fatigue (66.6%), loss of strength (61.8%), pain (61.6%), sleep disturbance (60.1%), and weight changes (57.7%), with no difference in symptom experience between Australian data and all other countries, or between HICs and LMICs. Unmet needs of moderate/strong level were particularly high in all aspects assessed, particularly in the area of existential survivorship (psychosocial care) and receiving comprehensive cancer care. Australia and HICs were similar in terms of unmet needs (all low), but LMICs had a significantly higher number of needs both compared with Australia and HICs (all P < 0.001). Conclusion: Health care systems in Asian countries need to re-think and prioritize survivorship cancer care and put action plans in place to overcome some of the challenges surrounding the delivery of optimal supportive cancer care, use available resource-stratified guidelines for supportive care and test efficient and cost-effective models of survivorship care.

Assessment of exposure to mixture pollutants in Mexican indigenous children.

The aim of the present work was to complete an exposure assessment in three Mexican indigenous communities using the community-based health risk assessment, which is the first step in the CHILD framework. We used 1-hydroxypyrene (1-OHP) as an exposure biomarker to polycyclic aromatic hydrocarbons (PAHs) and trans, trans-muconic acid (t,t-MA) as an exposure biomarker to benzene, persistent organic pollutants (POPs), lead, manganese, arsenic, and fluoride. Anthropometric measurements were also taken. In these communities, high percentages of children with chronic malnutrition were found (28 to 49 %) based on their weight and age. All communities showed a high percentage of children with detectable levels of four or more compounds (70 to 82 %). Additionally, our results showed that in indigenous communities, children are exposed to elevated levels of certain environmental pollutants, including manganese with 17.6, 16.8, and 7.3 µg/L from SMP, TOC, and CUA, respectively. Lead and HCB levels were similar in the indigenous communities (2.5, 3.1, and 4.2 µg/dL and 2.5, 3.1, and 3.7 ng/mL, respectively). 1-OHP and t,t-MA levels were higher in TOC (0.8 µmol/mol of creatinine, 476 µg/g of creatinine, respectively) when compared with SMP (0.1 µmol/mol of creatinine, 215.5 µg/g of creatinine, respectively) and CUA (0.1 µmol/mol of creatinine, 185.2 µg/g of creatinine, respectively). DDE levels were 30.7, 26.9, and 9.6 ng/mL in CUA, SMP, and TOC, respectively. The strength of this study is that it assesses exposure to pollutants with indications for the resultant risk before an intervention is made by the CHILD program to manage this risk in the indigenous communities. Considering the large number of people, especially children, exposed to multiple pollutants, it is important to design effective intervention programs that reduce exposure and the resultant risk in the numerous indigenous communities in Mexico.

Belgian and Spanish consumption data and consumer handling practices for fresh fruits and vegetables useful for further microbiological and chemical exposure assessment.

A consumer survey was organized in Spain and Belgium to obtain consumption data and to gain insight into consumer handling practices for fresh vegetables consumed raw or minimally processed (i.e., heads of leafy greens, bell peppers, tomatoes, fresh herbs, and precut and packed leafy greens) and fruits to be consumed without peeling (i.e., apples, grapes, strawberries, raspberries, other berries, fresh juices, and precut mixed fruit). This information can be used for microbiological and/or chemical food safety research. After extensive cleanup of rough databases for missing and extreme values and age correction, information from 583 respondents from Spain and 1,605 respondents from Belgium (18 to 65 years of age) was retained. Daily intake (grams per day) was calculated taking into account frequency and seasonality of consumption, and distributions were obtained that can be used in quantitative risk assessment for chemical hazards with chronic effects on human health. Data also were recalculated to obtain discrete distributions of consumption per portion and the corresponding frequency of consumption, which can be used in acute microbiological risk assessment or outbreak investigations. The ranked median daily consumption of fruits and vegetables was similar in Spain and Belgium: apple > strawberry > grapes > strawberries and raspberries; and tomatoes > leafy greens > bell peppers > fresh herbs. However, vegetable consumption was higher (in terms of both portion and frequency of consumption) in Spain than in Belgium, whereas the opposite was found for fruit consumption. Regarding consumer handling practices related to storage time and method, Belgian consumers less frequently stored their fresh produce in a refrigerator and did so for shorter times compared with Spanish consumers. Washing practices for lettuce heads and packed leafy greens also were different. The survey revealed differences between these two countries in consumption and consumer handling practices, which can have an impact on outcomes of future microbiological or chemical risk assessment studies.

[A cost-effectiveness study of dexamethasone implants in macular edema]. / Resultados coste-efectividad del implante de dexametasona en edema macular.

OBJECTIVE: To analyze the cost-effectiveness and benefits of a dexamethasone intravitreal implant (Ozurdex®, Allergan, Irvine, CA, USA.) in its clinically relevant applications. MATERIAL AND METHODS: A total of 88 eyes of 86 patients with macular edema of > 300 µm measured by optical coherence tomography (Cirrus Zeiss, Dublin, CA, USA) were included in this two-year retrospective study, with a minimum of 6 months follow-up. The patients were divide into 3 groups: group 1 with macular edema in retinal vein occlusion, group 2 with non-infectious posterior uveitis, and group 3 with diabetic macular edema. The treatment was off-label but supported by the literature. Before implantation, and on days 1, 30, 60, 90 and 180, corrected visual acuity (Snellen), central retinal thickness, intraocular pressure and biomicroscopy were evaluated. The cost-benefit analysis was tabulated by line of visual acuity gained, comparing the main therapeutic alternatives and assessment of the safety profile of the dexamethasone intravitreal implant (Ozurdex®, Allergan, Irvine, CA, USA). RESULTS: The results of this study did not differ from the published studies, in terms of visual acuity improvement in 63.3% of cases, and with central macular thickness improvement in 97% of cases. There were relapses, which occurred after 120 days on average, and the need for retreatment was 40.9%. Increased intraocular pressure >23 mm Hg was among the side effects in 29.54%, and was controlled with topical treatment, except in 1.13% requiring surgical treatment. The development of cataract was 44.7%, and 10.6% required surgery. Treatment results showed less frequent use of Ozurdex® than other treatments for disease control, being a cost saving option. DISCUSSION: Cost-effectiveness analyses are clinically relevant when applying treatment strategies in patients with macular edema. Dexamethasone intravitreal implant appears to be a safe and efficient therapy.

Concordance of estimated glomerular filtration rates using Cockcroft-Gault modification of diet in renal disease, and chronic kidney disease epidemiology in renal transplant recipients.

INTRODUCTION: Various equations have been used to estimate the glomerular filtration rate (GFR) in renal patients, including kidney transplant recipients. Controversy exists concerning which equation is more precise to determine kidney failure. AIM: The aim of this study was to analyze the concordance (bias, variability, and exactness) of GFR estimated by the Modification of Diet in Renal Disease (MDRD4) and the Chronic Kidney Disease Epidemiology (CKD-EPI) equations using the Cockcroft-Gault (CG) method as the reference. MATERIAL AND METHODS: This observational, cross-sectional study included 153 clinically stable patients who underwent kidney transplantation between 2007 and 2009. The GFR was estimated at 12 months after the transplantation using the MDRD and CKP-EPI formula, using CG as the reference. RESULTS: The mean GFR for the various methods was as follows: CG = 65.6 ± 23.3 mL/min/1.73 m(2), MDRD4 = 54.9 ± 19.3 mL/min/1.73 m(2), and CKD-EPI = 55.8 ± 19.6 mL/min/1.73 m(2). Good correlations were found between CG-MDRD4 (r = 0.84; P < .001), CG-CKD-EPI (r = 0.87; P < .001), and MDRD4-CKD-EPI (r = 0.98; P < .001). The analysis of concordance detected a bias (normal difference) of -10.6 ± 12.7 versus -9.8 ± 11.3 mL/min/1.73 m(2) (P = .006), a variability (percent difference) of 14.5 ± 15.4% versus 13.6 ± 14.5% (P = .031), and an exactness (P30) of 81.7% versus 86.9% (P < .001) of CG-MDRD4 versus CG-CKD-EPI, respectively. For a GFR >60 mL/min/1.73 m(2) the exactness was 75.3% versus 83.5% (P < .001) for CG-MDRD4 versus CG-CKD-EPI, and for a GFR ≤ 60 mL/min/1.73 m(2) it was 89.7% versus 91.2% (P < .001). CONCLUSIONS: In our population the CKD-EPI method most approached the CG values, particularly when the GFR was >60 mL/min/1.73 m(2).

[ISMP-Spain questionnaire and strategy for improving good medication practices in the Andalusian health system]. / Cuestionario ISMP-España y estrategia de mejora en el uso seguro del medicamento dentro del Servicio Andaluz de Salud.

OBJECTIVE: To describe the strategy employed by Andalusian public health service hospitals to foster safe medication use. The self-evaluation questionnaire on drug system safety in hospitals, adapted by the Spanish Institute for Safe Medication Practices was used as a fundamental tool to that end. MATERIAL AND METHOD: The strategy is developed in several phases. We analyse the report evaluating drug system safety in Andalusian public hospitals published by the Spanish Ministry of Health and Consumption in 2008 and establish a grading system to assess safe medication practices in Andalusian hospitals and prioritise areas needing improvement. We developed a catalogue of best practices available in the web environment belonging to the Andalusian health care quality agency's patient safety observatory. We publicised the strategy through training seminars and implemented a system allowing hospitals to evaluate the degree of compliance for each of the best practices, and based on that system, we were able to draw up a map of centres of reference. RESULTS: We found areas for improvement among several of the questionnaire's fundamental criteria. These areas for improvement were related to normal medication procedures in daily clinical practice. We therefore wrote 7 best practice guides that provide a cross-section of the assessment components of the questionnaire related to the clinical process needing improvement. CONCLUSIONS: The self-evaluation questionnaire adapted by ISMP-Spain is a good tool for designing a systematic, rational intervention to promote safe medication practices and intended for a group of hospitals that share the same values.

Situaciones generadoras de estrés en los estudiantes de enfermería en las prácticas clínicas / Situations that generate stress in nursing students in clinical practice

Objetivos: Conocer qué situaciones les resultan más estresantes a los alumnos de enfermería durante las prácticas clínicas, por curso y de forma global, así como la asociación de los factores causantes de estrés, con determinadas variables sociodemográficas y laborales. Método: Estudio transversal, descriptivo, comparativo y correla-cional, realizado a 215 estudiantes de Enfermería matriculados durante el curso 2009-2010 en la Universidad de Murcia, utilizando como instrumento de medición una modificación del cuestionario KEZKAK, que mide factores causantes de estrés en las prácticas clínicas de alumnos de enfermería. Este cuestionario presenta un alto nivel de validez y fiabilidad y fue adaptado a las características de la muestra, previo pretest a un grupo control. Los datos recogidos fueron analizados estadísticamente con el programa SPSS 18.0, valorando las asociaciones con un grado de significación de p<0,05. Resultados: Los/as estudiantes presentan niveles de estrés altos durante sus prácticas clínicas, siendo los más afectados los estudiantes de segundo. Los estresores que más les afectan son los relacionados con desconocimiento, impotencia e incertidumbre ante una situación clínica. Además se ha comprobado que los factores sociodemográficos están asociados a los niveles de estrés. Conclusiones: Las mujeres presentan más estrés que los hombres, relacionado con situaciones emocionales. En los hombres el estrés se asocia más a desconocimiento ante situaciones clínicas no controladas. La edad, estado civil, experiencia previa en trabajos de ámbito sanitario y trabajo compaginado con el estudio influye en los niveles de estrés. Para mejorar estos niveles de estrés de los/as estudiantes se recomienda el desarrollo de programas de prevención.

Objectives: To determine what situations the nursing students fnd most stressful during clinical practice, globally and per course, as well as the association of stressors, with certain sociodemographic and occupational variables. Method: Cross-sectional, descriptive, comparative and correlational study carried out at 215 nursing students who were registered during the 2009-2010 academic year at the University of Murcia, using as a measuring tool a modification of the questionnaire KEZKAK, which measures stress factors in nursing students during clinical practices. This questionnaire has a high level of validity and reliability and was adapted to the characteristics of the sample, prior a control group pretest. Data collected were statistically analyzed using SPSS 18.0, valuing associations with a significance level of p <0.05. Results: The students have high levels of stress during clinical practices; the most affected are the ones attending the second academic year. The stressors that affect them most are related to ignorance, helplessness and uncertainty about a clinical situation. It was also found that sociodemographic factors are associated with stress levels. Conclusions: Women report more stress than men, related to emotional situations. In men, stress is more associated with ignorance for uncontrolled clinical situations. Age, marital status, previous experience in health area and working and studying at the same time, influences the stress levels. To improve these stress levels among students, prevention programs development are recommended.

[Assessment of nutritional status in esophageal atresia]. / Valoración del estado nutricional en los pacientes afectos de atresia de esófago.

OBJECTIVE: The aim of the study was to find out whether patients who underwent esophageal atresia (EA) surgery suffered from nutritional problems, to compare the nutritional status of these patients with a control group, and to determine if there is a relationship between the type of atresia and the nutritional condition. MATERIAL AND METHODS: We selected 25 patients out of a total of 32 who underwent EA surgery in our hospital from 2000 to 2006. A retrospective was conducted study based on the information obtained from the medical histories. A case-control study was also carried out by selecting a control group from a randomized population. RESULTS: The analyses performed showed that the mean weight and height Z-score was always negative, but not below -2 SD. There was a significant decrease in the weight Z-score between 3 and 9 months and in the weight/size Z-score between 3 and 24 months. Significant differences in weight and size Z-score were found between cases and controls, but not in skin-fold thickness. Independently of the type of atresia and the presence or not of congenital heart defects, no significant differences were found. CONCLUSIONS: There are significant differences in the weight and height Z-score between cases and controls. We stress the need to be aware of the nutritional status in order to prevent changes that could lead to a further deterioration of the patient.

Current status of pediatric home enteral nutrition in Spain: the importance of the NEPAD register.

Home enteral nutrition (HEN) is a type of enteral nutrition (EN) which is becoming progressively more widespread in pediatrics due to the benefits it affords to patients, their families and to reducing hospital costs. However, the true extent of its use is unknown in Spain as the data-base set up for this purpose is still underused (Registro de Nutrición Enteral Pediátrica Ambulatoria y Domiciliaria -NEPAD-). More thorough registration of patients in the NEPAD online register will provide information about the characteristics of HEN in Spain: prevalence, diagnosis, the population sector being administered HEN, complications and developments. Likewise, forecast and planning of the necessary resources could be made while those in use could be analysed.

Cost-consequence analysis comparing 2-octyl cyanoacrylate tissue adhesive and suture for closure of simple lacerations: a randomized controlled trial.

STUDY OBJECTIVE: We investigate the cost difference between conventional suture and tissue adhesive methods in simple wound closure. METHODS: A cost-consequence analysis was conducted alongside a nonblinded randomized controlled trial comparing 2-octyl cyanoacrylate tissue adhesive with conventional suture in simple lacerations closure in emergency departments (EDs) of a university teaching hospital and a major regional hospital in Hong Kong. One hundred eighty-six adult patients with simple lacerations of length within 8 cm were randomized to receive tissue adhesive (93 patients) or conventional suture (93 patients) for wound closure. The primary outcome measures were the costs to the Hospital Authority and the charges on participants incurred in each treatment method. The secondary outcome measures included the cosmetic visual analog scale, visual analog scale, Wound Evaluation Score, total time spent in each closure method, and the overall patients' satisfaction on the whole process of wound management. RESULTS: The 2 groups had similar baseline characteristics. The tissue adhesive method incurred a higher cost to the Hospital Authority (216.12 [US $27.70] versus 171.33 [US $21.96]; absolute difference 44.79 [US $5.74] [95% confidence interval (CI) 32.76 to 55.95 [US $4.20 to 7.14]]) but a lower charge to patients (109.68 [US $14.06] versus 156.96 [US $20.12]; absolute difference 47.28 [US $6.06] [95% CI, 35.58 to 58.98 [US $4.56 to 7.56]) than the conventional suture method. The mean cosmetic visual analog scale score, visual analog scale score, and Wound Evaluation Score of the 2 groups were similar at various intervals within 3 months after wound closure. Compared with the suture group, the tissue adhesive group had a shorter median procedure time, fewer patients had wound erythema or swelling after wound closure, fewer patients required analgesics on discharge at ED, and there was a higher overall patient satisfaction score. CONCLUSION: Simple wounds closed by tissue adhesives incur a higher cost to the Hospital Authority than the conventional suture but may be favored by patients because of lower personal charge.

A Chinese Mandarin translation and validation of the Myocardial Infarction Dimensional Assessment Scale (MIDAS).

AIMS: To evaluate the validity, reliability, and cultural relevance of the Chinese Mandarin version of Myocardial Infarction Dimensional Assessment Scale (MIDAS) as a disease-specific quality of life measure. METHODS: The cultural relevance and content validity of the Chinese Mandarin version of the MIDAS (CM-MIDAS) was evaluated by an expert panel. Measurement performance was tested on 180 randomly selected Chinese MI patents. Thirty participants from the primary group completed the CM-MIDAS for test-retest reliability after 2 weeks. Reliability, validity and discriminatory power of the CM-MIDAS were calculated. RESULTS: Two items were modified as suggested by the expert panel. The overall CM-MIDAS had acceptable internal consistency with Cronbach's alpha coefficient 0.93 for the scale and 0.71-0.94 for the seven domains. Test-retest reliability by intraclass correlations was 0.85 for the overall scale and 0.74-0.94 for the seven domains. There was acceptable concurrent validity with significant (p < 0.05) correlations between the CM-MDAS and the Chinese Version of the Short Form 36. The principal components analysis extracted seven factors that explained 67.18% of the variance with high factor loading indicating good construct validity. CONCLUSION: Empirical data support CM-MIDAS as a valid and reliable disease-specific quality of life measure for Chinese Mandarin speaking patients with myocardial infarction.

Impact on health-related quality of life and perceived burden of informal caregivers of individuals with Alzheimer's disease.

This study assessed the impact on health-related quality of life (HRQL) and the perceived burden of informal caregivers of individuals with Alzheimer's disease (AD) on the Canary Islands (Spain). We utilized a multicenter, cross-sectional design, based on questionnaire responses of 237 informal caregivers of AD patients. Patients were classified according to the degree of severity utilizing the Clinical Dementia Rating Scale. Sociodemographic, HRQL (EQ-5D) and functional dependency data were gathered together with the degree of caregiver burden. Caregivers had a higher frequency of problems than did the general population for every EQ-5D dimension. Caregivers' HRQL was inversely associated with the subject dependency level and caregiver age. HRQL was higher for more educated caregivers. Variables with a negative and/or significant effect on caregivers' HRQL were high feelings of burden, more committed time to care, and older age. The caregiver burden quantified by the Zarit scale showed 83.3% of caregivers with a high level of burden.

The use of low glycemic and high satiety index food dishes in Mexico: a low cost approach to prevent and control obesity and diabetes.

Obesity and diabetes are epidemics in Mexico and the prevalence is currently highest among the low-income population. The aim of the present study was to compare the action of different breakfasts on satiety and subsequent food intake among healthy women. Eight healthy women participated in the study. Participants were given four experimental breakfasts. Visual analogue rating scales were completed before and every 30 minutes for 3 hours after each experimental meal to record subjective feelings of satiety. Subjects were exposed to an ad libitum buffet 3 h after the experimental breakfast. Energy and macronutrient intakes were calculated at each meal. Mean +/- SD SAUC for white bread was 355 +/- 60, for rice and bananas: 405 +/- 108, for whole wheat bread and boiled beans: 446 +/- 83, and for fruit salad: 585 +/- 79 (Table II). Statistical differences were observed among the four experimental meals (p = 0,002). After the consumption of white bread, energy intake was the highest with 872 +/- 58 kcal, and after the consumption of fruit salad the intake of calories was the lowest: 461 +/- 51 kcal. Energy intake 4 h after each breakfast shows statistical differences (p = 0,0001). These results suggest the need to promote culturally based combined foods with high fiber and low GI, as well as foods with high volume and water content. This approach might contribute to the prevention of obesity by increasing satiety and reducing food consumption and energy intake.