VIM-Klebsiella oxytoca outbreak in a Neonatal Intensive Care Unit. This time it wasn't the drain.

OBJECTIVE: We describe an outbreak of VIM-carbapenemase Klebsiella oxytoca (VIM-Kox) in a NICU. MATERIALS AND METHODS: Prospective Epidemiological Surveillance:Systematically (weekly screening cultures) or on admission, if the patient had a history of previous colonization by VIM-Kox.Clinical cultures, done if infection was suspected.Other possible microorganism sources were investigated: their mothers (rectal microbiota), milk packages and preparation apparata in the lactodietary section, echocardiagram transductors, cribs, the sinks (faucets and drains), washing bowls, etc.Molecular typing was performed using the DiversiLab (bioMérieux) system on all VIM-Kox isolated from environment or patients (one by neonate). RESULTS: We identified 20 VIM-Kox cases, the most only presented colonization, but 4 showed infection. Three of the ten sinks (drains) in our NICU, were positive for VIM-Kox. Another four drains harbored P.aeruginosa, S. maltophilia and/or Enterobacter sp. Nevertheless the VIM-Kox bacteria in the sinks (drains) were not the same as those in the patients, who showed three different strains. CONCLUSIONS: A VIM-Kox colonization or infection outbreak in a NICU is described. Rather than environment, not even drains, the source of the outbreak was other patients. The outbreak was relatively brief, as a result of the rapidness with which appropriate measures were taken and followed.

[Computerized interpretation of the electrocardiogram in the diagnosis of left ventricular hypertrophy. The ELECTROPRES project]. / Interpretación computarizada del electrocardiograma para el diagnóstico de hipertrofia del ventrículo izquierdo. Proyecto ELECTROPRES.

INTRODUCTION: Despite its low sensitivity, the electrocardiogram (ECG) is the tool used the most in the daily practice for detection of left ventricular hypertrophy (LVH). This study has aimed to assess the impact of the computerized interpretation of the ECG on the diagnosis of LVH in the practical clinical setting. METHODS: ELECTROPRES is a project based on a free access computer platform that permits an online interpretation of the electrocardiogram. It includes 19 different left LVH criteria previously validated by echocardiography in a substudy. We analyzed the data from the first 669 patients with essential arterial hypertension (ATH) included in the ELECTROPRES platform from 21 primary care centers in 9 of the 17 Spanish autonomous communities. RESULTS: Up to April 2010, a cohort of 669 hypertensive patients (51.7% women), with a mean age of 66.3±11.89 years, was analyzed. The mean evolution of the disease was 8 years, and the patients had been receiving an average of 2.4 antihypertensive agents. Systolic blood pressure was 139±17 mmHg and diastolic blood pressure 76±11. The ECG-known frequency of LVH was 3%. The prevalence of LVH increased up to 33.3% (P<0.001) with the ELECTROPRES platform. When all the criteria were independently examined, the Lewis index (R-I+S-III) and the Cornell product [(R-aVL+S-V3 (+6 for women)] were those in which the most cases of left ventricular hypertrophy were detected (24.8% and 13.3%, respectively). The Lewis index and the Cornell product were the criteria that detected more cases of left ventricular hypertrophy, regardless of the AHT stage and of the presence of cardiovascular complications. CONCLUSIONS: The ECG computerized reading (ELECTROPRES platform) significantly increases detection of left ventricular hypertrophy in a population of essential hypertense subjects compared to conventional detection with the ECG by the physician in the usual clinical practice setting.

Regulated expression of vimentin cDNA in cells in the presence and absence of a preexisting vimentin filament network.

Human cells were transfected with a mouse vimentin cDNA expression vector containing the hormone response element of mouse mammary tumor virus. The distribution of mouse vimentin after induction with dexamethasone was examined by indirect immunofluorescence with antivimentin antibodies specific for either mouse or human vimentin. In stably transfected HeLa cells, which contain vimentin filaments, addition of dexamethasone resulted in the initial appearance of mouse vimentin in discrete areas, usually perinuclear, that always corresponded to areas of the human filament network with the most intense fluorescence. Within 20 h after addition of dexamethasone, the mouse and human vimentin immunofluorescence patterns were identical. However, in stably transfected MCF-7 cells, which lack vimentin filaments, induction of mouse vimentin synthesis resulted in assembly of vimentin filaments throughout the cytoplasm without any obvious local concentrations. Transient expression experiments with SW-13 cell subclones that either lack or contain endogenous vimentin filaments yielded similar results to those obtained with MCF-7 and HeLa transfectants, respectively. Further experiments with HeLa transfectants were conducted to follow the fate of the mouse protein after synthesis had dropped after withdrawal of dexamethasone. The mouse vimentin-specific fluorescence was initially lost from peripheral areas of the cells while the last detectable mouse vimentin always corresponded to the human filament network with the most intense fluorescence. These studies are consistent with a uniform assembly of vimentin filaments throughout the cytoplasm and suggest that previous observations of polarized or vectorial assembly from a perinuclear area to more peripheral areas in cells may be attributable to the nonuniformly distributed appearance of vimentin filaments in immunofluorescence microscopy.

Characterizing beach changes using high-frequency Sentinel-2 derived shorelines on the Valencian coast (Spanish Mediterranean).

Shoreline position can be efficiently extracted with subpixel accuracy from mid-resolution satellite imagery using tools as SHOREX. However, it is necessary to develop procedures for deriving descriptors of the beach morphology and its changes in order to become truly useful data for characterizing the coastal dynamism. A new approach is proposed based on a spatiotemporal model of the beach widths. Divided into 80m analysis segments, it offers a robust and detailed characterization of the beach state along large micro-tidal regions, with continuous information through time and space. Geographical and temporal differences can be recognized and measured, making it possible to study the beach response both to general factors (as wave conditions) and to punctual anthropic actions (as small sand nourishments). Widths were defined throughout two and a half years from 60 shorelines (3.04m RMSE) covering 50km of the Gulf of Valencia. Important width contrasts appeared along the study site associated with sediment imbalances motivated by sediment traps and other anthropic actions. Segments too narrow for maintaining the recreational function were located and mapped (16% narrower than 30m). Short-term width changes appeared linked to storm events, with fast retreatments and slow recoveries. Punctually, even small-magnitude nourishments created perceptible changes in width (12,830m3 were associated with a 4m increase). This novel description of the beach state and its changes from Satellite-Derived Shorelines is useful for coastal management, especially considering the global coverage of these free satellite images. It may improve the comprehension of coastal processes as well as monitor human interventions on the coast, helping in the decision-making.

Anthropometric body fat composition reference values in Spanish adolescents. The AVENA Study.

OBJECTIVE: To determine reference values for body mass index (BMI), sum of six skinfolds (sigma6 skinfolds) and body fat percentage (BF%) in Spanish adolescents aged 13-18 years, included in the AVENA Study (Alimentación y Valoración del Estado Nutricional en Adolescentes: Food and Assessment of the Nutritional Status of Adolescents). DESIGN: Multicentre cross-sectional study. SETTING: Representative sample of Spanish adolescents. SUBJECTS: The population was selected by means of a multiplestep, simple random sampling. The final number of subjects included in the AVENA Study was 2859 adolescents; 2160 adolescents had a complete set of anthropometric measurements and were then included in this study (1109 males and 1051 females). INTERVENTIONS: Weight, height and six skinfold thicknesses were measured. As indices of total adiposity, we calculated BMI, summation sigma6 skinfolds and BF% with the formulas described by Slaughter et al. RESULTS: Sigma6 skinfolds and BF% in each age group were significantly higher in females than in males. In males, age showed a significant effect for BMI, sigma6 skinfolds and BF%; however, in females, the effect was only significant for BF%. The percentile distribution was more disperse towards higher sigma6 skinfolds and BF% values in males when compared with females. CONCLUSIONS: The presented percentile values will help us to classify adolescents in comparison with a well-established reference population, and to estimate the proportion of adolescents with high or low adiposity amounts. SPONSORSHIP: The AVENA-Study was supported by the Spanish Ministry of Health (FIS 00/0015), and grants from Panrico SA, Madaus SA and Procter and Gamble SA. This study was also supported by Instituto de Salud Carlos III (Spain), RCESP (C03/09) and Spanish Ministry of Education (AP2003-2128).

Body fat measurement in adolescents: comparison of skinfold thickness equations with dual-energy X-ray absorptiometry.

OBJECTIVE: To compare the most commonly used equations to predict body fatness from skinfold thickness, in male and female adolescents, with dual-energy X-ray absorptiometry (DXA) as a reference method of fatness measurement. DESIGN: Cross-sectional nutrition survey. SETTING: General adolescent population from Zaragoza (Spain). SUBJECTS AND METHODS: A total of 238 Caucasian adolescents (167 females and 113 males), aged 13.0-17.9 y, were recruited from 15 school groups in 11 public and private schools. The percentage fat mass (%FM) was calculated by using skinfold-thickness equations. Predicted %FM was compared with the reference %FM values, measured by DXA. The lack of agreement between methods was assessed by calculating the bias and its 95% limits of agreement. RESULTS: Most equations did not demonstrate good agreement compared with DXA. However, in male adolescents, Slaughter et al equations showed relative biases that were not dependent on body fatness and the limits of agreement were narrower than those obtained from the rest of equations. In females, Brook's equation showed nonsignificant differences against DXA and the narrowest 95% limits of agreement. Only biases from Brook and Slaughter et al equations were not dependent on body fatness in female adolescents. CONCLUSIONS: Accuracy of most of the skinfold-thickness equations for assessment of %FM in adolescents was poor at the individual level. Nevertheless, to predict %FM when a relative index of fatness is required in field or clinical studies, Slaughter et al equations may be used in adolescents from both sexes and the Brook equation in female adolescents.

Dietary fat intake and body mass index in Spanish children.

Our objectives were to describe the pattern of dietary fat intake and to present data on trends of growth in Spanish children in past decades. In 1984 a nationwide nutritional survey was conducted in Spain. The average nationwide fat intake was 42% of energy. Across different regions, saturated fat intakes ranged from 13% to 15% of energy and monounsaturated fat intakes ranged from 18% to 19% of energy. More recently, some surveys were conducted at a regional or local level. In children aged 6-10 y, total fat intake ranged from 38% to 48% of energy, of which saturated fat intake ranged from 16% to 18% and monounsaturated fat ranged from 19% to 20%. In children aged 11-14 y, total fat intake ranged from 41% to 51% of energy, of which saturated fat intake ranged from 12% to 18% and monounsaturated fat intake accounted for 20%. In our region of Aragón, we observed a significant trend in children's growth, especially when we accounted for body mass index. The results reflect an increasing total fat consumption in Spain, especially of saturated and monounsaturated fat. The following question remains unanswered: what percentage of fat intake should be recommended when monounsaturated fat is the principal source of fat? Trends on body mass index values in children of our region during the past decades could be related to the amount of fat intake in our population. To confirm these findings we must measure dietary fat intake and nutritional status in the same population of children and adolescents.

Lymphocyte T subset counts in children with elevated low-density lipoprotein cholesterol levels.

The aim of this study was to determine blood lymphocyte T subset counts in children with elevated levels of low-density lipoprotein cholesterol. We studied 107 children, ages 2.0 to 15.9 years, from 79 families who were referred to our Lipid Research Clinic because total cholesterol serum levels higher than 200 mg/dl had been detected in at least one child. At the time of diagnosis we analyzed serum lipoprotein profile and blood lymphocyte T subsets (CD3, CD4 and CD8). Children were classified according to LDL-C levels into three groups: (1) normal, if levels were between the 5th and 75th percentiles (50 and 125 mg/dl, respectively); (2) at moderate risk, if levels were between the 75th and 95th percentiles (125 and 150 mg/dl, respectively); and (3) at high risk, if levels were above the 95th percentile (150 mg/dl). In children aged 2.0 to 6.9 years, all lymphocyte T subset counts were higher in the high risk group than in the normal group (P < 0.05 and P < 0.01). In children aged 11.0 to 15.9 years, the CD4 subset count was also significantly higher in the high risk group in the other two groups (P < 0.05 and P < 0.01). These results are in agreement with pathologic findings in the atheromatous plaque.

Sociodemographic factors and trends on overweight prevalence in children and adolescents in Aragón (Spain) from 1985 to 1995.

From 1985 to 1995, the Aragón School Health Examination Surveys staff has surveyed the whole population of children (age 6-7 years) and adolescents (age 13-14 years). A total of 90,997 children (age 6-7 years) were examined in the nine cross-sectional surveys conducted between 1985 and 1995. A total of 106,284 adolescents (age 13-14 years) were also examined. We defined overweight when the body mass index was > or = 95th percentile. The measure of association between overweight and the other variables studied was the odds ratio, which was calculated by logistic regression. In the children and adolescents studied, the probability to be overweight was higher in the rural than in the urban areas. In the adolescents, the probability to be overweight was higher in the public than in the private schools. Our results also show a significant increase in the prevalence of overweight children in the region of Aragón (Spain) during the 1985-1995 decade, especially in males. Prevention of overweight in the populations at risk would help reduce social inequality in health, a major challenge for public health policy.

Relationship between immunoinflammatory proteins containing sialic acid and low-density lipoprotein serum concentrations.

The aim of this study was to investigate the relationship between sialoglycoproteins and the lipoprotein profile in a group of children with different levels of low-density lipoprotein cholesterol. We have studied 177 children of 132 families who were sent to our Pediatric Lipid Research Clinic because of serum cholesterol concentrations higher than 5.17 mmol/l. At the time of diagnosis, we analyzed the serum lipoprotein profile and the sialoglycoproteins: alpha 1-antitrypsin, acid alpha 1-glycoprotein, haptoglobin, alpha 2-macroglobulin, transferrin, IgA, IgG, IgM, complement C3 component and ceruloplasmin. At 7.0 to 10.9 years, alpha 1-glycoprotein serum concentrations were higher in the high risk group than in the moderate risk group (P < 0.05). At 2.0 to 6.9 years, IgA and IgM serum concentrations were higher in the moderate risk group than in the low risk group (P < 0.05 and P < 0.01, respectively), and IgG and IgM serum concentrations were also higher in the high risk group than in the low risk group (P < 0.05). Our results seems to reflect a general reaction to injury or inflammation which could be associated with the atherosclerotic process.

Resting energy expenditure in children and adolescents: agreement between calorimetry and prediction equations.

BACKGROUND AND AIMS: To assess the degree of agreement between indirect calorimetry and five equations commonly used to predict resting energy expenditure (REE) in obese and non-obese children and adolescents. METHODS: In 116 children and adolescents (57 obese and 59 non-obese) aged between 7.8 and 16.6 years, REE was measured (MREE) by open-circuit indirect calorimetry under standardized conditions. REE was predicted (PREE) in all subjects with equations from the Food and Agriculture/World Health Organization/United Nations University (FAO/WHO/UNU), Maffeis et al., Harris and Benedict, and two from Schofield: one using weight (W) and one using height and weight (H-W). Agreement between indirect calorimetry and equations was assessed following the Bland-Altman method. RESULTS: In the entire cohort group, only data from FAO/WHO/UNU, Schofield-W and Schofield-HW equations showed non-statistic differences against calorimetry results. When agreement between equations and calorimetry was tested, Schofield-HW equation showed the lowest mean MREE-PREE difference: 3.7 kcal/d (limits of agreement -293 and 300 kcal/d; 95% confidence interval for the bias -24.0 to 31.5 kcal/d) and the best agreement. Group by group, equations which obtained the best agreement were: FAO/WHO/UNU in girls, Schofield-HW in boys, Schofield-HW in obese, and Schofield-W in non-obese. CONCLUSIONS: Until more accurate prediction equations are developed, we recommend Schofield-HW equations for REE studies with a mixed population of obese and non-obese children and adolescents; however, FAO/WHO/UNU equation may also be useful in girls and Schofield-W equation in non-obese children.

The nutrition transition in Spain: a European Mediterranean country.

BACKGROUND: Mediterranean diets are felt to be healthful diets linked with reduced mortality from diet-related noncommunicable diseases. OBJECTIVE: To examine trends in diet, activity, obesity and diet-related noncommunicable diseases for Spain and compare these with other European countries, particularly those from the Mediterranean area. DESIGN: A combination of large-scale primary and secondary nationally representative data analysis are used. DATA: Nationally representative data on household food consumption, physical activity, adult obesity, and cause of death are combined with regionally representative adolescent obesity data, obtained in the last four decades. Comparative diet and obesity data come from nationally representative comparable data, obtained during the same period. RESULTS: The Spanish diet has shifted toward a very high level of fat intake, high fruit and dairy intake and moderate vegetable intake. Dairy and fruit intakes were the highest in Europe, as was the proportion of energy from fat, when we compared with the available data. Adult overweight and obesity trends show a marked increase in the past decade to levels as high as Italy and far above France. Overweight for children aged 6-7 is above that of even the USA, while adolescent overweight levels are among the highest in the world. Cardiovascular disease mortality is low, as with Italy and France, and the cancer mortality rate is lower than Italy and France. CONCLUSIONS: We have observed that, in Spain, relatively high obesity prevalences and dairy intake levels are related to much lower levels of cardiovascular disease and cancer mortality than are found in other European countries. This unique Spanish dietary and obesity pattern should be further explored in order to clarify the causal links. SUPPORT: The National Institutes of Health (NIH; R01-HD30880 and R01-HD38700).

Skinfold thickness measurements are better predictors of body fat percentage than body mass index in male Spanish children and adolescents.

OBJECTIVE: To develop equations, from some simple anthropometric measurements, for the prediction of body density from underwater weighing in male spanish children and adolescents. SUBJECTS: One hundred and seventy-five males, aged 7.0-16.9 y, participated in this study, they were recruited from primary and secondary schools. MEASUREMENTS: Body weight and height and skinfold thicknesses by anthropometry, body density by underwater weighing. RESULTS: Correlations between body density and body mass index (BMI) were high until 14.0-16.9y. Correlations between body density and log sigma 4 skinfolds were higher than those with BMI at all ages. Log sigma 4 skinfolds explained between 61% (14.0-16.9 y) and 68% (11.0-13.9 y) of the body density variance. Regression equations for body density from BMI and triceps skinfold thickness explained between 51% (14.0-16.9y) and 68% (7.0-10.9 y) of the body density variance. CONCLUSIONS: The best estimators of body density in the children and adolescents studied were log sigma 4 skinfolds and a combination of BMI and triceps skinfold.

Waist circumference values in Spanish children--gender related differences.

OBJECTIVE: To obtain reference values of the waist circumference in Spanish children, and to investigate their dependence on age and gender. DESIGN: Cross-sectional study. SETTING: General school-age population. SUBJECTS: A representative sample of the schools in Zaragoza, Spain, was drawn from seven schools. The population selected comprised 1728 children with ages ranging from 6.0-14.9y. Of the original sample, 368 children (21.29%) were excluded because of chronic diseases or refusal. Finally, 1360 children and adolescents: 701 boys and 659 girls, were studied. INTERVENTIONS: Waist and hip circumferences were measured with an unelastic tape. RESULTS: Waist circumference tended to be higher in males than in females and this difference was significant after 11.5y. In general, hip circumference was higher in females than in males (statistically significant differences at 7.5, 10.5, 12.5 and 13.5 y). In general, percentile values of waist circumference were higher in males than in females, especially after 12.5 y. Difference between males and females on percentile 95 at 14.5 y was 7.6 cm. Hip was greater than waist in both sexes, and the two curves run nearly parallel in males. In females, while hip enlarges continuously, waist shows the reverse tendency between 11.5 and 14.5 y. CONCLUSIONS: Waist circumference showed higher values in boys than in girls, especially after 11.5 y, and waist values increase with age both in males and females. These findings justify the use of age and gender specific reference standards.

Effect of husbandry methods on seropositivity to African swine fever virus in Sardinian swine herds.

Multiple logistic regression was used on serological data collected in the context of the Sardinian African swine fever (ASF) eradication program from pig farms in the province of Nuoro, Sardinia. The monthly percentage of ASFV-positive herds decreased significantly from October 1994 through March 1996 (P < 0.001). The farm-level risk of seropositivity to African swine fever virus (ASFV) was higher in free-range farms than in partial-confinement farms (odds ratios (OR) varied between 4.9 in October 1994, and 5.7 in March 1996, P < 0.001). The risk of infection for total-confinement farms was one-fifth of the risk for partial-confinement farms in October 1994 (OR = 0.2, P < 0.001), whereas in March 1996, the estimated OR was 0.57 and not significant (upper confidence limit = 1.1). The maintenance of ASFV in Sardinia was primarily associated with free-range pig farms. The natural logarithm of the number of pigs tested per visit in a farm was positively associated with the risk of herd seropositivity (OR = 2.6, P < 0.001).

Postprandial triglyceridemia in obese and non-obese adolescents. Importance of body composition and fat distribution.

BACKGROUND: It has recently been shown that obese adults have a disturbed metabolism of postprandial lipoproteins, resulting in postprandial hypertriglyceridemia. To the best of our knowledge, there are no data about postprandial triglyceridemia in obese and non-obese children and adolescents. SUBJECTS: 12 obese and 12 non-obese adolescents, aged 11.0 to 13.8 years. METHODS: Body composition and fat distribution (waist-to-hip circumference ratio and triceps/ subscapular skinfold thickness ratio) were assessed by anthropometry. An oral fat tolerance test was carried out, and fasting and postprandial lipid-lipoprotein serum concentrations were measured. RESULTS: We observed a significant increase in triglyceride serum concentrations 2 and 4 hours after the oral fat load, in both obese and non-obese adolescents. In obese and non-obese adolescents there were significant correlations between some variables of postprandial lipemia and the studied indices of body fat distribution. When we compare postprandial lipemia in adolescents having a central pattern of fat distribution with those having a peripheral pattern of fat distribution, we observed higher variables related to postprandial lipemia in those having a central pattern of fat distribution compared with those with a peripheral pattern (sum of serum triglyceride concentrations: 6.06 vs 4.41, p = 0.0243). CONCLUSIONS: We present a protocol to study postprandial lipemia in children and adolescents that allowed us to observe significant changes after an oral fat load. Results obtained indicate that the pattern of distribution of adipose tissue may be more important for lipid metabolism disturbances than total adipose tissue per se.

Determinants of resting energy expenditure in obese and non-obese children and adolescents.

Resting energy expenditure (REE) is the largest component of total daily energy expenditure. Objectives of this study were to examine whether differences in REE exist after obesity develops in a group of children and adolescents, and to determine the effects of body composition, gender, age, pubertal development and parental obesity on REE. In 116 Caucasian children and adolescents (57 obese and 59 non-obese), aged 7.8 to 16.6 years, REE was assessed by open-circuit indirect calorimetry and different anthropometric variables and bioelectrical impedance were obtained (weight, height, skinfold thicknesses, waist and hip circumferences). Anthropometric indices and body compartments were calculated: the body mass index, surface area (SA), fat-free mass (FFM), fat-mass (FM) and percentage of FM. Differences between obese and non-obese subjects were tested and stepwise multiple regression analysis was performed with REE as dependent variable. Results show that REE was significantly higher in obese than in non-obese children and adolescents but REE/FFM ratio was not significantly different between these groups. In the non-obese group, FFM explained 73.1% of the variability in REE and gender, age and SA added 3.8%, 2.6%, and 2.6% to it, respectively. In the obese group, FFM was also the most powerful predictor of REE with 72.3%, followed by waist circumference and age with 2.5% and 2.1%, respectively. These results show that REE differences between obese and lean children do not seem to justify the maintenance of obesity. The main determinant of REE is FFM in both groups. No significant contribution of FM, pubertal development or parental obesity in REE was found in children and adolescents.

Relationship of body fat distribution to metabolic complications in obese prepubertal girls.

The purpose of this study is to assess the relative effects of body fat distribution and obesity "per se" on serum glucose, insulin, and insulin resistance. Seventeen obese and nine nonobese control prepubertal girls were studied. Biceps, triceps, subscapular, and suprailiac skinfold thickness were measured. Percentage of body fat (% BF) and total body fat (TBF) were calculated. Body fat distribution was assessed by analyzing the central (suprailiac, subscapular)/peripheral (biceps, triceps) ratios. Oral glucose tolerance test was performed. Serum glucose and insulin were measured and insulinogenic index (insulin/glucose) was calculated. Body fat anthropometric data and body fat distribution indexes were significantly higher (p less than 0.001) in the obese group. The obese population presented significantly elevated values of glucose, insulin, and insulinogenic indexes (p less than 0.01-p less than 0.001). In the obese group, insulin showed significant positive correlations (p less than 0.05-p less than 0.001) with biceps, subscapular, and suprailiac skinfolds, % BF and TBF, whereas the insulinogenic index had positive correlations with suprailiac skinfold and TBF (p less than 0.05). Obese girls showed positive correlations between the body fat distribution indexes and insulin or insulinogenic indexes (p less than 0.05-p less than 0.001). In prepubertal girls obesity is of the centripetal (central) type. This pattern has an important role in determining the alterations in the glucose-insulin homeostasis that characterize the childhood nutritional obesity.

[Evaluation of health technologies and benefits entitlement in advanced social systems]. / Evaluación de las tecnologías sanitarias y ordenación de las prestaciones en los sistemas sociales avanzados.

In the present study, health is considered a subject of insurance whose protection has become a Fundamental Right. In the same line, health care has acquired a contractual character whose "nature" has evolved from individual to collective, expressed in terms of "health care insurance", public or private. In such context, outcome measurement becomes necessary to be able to define the variables of the System and, subsequently, the contracting conditions. Having an understanding of the economic impact is required to analyze the costs and, in consequence, the financial necessities of the System; as well as the clinical results in order for the insured to have some realistic expectations of the benefits that can be expected from the health care that is offered. In turn, the vertiginous rhythm of technological innovation that characterizes the modern medicine forces to the continuous revision of the state of the art framed in a health sector whose multifactorial profile confers it growing complexity. In conclusion, health technology assessment becomes indispensable to identify health care effectiveness, to facilitate its efficient management, to define responsibilities and to offer guarantees to the users; all which is already part of an ethical body that, day by day with more clarity, is being configured by the legislation and that, in turn, guarantees the survival of the Health Care System.

Microbe associated molecular patterns from rhizosphere bacteria trigger germination and Papaver somniferum metabolism under greenhouse conditions.

Ten PGPR from different backgrounds were assayed on Papaver somniferum var. Madrigal to evaluate their potential as biotic elicitors to increase alkaloid content under the rationale that some microbe associated molecular patterns (MAMPs) are able to trigger plant metabolism. First, the 10 strains and their culture media at two different concentrations were tested for their ability to trigger seed germination. Then, the best three strains were tested for their ability to increase seedling growth and alkaloid levels under greenhouse conditions. Only three strains and their culture media enhanced germination. Then, germination enhancing capacity of these best three strains, N5.18 Stenotrophomonas maltophilia, Aur9 Chryseobacterium balustinum and N21.4 Pseudomonas fluorescens was evaluated in soil. Finally, the three strains were applied on seedlings at two time points, by soil drench or by foliar spray. Photosynthesis was measured, plant height was recorded, capsules were weighted and alkaloids analyzed by HPLC. Only N5.18 delivered by foliar spray significantly increased plant height coupled to an increase in total alkaloids and a significant increase in opium poppy straw dry weight; these increases were supported by a better photosynthetic efficiency. The relative contents of morphine, thebaine, codeine and oripavine were affected by this treatment causing a significant increase in morphine coupled to a decrease in thebaine, demonstrating the effectivity of MAMPs from N5.18 in this plant species. Considering the increase in capsule biomass and alkaloids together with the acceleration of germination, strain N5.18 appears as a good candidate to elicit plant metabolism and consequently, to increase productivity of Papaver somniferum.