Autochthonous Wheat Grown in Organic and Conventional Systems: Nutritional Quality of Flour and Bread.

A growing interest in the recovery and enhancement of crops, particularly local varieties such as 'Caaveiro' wheat, has been observed. This study aims to investigate the impact of cultivation systems (organic versus conventional) on the nutritional quality of 'Caaveiro' flour and breads protected by the PGI "Pan Galego," employing two fermentation methods (sourdough versus sourdough and biological yeast). Organic flour exhibited significantly higher levels of moisture, fat, sucrose, phosphorus (P), sodium (Na), and copper (Cu) while also exhibiting a lower total starch and zinc (Zn) content. Organic bread, produced using both fermentation methods, demonstrated significantly higher protein, carbohydrate, total, resistant, and rapidly digestible starch, ash, Na, P, iron (Fe), and Cu content. Additionally, they contained less moisture compared to conventional bread. Despite variations in nutritional characteristics based on the cultivation system, the organic approach proved effective at producing high-quality products with a positive environmental impact, which is highly appreciated by consumers.

Whey Cheeses Containing Probiotic and Bioprotective Cultures Produced with Ultrafiltrated Cow's Whey.

Bovine whey cheese (WC) is a product from southern European countries that presents some challenges: its production process involves high energy inputs; the yield is low; and WC has a short shelf life. The application of ultrafiltration (UF) to bovine whey before manufacture of WC and the employment of protective cultures can reduce these disadvantages. The objective of this research was the production of whey cheeses using ultrafiltrated bovine cheese whey with added probiotics or probiotics plus protective cultures. Three types of WC were produced: control CW without any addition (C); CW with the addition of the probiotic Lactobacillus acidophilus (LA5); and CW with the addition of Lactobacillus acidophilus plus a protective culture containing Lacticaseibacillus paracasei and Lacticaseibacillus rhamnosus (LA5FQ4). The WCs were stored under refrigerated conditions for 28 days. The products with added cultures presented lower pH values and higher titratable acidities when compared to the control. Sample LA5 presented the lowest pH and the highest titratable acidity, while LA5FQ4 presented intermediate values. Slight differences were observed between products regarding color parameters, chiefly resulting from storage time. The samples with added cultures were firmer when compared to the control, with LA5 cheeses showing the highest values at the end of the storage. Lactic acid bacteria (LAB) counts were on the order of log 8-9 CFU/g for the products with added cultures. Lower levels of yeasts and molds were detected on the sample with the protective culture (LA5FQ4), so that by the end of storage they presented counts one log cycle lower than C and LA5. Hence, the beneficial impact of the protective culture on the shelf life of the product is evident. Regarding sensory evaluation, LA5FQ4 cheeses obtained the highest scores for all parameters evaluated. It can be concluded that the use of UF associated with the addition of protective cultures can be very useful to reduce the energy consumption of the manufacturing process, to prolong the shelf life of WC and to improve its sensory properties.

Vectores de impedancia bioeléctrica en la población universitaria colombiana / Bioelectrical impedance vectors in the Colombian university population

Introducción: el análisis de la composición corporal (CC) es un elemento esencial en la práctica clínica nutricional. La impedancia bioeléctrica es una de las técnicas más utilizadas para estimar la CC. Se han planteado diversos enfoques para disminuir el margen de error que presenta, asegurando su aplicación en todas las poblaciones. Uno de ellos es el uso de vectores de impedancia, mediante el empleo de elipses de tolerancia. Objetivo: comparar los vectores de la muestra con la población italiana y determinar elipses de tolerancia específicas para población universitaria colombiana. Materiales y métodos: estudio observacional de corte transversal en 608 universitarios. La participación fue a conveniencia y voluntaria, entre febrero de 2022 y marzo de 2023. El software BIVA 2002 fue usado para calcular las elipses de tolerancia y BIVA Confidence para comparar los vectores de las elipses con la población italiana a partir de la prueba T2 de Hotelling, que se consideró significativa con p < 0,05. Resultados: las medidas de R/Hy Xc/H fueron mayores en mujeres (420,75 ± 56,012 Ω/m vs. 308,7508 ± 41,81 Ω/m) y (46,15 ± 5,79 Ω/m vs. 39,44 ± 5,01 Ω/m), respectivamente. Los vectores de impedancia se posicionaron sobre los cuadrantes superiores del gráfico RXc, evidenciando diferencias significativas en la distribución de los vectores de composición entre las muestras. Conclusiones: los vectores de los universitarios colombianos fueron diferentes a la población de referencia, por lo que fue necesario determinar las elipses específicas.(AU)

Introduction: body composition (BC) analysis is an essential element in clinical nutritional practice. Bioelectrical impedance is one of the most widely used techniques for estimating BC. Several approaches have been proposed to reduce the margin of error it presents, ensuring its appli- cation in all populations. One of them is the use of impedance vectors, using tolerance ellipses.Objective: to compare the sample vectors with the Italian population and to determine specific tolerance ellipses for the Colombian university population. Materials and methods: observational cross-sectional study in 608 university students. Participation was at convenience and voluntary, betweenFebruary 2022 and March 2023. BIVA 2002 software was used to calculate the tolerance ellipses and BIVA confi dence to compare the vectorsof the ellipses with the Italian population using Hotelling’s T2 test, which was considered as significant at p < 0.05. Results: R/H and Xc/H measurements were higher in females (420.75 ± 56.012 Ω/m vs 308.7508 ± 41.81 Ω/m) and (46.15 ± 5.79 Ω/m vs 39.44 ± 5.01 Ω/m), respectively. The impedance vectors were positioned over the upper quadrants of the RXc plot, evidencing significant differences in the distribution of the composition vectors between samples. Conclusions: the vectors of the Colombian university students were different from the reference population, so it was necessary to determinethe specific ellipses.

Sheep's Second Cheese Whey Edible Coatings with Oregano and Clary Sage Essential Oils Used as Sustainable Packaging Material in Cheese.

Sheep's second cheese whey (SCW), the by-product resulting from whey cheese production, was used as a component of cheese coatings containing oregano (Origanum compactum) and clary sage (Salvia sclarea) essential oils (EOs). SCW powder was obtained by the ultrafiltration/diafiltration of SCW followed by reverse osmosis and freeze drying. The coatings were produced with a mixture of SCW and whey protein isolate (WPI) using glycerol as plasticizer. Model cheeses were produced with cow´s milk and those containing SCW:WPI coatings; those with and without EOs were compared to controls without coating and with a commercial coating containing natamycin. At the end of ripening (28 days), the cheeses containing EOs presented higher water activity (ca. 0.930) and moisture content, as well as lower titratable acidity. Concerning color parameters, significant differences were also observed between products and as a result of ripening time. However, the use of SCW:WPI coatings did not significantly influence the color parameters at the end of ripening. Regarding texture parameters, the cheeses containing SCW:WPI coatings presented significantly lower values for hardness, chewiness, and gumminess. Significant differences were also observed for all microbial groups evaluated either between products and as a result of ripening time. In all cases, lactobacilli and lactococci counts surpassed log 7-8 CFU/g, while the counts of yeasts and molds increased steadily from ca. log 3 to log 6 CFU/g. The lowest counts of yeasts and molds were observed in the samples containing natamycin, but nonsignificant differences between products were observed. In conclusion, SCW:WPI cheese coatings can successfully substitute commercial coatings with the advantage of being edible packaging materials manufactured with by-products.

Hydrodissection as a Novel Alternative After Failed Management of a Cervical Pregnancy With Methotrexate: Case Report and Literature Review.

Cervical ectopic pregnancies (CEPs) are rare and life-threatening diagnoses. Risk factors have been associated with CEPs, yet their etiology and pathogenesis remain unknown. Timely intervention is vital for successful outcomes, yet it is challenged as there is no standardized approach to treatment. We present the case of a 42-year-old woman diagnosed with CEP following five weeks and one day of amenorrhea. The patient was treated with a two-dose regimen of intramuscular methotrexate (MTX) but failed to respond. Ultrasound-guided intrasac MTX injection was considered a secondary treatment. However, spontaneous expulsion was observed after administering lidocaine at different cervical points. Hydrodissection following systemic MTX could present a novel alternative for treating CEP. Expulsion of pregnancy after hydrodissection could be associated with tissue necrosis and/or destabilized implantation of pregnancy, secondary to the effects of MTX. Further research is vital for evaluating the underlying mechanisms for expulsion and the role of hydrodissection following MTX in treating CEP.

Outlining Individual and Contextual Factors Related to LGBTQ+ Bullying: A Systematic Review of Two Decades of Research.

Scientific interest in lesbian, gay, bisexual, transgender, queer and any other sexual orientation, gender identity and/or expression (LGBTQ+) bullying in educational settings has grown exponentially in recent years. However, the varied ways of measuring its occurrence and associated factors have made it difficult to achieve a holistic understanding of this problem. Therefore, this systematic review aimed to provide an updated overview of individual and contextual factors related to LGBTQ+ bullying over the past two decades, based on the measurement approach to this phenomenon. Studies published from 2000 to 2020 were analyzed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses strategy. Inclusion and exclusion criteria were applied in a staggered process, and 111 articles met all the criteria. Studies focusing on LGBTQ+ bullying victimization or aggression were eligible for inclusion. Our analysis revealed LGBTQ+ bullying is usually examined by measures of general aggressions (47.8%) from the victims' perspective (87.3%). The best-represented factors across studies were individual characteristics (63.1%; n = 70), especially participants' sexual orientation and gender identity and expression (68.5%). Boys/males, from a binary gender perspective, and sexual and gender minority youth in general, were more at risk of being targeted for LGBTQ+ bullying. Although contextual factors were far less well-represented, the results revealed that gay-straight alliances, anti-homophobia policies, and social support act as protective factors. This review highlights the need to analyze LGBTQ+ bullying considering the full spectrum of sexual and gender diversity, to examine in more detail its contextual risk/protective factors, and to design public policies and psychoeducational programs in order to address the low effectiveness of generic interventions. Implications for future research and practice are discussed.

[Bioelectrical impedance vectors in the Colombian university population]. / Vectores de impedancia bioeléctrica en la población universitaria colombiana.

INTRODUCTION: body composition (BC) analysis is an essential element in clinical nutritional practice. Bioelectrical impedance is one of the most widely used techniques for estimating BC. Several approaches have been proposed to reduce the margin of error it presents, ensuring its application in all populations. One of them is the use of impedance vectors, using tolerance ellipses. OBJECTIVE: to compare the sample vectors with the Italian population and to determine specific tolerance ellipses for the Colombian university population. MATERIALS AND METHODS: observational cross-sectional study in 608 university students. Participation was at convenience and voluntary, between February 2022 and March 2023. BIVA 2002 software was used to calculate the tolerance ellipses and BIVA confidence to compare the vectors of the ellipses with the Italian population using Hotelling's T2 test, which was considered as significant at p < 0.05. RESULTS: R/H and Xc/H measurements were higher in females (420.75 ± 56.012 Ω/m vs 308.7508 ± 41.81 Ω/m) and (46.15 ± 5.79 Ω/m vs 39.44 ± 5.01 Ω/m), respectively. The impedance vectors were positioned over the upper quadrants of the RXc plot, evidencing significant differences in the distribution of the composition vectors between samples. CONCLUSIONS: the vectors of the Colombian university students were different from the reference population, so it was necessary to determine the specific ellipses.

"Long-term oncologic outcomes and risk factors for distant recurrence after pathologic complete response following neoadjuvant treatment for locally advanced rectal cancer. A nationwide, multicentre study".

BACKGROUND: Pathologic complete response (pCR) after multimodal treatment for locally advanced rectal cancer (LARC) is used as surrogate marker of success as it is assumed to correlate with improved oncologic outcome. However, long-term oncologic data are scarce. METHODS: This retrospective, multicentre study updated the oncologic follow-up of prospectively collected data from the Spanish Rectal Cancer Project database. pCR was described as no evidence of tumour cells in the specimen. Endpoints were distant metastases-free survival (DMFS) and overall survival (OS). Multivariate regression analyses were run to identify factors associated with survival. RESULTS: Overall, 32 different hospitals were involved, providing data on 815 patients with pCR. At a median follow-up of 73.4 (IQR 57.7-99.5) months, distant metastases occurred in 6.4% of patients. Abdominoperineal excision (APE) (HR 2.2, 95%CI 1.2-4.1, p = 0.008) and elevated CEA levels (HR = 1.9, 95% CI 1.0-3.7, p = 0.049) were independent risk factors for distant recurrence. Age (years) (HR 1.1; 95%-CI 1.05-41.09; p < 0.001) and ASA III-IV (HR = 2.0; 95%-CI 1.4-2.9; p < 0.001), were the only factors associated with OS. The estimated 12, 36 and 60-months DMFS rates were 96.9%, 91.3%, and 86.8%. The estimated 12, 36 and 60-months OS rates were 99.1%, 94.9% and 89.3%. CONCLUSIONS: The incidence of metachronous distant metastases is low after pCR, with high rates of both DMFS and OS. The oncologic prognosis in LARC patients that achieve pCR after neoadjuvant chemo-radiotherapy is excellent in the long term.

Ensayo clínico multicéntrico para la resección de pólipos rectales mediante un nuevo dispositivo de acceso transanal híbrido laparoendoscópico / Multicenter clinical trial for the resection of rectal polyps using a new laparoendoscopic hybrid transanal access device

Introducción: Los pólipos complejos requieren el uso de técnicas endoscópicas avanzadas o la cirugía mínimamente invasiva para su abordaje. En los pólipos rectales es de especial relevancia llegar a un consenso de cuál es el mejor abordaje de estos para evitar infratratamientos o sobretratamientos que incrementen una morbimortalidad innecesaria. Métodos: Se describe un ensayo clínico piloto con un producto sanitario de primer uso en humanos multicéntrico y prospectivo. Se plantea la hipótesis que UNI-VEC® facilita la cirugía laparoendoscópica transanal para la extirpación de tumores rectales precoces. El objetivo principal es evaluar que es seguro y cumple los requisitos funcionales establecidos. Los secundarios son evaluar resultados, complicaciones y nivel de satisfacción.Resultados: Se reclutaron 16 pacientes en 12 meses con un seguimiento mínimo de dos meses. El tamaño medio ha sido de 3,4 cm, siendo el pólipo mayor de 6 cm. Respecto a la localización, la media se encontraba a 6,6 cm del margen anal. Se realizó resección endoscópica mucosa (REM) (6,3%), disección submucosa endoscópica (DSE) (43,8%), resección espesor completo (REC) (6,3%) y transanal minimally invasive surgery (TAMIS) (43,8%). El tiempo medio fueron 73,25 min; 56,3% utiliza una cámara de 30̊ y 43,8% el endoscopio flexible como instrumento de visión. El 56,3% son lesiones benignas y 43,8% malignas. En 87,5% se consigue resección completa. En cuanto a las complicaciones, se presenta sangrado leve (Clavien I) en 25, 6,3 y 21,4% a las 24 h, 48 h y siete días, respectivamente. La continencia se valora según la Escala de Wexner. A los siete días, 60% presentan continencia perfecta, 26,7% IF leve y 13,3% IF moderada. A los 30 días, 66,7% continencia perfecta, 20% IF leve y 13,3% IF moderada. A los dos meses se revisan cuatro de los pacientes que a los 30 días presentaban un Wexner superior al preoperatorio y se demuestra continencia perfecta en 25% de los pacientes, 50% leve y 25% moderada. (AU)

Introduction: Complex polyps require the use of advanced endoscopic techniques or minimally invasive surgery for their approach. In rectal polyps it is of special relevance to reach a consensus on the best approach to avoid under- or overtreatment that increases unnecessary morbidity and mortality. Methods: We describe a prospective, multicenter, pilot clinical trial with a first-in-human medical device. It is hypothesized that UNI-VEC® facilitates transanal laparoendoscopic surgery for the removal of early rectal tumors. The primary objective is to evaluate that it is safe and meets the established functional requirements. Secondary objectives are to evaluate results, complications and level of satisfaction. Results: Sixteen patients were recruited in 12 months with a minimum follow-up of 2 months. The mean size was 3.4 cm with the largest polyp being 6 cm. Regarding location, the mean was 6.6 cm from the anal margin. Endoscopic mucosal resection (EMR) (6.3%), endoscopic submucosal dissection (ESD) (43.8%), REC (6.3%) and TAMIS (43.8%) were performed. The mean time was 73.25 min. The 56.3% used a 30° camera and 43.8% used the flexible endoscope as a viewing instrument. The 56.3% were benign lesions and 43.8% malignant. Complete resection is achieved in 87.5%. Regarding complications, mild bleeding (Clavien I) occurred in 25%, 6.3% and 21.4% at 24 h, 48 h and 7 days, respectively. Continence was assessed according to the Wexner scale. At 7 days, 60% showed perfect continence, 26.7% mild FI and 13.3% moderate FI. At 30 days, 66.7% had perfect continence, 20% mild FI and 13.3% moderate FI. At 2 months, 4 patients were reviewed who at 30 days had a Wexner's degree higher than preoperative and perfect continence was demonstrated in 25% of the patients, 50% mild and 25% moderate. (AU)

Application of Ultrafiltration to Produce Sheep's and Goat's Whey-Based Synbiotic Kefir Products.

Membrane filtration technologies are the best available tools to manage dairy byproducts such as cheese whey, allowing for the selective concentration of its specific components, namely proteins. Their acceptable costs and ease of operation make them suitable for application by small/medium-scale dairy plants. The aim of this work is the development of new synbiotic kefir products based on sheep and goat liquid whey concentrates (LWC) obtained by ultrafiltration. Four formulations for each LWC based on a commercial kefir starter or traditional kefir, without or with the addition of a probiotic culture, were produced. The physicochemical, microbiological, and sensory properties of the samples were determined. Membrane process parameters indicated that ultrafiltration can be applied for obtaining LWCs in small/medium scale dairy plants with high protein concentration (16.4% for sheep and 7.8% for goats). Sheep kefirs showed a solid-like texture while goat kefirs were liquid. All samples presented counts of lactic acid bacteria higher than log 7 CFU/mL, indicating the good adaptation of microorganisms to the matrixes. Further work must be undertaken in order to improve the acceptability of the products. It could be concluded that small/medium-scale dairy plants can use ultrafiltration equipment to valorize sheep's and goat's cheese whey-producing synbiotic kefirs.

'Superfoods': Reliability of the Information for Consumers Available on the Web.

The term 'superfoods', used frequently with marketing purposes, is usually associated with foodstuffs with beneficial health properties. 'Superfoods' appears in many information sources, including digital media. The information they provide is easily accessible for consumers through Internet search engines. The objective of this work is to investigate the data that web pages offer to consumers and their accuracy according to current scientific knowledge. The two main search engines were utilized for English language websites search, introducing the term 'superfoods'. In total, 124 search results were found. After applying the selection criteria, 45 web pages were studied. A total of 136 foods were considered as 'superfoods' by sites; 10 of them (kale, spinach, salmon, blueberries, avocado, chia, walnuts, beans, fermented milks and garlic) were mentioned on at least 15 sites. Nutritional and healthy properties displayed on sites were compared to scientific information. In conclusion, websites present the information in a very simplified manner and it is generally not wrong. However, they should offer to consumers comprehensible information without raising false expectations regarding health benefits. In any case, 'superfoods' consumption can have salutary effects as part of a balanced diet.

Multicenter clinical trial for the resection of rectal polyps using a new laparoendoscopic hybrid transanal access device.

INTRODUCTION: Complex polyps require the use of advanced endoscopic techniques or minimally invasive surgery for their approach. In rectal polyps it is of special relevance to reach a consensus on the best approach to avoid under- or overtreatment that increases unnecessary morbidity and mortality. METHODS: We describe a prospective, multicenter, pilot clinical trial with a first-in-human medical device. It is hypothesized that UNI-VEC® facilitates transanal laparoendoscopic surgery for the removal of early rectal tumors. The primary objective is to evaluate that it is safe and meets the established functional requirements. Secondary objectives are to evaluate results, complications and level of satisfaction. RESULTS: 16 patients were recruited in 12 months with a minimum follow-up of 2 months. The mean size was 3.4 cm with the largest polyp being 6 cm. Regarding location, the mean was 6.6 cm from the anal margin. Endoscopic Mucosal Resection (EMR) (6.3%), Endoscopic Submucosal Dissection ESD (43.8%), REC (6.3%) and TAMIS (43.8%) were performed. The mean time was 73.25 min. The 56.3% used a 30° camera and 43.8% used the flexible endoscope as a viewing instrument. The 56.3% were benign lesions and 43.8% malignant. Complete resection is achieved in 87.5%. Regarding complications, mild bleeding (Clavien I) occurred in 25%, 6.3% and 21.4% at 24 h, 48 h and 7 days respectively. Continence was assessed according to the Wexner scale. At 7 days, 60% showed perfect continence, 26.7% mild FI and 13.3% moderate FI. At 30 days, 66.7% had perfect continence, 20% mild FI and 13.3% moderate FI. At 2 months, 4 patients were reviewed who at 30 days had a Wexner's degree higher than preoperative and perfect continence was demonstrated in 25% of the patients, 50% mild and 25% moderate. In no case did rectal perforation or major complications requiring urgent reintervention occur. As for the level of reproducibility, safety, level of satisfaction with the device and evaluation of the blister, the evaluation on a scale of 0-10 (9.43, 9.71, 9.29 and 9.50 respectively). All the investigators have previous experience with transanal devices. CONCLUSIONS: The study demonstrates the efficacy and safety of UNI-VEC® for the treatment of rectal lesions. It will facilitate the implementation of hybrid procedures that seek to solve the limitations of pure endoscopic techniques by allowing the concomitant use of conventional laparoscopic and robotic instrumentation with the flexible endoscope.

Impact of Nanoclays Addition on Chickpea (Cicer arietinum L.) Flour Film Properties.

Chickpea flour is an affordable natural blend of starch, proteins, and lipids, which can create films with suitable properties as an eco-friendly packaging material. Nanoclays' incorporation into natural biopolymers enhances the barrier properties of the resulting nanocomposites, so they could improve the properties of flour films. The objective of this work was to assess the influence of three types of nanoclays (halloysite, bentonite, and Cloisite 20A) at two concentrations on the characteristics of chickpea flour films. In general terms, when the lowest dose (5%) was added, no or very slight significant differences with the control were observed in most parameters, except for thermal stability and opacity, which increased, and solubility, which decreased. At the highest concentration (10%), films containing any of the nanoclays demonstrated greater thermal stability, opacity, and rigidity while being less soluble than those without nanofillers. Bentonite exhibited superior film structure distribution compared to other nanoclays. At the highest concentration, it had the most significant impact on modifying the properties of chickpea flour films, increasing their tensile and puncture strengths while decreasing elasticity and water vapor permeability. The incorporation of nanoclays into chickpea flour films could be a useful technique to enhance their properties.

Evaluation of the Characteristics of Sheep's and Goat's Ice Cream, Produced with UF Concentrated Second Cheese Whey and Different Starter Cultures.

Second cheese whey (SCW) is the by-product resulting from the manufacture of whey cheeses. In the present work, sheep (S) and goat (G) SCW concentrated by ultrafiltration (UF) were used in the production of ice creams. Concentrated liquid SCW samples with inulin added as a prebiotic were fermented with yoghurt, kefir and probiotic commercial cultures before being frozen in a horizontal frozen yoghurt freezer. The physicochemical, microbiological and sensory properties of the products were evaluated over 120 days of frozen storage. The products presented significant differences regarding these properties, specifically the higher total solids and protein contents of sheep's ice creams, which were higher compared to their goat ice cream counterparts. Sheep's ice creams also presented higher hardness and complex viscosity, which increased with storage. These ice creams also presented higher overrun and lower meltdown rates. The color parameters of the ice creams showed significant differences between formulations resulting from storage time. In all cases, Lactobacilli sp. cell counts were higher than log 6 CFU/g at the first week of storage. In the case of sheep's ice creams these values were maintained or increased until the 30th day, but decreased until the 60th day. Lactococci sp. counts surpassed log 7 CFU/g in all products, and these values were maintained until the end of storage, except in the case of G-Yoghurt and G-Kefir. Concerning the products containing probiotics, the sum of Lactococci sp. and Lactobacilli sp. counts was of the order log 8-9 CFU/g until the 60th day of storage, indicating that the probiotic characteristics of ice creams were maintained for at least 2 months. All products were well accepted by the consumer panel. Sheep's SCW ice creams were better rated regarding aroma, taste and texture. However, only the ranking test was able to differentiate preferences among formulations.

Más allá de los límites de la disciplina con niños prematuros: una reflexión holística / Beyond the Limits of Discipline with Premature Children: A Holistic Reflection / Além dos limites da disciplina com bebés prematuros: uma reflexão holística

Introducción. En este artículo se presenta una reflexión sobre la necesidad de tener una visión holística en la problemática de la prematurez, para que los equipos del área de salud puedan tener una comprensión de la multiplicidad de factores presentes en el parto prematuro, y sus consecuencias para el menor, la madre, los familiares y el personal de salud involucrado. Tema de reflexión. El tema se sustenta en dos investigaciones realizadas con las madres, los padres y los niños beneficiarios del Programa Madre Canguro en un hospital del Estado, en dos momentos, 2012 y 2014, con algunos de los autores del presente artículo. Conclusiones. Además de la revisión de la literatura científica relacionada con el tema y la problemática, se concluye que, bajo una mirada holística, se comprende de manera integral la problemática y se propicia una mejor comunicación con los padres; con el equipo de la atención en salud, se logra un manejo transdisciplinario, superando los objetos de estudios aislados. Se da así un abordaje integrador y significativo en la cotidianidad de cada actor, desde la piel, con el Programa Madre Canguro, hasta la racionalidad de la ciencia.

Introduction. This article presents a reflection on the need for a holistic view of the problem of premature births, so that healthcare teams can understand the multiplicity of factors present in premature births, and its consequences for the minor, the mother, the family members, and the healthcare staff involved. Topic of reflection. The topic is based on two investigations carried out with mothers, fathers, and children's beneficiaries of the Mother Kangaroo Program in a State hospital, at two moments, 2012 and 2014, with some of the authors of this article. Conclusions. In addition to the review of the scientific literature related to the topic and the problem, it is concluded that, under a holistic view, the problem is understood in a comprehensive way and better communication with the parents is encouraged. With the healthcare team, cross-disciplinary handling is achieved, overcoming the objects of isolated studies. As such, there is an integrative and significant approach in the daily life of each actor, from the skin, with the Mother Kangaroo Program, to the rationality of science.

Introdução. Este artigo apresenta uma reflexão sobre a necessidade de se ter uma visão holística da problemática da prematuridade, para que as equipes da área da saúde possam ter uma compreensão da multiplicidade de fatores presentes no parto prematuro, e suas consequências para a criança, a mãe, os familiares e o pessoal de saúde envolvido. Tópico de reflexão. O tema é baseado em duas pesquisas realizadas com mães, pais e filhos beneficiários do Programa Mãe Canguru em um hospital estadual, em dois momentos, 2012 e 2014, com alguns dos autores deste artigo. Conclusões. Além da revisão da literatura científica relacionada ao tópico e ao problema, conclui-se que, sob uma visão holística, o problema é plenamente compreendido e incentiva-se uma melhor comunicação com os pais; com a equipe de saúde, consegue-se uma gestão transdisciplinar, superando os objetos de estudos isolados. Isto proporciona uma abordagem integradora e significativa no cotidiano de cada ator, desde a pele, com o Programa Mãe Canguru, até a racionalidade da ciência.

Primary HPV and Molecular Cervical Cancer Screening in US Women Living With Human Immunodeficiency Virus.

BACKGROUND: Primary human papillomavirus (HPV) screening (PHS) utilizes oncogenic human papillomavirus (oncHPV) testing as the initial cervical cancer screening method and typically, if positive, additional reflex-triage (eg, HPV16/18-genotyping, Pap testing). While US guidelines support PHS usage in the general population, PHS has been little studied in women living with HIV (WLWH). METHODS: We enrolled n = 865 WLWH (323 from the Women's Interagency HIV Study [WIHS] and 542 from WIHS-affiliated colposcopy clinics). All participants underwent Pap and oncHPV testing, including HPV16/18-genotyping. WIHS WLWH who tested oncHPV[+] or had cytologic atypical squamous cells of undetermined significance or worse (ASC-US+) underwent colposcopy, as did a random 21% of WLWH who were oncHPV[-]/Pap[-] (controls). Most participants additionally underwent p16/Ki-67 immunocytochemistry. RESULTS: Mean age was 46 years, median CD4 was 592 cells/µL, 95% used antiretroviral therapy. Seventy WLWH had histologically-determined cervical intraepithelial neoplasia grade 2 or greater (CIN-2+), of which 33 were defined as precancer (ie, [i] CIN-3+ or [ii] CIN-2 if concurrent with cytologic high grade squamous intraepithelial lesions [HSILs]). PHS had 87% sensitivity (Se) for precancer, 9% positive predictive value (PPV), and a 35% colposcopy referral rate (Colpo). "PHS with reflex HPV16/18-genotyping and Pap testing" had 84% Se, 16% PPV, 30% Colpo. PHS with only HPV16/18-genotyping had 24% Colpo. "Concurrent oncHPV and Pap Testing" (Co-Testing) had 91% Se, 12% PPV, 40% Colpo. p16/Ki-67 immunochemistry had the highest PPV, 20%, but 13% specimen inadequacy. CONCLUSIONS: PHS with reflex HPV16/18-genotyping had fewer unnecessary colposcopies and (if confirmed) could be a potential alternative to Co-Testing in WLWH.

Long-Term Effects of a Cognitive Behavioral Conference Call Intervention on Depression in Non-Professional Caregivers.

Recent evidence supports the efficacy of conference call cognitive-behavioral interventions in preventing depression in caregivers at post-intervention, but we do not know whether the results are sustained long term. The main objective of this study was to evaluate the long-term efficacy of a cognitive-behavioral intervention administered by telephone conference call in preventing depression in caregivers with elevated depressive symptoms, comparing all components of the intervention versus only the behavioral ones. A randomized controlled trial was conducted using a dismantling strategy. At total of 219 caregivers were randomly assigned to a cognitive-behavioral conference call intervention (CBCC; n = 69), a behavioral-activation conference call intervention (BACC; n = 70), or a usual care control group (CG, n = 80). Information was collected on depressive symptoms and depression at pre-intervention and at 1, 3, 6, 12, and 36 months post-intervention. At 36 months, there was a reduction in depressive symptoms (p < 0.001) and a lower incidence of major depressive episodes in both the CBCC and BACC groups compared to CG (8.7%, 8.6%, and 33.7%, respectively). The results show that a conference call intervention was effective in the long term to prevent depression in caregivers and that the behavioral-activation component was comparable to the complete cognitive-behavioral protocol.

Descriptive epidemiology of classical swine fever outbreaks in the period 2013-2018 in Colombia.

Classical swine fever (CSF) is an infectious viral disease caused by an RNA virus belonging to the Pestivirus genus. A total of 134 outbreaks of CSF have occurred in the last seven years in the North of Colombia. The objective of this study was the characterization of the herds affected by CSF from 2013 to 2018. Most of the outbreaks (95%) occured in backyard piggeries. The principal causes of transmission of CSF were the introduction of infected pigs (38%), movements of people (37%) and unknown origin (13%). The epidemiological relationships with 15 affected farms explained 31 outbreaks. The overall attack and mortality rates were 39% and 32%, respectively. The main clinical signs were high fever (67%), incoordination of movements (54%), and prostration (52%). Seventy-three percent of the herds had not been vaccinated against CSF and 17% had been only partially vaccinated. A spatio-temporal analysis, using a Poisson regression model, revealed two clusters with high risk; the first and largest one from 2014 to 2016 had a relative risk (RR) of 13.4 and included part of the departments of Atlántico, Bolívar, Cesar, La Guajira, Norte de Santander, Magdalena and Sucre; and the second cluster (RR = 9.6 in 2016) included municipalities in the north of the department of Cordoba.

Experiencia en la implantación y consolidación de las Guías de buenas prácticas de la Registered Nurses' Association of Ontario (RNAO) en el ámbito clínico y académico en Colombia / Experience on implementing and consolidating the Best practice guidelines of the Registered Nurses' Association of Ontario (RNAO) in clinical and academic scenarios in Colombia

Este artículo describe la experiencia de implantación y consolidación de las Guías de buenas prácticas clínicas (GBP) de la Registered Nurses' Association of Ontario (RNAO) en el ámbito clínico y académico, en Santander (Colombia) y su proyección futura. Para la implantación de las Guías de buenas prácticas en ambos contextos se utilizó la herramienta propuesta por la RNAO. En el ámbito clínico, la implantación de las guías ha permitido iniciar el proceso de estandarización del cuidado de forma transversal en la institución, con seguimiento sistemático de los indicadores, lo cual ha hecho posible la toma de decisiones y la visualización de la calidad del cuidado que prestan las enfermeras en sus diferentes roles. En el ámbito académico, la implantación de las guías ha potenciado la función docente e investigadora, y en menor proporción la función de extensión (entendida como educación continua o proyección social). En la fase de consolidación se han logrado avances en 10 componentes a nivel de docentes, estudiantes, escenarios de práctica clínica en instituciones de salud públicas/privadas, usuarios (paciente/cuidadores), profesionales sanitarios y vinculación a otros programas enfermeros a nivel nacional e internacional con la organización RNAO. Consecuentemente, la implantación de GBP ha favorecido la disminución de la brecha en la relación entre la docencia y los servicios clínicos, mejorando así la colaboración entre la asistencia y la academia, donde se potencia el trabajo colaborativo e interinstitucional en pro de la obtención de los mejores resultados en el paciente usando la evidencia disponible. Por tanto, se ha obtenido una trasformación de práctica enfermera a través del conocimiento, como pretende el programa de implantación de las GPC a través del establecimiento del programa Best Practice Spotlight Organizations (BPSO®) en nuestro entorno

This paper describes the results of the implementation, consolidation and future projection of the Best practice guidelines of the Registered Nurses' Association of Ontario (RNAO) in clinical and academic scenarios in Santander, Colombia. The tool proposed by the RNAO was used for the implementation of the guidelines in both clinical and academic settings. Preliminary results on the implementation of the guidelines are presented in this paper. In the clinical setting, the implementation of the guidelines has made it possible to start the process of standardizing care across the institution, with systematic follow-up based on indicators. This has allowed decision-making and visualization of the quality of nursing care provided by nurses in their different roles. In the academic scenario, implementing the guidelines has strengthened teaching and research functions, and, to a lesser extent, continuing education and social projection processes. In the consolidation phase, advances were achieved in 10 components, relevant to teachers, students, and practice scenarios of public / private health institutions, users (patients/caregivers), health personnel and other nursing programmes at a national and international level. Implementing the clinical practice guidelines has reduced the gap between the clinical and the academic scenarios, where collaborative and inter-institutional work is enhanced to obtain better patient outcomes, based on the available evidence

Preoperative oral antibiotics and surgical-site infections in colon surgery (ORALEV): a multicentre, single-blind, pragmatic, randomised controlled trial.

BACKGROUND: Previous studies have found that mechanical bowel preparation with oral antibiotics can reduce the incidence of surgical-site infections, but no randomised controlled trial has assessed oral antibiotics alone without mechanical bowel preparation. The aim of this study was to determine whether prophylaxis with oral antibiotics the day before elective colon surgery affects the incidence of postoperative surgical-site infections. METHODS: In this multicentre, pragmatic, randomised controlled trial (ORALEV), patients undergoing colon surgery were recruited from five major hospitals in Spain and 47 colorectal surgeons at these hospitals participated. Patients were eligible for inclusion if they were diagnosed with neoplasia or diverticular disease and if a partial colon resection or total colectomy was indicated. Participants were randomly assigned (1:1) using online randomisation tables to either administration of oral antibiotics the day before surgery (experimental group) or no administration of oral antibiotics before surgery (control group). For the experimental group, ciprofloxacin 750 mg was given every 12 h (two doses at 1200 h and 0000 h) and metronidazole 250 mg every 8 h (three doses at 1200 h, 1800 h, and 0000 h) the day before surgery. All patients were given intravenous cefuroxime 1·5 g and metronidazole 1 g at the time of anaesthetic induction. The primary outcome was incidence of surgical-site infections. Patients were followed up for 1 month after surgery and all postsurgical complications were registered. This study was registered with EudraCT, 2014-002345-21, and ClinicalTrials.gov, NCT02505581, and is closed to accrual. FINDINGS: Between May 2, 2015, and April 15, 2017, we assessed 582 patients for eligibility, of whom 565 were eligible and randomly assigned to receive either no oral antibiotics (n=282) or oral antibiotics (n=282) before surgery. 13 participants in the control group and 16 in the experimental group were subsequently excluded; 269 participants in the control group and 267 in the experimental group received their assigned intervention. The incidence of surgical-site infections in the control group (30 [11%] of 269) was significantly higher than in the experimental group (13 [5%] of 267; χ2 test p=0·013). Oral antibiotics were associated with a significant reduction in the risk of surgical-site infections compared with no oral antibiotics (odds ratio 0·41, 95% CI 0·20-0·80; p=0·008). More complications (including surgical-site infections) were observed in the control group than in the experimental group (76 [28%] vs 51 [19%]; p=0·017), although there was no difference in severity as assessed by Clavien-Dindo score. No differences were noted between groups in terms of local complications, surgical complications, or medical complications that were not related to septic complications. INTERPRETATION: The administration of oral antibiotics as prophylaxis the day before colon surgery significantly reduces the incidence of surgical-site infections without mechanical bowel preparation and should be routinely adopted before elective colon surgery. FUNDING: Fundación Asociación Española de Coloproctología.