Beverage industry TV advertising shifts after a stepwise mandatory food marketing restriction: achievements and challenges with regulating the food marketing environment.

OBJECTIVE: Sugar-sweetened beverages (SSB) are heavily advertised globally, and SSB consumption is linked to increased health risk. To reduce unhealthy food marketing, Chile implemented a regulation for products classified as high in energies, sugar, saturated fat or sodium, starting with a 2016 ban on child-targeted advertising of these products and adding a 06.00-22.00 daytime advertising ban in 2019. This study assesses changes in television advertising prevalence of ready-to-drink beverages, including and beyond SSB, to analyse how the beverage industry shifted its marketing strategies across Chile's implementation phases. DESIGN: Beverage advertisements were recorded during two randomly constructed weeks in April-May of 2016 (pre-implementation) through 2019 (daytime ban). Ad products were classified as 'high-in' or 'non-high-in' according to regulation nutrient thresholds. Ads were analysed for their programme placement and marketing content. SETTING: Chile. RESULTS: From pre-regulation to daytime ban, child-targeted, daytime and total ads decreased by 51·8 percentage points (p.p.), 51·5 p.p. and 61·8 p.p. for high-in products and increased by 62·9 p.p., 54·9 p.p. and 61·8 p.p. for non-high-in products (Ps < 0·001). Additionally, total ready-to-drink beverage ads increased by 5·4 p.p. and brand-only ads (no product shown) by 7 p.p. CONCLUSIONS: After the regulation implementation, 'high-in' ads fell significantly, but 'non-high-in' ads rose and continued using strategies targeting children and being aired during daytime. Given research showing that advertising one product can increase preferences for a different product from that same brand and product categories, broader food marketing regulation approaches may be needed to protect children from the harmful effects of food marketing.

Framing a New Nutrition Policy: Changes on Key Stakeholder's Discourses throughout the Implementation of the Chilean Food Labelling Law.

The global implementation of structural policies to tackle obesity has been slow, likely because of the competing interests of governments and the food industry. We used the discussion of the Chilean Food Labeling Law to identify influential stakeholders in the media and their frames during different periods of the law's implementation. This involved a content analysis of the food regulation media coverage in five key periods from 2007, when the food bill was first introduced in Congress, to 2018, when the second phase of the law was implemented (N = 1295). We found that most of the law coverage was through elite press. Half of the sources were from the food industry (26.7%) and government (26.2%), while other stakeholders, were less prevalent. Frames were mostly competing, except for cooperation with the law. The main food industry frame used during the discussion of the law was the "economic threat" (41.9%), whose prevalence decreased at the post-implementation period (13%, p < 0.01). No other relevant stakeholders changed their framing. Our results highlight that there are several aspects of public health communication, such as the type of media used, the involvement of scholars and civil society, and the framing, that could be improved to advance food environment policies.

Restricting child-directed ads is effective, but adding a time-based ban is better: evaluating a multi-phase regulation to protect children from unhealthy food marketing on television.

BACKGROUND: As childhood obesity rates continue to rise, health organizations have called for regulations that protect children from exposure to unhealthy food marketing. In this study, we evaluate the impact of child-based versus time-based restrictions of "high-in" food and beverage advertising in Chile, which first restricted the placement of "high-in" advertisements (ads) in television attracting children and the use of child-directed content in high-in ads and, second, banned high-in ads from 6am-10pm. "High-in" refers to products above regulation-defined thresholds in energy, saturated fats, sugars, and/or sodium. High-in advertising prevalence and children's exposure to high-in advertising are assessed. METHODS: We analyzed a random stratified sample of advertising from two constructed weeks of television at pre-regulation (2016), after Phase 1 child-based advertising restrictions (2017, 2018), and after the Phase 2 addition of a 6am-10pm high-in advertising ban (2019). High-in ad prevalence in post-regulation years were compared to prior years to assess changes in prevalence. We also analyzed television ratings data for the 4-12 year-old child audience to estimate children's ad exposure. RESULTS: Compared to pre-regulation, high-in ads decreased after Phase 1 (2017) by 42% across television (41% between 6am-10pm, 44% from 10pm-12am) and 29% in programs attracting children (P < 0.01). High-in ads further decreased after Phase 2, reaching a 64% drop from pre-regulation across television (66% between 6am-10pm, 56% from 10pm-12am) and a 77% drop in programs attracting children (P < 0.01). High-in ads with child-directed ad content also dropped across television in Phase 1 (by 41%) and Phase 2 (by 67%), compared to pre-regulation (P < 0.01). Except for high-in ads from 10pm-12am, decreases in high-in ads between Phase 1 (2018) and Phase 2 were significant (P < 0.01). Children's high-in ad exposure decreased by 57% after Phase 1 and by 73% after Phase 2 (P < 0.001), compared to pre-regulation. CONCLUSIONS: Chile's regulation most effectively reduced children's exposure to unhealthy food marketing with combined child-based and time-based restrictions. Challenges remain with compliance and limits in the regulation, as high-in ads were not eliminated from television. Yet, having a 6am-10pm ban is clearly critical for maximizing the design and implementation of policies that protect children from unhealthy food marketing.

Why Don't You [Government] Help Us Make Healthier Foods More Affordable Instead of Bombarding Us with Labels? Maternal Knowledge, Perceptions, and Practices after Full Implementation of the Chilean Food Labelling Law.

Experimental and real-life evaluations show that the use of front-of-package warning labels (FoP) in unhealthy foods is well understood and can modify people's behaviors. However, it is unclear whether these effects remain in the long term because of the risk of message fatigue. The purpose of this study is to explore after four years of implementation of the Chilean Food Labelling law people's dietary behavior and FoP labels attention. Nine focus groups of mothers (7-10 people each) of children (2-14 yo) were conducted in Santiago, Chile, and macrocodes were developed, combining an iterative process of deductive and inductive thematic analyses. We found that mothers experienced labels' fatigue but also had greater knowledge about nutrition and appreciation for more natural foods. This greater knowledge about better nutrition interferes with the perception that healthier and less processed foods are financial and physically inaccessible. The key role of schools as an environment for promoting healthier diets in children was strengthened by the mothers. These results suggest that policies based on providing consumer information need reinforcement campaigns to maintain their effectiveness and that we also need to advance policies to improve access and affordability of healthy foods to ensure better diets.

Asociación entre el Material Particulado y la Función Pulmonar durante el Ejercicio en Sujetos Físicamente Activos / Association between particulate matter and lung function during exercise in physically active subjects

Introducción: El material particulado (MP) es una mezcla de partículas potencialmente peligrosas debido a su capacidad de penetrar el sistema respiratorio. La cantidad de MP que ingresa al organismo depende de su concentración ambiental, tiempo de exposición y la ventilación pulmonar. Esta última aumenta fisiológicamente durante el ejercicio físico. Objetivo: Determinar la asociación entre el MP y la función pulmonar. Métodos: Los participantes completaron un protocolo de actividad física en condiciones ambientales con concentraciones de MP habituales durante 4 días consecutivos (24-km). La función pulmonar fue evaluada antes (día-0) y después de una exposición aguda (día-1, post 6-km) y exposición prolongada (día-4, post 24-km). Para determinar la correlación entre los niveles de MP y las variables de función pulmonar, se aplicó la prueba de correlación de Spearman. El nivel de significancia se estableció en p<0.05. Resultados: La función pulmonar, evaluada a través de las variables de espirometría de volumen espiratorio forzado al primer segundo (VEF1), su relación con la capacidad vital forzada (VEF1/CVF) y flujo espiratorio medio (FEF25-75%), se asoció inversamente con las concentraciones de MP en el día-1 (p<0.05), pero no en el día-4 (p>0.05). Conclusión: Este estudio encontró que a mayor dosis efectiva de MP inhalado, mayor es la disminución en variables de función pulmonar evaluadas con espirometría. Este efecto fue más notorio posterior a la exposición aguda que a la exposición prolongada, infiriendo una posible habituación por parte del sistema respiratorio a la inhalación permanente de material particulado.

Introduction: Particulate matter (PM) is a mixture of potentially dangerous particles due to its ability to penetrate the respiratory system. The amount of PM that enters the body depends on its environmental concentration, the exposure time and pulmonary ventilation. The latter increase physiologically during physical exercise. Objective: To determine the association between MP and lung function in physically active young adults during physical exercise. Methods: the subjects completed a physical activity protocol in environmental conditions with habitual PM concentrations for four consecutive days (24-km). Lung function was evaluated before (day-0) and after acute exposure (day-1, post-6-km) and prolonged exposure (day-4, post-24-km). To determine the correlation between MP levels and lung function variables, the Spearman correlation test was applied. The level of significance was established at p <0.05. Results: Lung function, evaluated through the spirometry variables of forced expiratory volume in the first second (FEV1), its relationship with forced vital capacity (FEV1 / FVC) and mean expiratory flow (FEF25-75%) was inversely associated with MP concentrations on day-1 (p<0.05), but not on day-4 (p>0.05). Conclusion: This study found that the higher the effective dose of inhaled PM, the greater the decrease in lung function variables evaluated with spirometry. This effect is more noticeable after acute exposure than after prolonged exposure, inferring the respiratory system's possible habituation to permanent inhalation of particulate matter.

Food Advertising on Television Before and After a National Unhealthy Food Marketing Regulation in Chile, 2016-2017.

Objectives. To study changes in food advertising on television after Chile's food marketing restriction was implemented in June 2016.Methods. Food advertisements shown between 6 am and 12 am on the 4 primary broadcast and 4 cable channels with the largest Chilean youth audiences during 2 random weeks in April and May 2016 and 2017 were analyzed for product nutrition and child-directed marketing.Results. The percentage of ads for foods high in energy, saturated fats, sugars, or sodium (HEFSS) decreased from 41.9% before the regulation to 14.8% after the regulation (P < .001). This decrease occurred in programs intended for children (from 49.7% to 12.7%; P < .001) as well as general audiences (from 38.5% to 15.7%; P < .001). The largest declines were seen for sodas, desserts, breakfast cereals and industrialized fruit- and vegetable-flavored drinks. Fewer HEFSS ads featured child-directed content (a decrease from 44.0% to 12.0%; P < .001), and the remaining child-directed HEFSS ads primarily aired on internationally owned cable channels.Conclusions. The significant postregulation decrease in the prevalence of HEFSS television ads suggests that children in Chile are now less exposed to unhealthy food advertising. However, television originating from national and international outlets should still be monitored for compliance.

La construcción de nuevos significados en la adolescencia / Giving new meaning in adolescence / La construcció de nous significats en l'adolescència

Este artículo pretende explorar la experiencia adolescente de conocer y comprender su nueva realidad, a partir de la complejidad simbólica y subjetiva que despliega la intersubjetividad. Una de las temáticas centrales que frecuentemente observamos refiere a la bús­queda del sí mismo en tanto otro, que comienza a pensar su existencia apuntalado de otros sujetos, en la singu­lar aventura de poder investirse como diferente. Adscribirse a una dimensión semántica es parte de la tarea de la exogamia. Descubrirse -desde la interacción recíproca con otros significativos-, como sujeto, proyecto y agente, supeditado a nuevos desarrollos, emprendimientos y modificaciones, lo impulsarán a interpretar y reinterpretar la realidad

This article aims to explore the adolescent experience of knowing and understanding their new reality, based on the symbolic and subjective complexity that inter-subjectivity dis­plays. One of the main themes that we frequently observe refers to the search for self in another, who begins to think about his/her existence underpinned by other subjects, in the singular adventure of being able to identify himself/herself as different. To attach oneself to a semantic dimension is part of the exogamy's task. Discove­ring oneself - from the reciprocal interaction with other meanings-, as a subject, project and agent, subject to new developments, undertakings and modifications, will impel him/her to interpret and reinterpret reality

Aquest article pretén explorar l'experiència adolescent de conèixer I comprendre la seva nova realitat, a partir de la complexitat simbòlica I subjectiva que desplega la intersubjectivitat. Una de les temàtiques centrals que freqüentment observem té a veure amb la recerca de si mateix en tant que un altre, que comença a pensar la seva existència apuntalat d'altres subjectes, en la sin­gular aventura de poder investir-se com a diferent. Adscriure's a una dimensió semàntica és part de la tasca de l'exogàmia. Descobrir-se -des de la interacció recíproca amb altres significatius-, com a subjecte, projecte I agent, supeditat a nous desenvolupaments, iniciatives I modificacions, l' impulsaran a interpretar I reinterpretar la realitat

Evaluating the impact of Chile's marketing regulation of unhealthy foods and beverages: pre-school and adolescent children's changes in exposure to food advertising on television.

OBJECTIVE: To evaluate the effects of Chile's 2016 regulation restricting child-directed marketing of products high in energy, saturated fats, sodium and sugars on reducing children's exposure to 'high-in' television food advertising. DESIGN: Television use by pre-schoolers and adolescents was assessed via surveys in the months prior to implementation and a year after implementation. Hours and channels of television use were linked with the amount of high-in food advertising observed in corresponding content analyses of food advertisements (ads) from popular broadcast and cable channels to estimate changes in exposure to food ads from these channels. SETTING: Middle-lower and lower-income neighbourhoods in Santiago, Chile. PARTICIPANTS: Pre-schoolers (n 879; mothers reporting) and adolescents (n 753; self-reporting). RESULTS: Pre-schoolers' and adolescents' exposure to high-in food advertising in total decreased significantly by an average of 44 and 58 %, respectively. Exposure to high-in food advertising with child-directed appeals, such as cartoon characters, decreased by 35 and 52 % for pre-schoolers and adolescents, respectively. Decreases were more pronounced for children who viewed more television. Products high in sugars were the most prevalent among the high-in ads seen by children after implementation. CONCLUSIONS: Following Chile's 2016 child-directed marketing regulation, children's exposure to high-in food advertising on popular broadcast and cable television decreased significantly but was not eliminated from their viewing. Later stages of the regulation are expected to eliminate the majority of children's exposure to high-in food advertising from television.

Prevalence of Child-Directed Marketing on Breakfast Cereal Packages before and after Chile's Food Marketing Law: A Pre- and Post-Quantitative Content Analysis.

Food marketing has been identified as a contributing factor in childhood obesity, prompting global health organizations to recommend restrictions on unhealthy food marketing to children. Chile has responded to this recommendation with a restriction on child-directed marketing for products that exceed certain regulation-defined thresholds in sugars, saturated fats, sodium, or calories. Child-directed strategies are allowed for products that do not exceed these thresholds. To evaluate changes in marketing due to this restriction, we examined differences in the use of child-directed strategies on breakfast cereal packages that exceeded the defined thresholds vs. those that did not exceed the thresholds before (n = 168) and after (n = 153) the restriction was implemented. Photographs of cereal packages were taken from top supermarket chains in Santiago. Photographed cereals were classified as "high-in" if they exceeded any nutrient threshold described in the regulation. We found that the percentage of all cereal packages using child-directed strategies before implementation (36%) was significantly lower after implementation (21%), p < 0.05. This overall decrease is due to the decrease we found in the percentage of "high-in" cereals using child-directed strategies after implementation (43% before implementation, 15% after implementation), p < 0.05. In contrast, a greater percentage of packages that did not qualify as "high-in" used child-directed strategies after implementation (30%) compared with before implementation (8%), p < 0.05. The results suggest that the Chilean food marketing regulation can be effective at reducing the use of child-directed marketing for unhealthy food products.

Global benchmarking of children's exposure to television advertising of unhealthy foods and beverages across 22 countries.

Restricting children's exposures to marketing of unhealthy foods and beverages is a global obesity prevention priority. Monitoring marketing exposures supports informed policymaking. This study presents a global overview of children's television advertising exposure to healthy and unhealthy products. Twenty-two countries contributed data, captured between 2008 and 2017. Advertisements were coded for the nature of foods and beverages, using the 2015 World Health Organization (WHO) Europe Nutrient Profile Model (should be permitted/not-permitted to be advertised). Peak viewing times were defined as the top five hour timeslots for children. On average, there were four times more advertisements for foods/beverages that should not be permitted than for permitted foods/beverages. The frequency of food/beverages advertisements that should not be permitted per hour was higher during peak viewing times compared with other times (P < 0.001). During peak viewing times, food and beverage advertisements that should not be permitted were higher in countries with industry self-regulatory programmes for responsible advertising compared with countries with no policies. Globally, children are exposed to a large volume of television advertisements for unhealthy foods and beverages, despite the implementation of food industry programmes. Governments should enact regulation to protect children from television advertising of unhealthy products that undermine their health.

"Responses to the Chilean law of food labeling and advertising: exploring knowledge, perceptions and behaviors of mothers of young children".

BACKGROUND: In line with calls for action from international health organizations, Chile implemented in June 2016 a set of regulations to tackle the obesity epidemic. The new regulation includes the mandatory use of front-of-package warning labels on packaged foods/beverages high in energy, sugars, saturated fats and sodium. Additionally, such foods cannot be sold nor offered in daycares/schools and cannot be promoted to children under 14yo. The law is targeted to children; thus, this study examined mothers' understanding, perceptions, and behaviors associated with the regulation one year after its implementation, using a qualitative approach. METHODS: Nine focus groups of mothers (7-10 people each) of children (2-14yo) were conducted in July 2017 in Santiago-Chile. They were stratified by socioeconomic status (SES) and children's age. Macrocodes were developed by three researchers, combining an iterative process of deductive and inductive thematic analyses. Quotations representing each category were selected. RESULTS: Mothers understood the new regulation as a policy to fight child obesity and were aware that products with more labels were less healthy than products with fewer labels. Attention and use of labels in the buying decision-making process ranged from participants who did not pay attention to others who relied on them as a quick shortcut (mostly from middle and upper-SES); many mothers indicated changing their purchase habits only when buying new products. Mothers declared that young children accepted school environment changes while teens/preteens resisted them more. Many mothers agreed that schools have become key promoters of food behavioral change. Mothers were less aware about the food marketing regulations. Mothers declared that they perceived that the regulation was changing the perceptions, attitudes and behaviors toward healthier eating patterns. CONCLUSION: After the first year of implementation, the regulation was well known by mothers of diverse SES and different children ages. The degree of use of warning labels was heterogeneous among participants, but most of them agreed that their children, particularly the youngest have positive attitudes toward the regulation and have become promoters of change in their families. Many mothers also expressed that they perceived an important shift toward healthier eating, which may lead to a change in eating social norms. This information contributes to better understand how regulatory actions may influence people's consumer behaviors.

The prevalence and audience reach of food and beverage advertising on Chilean television according to marketing tactics and nutritional quality of products.

OBJECTIVE: In the light of Chile's comprehensive new restriction on unhealthy food marketing, we analyse food advertising on Chilean television prior to the first and final phases of implementation of the restriction. DESIGN: Content analysis of marketing strategies of 6976 advertisements, based on products' nutritional quality. Statistical analysis of total and child audience reached using television ratings data. SETTING: Advertising from television aired between 06.00 and 00.00 hours during two random composite weeks across April-May 2016 from the four broadcast and four cable channels with the largest youth audiences. RESULTS: Food ads represented 16 % of all advertising; 34 % of food ads featured a product high in energy, saturated fats, sugars and/or salt (HEFSS), as defined by the initial regulation. HEFSS ads were seen by more children and contained more child-directed marketing strategies than ads without HEFSS foods. If HEFSS advertising was restricted only in programmes where 20 % are children aged 4-12 years, 31 % of children's and 8 % of the general audience's HEFSS advertising exposure would be reduced. The newest 06.00-22.00 hours restriction captures 80 % of all audience exposure. CONCLUSIONS: HEFSS advertising was seen by a large proportion of children before Chile's regulation. Chile's first implementation based on audience composition should reduce a third of this exposure and its second restriction across the television day should eliminate most of the exposure. The current study is a crucial first step in evaluating how Chile's regulation efforts will impact children's diets and obesity prevalence.

La presencia parental como experiencia emocional intersubjetiva / The parental presence as an intersubjective emotional experience / La preséncia parental com a experiéncia emocional intersubjectiva

Este artículo pretende explorar la motivación intersubjetiva existente en la interacción parento filial en tanto posibilidad de conexión emocional profunda. Nos proponemos identificar e indagar -a partir de la modalidad de relación con un paciente-, acerca de las posibles interferencias o rupturas que ocurren en esta búsqueda de una continuidad sostenida, que remite al concepto winnicottiano del "estar siendo", a partir de la presentación de dos casos. Esto señalaría el alcance del concepto de presencia en su máxima exponencia en tanto posibilidad de un verdadero encuentro

The aim of this article is to explore the existing intersubjective motivation in the parents-children interaction as an example of deep emotional connection. Our purpose is to identify and investigate, based on a relationship with a patient, the possible interferences or ruptures that occur in this sustained continuity search. It goes back to the Winnicottian concept of "continuity of being". This is done through the presentation of two cases. This would indicate the scope of the presence concept in its maximum exponent as a possibility of a true encounter

Aquest article pretén explorar la motivació intersubjectiva existent en la interacció parentofilial com a possibilitat de connexió emocional profunda. Ens pro­posem identificar I indagar -a partir de la modalitat de relació amb un pacient- sobre les possibles interferéncies o ruptures que ocorren en aquesta recerca d'una continuïtat sostinguda, que remet al concepte winnicottiá de l'"estar sent", a partir de la presentació de dos casos. Aixó assenyalaria l'abast del concepte de preséncia en la seva máxima exponéncia com a possibilitat d'una veritable trobada

Cesárea en paciente con trombosis portal crónica y trombocitopenia: reporte de caso / Caesarean section in a patient with chronic portal vein thrombosis and thrombocytopenia: Case report

Abstract We report the case of a pregnant woman at term with primary anti-phospholipid syndrome, portal vein thrombosis, massive splenomegaly, oesophageal varices and thrombocytopenia. The patient underwent an elective caesarean section under general anaesthesia to minimise the risk of spleen and variceal rupture, with a favourable outcome for both the mother and the newborn. Chronic portal vein thrombosis is a rare condition, caused by various reasons, mainly thrombotic diathesis. It leads to increased portal pressure, with development of collateral circulation, splenomegaly and thrombocytopenia. Pregnancy in these conditions is considered high risk, but is not contraindicated if the underlying disorder is stabilised. The management of these patients should be multidisciplinary, under close monitoring; diagnosis and treatment of possible oesophageal varices is essential. The decision about mode of delivery and anaesthetic management must be individualised, depending on obstetric factors, the presence or absence of varices and thrombocytopenia, and associated comorbidities.

Resumen Presentamos el caso de una gestante a término con síndrome antifosfolípido primario, trombosis portal crónica, esplenomegalia masiva, varices esofágicas y trombocitopenia. La paciente fue intervenida mediante una cesárea electiva bajo anestesia general para minimizar el riesgo de rotura del bazo y de las varices, con un resultado favorable para la madre y el neonato. La trombosis portal crónica es una entidad poco frecuente, motivada por distintas causas, principalmente las diátesis trombóticas. Induce un aumento de la presión portal, con desarrollo de circulación colateral, esplenomegalia y trombocitopenia. La gestación en estas condiciones se considera de alto riesgo, pero no está contraindicada si la enfermedad está estabilizada. El manejo de estas pacientes debe ser multidisciplinar y su seguimiento, estrecho; el diagnóstico y tratamiento de las posibles varices esofágicas es esencial. La decisión sobre el modo de finalizar la gestación y el manejo anestésico deben individualizarse en cada caso, en función de factores obstétricos, de la presencia o no de varices y trombocitopenia, y de las comorbilidades asociadas.

Parentalidad y procesos de integración yoica / Parenthood and self-integration processes / Parentalitat I Processos D’integració Joica

A partir de una investigación realizada en la Facultad de Psicología de la Universidad Nacional de San Luis en Argentina, presentamos una articulación entre material clínico y fundamentación teórica que da cuenta de que la integración es la resultante de ciertos procesos que se dan en la interdependencia emocional de la función parental con el hijo. Consideramos la integración del yo como uno de los procesos mentales primarios que debe realizar el psiquismo incipiente. Mostraremos la desintegración yoica -desde una mirada intersubjetiva- cuando existe déficit en el ejercicio de la parentalidad

From a study conducted at the School of Psychology at Universidad Nacional de San Luis in Argentina, we present a link between clinical material and its theoretical foundation, pointing out that integration is the result of certain processes that occur in the context of the emotional interdependence arising in a parent’s relationship with the baby. We consider the integration of the self to be one of the primary mental processes that must be performed by the incipient psychism. The paper will detail the disintegration of the ego disintegration - from an inter-subjective point of view- when there is a deficit in the parental function

A partir d’una investigació portada a terme a la Facultat de Psicologia de la Universitat Nacional de San Luis a Argentina, presentem una articulació entre material clínic i fonamentació teòrica que conclou que la integració és la resultant de certs processos que es donen en la interdependència emocional de la funció parental amb el fill. Considerem la integració del jo com un dels processos mentals primaris que ha de realitzar el psiquisme incipient. Mostrarem la desintegració joica –des d’una mirada intersubjectiva- quan existeixen mancances en l’exercici de la parentalitat

Intubación traqueal a ciegas a través de dos dispositivos extraglóticos: Ambu® AuraGainTM versus LMA FastrachTM / Blind tracheal intubation through 2 supraglottic devices: the Ambu AuraGain vs the LMA Fastrach

Objetivos: Los dispositivos extraglóticos se consideran actualmente como una alternativa de primera línea en un escenario de vía aérea difícil. El objetivo principal de nuestro estudio fue comparar el porcentaje de éxito global en la intubación a ciegas con los dispositivos Ambu® AuraGainTM frente a LMA Fastrach™. Método: Estudio de intervención de grupos paralelos, aleatorizado y simple ciego. Se evaluaron los siguientes parámetros: la ventilación adecuada, la visión de la glotis utilizando la escala Brimacombe, el éxito en la intubación a ciegas y los efectos adversos. Resultados: Los dispositivos se insertaron en 80 pacientes (40 pacientes por grupo). Se logró ventilación adecuada con ambos dispositivos (92,5% frente al 95% respectivamente). La visión fibroendoscópica de la glotis fue mejor con la Ambu® AuraGainTM en ambos intentos (p < 0,001). El éxito en la intubación fue mejor con LMA FastrachTM (70% frente al 17,5%, p < 0,001). La disfonía y la presencia de restos de sangre fueron más frecuentes con Ambu® AuraGainTM (12,5% frente al 0%, p = 0,027 y 17,5% frente al 0%, p = 0,006, respectivamente). Conclusiones: A pesar de la similar eficacia para la ventilación de ambos dispositivos, el éxito en la intubación a ciegas fue mayor con LMA FastrachTM (AU)

Background and objective: Supraglottic devices are now considered first-line tools for managing the difficult airway. Our main aim was to compare the percentage of successful blind intubations achieved with the Ambu AuraGain and LMA Fastrach devices. Methods: Randomized, single-blind, parallel group trial. The following variables were analyzed: adequate ventilation, visualization of the glottis on the Brimacombe scale, success of blind intubation, and adverse events. Results: The devices were inserted in 80 patients (40 per group). Adequate ventilation was achieved with both devices, in 92.5% in the AuraGain group and in 95% in the LMA group. The AuraGain provided a better view of the glottis on 2 attempts (P< aGain group and in 95% in the LMA group. The AuraGain provided a better view of the glottis on 2 attempts (P< 001). Hoarseness and signs of bleeding were observed more often with the AuraGain device than with the LMA: hoarseness, 12.5% vs 0%, respectively, P.027; blood, 17.5% vs 0%, P=.006 (AU)

[Blind tracheal intubation through 2 supraglottic devices: the Ambu AuraGain vs the LMA Fastrach]. / Intubación traqueal a ciegas a través de dos dispositivos extraglóticos: Ambu® AuraGainTM versus LMA FastrachTM.

OBJECTIVES: Supraglottic devices are now considered first-line tools for managing the difficult airway. Our main aim was to compare the percentage of successful blind intubations achieved with the Ambu AuraGain and LMA Fastrach devices. MATERIAL AND METHODS: Randomized, single-blind, parallel group trial. The following variables were analyzed: adequate ventilation, visualization of the glottis on the Brimacombe scale, success of blind intubation, and adverse events. RESULTS: The devices were inserted in 80 patients (40 per group). Adequate ventilation was achieved with both devices, in 92.5% in the AuraGain group and in 95% in the LMA group. The AuraGain provided a better view of the glottis on 2 attempts (P<.001). The rate of intubation success was higher with the LMA (70%) than with the AuraGain (17.5%) (P<.001). Hoarseness and signs of bleeding were observed more often with the AuraGain device than with the LMA: hoarseness, 12.5% vs 0%, respectively, P.027; blood, 17.5% vs 0%, P=.006 CONCLUSION: Even though the 2 devices are similarly effective, blind intubation was superior with the LMA Fastrach mask

OBJETIVO: Los dispositivos extraglóticos se consideran actualmente como una alternativa de primera línea en un escenario de vía aérea difícil. El objetivo principal de nuestro estudio fue comparar el porcentaje de éxito global en la intubación a ciegas con los dispositivos Ambu® AuraGainTM frente a LMA Fastrach™. METODO: Estudio de intervención de grupos paralelos, aleatorizado y simple ciego. Se evaluaron los siguientes pará- metros: la ventilación adecuada, la visión de la glotis utilizando la escala Brimacombe, el éxito en la intubación a ciegas y los efectos adversos. RESULTADOS: Los dispositivos se insertaron en 80 pacientes (40 pacientes por grupo). Se logró ventilación adecuada con ambos dispositivos (92,5% frente al 95% respectivamente). La visión fibroendoscópica de la glotis fue mejor con la Ambu® AuraGainTM en ambos intentos (p < 0,001). El éxito en la intubación fue mejor con LMA FastrachTM (70% frente al 17,5%, p < 0,001). La disfonía y la presencia de restos de sangre fueron más frecuentes con Ambu® AuraGainTM (12,5% frente al 0%, p = 0,027 y 17,5% frente al 0%, p = 0,006, respectivamente). CONCLUSIONES: A pesar de la similar eficacia para la ventilación de ambos dispositivos, el éxito en la intubación a ciegas fue mayor con LMA FastrachTM.

[Anesthesia in head and neck paragangliomas]. / La anestesia en los paragangliomas cervicocefálicos.

Head and neck paragangliomas are infrequent tumors that, for various reasons, may pose a particular challenge to anesthesiologists. It is especially important to rule out vasoactive amine secretion by the tumor and, when this occurs, to establish appropriate medical treatment before surgery as well as to maintain hemodynamic stability in the perioperative period. Balanced anesthetic techniques that allow early awakening and neurological evaluation are recommended. Bleeding, which can be profuse, must be closely monitored. In the postoperative period, special attention must be paid to the risk of bronchial aspiration and the development of compressive cervical hematoma, as well as to the possibility of stroke.

La anestesia en los paragangliomas cervicocefálicos / Anesthesia in head and neck paragangliomas

Los paragangliomas cervicocefálicos son tumores poco frecuentes, que pueden constituir un auténtico reto para el anestesiólogo, por varios motivos. Es especialmente importante descartar la producción de aminas vasoactivas por el tumor y, en caso afirmativo, el establecimiento del tratamiento médico oportuno previamente a la cirugía, así como el mantenimiento de la estabilidad hemodinámica en el perioperatorio. Se recomiendan las técnicas anestésicas balanceadas, que permitan un despertar y una evaluación neurológica precoces. Hay que vigilar estrechamente el sangrado, que puede ser profuso. En el postoperatorio debe prestarse especial atención al riesgo de broncoaspiración y al desarrollo de un hematoma cervical compresivo, así como a la posibilidad de que se produzca un accidente cerebrovascular agudo (AU)

Head and neck paragangliomas are infrequent tumors that, for various reasons, may pose a particular challenge to anesthesiologists. It is especially important to rule out vasoactiveamine secretion by the tumor and, when this occurs, to establish appropriate medical treatment before surgery as well as to maintain hemodynamic stability in the perioperative period. Balanced anesthetic techniques that allow early awakening and neurological evaluation are recommended. Bleeding, which can be profuse, must be closely monitored. In the postoperative period, special attention must be paid to the risk of bronchial aspiration and the development of compressive cervical hematoma, as well as to the possibility of stroke (AU)

Gas chromatography-mass spectrometry profile of urinary organic acids of Wistar rats orally treated with ozonized unsaturated triglycerides and ozonized sunflower oil.

The main products in the ozonolysis of unsaturated triglycerides or vegetable oils are peroxides, aldehydes, Criegee ozonides and carboxylic acids. Some of these compounds are present in different concentrations in the biological fluids. The aim of this work is to study, using gas chromatography-mass spectrometry (GC-MS), the organic acid excretion in urine of rats orally treated with ozonized sunflower oil (OSO), ozonized triolein or ozonized trilinolein. Oral administration of OSO to Wistar rats has produced changes in the urinary content of dicarboxylic organic acids. Among others heptanedioic (pimelic acid) and nonanedioic acids (azelaic acid) were the major increased dicarboxylic acids found. The urinary dicarboxylic acid profiles of rats which received ozonized triolein only showed an increase in heptanedioic and nonanedioic acids. However, when ozonized trilinolein is applied, the profile is similar to that obtained when OSO is administered. A biochemical mechanism is proposed to explain the formation of dicarboxylic acids from ozonated unsaturated triglycerides.