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Introduction: Childhood and adolescent obesity and overweight is associated with serious physical, psychological and social health complications. The aim of the present study was to explore in depth parents' perceptions of factors associated with obesity and overweight in their adolescent children.Methods: A descriptive phenomenological qualitative study was carried out through focus groups. Twenty-five mothers and fathers whose children were diagnosed with obesity or overweight who were under follow-up in the Paediatric Department of the Hospital Clinico San Cecilio (Spain) participated. Data analysis was performed with Atlas.ti 6.2 software through thematic analysis.Results: Lack of limit with food was perceived as a source of conflict and anxiety. The most common unhealthy lifestyle habits were sedentary, lack of time for cooking and skiping breakfast. Parents' perceptions of the negative effects of obesity are related to traumatic events, effects on body image, isolation and discrimination and the occurrence of other diseases associated with excess weight. Modulating factors of eating behavior were observed such as the promotion of healthy habits in the school environment, awareness of the problem, meal planning, talking about the issue and the search for solutions.Conclusions: Parents encounter obstacles that hinder change and improvement in this population. Thus, it is necessary to address obesity and overweight as a multifactorial problem.

The impact of hypocapnia in the prognosis of cardiogenic acute pulmonary edema (CAPE) has not been sufficiently studied. The aim of this study was to analyse whether hypocapnia is a risk factor for non-invasive ventilation (NIV) failure and hospital mortality, in CAPE patients CAPE.Retrospective observational study of all patients with CAPE treated with NIV. Patients were classified in three groups according to PaCO1138 patients were analysed, 390 (34.3%) of which had hypocapnia, 186 (16.3%) had normocapnia and 562 (49.4%) had hypercapnia. NIV failure was more frequent in hypocapnic (60 patients, 15.4%) than in eucapnic (16 pacientes, 8.6%) and hypercapnic group (562 pacientes, 10.7%), with statistical significance (p = 0.027), as well as hospital mortality, 73 (18.7%), 19(10.2%) and 83 (14.8%) respectively (p = 0.026). The predicted factors for NIV failure were the presence of do-not-intubate order, complications related to NIV, a lower left ventricular ejection fraction, higher SAPS II and SOFA score and a higher HACOR score at one hour of NIV initiation.Hypocapnia in patients with CAPE is associated with NIV failure and a greater in-hospital mortality.

A biodegradable packaging film containing cellulose nanofibers from olive tree pruning, a by-product of olives production, was obtained using a solvent casting method. Nanocellulose was added to polyvinyl alcohol (PVA) to enhance the technological properties of the composite film as food packaging material. Nanocellulose was obtained from unbleached and bleached pulp through a mechanical and TEMPO pretreatment. Crystalline and chemical structure, surface microstructure, UV and gas barrier, optical, mechanical and antioxidant properties, as well as thermal stability were evaluated. Regarding optical properties, the UV barrier was increased from 6% for the pure PVA film to 50% and 24% for unbleached and bleached nanocellulose, respectively. The antioxidant capacity increased significantly in unbleached mechanical nanocellulose-films (5.3%) compared to pure PVA film (1.7%). In terms of mechanical properties, the tensile strength of the 5% unbleached mechanical nanocellulose films was significantly improved compared to the pure PVA film. Similarly, the 5% nanocellulose films had increased the thermal stability and improved barrier properties, reducing water vapor permeability by 38–59% and presenting an oxygen barrier comparable to aluminum layer and plastic films. Our results support the use of the developed films as a green alternative material for food packaging.

Olea europaea L. leaves constitute a source of bioactive compounds with recognized benefits for both human health and technological purposes. In the present work, different extracts from olive leaves were obtained by the application of two extraction methods, Soxhlet and microwave-assisted extraction (MAE), and six solvents (distilled water, ethanolic and glycerol mixtures solvents). MAE was applied under 40, 60 and 80 °C for 3, 6.5 and 10 min. The effect of the extraction method, solvent and treatment factors (the latter in MAE) on the total phenol content (TPC), the antioxidant activity (AA) and the phenolic profile of the extracts were all evaluated. The extracts showed high values of TPC (up to 76.1 mg GAE/g DW) and AA (up to 78 mg TE/g DW), with oleuropein being the most predominant compound in all extracts. The Soxhlet extraction method exhibited better yields in TPC than in MAE, although both methods presented comparable AA values. The water MAE extract presented the strongest antimicrobial activity against five foodborne pathogens, with minimum inhibitory concentration (MIC) values ranging from 2.5 to 60 mg/mL. MAE water extract is proposed to be exploited in the food and nutraceutical industry in the frame of a sustainable economy.

Foodborne diseases constitute a major concern in societies, and their causes are aimed to be identified and minimized. Only in the last few years, this is encouraged by the application of risk assessment, management, and communication. This work presents a probabilistic quantitative microbiological risk assessment and management of Listeria monocytogenes in ready-to-eat lettuce salads in Spain. For risk assessment, a guideline provided by Codex Alimentarius was followed. Food chain was modeled from processing of raw material at the factory up to consumption. Different assumptions were made to describe the variables of the model by probability distributions or mathematical models. Monte Carlo simulations of the model were run to estimate the number of cases in low-risk and high-risk populations. Although results deviated from the number of cases observed in Spain, given an ideal situation of 100% compliance of the microbiological criterion ≤100 cfu/g throughout the shelf-life of the product, the resulting number of cases was near the real situation. From the 4 risk management measures simulated, the injection of a mixture of gases into packages at manufacture (CO2 about 5.5%, O2 about 3%, and N2 for the balance) was the most effective in reducing the number of cases, followed by 4 d of storage at home and prevention of high-risk consumers from consumption of ready-to-eat lettuce salads. More research and cooperation between different stakeholder organizations are needed in order to progressively improve the model. With this work, a breakthrough has been made with regards to risk assessment and management procedures and implementation.

19 Páginas.-- 6 Figuras.-- 2 Tablas, Olea europaea L. leaves constitute a source of bioactive compounds with recognized benefits for both human health and technological purposes. In the present work, different extracts from olive leaves were obtained by the application of two extraction methods, Soxhlet and microwave-assisted extraction (MAE), and six solvents (distilled water, ethanolic and glycerol mixtures solvents). MAE was applied under 40, 60 and 80 °C for 3, 6.5 and 10 min. The effect of the extraction method, solvent and treatment factors (the latter in MAE) on the total phenol content (TPC), the antioxidant activity (AA) and the phenolic profile of the extracts were all evaluated. The extracts showed high values of TPC (up to 76.1 mg GAE/g DW) and AA (up to 78 mg TE/g DW), with oleuropein being the most predominant compound in all extracts. The Soxhlet extraction method exhibited better yields in TPC than in MAE, although both methods presented comparable AA values. The water MAE extract presented the strongest antimicrobial activity against five foodborne pathogens, with minimum inhibitory concentration (MIC) values ranging from 2.5 to 60 mg/mL. MAE water extract is proposed to be exploited in the food and nutraceutical industry in the frame of a sustainable economy., The authors are grateful to the Ministry of Economy and Competitiveness of Spain for funding this research through the project CTQ2016-78729-R, to the Andalusian research project PY18-616 (Plan for Research, Development and Innovation 2020), and to the Andalusian knowledge transfer project AT17-5927 co-funded by the European Regional Development Fund instrument (ERDF Andalusian Operative Programme 2014–2020).

Strawberry production represents an agriculture sector of high relevance for the Spanish economy, due to their strawberries, highly appreciated for their organoleptic characteristics and health benefits. However, the reported outbreaks in different countries by enteric pathogens associated with this product have increased the safety concerns among different stakeholders. A number of factors and pathways for introducing pathogens in the strawberry production chain has been investigated. However, information on the potential internalization of enteric pathogens in strawberries is still scarce. The present study aimed to evaluate the potential internalization of Salmonella enterica sv Thompson via root in strawberry plants under the application of successive contamination events through capillary irrigation. Strawberry plants were organized in three groups (16 plants per group), and they were submitted to different contamination scenarios; groups 1, 2 and 3 were irrigated 1, 2 and 3 times respectively, with 100 mL of water containing Salmonella Thompson (8.8 log10 CFU/mL) every other day for 9 days. Fruits, calyces, and leaves were analyzed during the experiment, while roots were analyzed on the 9th day. The results showed that all calyces analyzed were negative, while one strawberry sample (group 3; day 8), four leaves samples (groups 2 and 3; day 8) and one root sample (group 3; day 9) were positive for Salmonella Thompson, representing the 0.85% (95% C.I.: [0.02–4.63%]), 8.88% (95% C.I.: [2.48–21.22%]), and 2.22% (95% C.I.: [0.06–11.77%]), respectively, of the overall samples analyzed. A significant association between the increased frequency of contamination (three irrigations) and the presence of the pathogen in the samples was elucidated. Our findings, in comparison with other studies, also point out the importance of watering by drip irrigation as a more hygienic and safer agronomic practice than systems like sprinkling irrigation.

Resumen Introduccion El maltrato a personas mayores tiene dimensiones todavia no suficientemente exploradas. Una de ellas es el maltrato sufrido por personas mayores que viven en residencias pero cuyo origen no es institucional, sino que es causado por agentes sociales externos al funcionamiento de la residencia. La ausencia de datos a este respecto nos ha llevado a la elaboracion del presente trabajo, de indole exploratorio, para evaluar la prevalencia de este maltrato. Material y metodos Se aplico el cuestionario Elder Abuse Suspicious Index a 286 sujetos perteneciente a las residencias de personas mayores de la Asociacion Mensajeros de la Paz de Murcia. Los casos de sospecha de maltrato fueron confirmados por el equipo de trabajadores sociales. Resultados Al ingreso, 53 sujetos sufrian algun tipo de maltrato (18,5%), que se redujo a 26 casos tras haber transcurrido un ano. Por otro lado, el maltrato aparecio tras el ingreso en 20 sujetos (7%), los cuales presentarian lo que hemos denominado en el presente trabajo maltrato no-institucional. El maltrato economico fue el mas prevalente, seguido del maltrato psicologico, por negligencia, fisico y, finalmente, el sexual. Los datos muestran una relacion significativa entre los diferentes tipos de maltrato. Conclusiones Estas evidencias muestran un escenario que debe ser abordado de manera profesional y social debido al contexto en el que tiene lugar. Los profesionales sanitarios y del ambito social deben sensibilizarse con esta realidad, informar y formarse de las formas de abordaje para poder dignificar la atencion a las personas mayores.

A tool able to quantitatively assess the fate of potential pathogenic microorganisms in foods along the food chain and their impact on public health is highly valuable for food safety decision-makers. The aim of this work was to present an overview of the Predictive Microbiology software MicroHibro, which is able to assess the evolution of potential pathogens and spoilage microorganisms along the food chain, providing estimates for the exposure level and risk associated with a food product. The application is built on an extensive Predictive Microbiology Model Data Base (PMDB) including kinetic processes like growth, inactivation, transfer as well as dose-response models. PMDB can be populated with new models by using an on-line tool in combination with a standardized method for describing Predictive Microbiology models. This enables MicroHibro to be easily updated, increasing its applicability and use. Estimation of microbial risk associated with a food product can be achieved, in MicroHibro, by describing steps in any food chain using four different microbial processes (growth, inactivation, transfer and partitioning). As a result, an estimate of the concentration and prevalence of microorganisms in the food of interest as well as attendant risk are provided. Also, MicroHibro allows comparing different predictive models and validate them by introducing user's data. In this paper, examples are provided to illustrate how predictive models can be incorporated in MicroHibro, and then, used to develop a Quantitative Microbial Risk Assessment model. The use of expert computational systems is a powerful tool for supporting food safety and quality activities by Health Authorities and the food industry. They represent a breakthrough in the assessment and management of food safety based on scientific evidence.

Insulin resistance is a prevalent condition commonly associated with unhealthy lifestyles. It affects several metabolic pathways, increasing risk of abnormalities at different organ levels. Thus, diverse medical specialties should be involved in its diagnosis and treatment. With the purpose of unifying criteria about this condition, a scientific-based consensus was elaborated. A questionnaire including the most important topics such as cardio-metabolic risk, non-alcoholic fatty liver disease and polycystic ovary syndrome, was designed and sent to national experts. When no agreement among them was achieved, the Delphi methodology was applied. The main conclusions reached are that clinical findings are critical for the diagnosis of insulin resistance, not being necessary blood testing. Acquisition of a healthy lifestyle is the most important therapeutic tool. Insulin-sensitizing drugs should be prescribed to individuals at high risk of disease according to clinically validated outcomes. There are specific recommendations for pregnant women, children, adolescents and older people.

Desarrollar e intentar alcanzar una elevada calidad en el servicio prestado por los profesionales de enfermería de los centros geriátricos mediante la implantación de sistemas de gestión de calidad es tema de actualidad, hecho este probado ya en otros trabajos. Es por esta razón que el objetivo general de este estudio se haya centrado en analizar los efectos más relevantes que surten de la instauración de una forma de gestionar la calidad basada en la Norma UNE EN ISO 9001:2008 en el área de enfermería de cuatro residencias de ancianos. Se ha llevado a cabo un análisis de más de 200 encuestas de satisfacción respecto del servicio de enfermería de cuatro residencias de personas mayores, así como una revisión bibliográfica de los resultados obtenidos tras la implantación de un sistema de gestión de calidad en el área de enfermería de residencias geriátricas. Apreciamos resultados muy positivos en el desarrollo diario de las funciones de enfermería de las residencias geriátricas derivados de la utilización de un sistema de gestión de calidad, pues ha mejorado considerablemente la calidad en la práctica clínica. El estudio muestra que la implantación de un sistema de gestión de calidad proporciona una herramienta útil al servicio de enfermería en residencias de personas mayores evidenciándose los efectos positivos que resultan de dicha implantación mediante encuestas de satisfacción e indicadores sanitarios.

Nowadays, microorganisms with probiotic or antimicrobial properties are receiving major attention as alternative resources for food preservation. Lactic acid bacteria are able to synthetize compounds with antimicrobial activity against pathogenic and spoilage flora. Among them, Lactobacillus plantarum ATCC 8014 has exhibited this capacity, and further studies reveal that the microorganism is able to produce bacteriocins. An assessment of the growth of L. plantarum ATCC 8014 at different conditions becomes crucial to predict its development in foods. A response surface model of the growth rate of L. plantarum was built in this study as a function of temperature (4, 7, 10, 13, and 16°C), pH (5.5, 6.0, 6.5, 7.0, and 7.5), and sodium chloride (0, 1.5, 3.0, 4.5, and 6.0%) and sodium lactate (0, 1, 2, 3, and 4%) concentrations. All the factors were statistically significant at a confidence level of 90% (p<0.10). When temperature and pH increased, there was a corresponding increase in the growth rate, while a negative relationship was observed between NaCl and Na-lactate concentrations and the growth parameter. A mathematical validation was carried out with additional conditions, demonstrating an excellent performance of the model. The developed model could be useful for designing foods with L. plantarum ATCC 8014 added as a probiotic.

Introduction Type 1 diabetes (T1D) has a complex etiology in which genetic and environmental factors are involved, whose interactions have not yet been completely clarified. In this context, the role in PD-1 pathway and its ligands 1 and 2 (PD-L1 and PD-L2) have been proposed as candidates in several autoimmune diseases. The aim of this work was to determine the allele and haplotype frequency of six gene polymorphisms of PD-ligands (PD-L1 and PD-L2) in Chilean T1D patients and their effect on serum levels of PD-L1 and autoantibody profile (GAD65 and IA2). Methods This study cohort comprised 205 T1D patients and 205 normal children. We performed genotypic analysis of PD-L1 and PD-L2 genes by TaqMan method. Determination of anti-GAD65 and anti-IA-2 autoantibodies was performed by ELISA. The PD-L1 serum levels were measured. Results The allelic distribution of PD-L1 variants (rs2297137 and rs4143815) showed differences between T1D patients and controls (p = 0.035 and p = 0.022, respectively). No differences were detected among the PD-L2 polymorphisms, and only the rs16923189 showed genetic variation. T1D patients showed decreased serum levels of PD-L1 compared to controls: 1.42 [0.23–7.45] ng/mL versus 3.35 [0.49–5.89] ng/mL (p

Background Pollution and viral infections could be associated with the incidence of type 1 diabetes mellitus. Aim To look for associations between the temporal patterns of Type 1 Diabetes Mellitus (T1D) in infants younger than the age of 15 years, and environmental factors, such as air pollution and viruses. Material and methods Data registries from hospitals, emergency services, and the Infantile Diabetes Foundation were reviewed, corresponding to children aged less than 15 years, who received their first insulin injection between 2000 and 2007. The incidence of type 1 diabetes was computed for each epidemiological week. Environmental ozone and particulate matter rates for each week were obtained from Environmental services. Rates of influenza and respiratory syncytial virus infections were obtained from the epidemiological department of the Ministry of Health. An ecological Bayesian Poisson regression model was fitted, introducing the covariates, lagged covariates and errors, to estimate the incidence by epidemiological week. Results Three factors were significant by the proposed model: particulate matter PPM 2.5 (relative risk (RR): 1.003) lagged by two weeks, influenza (RR: 0.1808) and RSV (RR: 1.021). Trends and seasonality were clearly controlled by these covariates, considering the epidemiological week as a counting period. Conclusions These results show that environmental factors could be related to peaks of type 1 diabetes incidence.

Purpose There is increasing evidence on the relationship between endogenously produced immunoglobulins and the clinical outcome in septic shock (SS). Materials and methods Levels of immunoglobulin G (IgG) subclasses, immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin E were measured in plasma from 42 patients with SS and in 36 patients with systemic inflammatory response syndrome at diagnosis. Association of immunoglobulins levels with disease severity and outcome was evaluated. Results Eighteen patients with SS finally died. Both patients with systemic inflammatory response syndrome and SS showed subnormal levels of total IgG, IgG2, and IgM. Patients with SS who died showed the lowest levels of total IgG and IgG1. Total IgG, IgG1, IgG2, IgG3, IgG4, and IgA correlated inversely with Acute Physiology and Chronic Health Evaluation II score in SS. Univariate Cox regression analysis showed that levels of IgG1, IgG2, IgG3, IgM, IgA, and total IgG were inversely associated to the probability of death at 28 days. Multivariate analysis showed that IgG1, total IgG, IgM, and IgA behaved as independent protective factors against mortality (hazard ratio, P ): 0.23, 0.026; 0.16, 0.028; 0.11, 0.042; 0.05, 0.010, respectively, whereas IgG3 showed a protective trend also. Conclusions Our study evidenced that, in addition to IgG1, other major endogenous immunoglobulins isotypes and subclasses seem to play a beneficial role in SS.

“Hurdle technology” is a worldwide technique of food preservation based on the application of a combination of generally mild treatments which act as “obstacles” that microflora must overcome to start to grow. Then, bacteria invest their energy in trying to maintain their homeostatic equilibrium instead of multiplying. While the action mechanisms underlying these treatments are not fully understood, it is very useful to know their effect on bacteria cells as well as the extension of such effects. Growth/no growth models have been developed to offer a response to this need. A review on growth/no growth microbial modeling is presented in this paper, addressing the most important factors and approaches employed. Five growth/no growth models of Salmonella published in the period 2001–2011 are reviewed, and their boundary regions were represented (Temperature vs pH) at two water activity values (0.983 and 0.990) and two cut-off probabilities (0.1 and 0.5). With this illustration, a picture of the relative grade of conservatism of the five models is provided. Additionally, the most important predictive tools in food microbiology (or tertiary models), including a software for growth/no growth modeling (Microbial Responses Viewer), are commented. Finally, some caveats in growth/no growth Salmonella modeling are addressed for future research.

BACKGROUND: This study was conducted in eight Spanish school canteens during the period 2008 – 2009. Food handlers’ practices, kitchen equipment, hygiene/sanitation conditions and handling practices were evaluated using checklists. In parallel, the microbiological quality and safety of ready-to-eat (RTE) vegetable salads were assessed. In addition, food contact surfaces and environmental air quality of different areas were analysed. The study determined the relationship between the microbiological quality of RTE foods and food handling practices, together with the degree of contamination of working surfaces and environmental contamination of processing and distribution areas. RESULTS: Some deficiencies were found regarding the use and change of gloves, hand-washing and cleanliness of working surfaces. The microbial levels detected in the foods examined indicated the absence of pathogens in the samples analysed. Surface counts were higher on cutting boards and faucets, showing insufficient cleanliness procedures. CONCLUSION: This study constitutes a descriptive analysis of the hygiene/sanitation conditions implemented in food service systems in eight Spanish school canteens. The results should help risk managers to better define control measures to be adopted in order to prevent foodborne infections. c � 2012 Society of Chemical Industry

The presence of Salmonella in foodstuffs represents an internationally accepted human health concern. Although Salmonella causes many foodborne disease outbreaks, there is little evidence to support cross-contamination as a major contributing factor. However, the paramount importance of preventing cross-contamination and recontamination in assuring the safety of foodstuffs is well known. Sources and factors linked to cross-contamination and recontamination of Salmonella in foods are reviewed in detail. Those foods which are not submitted to lethal treatment at the end of processing or which do not receive further treatment in the home deserves special attention. Salmonella cross-contamination and recontamination episodes have been connected to the following factors: poor sanitation practices, poor equipment design, and deficient control of ingredients. We also examine potential cross-contamination in the home. Cross-contamination and recontamination events at factory level evidence the difficulty encountered for eradicating this pathogen from the environment and facilities, highlighting the need to reinforce industry preventive control measures such as appropriate and standardized sanitation. Also, at consumer level, Public Health Authorities should install hygiene education programs in order to raise consumer awareness of the risks of cross-contamination in the home and their role in its prevention. Finally, a review on cross-contamination models of Salmonella spp. is presented.