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Abstract Background In the treatment of phenylketonuria (PKU), there was disparity between UK dietitians regarding interpretation of how different foods should be allocated in a low phenylalanine diet (allowed without measurement, not allowed, or allowed as part of phenylalanine exchanges). This led to variable advice being given to patients. Methodology In 2015, British Inherited Metabolic Disease Group (BIMDG) dietitians (n = 70) were sent a multiple-choice questionnaire on the interpretation of protein from food-labels and the allocation of different foods. Based on majority responses, 16 statements were developed. Over 18-months, using Delphi methodology, these statements were systematically reviewed and refined with a facilitator recording discussion until a clear majority was attained for each statement. In Phase 2 and 3 a further 7 statements were added. Results The statements incorporated controversial dietary topics including: a practical ‘scale’ for guiding calculation of protein from food-labels; a general definition for exchange-free foods; and guidance for specific foods. Responses were divided into paediatric and adult groups. Initially, there was majority consensus (≥86%) by paediatric dietitians (n = 29) for 14 of 16 statements; a further 2 structured discussions were required for 2 statements, with a final majority consensus of 72% (n = 26/36) and 64% (n = 16/25). In adult practice, 75% of dietitians agreed with all initial statements for adult patients and 40% advocated separate maternal-PKU guidelines. In Phase 2, 5 of 6 statements were agreed by ≥76% of respondents with one statement requiring a further round of discussion resulting in 2 agreed statements with a consensus of ≥71% by dietitians in both paediatric and adult practice. In Phase 3 one statement was added to elaborate further on an initial statement, and this received 94% acceptance by respondents. Statements were endorsed by the UK National Society for PKU. Conclusions The BIMDG dietitians group have developed consensus dietetic statements that aim to harmonise dietary advice given to patients with PKU across the UK, but monitoring of statement adherence by health professionals and patients is required.

Background. In the fall of 2014, a North American outbreak of enterovirus D68 resulted in a significant number of pediatric hospital admissions for respiratory illness throughout North America. This study characterized the clinical presentation and risk factors for a severe clinical course in children admitted to British Columbia Children’s Hospital during the 2014 outbreak. Methods. Retrospective chart review of patients with confirmed EV-D68 infection admitted to BCCH with respiratory symptoms in the fall of 2014. Past medical history, clinical presentation, management, and course in hospital was collected and analyzed using descriptive statistics. Comparison was made between those that did and did not require ICU admission to identify risk factors. Results. Thirty-four patients were included (median age 7.5 years). Fifty-three percent of children had a prior history of wheeze, 32% had other preexisting medical comorbidities, and 15% were previously healthy. Ten children (29%) were admitted to the pediatric intensive care unit. The presence of complex medical conditions (excluding wheezing) (P=0.03) and copathogens was associated with PICU admission (P=0.02). Conclusions. EV-D68 infection resulted in severe, prolonged presentations of asthma-like illness in the hospitalized pediatric population. Patients with a prior history of wheeze and preexisting medical comorbidities appear to be most severely affected, but the virus can also cause wheezing in previously well children.

To conduct a pilot study on the potential to optimise care pathways in syncope/Transient Loss of Consciousness management by using Lean Six Sigma methodology while maintaining compliance with ESC and/or NICE guidelines.Five hospitals in four European countries took part. The Lean Six Sigma methodology consisted of 3 phases: 1) Assessment phase, in which baseline performance was mapped in each centre, processes were evaluated and a new operational model was developed with an improvement plan that included best practices and change management; 2) Improvement phase, in which optimisation pathways and standardised best practice tools and forms were developed and implemented. Staff were trained on new processes and change-management support provided; 3) Sustaining phase, which included support, refinement of tools and metrics. The impact of the implementation of new pathways was evaluated on number of tests performed, diagnostic yield, time to diagnosis and compliance with guidelines. One hospital with focus on geriatric populations was analysed separately from the other four.With the new pathways, there was a 59% reduction in the average time to diagnosis (p = 0.048) and a 75% increase in diagnostic yield (p = 0.007). There was a marked reduction in repetitions of diagnostic tests and improved prioritisation of indicated tests.Applying a structured Lean Six Sigma based methodology to pathways for syncope management has the potential to improve time to diagnosis and diagnostic yield.

Traumatic brain injury (TBI) increases Alzheimer's disease (AD) risk and leads to the deposition of neurofibrillary tangles and amyloid deposits similar to those found in AD. Agonists of Liver X receptors (LXRs), which regulate the expression of many genes involved in lipid homeostasis and inflammation, improve cognition and reduce neuropathology in AD mice. One pathway by which LXR agonists exert their beneficial effects is through ATP-binding cassette transporter A1 (ABCA1)-mediated lipid transport onto apolipoprotein E (apoE). To test the therapeutic utility of this pathway for TBI, we subjected male wild-type (WT) and apoE-/- mice to mild repetitive traumatic brain injury (mrTBI) followed by treatment with vehicle or the LXR agonist GW3965 at 15 mg/kg/day. GW3965 treatment restored impaired novel object recognition memory in WT but not apoE-/- mice. GW3965 did not significantly enhance the spontaneous recovery of motor deficits observed in all groups. Total soluble Aβ(40) and Aβ(42) levels were significantly elevated in WT and apoE-/- mice after injury, a response that was suppressed by GW3965 in both genotypes. WT mice showed mild but significant axonal damage at 2 d post-mrTBI, which was suppressed by GW3965. In contrast, apoE-/- mice showed severe axonal damage from 2 to 14 d after mrTBI that was unresponsive to GW3965. Because our mrTBI model does not produce significant inflammation, the beneficial effects of GW3965 we observed are unlikely to be related to reduced inflammation. Rather, our results suggest that both apoE-dependent and apoE-independent pathways contribute to the ability of GW3965 to promote recovery from mrTBI.

IntroductionDysphagia and cognitive impairment are prevalent in older individuals. This study aimed to understand the characteristics of dysphagia through fluoroscopy in older adults with mild cognitive impairment (MCI) and dementia.MethodsA cross-sectional study was conducted at a memory clinic in a tertiary hospital in Mexico City. A total of 158 patients were included, of whom 86 (54.4%) showed a risk of dysphagia, and 84 underwent barium swallow fluoroscopy.ResultsAn association was observed between MCI and alteration in the oral phase (OR 0.33, 95% CI 0.12, 0.92, p = 0.034). Compared to patients with dementia, patients with MCI showed greater alteration in protection against regurgitation (OR 3.19, 95% CI: 1.05 to 9.72, p = 0.042) and in the contraction of the laryngeal muscles (OR 3.54, 95% CI: 1.30 to 9.62, p = 0.013).DiscussionOur findings highlight the altered phases of swallowing in patients with dementia. Additionally, we found a high prevalence of dysphagia in older adults with MCI, underscoring the importance of early detection and intervention.

Antecedentes: El deterioro cognitivo y la disfagia son comunes en personas mayores. Objetivo: Explorar las características de la disfagia mediante fluoroscopia en pacientes con deterioro cognitivo leve (DCL) y demencia. Material y métodos: Se analizaron 158 adultos de una clínica de memoria. Para evaluar el DCL y la demencia, se emplearon criterios específicos; y para la disfagia, la escala EAT-10. Se realizó fluoroscopia con trago de bario para evaluar las fases de la deglución; la presencia de broncoaspiración apoyó el diagnóstico de disfagia. Se realizó análisis de regresión logística para establecer la relación entre disfagia y DCL. Resultados: Según EAT-10, 86 pacientes (54.4 %) tenían riesgo de disfagia, la cual fue confirmada en 84 mediante fluoroscopia (53.8 % tenía DCL y 46.2 %, demencia). En el grupo con DCL se observó asociación inversa con alteraciones en la fase oral (RM = 0.23, p < 0.025) y asociación positiva con alteraciones en la protección contra la regurgitación (RM = 3.76, p < 0.056) y contracción del músculo laríngeo (RM = 3.22, p < 0.045) versus grupo con demencia. Conclusiones: El estudio mostró alta frecuencia de disfagia en pacientes con DCL, lo que resalta la importancia de su detección temprana para mejorar las complicaciones asociadas.

En este trabajo se analizan diversas conductas sobre sexualidad y las expectativas educativas de un grupo de madres adolescentes en Ciudad Juárez, Chihuahua. El objetivo es conocer el contexto en el que ocurre el embarazo adolescente y cómo afecta las expectativas que sobre su formación educativa tienen las adolescentes, así como aquellos factores que limitan o facilitan la continuación de sus estudios cuando ellas así se lo han planteado. Se entrevistó a 67 jóvenes con embarazo adolescente provenientes de diversos puntos de Ciudad Juárez, con el común denominador de provenir de poblaciones de escasos recursos. Este estudio tiene una aproximación cualitativa. La recolección de información se llevó a cabo mediante 7 grupos focales y un cuestionario que proporcionó información sociodemográfica básica sobre las jóvenes y sus familias. Los resultados muestran que gran parte de las jóvenes debutan sexualmente en el contexto de una relación de pareja, la mitad utilizó algún anticonceptivo en su debut sexual; sin embargo, conforme se afianzó la relación dejaron de verlo como necesario. Poco más de la mitad dijo no haber planeado su embarazo. Más de la mitad de las jóvenes ya había dejado la escuela antes del embarazo, una buena parte de éstas no se planteaba continuar sus estudios. Las jóvenes que siguieron estudiando vieron favorecida su permanencia por el apoyo familiar para el cuidado de los hijos: quienes no tuvieron apoyo familiar, o cuya necesidad económica era mayor, tuvieron que posponer sus planes educativos.

The aim of this 2-year study was to evaluate the influence of bed depth (40 and 60 cm) on the development of tropical ornamental species (Alpinia purpurata, Heliconia latispatha and Strelitzia reginae) and on the removal of different contaminants such as chemical oxygen demand (COD), nitrate (N-NO3), ammonium (N-NH4), total nitrogen (TN), total phosphorus (TP), total suspended solids (TSS), total coliforms (TCs) and fecal coliforms (FCs), in horizontal subsurface flow constructed wetlands (HSSF-CWs) for municipal wastewater treatment. The results showed that the depth of 60 cm favored the removal of COD, with removal efficiencies of 94% for the three plant species. The depth of 40 cm was most effective for the removal of N-NH4 (80–90%). Regarding the removal of TN, the removals were similar for the different plants and depths (72–86%). The systems only achieved up to 60% removal of TCs and FCs. The depth of the CWs substrate and its saturation level influenced the development of ornamental vegetation, particularly flower production. For Heliconia latispatha, a bed depth level of 60 cm was more suitable, while for Alpinia purpurata 40 cm was better, and for Strelitzia reginae in both cases there was no flower production. The impact of bed depth on contaminant removal depends on the specific type of contaminant.

Rare diseases (RDs) are serious and often fatal uncommon conditions with a high subjacent genetic origin. Since RD are not prevalent, knowledge regarding these diseases among health care providers and health students is scarce. The management of RD is often inadequate and precarious. Therefore, the aim of the present study is to assess the degree of knowledge, perceptions and attitudes of healthcare practitioners and students in Mexico. Herein we present a reliable questionnaire to assess the degree of knowledge, perceptions, awareness and attitudes of healthcare practitioners and students in Mexico with regard to RDs. The pilot study showed satisfactory levels of knowledge and significant differences in perceptions, awareness and attitudes among the study groups.

The production of both aboveground and belowground plant biomass in constructed wetlands (CW) is a poorly understood topic, although vegetation plays an important role in the process of pollutant removal from wastewater. The objective of this study was to evaluate the aboveground and belowground biomass production of Typha latifolia and Canna hybrids in a large-scale constructed wetland treating swine wastewater in tropical climates. Parameters, such as temperature, DO, pH, COD, TSS, TN, TP, and TC, as well as destructive and non-destructive biomass, were evaluated. It was found that, despite the high concentrations of pollutants, the vegetation adapted easily and also grew healthily despite being exposed to high concentrations of pollutants from swine water. Although Typha latifolia (426 plants) produced fewer plants than Canna hybrids (582 plants), the higher biomass of the Typha latifolia species was slightly higher than that of Canna hybrids by 5%. On the other hand, the proximity of the water inlet to the system decreased the capacity for the development of a greater number of seedlings. As for the elimination of pollutants, after treatment in the constructed wetland, COD: 83.6 ± 16.9%; TSS: 82.2 ± 17.7%; TN: 94.4 ± 15.8%; TP: 82.4 ± 23.2%; and TC: 94.4 ± 4.4% were significantly reduced. These results show that wetlands constructed as tertiary systems for the treatment of swine wastewater produce a large amount of plant biomass that significantly helps to reduce the concentrations of pollutants present in this type of water in tropical areas. The use of these plants is recommended in future wetland designs to treat swine wastewater.

Este artículo analiza las asociaciones del abuso de alcohol con la afiliación religiosa, la asistencia a la iglesia y el valor por la religión ent re los adolescentes mexicanos, y examina las interacciones entre estas variables independientes, siendo esta su principal contribución. A partir de la Encuesta Nacional de la Juventud 2010, se emplearon estadísticas descriptivas y modelos multivariados de regresión logística. Los evangélicos exhibieron momios más bajos de abusar del alcohol que los católicos, así como aquellos con un mayor valor por la iglesia y que asistían a esta, acompañados de padres o amigos. Entre los católicos, sólo asistir a la igl esia con los padres se asoció a menores momios de abuso del alcohol, respecto a no ir a la iglesia, lo mismo que los evangélicos, para quienes también asistir con otras personas redujo estos momios. No obstante, asistir a la iglesia con los padres sin tene r valor por la religión no protegió a los adolescentes del abuso del alcohol. Tampoco asistir a la iglesia solo (sin compañía) se asoció a esta protección, aun cuando los adolescentes tuvieran un valor alto por la religión. Se concluye que ambos, tanto ser parte de una red social que asiste a la iglesia, como tener valor por esta, condicionan la asociación del abuso del alcohol con la afiliación religiosa y son factores protectores fundamentales contra el abuso del alcohol entre los adolescentes mexicanos.

This paper examines the association between preschool enrolment of 3-5 year olds and maternal marital status in Mexico and determines how this association varies by maternal education and socioeconomic status. Based on microdata from the 2010 Mexican census, we used descriptive statistics and random-effect logistic models for this analysis. Children of single, separated or cohabiting mothers have lower preschool enrolment rates than children of married mothers. However, for children of highly-educated mothers, these disadvantages are slightly reduced, and reversed for children of divorced mothers, except for children of cohabiting mothers, whose lower preschool enrolment persist across social groups.

This article’s intension is to investigate the literary representation of the ‘’poor childhood” in the contemporary Brazilian literature, as well as its alignment be- tween ethics and aesthetics for a literary construction of a model of childhood. Its purpose is also deepens the related questions, concerned to the subject, in order to show the differences and similarities amongst the various forms of narratives and the comprehension of such representation.The material for analysis are the short stories of Antonio Carlos Viana, Marcelino Freire and Rubens Figueiredo, whose texts reflect the situation of precariousness that we will find a significant part of the contemporary childhood

Este artículo analiza las asociaciones del abuso de alcohol con la afiliación religiosa, la asistencia a la iglesia y el valor por la religión entre los adolescentes mexicanos, y examina las interacciones entre estas variables independientes, siendo esta su principal contribución. A partir de la Encuesta Nacional de la Juventud 2010, se emplearon estadísticas descriptivas y modelos multivariados de regresión logística. Los evangélicos exhibieron momios más bajos de abusar del alcohol que los católicos, así como aquellos con un mayor valor por la iglesia y que asistían a esta, acompañados de padres o amigos. Entre los católicos, sólo asistir a la iglesia con los padres se asoció a menores momios de abuso del alcohol, respecto a no ir a la iglesia, lo mismo que los evangélicos, para quienes también asistir con otras personas redujo estos momios. No obstante, asistir a la iglesia con los padres sin tener valor por la religión no protegió a los adolescentes del abuso del alcohol. Tampoco asistir a la iglesia solo (sin compañía) se asoció a esta protección, aun cuando los adolescentes tuvieran un valor alto por la religión. Se concluye que ambos, tanto ser parte de una red social que asiste a la iglesia, como tener valor por esta, condicionan la asociación del abuso del alcohol con la afiliación religiosa y son factores protectores fundamentales contra el abuso del alcohol entre los adolescentes mexicanos.

Se realiza un estudio descriptivo de intervención y corte transversal en el universo de los asmáticos mayores de 20 años atendidos en el consultorio médico de la familia No. 18, perteneciente al área de salud del Policlínico Docente «Héroes de Girón», con el objetivo de evaluar los posibles beneficios de la aplicación de un programa para el automanejo del paciente asmático adulto en la comunidad. Con la aplicación del programa se obtuvo un incremento significativo del conocimiento de la enfermedad en la totalidad de los pacientes participantes. La evolución clínica del 100 % de los pacientes que siguieron todo el programa mejoró o no empeoró, a diferencia de aquéllos que no lo siguieron. El grupo que cumplió el programa íntegramente logró una disminución significativa del nivel de ansiedad, lo que se interpreta como consecuencia de su mejor preparación para comprender y manejar la enfermedadA descriptive crosswise study of over 20 years-old asthmatic persons cared for No. 18 family physician consulting room in «Héroes de Girón» Teaching Polyclinics health area was undertaken with the objective of assessing the possible benefits of the community-wide implementation of an asthmatic adult patient self-management program. This program resulted in a significantly increased knowledge of the disease by all the participating patients. The clinical condition of all the patients following the program either improved or did not worsen unlike that of those who did not participate. The group which complied with the whole program showed a meaningful reduction in anxiety level which was considered to be the outcoume of a better understanding and management of asthma

El objetivo de este trabajo es analizar la asociación entre la afiliación religiosa y dos aspectos de la vida sexual de los jóvenes solteros en México: la iniciación y el uso de condón en la primera relación. Basándonos en la Encuesta Nacional de la Juventud 2005, describimos las diferencias en estos dos aspectos según la afiliación religiosa mediante la tabla de vida y estadística descriptiva respectivamente. Enseguida, empleamos el modelo de regresión de Cox para examinar la asociación entre religión y debut sexual, y el modelo de regresión logística para analizar la relación entre religión y uso de condón en dicho debut. Respecto de los católicos nominales y los jóvenes sin afiliación religiosa, los católicos practicantes y los protestantes evangélicos mostraron menores riesgos de iniciar su vida sexual y los evangélicos menores posibilidades de hacer uso de condón en el debut sexual.