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Introduction: In recent years, there has been a change in the conceptualization of foetal growth restriction (FGR), which has gone from being defined solely based on weight criteria to being defined and staged based on Doppler criteria. The aim of our study was to evaluate neonatal risk in a cohort of neonates with moderate to severe early-onset FGR defined by Doppler criteria. Population and methods: We conducted a multicentre prospective cohort study in a cohort of neonates with early-onset foetal growth restriction and abnormal Doppler findings and a control cohort without Doppler abnormalities matched for sex and gestational age. Results: A total of 105 patients (50 cases, 55 controls) were included. We found a higher frequency of respiratory morbidity in the FGR group, with an increased need of surfactant (30% vs. 27.3%; OR, 5.3 [95% CI, 1.1−26.7]), an increased need for supplemental oxygen (66% vs. 49.1%; OR, 5.6 [95% CI, 1.5−20.5]), and a decreased survival without bronchopulmonary dysplasia (70 vs. 87.3%; OR, 0.16 [95% CI, 0.03−0.99]). Patients with FGR required a longer length of stay and more days of parenteral nutrition and had a higher incidence of haematological abnormalities such as neutropenia and thrombopenia. The lactate level at birth was higher in the severe FGR subgroup (6.12 vs. 2.4 mg/dL; P = .02). Conclusion: The diagnosis of early-onset moderate to severe FGR defined by Doppler criteria carries a greater risk of respiratory, nutritional and haematological morbidity, independently of weight and gestational age. These patients, therefore, should be considered at increased risk compared to constitutionally small for gestational age preterm infants or preterm infants without FGR. Resumen: Introducción: En los últimos años se ha producido un cambio en el concepto del crecimiento intrauterino retardado (CIR), pasando de estar definido únicamente por criterios de peso a estar definido y estadiado por criterios doppler. Este estudio pretende evaluar el riesgo neonatal de una cohorte de neonatos con CIR precoz moderado-grave definidos por criterios doppler. Población y métodos: Se realizó un estudio multicéntrico de cohortes prospectivo en el que se incluyó una cohorte de neonatos con restricción de crecimiento intrauterino precoz con doppler alterado y una cohorte de control sin alteraciones doppler, pareada por sexo y edad gestacional. Resultados: Se incluyeron un total de 105 pacientes (50 casos, 55 controles). Se encontró mayor morbilidad respiratoria en el grupo CIR, con mayor necesidad de surfactante (30% versus 27,3%, OR IC95% 5,3 [1,1–26,7]), mayor necesidad de oxígeno suplementario (66% versus 49,1% OR IC95% 5,6 [1,5–20.5]), y menor supervivencia sin displasia broncopulmonar (70 vs. 87,3% OR IC95% 0,16 [IC 0,03−0.99]). Los pacientes CIR requirieron un ingreso más prolongado y más días de nutrición parenteral, así como una mayor incidencia de alteraciones hematológicas como neutropenia y trombopenia. El valor de lactato al nacimiento fue mayor en el subgrupo CIR grave (6,12 vs. 2,4 mg/dl, p = 0,02). Conclusiones: El diagnóstico de CIR precoz moderado-grave definido por criterios doppler conlleva un mayor riesgo de morbilidad respiratoria, nutricional y hematológica, independiente del peso y la edad gestacional. Estos pacientes, por tanto, deben ser considerados de mayor riesgo que pretérminos constitucionalmente de bajo peso o pretérminos no CIR.

Abstract Background The management of respiratory distress syndrome (RDS) in premature newborns is based on different types of non-invasive respiratory support and on surfactant replacement therapy (SRT) to avoid mechanical ventilation as it may eventually result in lung damage. European guidelines currently recommend SRT only when the fraction of inspired oxygen (FiO2) exceeds 0.30. The literature describes that early SRT decreases the risk of bronchopulmonary dysplasia (BPD) and mortality. Lung ultrasound score (LUS) in preterm infants affected by RDS has proven to be able to predict the need for SRT and different single-center studies have shown that LUS may increase the proportion of infants that received early SRT. Therefore, the aim of this study is to determine if the use of LUS as a decision tool for SRT in preterm infants affected by RDS allows for the reduction of the incidence of BPD or death in the study group. Methods/design In this study, 668 spontaneously-breathing preterm infants, born at 25+0 to 29+6 weeks’ gestation, in nasal continuous positive airway pressure (nCPAP) will be randomized to receive SRT only when the FiO2 cut-off exceeds 0.3 (control group) or if the LUS score is higher than 8 or the FiO2 requirements exceed 0.3 (study group) (334 infants per arm). The primary outcome will be the difference in proportion of infants with BPD or death in the study group managed compared to the control group. Discussion Based on previous published studies, it seems that LUS may decrease the time to administer surfactant therapy. It is known that early surfactant administration decreases BPD and mortality. Therefore, there is rationale for hypothesizing a reduction in BPD or death in the group of patients in which the decision to administer exogenous surfactant is based on lung ultrasound scores. Trial registration ClinicalTrials.gov identifier NCT05198375 . Registered on 20 January 2022.

La promulgación en 2014 de la Ley 30220 incorporó la sostenibilidad y la responsabilidad social universitaria (RSU) dentro de la gestión universitaria y desde entonces se ha impulsado la autoevaluación de estos aspectos hasta consolidar en 2020 el reporte oficial de 38 instituciones agrupadas en la Red Ambiental Interuniversitaria (RAI). En el artículo se analizaron los indicadores de desempeño de estos componentes según el modelo RAI. La evaluación contempló un peso por dimensión: gobierno (15%), gestión ambiental (35%), formación (20%), investigación (10%) y proyección social (20%). El puntaje promedio fue de 4278.6 ± 1348.4, menor al percentil 50, que indica que aún se está lejos del ideal de sostenibilidad. Emergieron asimetrías geográficas en el sector (U-Test/Kruskall-Wallis: p-valor ≤ 0.05), que evidencian que las universidades privadas y las de Lima Metropolitana exhibieron mejores puntajes y mayor agilidad estratégica para incorporar la sostenibilidad y la RSU en el sistema de gestión. SUSTAINABILITY AND SOCIAL RESPONSABILITY IN PERUVIAN UNIVERSITIES Abstract The enactment in 2014 of Law 30220 incorporated sustainability and University Social Responsibility into university management and since then, self-evaluation of these aspects has been promoted until the official report of 38 institutions grouped in the Inter-University Environmental Network - RAI - was consolidated in 2020. The article analyzed the performance indicators of these components according to the RAI model. The evaluation considered a weighting by dimension: Governance (15%), Environmental Management (35%), Education (20%), Research (10%) and Social Projection (20%). The average score was 4278.6 ± 1348.4, below the 50th percentile, which indicates that it is still far from the ideal of sustainability. Geographical asymmetries emerged in the sector (U-Test/Kruskall-Wallis: p-value ≤ 0.05), showing that private universities and those in Metropolitan Lima had better scores and greater strategic agility to incorporate sustainability and USR in the management system. Keywords: sustainability dimensions; university management; sustainability indicators; university social responsibility; university sustainability.

Juvenile Idiopathic Arthritis (JIA) is currently the most common chronic rheumatic disease in children. It is known to have no single identity, but a variety of diagnoses. Under-diagnosis is a barrier to early treatment and reduced complications of the disease. Other immune-mediated diseases may coexist in the same patient, making research in this area relevant. The main objective was to analyse whether links could be established between the molecular basis of JIA and other immune-mediated diseases. Early diagnosis may benefit patients with JIA, which in most cases goes undetected, leading to under-diagnosis, which can have a negative impact on children affected by the disease as they grow up. Methods: We performed a PRISMA systematic review focusing on immune molecules present in different autoimmune diseases. Results: A total of 13 papers from different countries dealing with the molecular basis of JIA and other immune diseases were evaluated and reviewed. Conclusions: Most of the autoimmune diseases analysed responded to the same group of drugs. Unfortunately, the reason for the under-diagnosis of these diseases remains unknown, as no evidence has been found to correlate the immunomolecular basis with the under-diagnosis of these immune-mediated diseases. The lack of information in this area means that further research is needed in order to provide a sound basis for preventing the development of immune-mediated diseases, especially in children, and to improve their quality of life through early diagnosis and treatment.

A legislação brasileira requer um Relatório de Impacto Ambiental para licenciar projetos que possuem potencial poluidor ou degradante do meio ambiente. Este trabalho usou a análise multicritério de decisão para elaborar um método para avaliação qualitativa desses relatórios baseado na integração do critério social com os critérios legal e técnico. Testou-se a metodologia em sete Relatórios de Impacto Ambiental elaborados em Santa Catarina e os resultados mostraram que nenhum desses relatórios atendeu de forma adequada o critério social. Concluiu-se que o processo formal para licenciamento ambiental tende a favorecer os requerimentos legais e técnicos, enquanto que negligencia a participação da sociedade nas etapas de implantação de empreendimentos potencialmente poluidores.

This action research aimed to study the use the Gamification-Incentive-Feedback (GIF) Model in enhancing the classroom learning experience of Grade 9 students in a private school in Cagayan de Oro, Philippines. The research used convenience sampling and used a combination of Likert scale pre-intervention and post-intervention survey questionnaires as well as focus group discussion (FGD) to gather data and responses. The results were analyzed through the Wilcoxon Signed Rank Test and interview responses from the FGD through thematic analysis. Results reveal a significant difference in students' classroom learning experience in terms of motivation. Further, the participants' responses to the FGD revealed that the GIF Model encourages participation and teamwork; that it promotes competition; that it is motivating, fun, exciting, and interesting; that it encourages learning retention; and that the GIF Model should be implemented face to face; among others. It is concluded that the use of GIF Model is a promising approach for the students in the classroom to create an engaging, motivating, and rewarding experience. Educators are encouraged to adapt the GIF Model in their teaching practice but should make sure that it is properly and fairly organized to avoid student frustration.

Thyroid dysfunction stands as the most prevalent endocrine disorder in individuals with Down syndrome, particularly showcasing both clinical and subclinical hypothyroidism. TSH and FT4 blood values serve as common diagnostic and treatment adjustment markers. In Down syndrome (DS), hormone values may deviate from those observed in the general population, which may lead to overdiagnosis and consequent iatrogenesis of subclinical hypothyroidism. The objective of this study was to analyze the appropriateness of the replacement therapeutic approach by identifying the TSH and FT4 values that can be considered normal in these patients. Methods: A cross-sectional study was conducted in 503 subjects with DS of both sexes and without age limit drawn from the Health Program for individuals with DS in Valencia (Spain) from February 1993 to November 2021. The exclusion criteria included hyperthyroidism, nodules, tumors, or individuals under treatment with drugs influencing iodine metabolism. The normality of data distribution was assessed using the Shapiro–Wilk test. Outliers were detected using the Reed’s criterion. Hormone values were estimated using quantile regression models for the 2.5th and 97.5th percentiles. Results: The normal values identified were 0.88–11.25 mIU/L for TSH and 0.71–1.63 ng/dL for FT4. The Wald test indicated no significant differences in the reference intervals based on age or sex. Conclusion: The establishment of these values, which, in people with DS, can be considered unique, is of great importance, allowing a watchful waiting attitude to be maintained before starting replacement therapy that is unnecessarily or adjusting medication in diagnosed cases.

The situation of social exclusion in which older adults live in extreme poverty is a problem that leads to psychological alterations such as depression or cognitive deterioration. Our objective was to analyze the living conditions and the psychosocial sphere of older adult people living in extreme poverty in Requena del Tapiche in Peru. This was an observational, descriptive, cross-sectional study. Sixty participants between 60 and 100 years of age of both sexes were included who gave their informed consent. Sociodemographic variables were analyzed, and the Gijón, family Apgar, Yesavage, and Pfeiffer scales were used. The sample was composed of 55% women and 45% men, with a mean age of 79.2 years (SD 6.67). More than half live alone or with their spouse. Fifty-seven percent sleep on the floor or on wood, and about 82% do not have safe water. Family dysfunction is found in 40%, and 98% are at social risk or with an established social problem and a precarious economic situation. More than 60% suffer from depressive symptoms, which are more frequent in women. We conclude that older adults perceive deficient family support, observing a deteriorated social situation. Most of them are at risk of social exclusion and loneliness, making them more vulnerable. They show sadness, with a high rate of depression. People with more cognitive impairment live alone, and those in social exclusion suffer a higher degree of depression. More cooperative projects and health promotion interventions developed in the peripheral neighborhoods of Requena del Tapiche are needed to improve the impact on the health of older adult people in extreme poverty.

The assessment of the nutritional and inflammatory status of paediatric patients with coeliac disease is an interesting approach to early diagnosis and functional follow-up. Most authors agree that the normalisation of symptoms takes about one year. The aim of the study was to evaluate the clinical manifestation and normalisation of routine analytics in Spanish children diagnosed with celiac disease. Methods: We performed a retrospective case–control study in Spanish paediatric patients, including 21 celiac patients and 20 healthy controls. The 21 patients selected in the case–control study were followed for 5 years after starting a gluten-free diet (GFD). All patients had type 3 villous atrophy according to the Marsh–Oberhuber classification. A total of 39 blood samples were taken before the start of the GFD, and 109 were taken after. Twenty control sera from healthy donors were used for comparison. Results: We found that patients had a subclinical but statistically significant increase in blood calcium, transaminases, and white blood cells, and a decrease in serum iron, at the time of diagnosis. Our study also shows that analytical values normalise within five years on a gluten-free diet. Conclusions: The use of a combination of subclinical changes, including low iron, high calcium, elevated leukocytes, lymphocytes, and ALT levels in blood samples, together with a low growth percentile, is pertinent in detecting coeliac disease. This set of parameters could help in the diagnosis of patients without clinical symptoms. We can also show that the levels of Fe, Ca, transaminases, and leucocytes remain subclinically altered after 3 years, despite the gluten-free diet.

Frailty is a biological syndrome that leads to a loss of physiological reserve, increasing susceptibility to adverse health events. In the Peruvian Amazon, the elderly live with hardly any economic resources, presenting a caloric deficit that is related to functional and cognitive deterioration. Our objective was to identify the health needs of elderly people living in extreme poverty in Requena (Peru) by means of a geriatric assessment of the nutritional and functional spheres to design, in the future, a cooperation project appropriate to the needs detected. This is an observational, descriptive, and cross-sectional study. Sixty participants were included, and sociodemographic and functional status variables were analyzed using the MNA and Barthel scales and the Get Up and Go test. The mean age of the participants was 79 ± 6.67 (women 55% and men 45%), where 60% had frailty. A statistically significant relationship was found between the MNA scores and Barthel test. Eighty-five percent were malnourished or at risk and thirteen percent had total or moderate dependence. We conclude that the nutritional status of the elderly was deficient. The high degree of living alone in which they live forces them to maintain their independence and their walking stability is normal. The situation of frailty exceeds the national average, a situation that has repercussions for their quality of life. We found a statistically significant association between nutritional status, dependence, and frailty. The better-nourished elderly are less frail and less dependent.

BackgroundBreakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in coronavirus disease 2019 (COVID-19) vaccinees typically produces milder disease than infection in unvaccinated individuals.MethodsTo explore disease attenuation, we examined COVID-19 symptom burden and immuno-virologic responses to symptomatic SARS-CoV-2 infection in participants (AZD1222: n=177/17,617; placebo: n=203/8,528) from a 2:1 randomized, placebo-controlled, phase 3 study of two-dose primary series AZD1222 (ChAdOx1 nCoV-19) vaccination (NCT04516746).ResultsWe observed that AZD1222 vaccinees had an overall lower incidence and shorter duration of COVID-19 symptoms compared with placebo recipients, as well as lower SARS-CoV-2 viral loads and a shorter median duration of viral shedding in saliva. Vaccinees demonstrated a robust antibody recall response versus placebo recipients with low-to-moderate inverse correlations with virologic endpoints. Vaccinees also demonstrated an enriched polyfunctional spike-specific Th-1-biased CD4+ and CD8+ T-cell response that was associated with strong inverse correlations with virologic endpoints.ConclusionRobust immune responses following AZD1222 vaccination attenuate COVID-19 disease severity and restrict SARS-CoV-2 transmission potential by reducing viral loads and the duration of viral shedding in saliva. Collectively, these analyses underscore the essential role of vaccination in mitigating the COVID-19 pandemic.

A inclusão de jovens e adultos com deficiência no sistema de educação pública do Brasil e a garantia de acesso a uma educação de qualidade e oportunidades para desenvolver suas habilidades é um desafio permanente. O objetivo deste estudo é compreender o processo de inclusão de jovens e adultos com deficiência na escola regular noturna do Ceará, a partir da análise de documentos que tratam da temática. A investigação constitue a primeira etapa ao macroprojeto de pesquisa intitulado Inclusão escolar de jovens e adultos com deficiência: experiências e possibilidades de participação plena na escola pública brasileira. O método de investigação baseia-se na pesquisa documental de fontes primárias, numa abordagem qualitativa, com foco nas políticas públicas que regem o processo de inclusão desses jovens. Os resultados evidenciam que a inclusão educacional envolve muito mais que a garantia de os alunos com deficiência estarem nas salas de aula regulares, pois a inclusão de jovens e adultos com deficiência implica uma ação conjunta que possibilite a construção de novos patamares educacionais. Indicam, também, que as políticas de inclusão do Estado vêm seguindo as diretrizes propostas na política nacional, em que a educação destas pessoas é um importante veículo de consolidação.

Esta pesquisa teve como objetivo principal investigar evidências de validade discriminante para o Desenho da Família Cinética. Pretendeu também analisar a influência de variáveis sociodemográficas, bem como a frequência e capacidade de discriminação de cada item de análise dessa técnica projetiva. Participaram 112 crianças de 9 a 12 anos pertencentes a dois grupos critério, sendo 80 da amostra normativa e 32 da amostra clínica (com problemas de aprendizagem). Os instrumentos utilizados foram o Desenho da Família Cinética, sua folha de correção e as Matrizes Progressivas e Coloridas de Raven. Os dados foram analisados por meio de estatísticas descritivas e inferenciais com o auxílio do software SPSS. Os principais resultados mostraram que a variável sociodemográfica Idade gerou efeito nos resultados obtidos; houve diferença estatisticamente significativa entre os grupos-critério, corroborando para as evidências de validade discriminante; e apenas 38,46% dos itens de análise obtiveram diferença estatisticamente significativa entre os grupos critério.

Eating together as a family has important health benefits, as the diet is more balanced and of a higher quality. Eating together is also a factor in the prevention of diet-related diseases. The promotion of family and shared meals is currently a public health strategy. The aim of this research was to study the eating habits of the Spanish young adult population and their impact on health. An observational, descriptive, cross-sectional study was carried out using surveys. A questionnaire was designed and validated to explore a set of variables related to food and health. The dissemination was carried out through social networks by means of an online form, using non-probabilistic snowball sampling to obtain a sample of 17,969 subjects aged between 18 and 45 years. We found statistically significant differences between people living in a family home compared to people living outside a family home in the healthy eating index for the Spanish population, fish consumption, and fried food consumption. This suggests that the nutrition of people living in a family home is healthier, although their BMI is higher. People living together have a statistically higher healthy eating index value than people living alone; consume fast food, fried food, and ultra-processed food less frequently; and eat fish more often. On the other hand, people who live in a family home or are accompanied are more likely to have a sedentary lifestyle and are less physically active. It was concluded that people living alone have a worse healthy eating index than those living with company, which seems to indicate that nutritional interventions should pay attention to people living alone as a variable to be taken into account in future analyses.

Silver diamine fluoride (SDF) has demonstrated its clinical success for years in the arrest of caries lesions; however, the influence it could have on the success of restorations after its application still remains unknown. The purpose of this research was to study the relationship between the use of SDF and the adhesive strength of the materials used in restorations made with glass ionomers and composite resin, as well as with different adhesive systems. A sample consisting of 240 teeth divided into eight groups with 30 teeth in each of them (n = 30) was used. In these groups, the use of restoration with composite resin and glass ionomer was compared using different adhesive systems, with and without prior application of SDF. Notable differences in adherence were observed among the different groups depending on the filling material. There is also a significant effect of tooth type on adhesion. We can conclude that there is a relationship between the use of SDF and the adhesion between the tooth and the restorative materials analyzed.

Abstract Background Although there are numerous publications about surgical treatment of proximal humeral fractures (PHFs), few assess conservative treatment, which is the most common approach. The aim of this systematic literature review was to assess criteria for indications, treatment protocols, and outcomes obtained with the conservative treatment of 3-part and 4-part PHF. Methods We searched the PubMed and Cochrane databases for clinical studies published between 2000 and 2019 on conservative treatment for 3-part and 4-part PHF that included patients older than 18 years, a minimum follow-up of 1 year, fracture classification, and description of outcomes with assessment scales. Results The search yielded 26,660 records. We reviewed 44 of them in full, and finally 6 studies were included. We obtained a population of 133 patients (79% women), with a mean age of 74.3 years (range 25 to 98) and mean follow-up of 32 months (range 12 to 68.8). According to the Neer classification system, there were 41% (55) three-part fractures and 59% (78) four-part fractures; 5.81% of the patients were lost to follow-up. The mean Constant score was 64.5 for three-part fractures and 54.9 patients with four-part fractures. Consolidation was achieved in 95% of the three-part fractures and 91% of the four-part fractures. Loss of mobility varied according to the type of fracture. Regarding complications, the most frequent was malunion (21%), followed by avascular necrosis (9%). Conclusions Our data show that most three-part PHFs treated conservatively achieve fracture consolidation even noting a negligible rate of malunion got fair–good functional results with few complications, while the orthopedic four-part PHF treatment presents high rate of consolidation with less rate of malunion than the three-part PHF but achieve poor functional results with few complications. Level of evidence Level IV, Systematic Review

Esta pesquisa teve como objetivo realizar estudos de fidedignidade para o Desenho da Família Cinética, sendo estes relativos aos parâmetros de fidedignidade entre avaliadores, intra-avaliador e estabilidade temporal/teste-reteste. Os instrumentos utilizados foram o Desenho da Família Cinética e o Teste das Matrizes Progressivas Coloridas de Raven. Participaram desses estudos dois juízes e 66 crianças, sendo 16 com problemas de aprendizagem. Para a análise de dados, utilizou-se o coeficiente kappa de Cohen, a correlação ρ de Spearman e a diferença estatística entre as médias dos pontos por meio do Teste Wilcoxon. Os resultados mostraram índices substanciais a perfeitos de concordância nos estudos de fidedignidade entre avaliadores e intra-avaliador para todos os itens de análise do Desenho da Família Cinética e, no teste-reteste, não houve diferenças estatisticamente significativas entre as médias das pontuações entre as duas aplicações. Conclui-se pela robustez psicométrica do Desenho da Família Cinética, em termos de indicadores de fidedignidade.

The aim of the present study was to test the hypothesis that ribs shape changes in patients with OI are more relevant for respiratory function than thoracic spine shape. We used 3D geometric morphometrics to quantify rib cage morphology in OI patients and controls, and to investigate its relationship with forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), expressed as absolute value and as percentage of predicted value (% pred). Regression analyses on the full sample showed a significant relation between rib shape and FEV1, FVC and FVC % pred whereas thoracic spine shape was not related to any parameter. Subsequent regression analyses on OI patients confirmed significant relations between dynamic lung volumes and rib shape changes. Lower FVC and FEV1 values are identified in OI patients that present more horizontally aligned ribs, a greater antero-posterior depth due to extreme transverse curve at rib angles and a strong spine invagination, greater asymmetry, and a vertically short, thoraco-lumbar spine, which is relatively straight in at levels 1–8 and shows a marked kyphosis in the thoraco-lumbar transition. Our research seems to support that ribs shape is more relevant for ventilator mechanics in OI patients than the spine shape. Keywords: Geometric morphometrics, Osteogenesis imperfecta, Pulmonary function, Rib cage, Scoliosis, Thoracic spine

Malnutrition is one of the main public health problems affecting early childhood development, compromising the health and quality of life of thousands of Peruvian children. The main contribution of this work is the analysis of the nutritional status of the infant population of the Chirikyacu Indigenous Community of Peru in order to evaluate current and future food policies. It is a cross-sectional study with a sample of 19 children between 6 months and 6 years of age. Sociodemographic, anthropometric, clinical variables and dietary habits were analyzed from 7 January to 4 February 2018. The mean age of the children was 29.74 months (SD = 23.91). We found statistically significant differences between the BMI values of boys and girls (p < 0.05; Mann–Whitney test). According to the z-scores, 35.29% suffer from malnutrition, although in no case is it severe. Hair, nails and skin were in good condition in general, except for some cases showing signs of nutritional deficiency. Dietary patterns are based on legumes, vegetables, dairy products, ice cream, cookies and sweets, and are considered insufficient to cover basic needs; water intake was also insufficient. Breastfeeding lasted an average of 14 months (SD = 2.9). We found a prevalence of malnutrition higher than that established by the WHO in Latin America among the children of Chirikyacu. The dietary pattern is insufficient to cover basic needs, so it is necessary to continue with nutritional educational interventions to improve it.

The spread of the COVID-19 virus was a worldwide phenomenon, which was unprecedented in modern times. The restriction measures can be perceived as a heavy burden for mental health during this period, particularly for some groups. The aim of this study is to examine a positive mental health model across ages, where a moderated mediation model is proposed involving sex differences and confidence in coping with COVID-19. Two independent samples were studied during the second and sixth waves in Spain: n = 2861 and n = 2462, respectively. The main conclusions can be described as follows: (i) while age was not related to mental health during the second wave, a positive relationship was found between it and the sixth one; (ii) age was positively related to the confidence in coping with COVID-19 during both of the waves; (iii) women showed worse scores for the variables in the study than the men did during the second wave, but this pattern was reversed in the sixth one; (iv) after a moderated mediation model on the relationship between age and positive mental health in terms of confidence in coping with COVID-19 and sex, an interaction was found for the second wave but not for the sixth one. These results suggest that older adults and women would develop more strategies and resources for a positive mental health across time.

Children who show better eating practices are less likely to suffer from severe caries than those who eat a diet rich in sugars. In the present study, we aimed to establish the relationship between the severity of dental caries and adherence to the Mediterranean diet. A cross-sectional study was carried out in which 263 children aged 2 to 14 years old were examined intraorally to analyze the presence and severity of caries. Children’s parents/caregivers completed the KIDMED questionnaire to determine their degree of adherence to the Mediterranean diet. The results showed that the prevalence of caries is greater than 80% in children with medium or low adherence to the Mediterranean diet, and remains significant at 67% in the high adherence group (p = 0.010). A statistically significant negative correlation of weak magnitude (r = −0.29; p < 0.001) was found between adherence and the number of carious teeth. Caries severity in the first molars is also influenced by adherence to the diet in a statistically significant way. In conclusion, there is an association between adherence to the Mediterranean diet and the prevalence, extension, and severity of caries in the pediatric population.

Background: The use of different growth tables to assess the population's nutritional status has given rise to a series of limitations arising from the lack of consensus and uniform methodological criteria. This leads to a disparity of results that prevent an accurate and reliable diagnosis of whether a child is overweight or obese.Objective: The purpose of this study was to develop growth references for weight, height, and body mass index for Eastern-Spanish children from 6 to 16 years of age.Methods: The final sample used to fit the growth curves was made up of 1,102 observations. The 2007 WHO curves are currently used for Child Health Service Cards. Therefore, to make the comparison of the internal values obtained as realistic as possible, the same construction method has been used for the internal curves, modeling age as a continuous variable and simultaneously adjusting the curves, smoothing them using cubic splines and further smoothing the edge effects by means of data extending above or below the upper and lower age limits.Results: Growth curves for percentiles were constructed for both sexes and higher values were noticeably found to set as growth-standard compared to WHO-standards.Conclusion: Our analysis shows that the WHO 2007 standard references are not suitable for Eastern-Spanish children. The standards shown in this study are much more realistic and current, and we believe that their use will help healthcare professionals more effectively combat the current epidemic of overweight and obesity.

Bebras tasks are considered to develop Computational Thinking (CT) and are currently used for this purpose in many studies. However, the relationship between Bebras tasks and CT is recent and, given the scarcity of validated instruments for assessing CT that are not associated with a specific learning environment, the expected development of CT through Bebras tasks has not been sufficiently evaluated, especially in Primary School. For this reason, we designed the ABC-Thinking program for the development of CT in which a set of Bebras tasks were selected and categorised according to the CT skills they were related to, specific lesson plans were designed to integrate these tasks in a 12-week curriculum, and teachers were trained to apply the program. Using the competent Computational Thinking test (cCTt) in a pre-post-test experimental design, we looked to determine whether Primary School students developed specific CT skills after the program, and, therefore, whether Bebras could be considered suitable for the development of this competence. The results show a significant development in specific CT skills, interesting findings in the gender differences in this development, and between high and low performers. Finally, qualitative data indicate the suitability of the ABC-Thinking program with respect to teachers' practice.

Objectives: To analyze the usefulness of plasma ACTH in predicting CD remission after surgery and to evaluate the prognostic usefulness of ACTH measurement after the cortisol and ACTH nadir (48 h prior to discharge). Design: A prospective study was made of 65 patients with CD operated upon between 2005 and 2016. Methods: Postsurgery plasma ACTH and cortisol were measured every 6 h, in the absence of corticosteroid coverage. Hydrocortisone was started in the presence of adrenal insufficiency or cortisol 3.2 pmol/L of recurrence (AUC 0.810; P < 0.001) in both ACTH values. A time to ACTH nadir 39 h was indicative of recurrence (AUC 0.773; P = 0.001). Conclusions: We propose an ACTH value

Este estudo integra uma investigação mais ampla, cujo propósito foi analisar o impacto da Perturbação de Hiperatividade/Défice de Atenção (PHDA) em contexto escolar, a nível académico, comportamental e social. A Vanderbilt Adhd Diagnostic Teacher Rating Scale (VADTRS) – Escala Vanderbilt de Diagnóstico de PHDA para Professores (EVDPP) - foi traduzida e adaptada para Português Europeu. 76 professores do 1.º ciclo da ilha de São Miguel (Açores) preencheram a EVDPP para 105 alunos diagnosticados com PHDA ou em avaliação, com idades compreendidas entre os 6 e os 11 anos, 85.7% são do género masculino e 14.3% do feminino. Os resultados demonstram a validade interna da escala, com alfas de Chronbach a situarem-se entre os .80 e .94 nas diferentes dimensões, corroborando outros estudos internacionais. Estes dados preliminares sugerem que a EVDPP pode ser um instrumento extremamente útil para as equipas multidisciplinares na sinalização, diagnóstico e caraterização dos principais problemas da PHDA em contexto escolar.

Resumen: Objetivos: Determinar la prevalencia de la lactancia materna exclusiva (LME) a los 3 meses posparto, y conocer las causas que contribuyen al abandono precoz. Diseño: Estudio observacional y restrospectivo. Emplazamiento: Departamento de Salud de la Ribera, Valencia, España. Participantes: Niños nacidos entre diciembre de 2012 y enero de 2017. Mediciones principales: prevalencia de lactancia materna al alta y de LME a los 3 meses. Motivos de abandono de LME. Determinación de Chi-cuadrado entre variables categóricas. Metodología: Las mujeres fueron entrevistadas en el posparto y a los 3 meses posparto, teniendo en cuenta las variables asociadas al inicio de la lactancia y su continuación. También se recogió información sobre las características socio-demográficas y obstétrico-neonatales. Resultados: Un total de 1.338 mujeres fueron seleccionadas. La prevalencia de lactancia materna al alta se situó en el 68,2% (913) y a los 3 meses descendió al 46,7% (625). La duración de la LME fue de 68,7 ± 32,7 días (IC 95%: 66,9-71,2). Encontramos diferencias estadísticamente significativas entre el tipo de lactancia al alta y las variables, año del estudio, país de origen y paridad (p

The FANTASTIC questionnaire is a scientific instrument that can be used by health professionals for quickly and effectively measuring the quality of life and lifestyle of people. It is a simple questionnaire that measures different dimensions including nutritional status, but the possibility of using it as a resource for studies in the nutritional field (regardless of its correlation with this) has never been considered, nor has it been used for studies in university populations. The aim was to validate the FANTASTIC questionnaire to report on the participant’s lifestyle in a Spanish university population by using a cross-sectional study. A sample of 501 participants was obtained. The study was approved by the Ethics Research Committee of Catholic University of Valencia, and written informed consent was obtained from all participants. Sociodemographic, lifestyle variables, habitual diet, and nutrition-related lifestyle were collected individually. Participants also completed the self-administered FANTASTIC questionnaire. The reliability analysis of the FANTASTIC questionnaire revealed a Cronbach’s Alpha statistic result of 0.797. The Kaiser–Meyer–Olkin (KMO) value was 0.786, with a significant Bartlett’s Test of Sphericity (p = 0.000). This shows that the FANTASTIC questionnaire has good internal consistency and good construct validity. A retest was performed in four weeks’ time, showing excellent intraclass correlation values. We consider the applicability of the FANTASTIC questionnaire for nutritional studies in Spanish university students to be appropriate, and most students have high scores in the nutritional aspects of the questionnaire, showing correct diet implementation and good cooking skills.

Lentils (Lens sp.) are one of the main sources of protein for humans in many regions, in part because their rusticity allows them to withstand semi-dry climates and tolerate a wide spectrum of pests. Both are also highly sought-after attributes to face climate change. Wild accessions, rather than cultivated varieties, are typically the holders of most influential alleles for rusticity traits. However, most genomic and transcriptomic research conducted in lentils has been carried out on commercial accessions (L. culinaris), while wild relatives have been largely neglected. Herein, we assembled, annotated, and evaluated the transcriptomes of eight lentil accessions, including the cultivated Lens culinaris and the wild relatives: L. orientalis, L. tomentosus, L. ervoides, L. lamottei, L. nigricans, and two L. odemensis. The assemblies allowed, for the first time, a comparison among different lentil taxa at the coding sequence level, providing further insights into the evolutionary relationships between cultivated and wild germplasm and suggesting a grouping of the seven accessions into at least three conceivable gene pools. Moreover, orthologous clustering allowed a first estimation of the lentil pan-transcriptome. It is composed of 15,910 core genes, encoded in all accessions, and 24,226 accessory genes. The different pan-transcriptome clusters were also screened for Pfam-domain enrichment. The present study has a high novelty, as it is the first pan-transcriptome analysis using six wild species in addition to cultivated species. Because of the amount of transcript sequences provided, our findings will greatly boost lentil research and assist breeding efforts.

Lupus vulgaris is a clinical variant of cutaneous tuberculosis, a rare subtype of extrapulmonary infection caused by the Mycobacterium tuberculosis complex. A paucibacillary form associated with high degrees of immunity, predominantly in the face, may present several clinical and histopathological differential diagnoses, which makes its diagnosis challenging. We present a case of lupus vulgaris in an immunocompetent patient, whose initial clinical presentation and histopathology did not suggest the condition. The objective is to highlight the relevance of the hypothesis of cutaneous tuberculosis as an important differential diagnosis, especially in endemic areas.