Global availability of parenteral nutrition: Pre- and post-COVID-19 pandemic surveys.

OBJECTIVE: Parenteral nutrition represents a therapeutic option for patients with type 3 intestinal failure. If used exclusively, parenteral nutrition has to be complete to provide all essential nutrients. The aim was to assess the availability of parenteral nutrition in all parts of the world, to better comprehend the global situation, and to prepare an action plan to increase access to parenteral nutrition. METHODS: An international survey using an electronic questionnaire was conducted in August 2019 and repeated in May 2022. An electronic questionnaire was sent to 52 members or affiliates of the International Clinical Nutrition Section of the American Society for Parenteral and Enteral Nutrition. Questions addressed the availability of parenteral nutrition admixtures and their components, reimbursement, and prescribing pre- and post-COVID-19 pandemic. All participating countries were categorized by their economic status. RESULTS: Thirty-six country representatives responded, answering all questions. Parenteral nutrition was available in all countries (100%), but in four countries (11.1%) three-chamber bags were the only option, and in six countries a multibottle system was still used. Liver-sparing amino acids were available in 18 (50%), kidney-sparing in eight (22.2%), and electrolyte-free in 11 (30.5%) countries (30.5%). In most countries (n = 28; 79.4%), fat-soluble and water-soluble vitamins were available. Trace elements solutions were unavailable in four (11.1%) countries. Parenteral nutrition was reimbursed in most countries (n = 33; 91.6%). No significant problems due to the coronavirus pandemic were reported. CONCLUSIONS: Despite the apparent high availability of parenteral nutrition worldwide, there are some factors that may have a substantial effect on the quality of parenteral nutrition admixtures. These shortages create an environment of inequality.

ENECOVID: una experiencia de mejora profesional / ENECOVID: An experience of profesional improvement

En el Centro de Salud El Doctoral, perteneciente al Área de Salud de Gran Canaria, seis enfermeras de Atención Primaria fueron las encargadas de atender a los requerimientos de las 133 familias que participaron en el Estudio Nacional de Seroprevalencia (ENECOVID) dirigido por el Instituto de Salud Carlos III y el Ministerio de Sanidad. En las tres fases del estudio comentadas en este trabajo se atendieron un total de 702 participantes. En la primera fase se valoró a un total de 203 personas, 251 en la segunda y 248 en la tercera fase. Los participantes en su mayoría fueron adultos, siendo el número total de niños atendidos 84. La participación por sexos fue igual (50% hombres y 50% mujeres). Para dar una respuesta adecuada al estudio, dentro del centro, se creó un circuito con puntos de entrada, espera e información a los participantes, donde se les explicaba el objetivo y la dinámica del mismo, y formalizaban el consentimiento informado antes de acceder a las consultas destinadas a su desarrollo. La experiencia de las enfermeras en la investigación ENECOVID redundó en la cohesión del grupo de trabajo, mejoró la destreza en el manejo del paciente con infección por SARS-CoV-2, aumentó la seguridad a la hora de utilizar los equipos de protección individual y repercutió en la capacidad de abordar un gran volumen de participantes sin mermar la calidad de los cuidados.(AU)

At the Doctoral Health Centre, belonging to the Gran Canaria Healthcare Area, six Primary Care nurses were in charge of meeting the requirements of the 133 families included in the National Seroprevalence Study (ENECOVID) conducted by the Instituto de Salud Carlos III and the Ministry of Health. During the three stages of the study discussed in this article, 702 participants were managed in total. In the first stage, 203 persons were evaluated, 251 in the second, and 248 in the third stage. The majority of participants were adult, and the total number of children included was 84. There was equal participation by gender (50% men and 50% women). In order to provide an adequate response to the study, a circuit was created within the centre, with entry, waiting, and information points for participants, where the objective and the dynamics of the study were explained to them, and they completed their informed consent forms before having access to the relevant consultations. The experience of nurses in the ENECOVID research resulted in the cohesion of the work team, improved the skills regarding the management of patients infected with SARS-CoV-2, increased safety at the time of using individual protection equipment, and had a positive impact on the ability to address a great volume of participants without reducing the quality of care.(AU)

Variaciones en el estado nutricional, presión arterial y en los patrones dietéticos de jóvenes posterior al ingreso a la educación superior

RESUMEN El objetivo fue analizar los cambios en el estado nutricional, presión arterial y patrones dietéticos de jóvenes evaluados durante la primera semana de inducción y seis meses posterior al ingreso a la Facultad de Ciencias de la Salud de una universidad pública de Valparaíso, Chile. Estudio comparativo, con diseño longitudinal de cohorte, análisis por-protocolo. Los patrones dietéticos se determinaron mediante una Encuesta de Tendencia de Consumo Cuantificado, la evaluación antropométrica incluyó mediciones estandarizadas de peso, estatura y perímetro de cintura, la composición corporal se determinó mediante impedancia bioeléctrica, y la presión arterial con esfigmomanómetro digital. Las mediciones se realizaron al inicio y término del primer semestre de 2017 (n= 76). En ambos sexos se observó una ganancia significativa de peso corporal, IMC, masa grasa e incremento de la presión arterial sistólica, además en hombres aumentó el perímetro de cintura y la presión arterial diastólica (p<0,05). Los hombres disminuyeron significativamente el consumo de lácteos (-43,1%) y aumentaron el consumo de carnes procesadas y comida rápida (40,6%), en cambio las mujeres disminuyeron significativamente el consumo de bebidas y refrescos (-58,0%) y de alimentos con cafeína (-54,1%). No hubo cambios en el consumo de energía y macronutrientes, sin embargo, un alto porcentaje presentó un consumo deficiente de ácidos grasos poliinsaturados ω-3, fibra dietética, ciertas vitaminas y minerales, y principalmente excesivo en ácidos grasos saturados, fósforo y sodio. Se identificaron cambios negativos en el estado nutricional, presión arterial y en los patrones dietéticos posterior al ingreso a la educación superior.

ABSTRACT The objective was to analyze the changes in nutritional status, blood pressure and dietary patterns, of young people evaluated during their induction week and six months after being admitted to the Faculty of Health Sciences of a public university in Valparaiso, Chile. This was a comparative study, with a longitudinal cohort, per-protocol analysis. Anthropometric evaluation included standardized measures of weight, height and waist circumference. Body composition was determined through bioelectrical impedance, and blood pressure was measured using a digital sphygmomanometer. Dietary patterns were determined through a survey of quantified consumption trends. Measurements were taken at the beginning (n= 139) and end of the first term in 2017 (n=76). In both sexes, significant increases in body weight, BMI, fat mass and systolic blood pressure were observed. Furthermore, in men, increases in waist circumference and diastolic blood pressure (p<0.05) were observed. Men significantly decreased their dairy consumption (-43.1%) and increased their consumption of processed meats and fast-food (40.6%). Conversely, women significantly decreased their soft drink consumption (-58.0%) and caffeinated products (-54.1%). No changes in energy and macronutrient consumption were observed. A high percentage of the participants presented a deficient consumption of polyunsaturated fatty acids ω-3, dietary fiber, and certain vitamins and minerals. They also presented excessive consumption of saturated fatty acids, phosphorus and sodium. Negative changes were identified in nutritional state, blood pressure and dietary patterns when admitted in tertiary education.

Separation and zeta-potential determination of proteins and their oligomers using electrical asymmetrical flow field-flow fractionation (EAF4).

Electrical asymmetrical flow field-flow fractionation (EAF4) is an interesting new analytical technique that separates proteins based on size or molecular weight and simultaneously determines the electrical characteristics of each population. However, until now, the research using EAF4 has not been published except for the proof-of-concept in the original publication by Johann et. al. in 2015 [1]. Hence the methods capabilities and optimized conditions need to be further investigated, such as composition of the carrier liquid, pH stability and effect of the electric field strength. The pH instability was observed in the initial method of EAF4 due to the electrolysis products when applied electric field. Therefore, we have investigated and provided a modified method for rapid pH stabilization through additional focusing step with the electric field. Then, the electrical properties such as the zeta-potential and effective net charge of the monomer and oligomers of three different proteins (GA-Z, BSA, and Ferritin) were determined based on their electrophoretic mobility from EAF4. The results showed that there were limitations to the applicability of separation by EAF4 to proteins. Nevertheless, this study shows that EAF4 is an interesting new technique that can examine the zeta-potential of individual proteins in mixtures (or monomers and oligomers) not accessible by other techniques.

Characterization of molecular properties of wheat starch from three different types of breads using asymmetric flow field-flow fractionation (AF4).

In this study, molecular properties of wheat starch from three different types of breads were analyzed using asymmetric flow field-flow (AF4) connected to multi-angle light scattering (MALS) and differential refractive index (dRI) detectors. This analysis allowed the determination of molecular properties, i.e. molar mass (M), root-mean-square radius (rrms), apparent density (ρapp) and conformation. Complementary analyses, such as resistant starch and amylose content, were also performed. The results show that wheat starch extracted from breads can have different properties reflected in changes in M, rrms and ρapp. In addition, the results suggest that some of the changes in molecular properties may be related to the presence of resistant starch.

Comparison between conventional and frit-inlet channels in separation of biopolymers by asymmetric flow field-flow fractionation.

Asymmetric flow field-flow fractionation (AF4) is a separation technique in which a focusing/relaxation step is used after the sample is injected onto the separation channel. During the focusing/relaxation step, the sample is focused by two counter-directed flows. This allows sample components to establish a diffusion-dependent equilibrium concentration profile. The focusing step may, in some cases, cause a loss of sample due to adsorption into the accumulation wall (i.e. the membrane) or due to aggregation of the sample. In addition, the increase in sample concentration during the focusing step may prevent complete relaxation and cause overloading effects. In this study, a modified AF4 channel equipped with a frit inlet (FI-AF4) is utilized, where the sample is relaxed hydrodynamically as it enters to the channel through the frit. The main advantage of the FI-AF4 channel is to omit the focusing step. The FI-AF4 channel could also allow higher injection mass than in a conventional channel while still avoiding overloading. The purpose of the present study is to compare two channels (conventional and FI-AF4 channels) in terms of the plate height (H), resolution (Rs) and the mass recovery for analysis of a mixture of glycogen and pullulan. In addition, waxy maize (WM) starch was used to compare the mass overloading of the two channels. The results show that the type of relaxation method (i.e. focusing or hydrodynamic relaxation) had no significant effect on mass recovery. The resolution (Rs), was higher in the conventional AF4 channel than in the FI-AF4 channel for the separation of glycogen and pullulan. The results also show that it was possible to inject a higher mass of WM starch (i.e. twice the mass) onto the FI-AF4 channel, compared to a conventional AF4 channel, without observing an overloading effect.

Fractionation and characterization of starch granules using field-flow fractionation (FFF) and differential scanning calorimetry (DSC).

Starch is one of the main carbohydrates in food; it is formed by two polysaccharides: amylose and amylopectin. The granule size of starch varies with different botanical origins and ranges from less than 1 µm to more than 100 µm. Some physicochemical and functional properties vary with the size of the granule, which makes it of great interest to find an efficient and accurate size-based separation method. In this study, the full-feed depletion mode of split-flow thin cell fractionation (FFD-SF) was employed for a size-based fractionation of two types of starch granules (corn and potato) on a large scale. The fractionation efficiency (FE) of fraction-a for corn and potato granules was 98.4 and 99.4%, respectively. The FFD-SF fractions were analyzed using optical microscopy (OM) and gravitational field-flow fractionation (GrFFF). The respective size distribution results were in close agreement for the corn starch fractions, while they were slightly different for the potato starch fractions. The thermal properties of FFD-SF fractions were analyzed, and the results for the potato starch showed that the peak temperature of gelatinization (Tp) slightly decreases as the size of the granules increases. Additionally, the enthalpy of gelatinization (ΔH) increases when the granule size increases and shows negative correlation with the gelatinization range (ΔT).

Characterization of non-solvent precipitated starch using asymmetrical flow field-flow fractionation coupled with multiple detectors.

Non-solvent precipitated starch (non-SPS) is a novel component for starch-based emulsions. Herein, three non-SPS materials were prepared using ethanol as a precipitant of waxy maize starch granules (WMs). The WMs were either untreated (SP) or pre-treated via acid-hydrolysis (AHSP). In addition, SP was modified using n-octenyl succinic anhydride (OSA), yielding OSASP. This study aimed to investigate the influence of the non-SPS preparation method on the size, molar mass (M), and apparent density (ρapp) of the materials when subjected to different dissolution/dispersion procedures using asymmetrical flow field-flow fractionation (AF4). The results showed that the molar mass, size, and apparent density depended on the type of non-SPS with a decrease in Mw (1.8-9.4 g/mol) and rrms (60-148 nm) upon re-dispersion in different media in the order: SP > OSASP > AHSP. Moreover, different types of non-SPS materials displayed different conformational properties and were stable in aqueous solution at room temperature in the investigated time (24 h).

Physicochemical and structural properties of starch from five Andean crops grown in Bolivia.

Three Andean grains - amaranth (Amaranthus caudatus), quinoa (Chenopodium quinoa), canihua (Chenopodium pallidicaulle) - and two Andean roots starches - achira (Canna indica), maca (Lepidium meyenii) - were studied. Physicochemical properties such as granule size, crystallinity, pasting properties among other as well as structural properties such as root-mean-square radius (rrms), weight-average molar mass (Mw) and apparent density (ρapp) were analyzed in order to evaluate the relation between them. Grains were similar in most of their characteristics as roots in their i.e. granule size, shape, type of crystallinity, Mw and rrms varied according to botanical source. The starch granules from grains were in a narrow diameter range (0.5 to 2 µm) and displayed A-type X-ray diffraction pattern (XRD). Roots starch had a wide granule diameter range (1 to 100 µm) and displayed a B-type XRD. The amylose content varied between 0 and 48% where amaranth had the lowest value and achira had the highest. Furthermore, quinoa and canihua starches had very low breakdown in pasting properties, indicating high stability during cooking. A model is proposed that relates pasting properties i.e. peak viscosity and final viscosity with ρapp, gelatinization enthalpy, granule size and amylose content.

Limitación del esfuerzo terapéutico: experiencias de enfermeras en una unidad de cuidados intensivos / Limitation of therapeutic effort: Experiences of nurses in an intensive care unit

El propósito de este estudio fue comprender cómo es la experiencia de las enfermeras en cuanto a vivenciar la limitación del esfuerzo terapéutico (LET) en unidades de paciente crítico de un hospital público de la región de Valparaíso. Se opta por un estudio de tipo cualitativo, de trayectoria fenomenológica, se realizó entrevista en profundidad a 3 enfermeras, con la pregunta orientadora ¿Qué experiencia tiene usted como enfermera de Unidad de Cuidados Intensivos (UCI) con respecto a la LET? Los discursos fueron interpretados bajo el referencial de Fenómeno Situado de Joel Martins. En los relatos se evidencia el uso de las palabras "manejo proporcional" como sinónimo, el rol de enfermería es confuso en la toma de decisión respecto a la LET pero se releva al momento del cuidado al final de la vida. Se concluye que las enfermeras son quienes deben asumir un rol más protagónico en el cuidado de la persona en esta situación, participando activamente en la toma de decisiones del binomio familia-paciente. Se recomienda la creación de protocolos para la LET, detallando la definición de la LET junto con el rol de enfermería y del equipo de salud, con el objetivo de no prolongar la vida innecesariamente, no aumentar la esperanza familiar y asegurar el cuidado al final de la vida.

The purpose of this study was to understand the experience of nurses in terms of experiencing limitation of therapeutic effort (LET) in critical patient units of a public hospital in Valparaíso. We opted for a qualitative study, a phenomenological trajectory, an in-depthinterview with 3 nurses, with the guiding question. What experience do you have as an Intensive Care Unit (ICU) nurse regarding LET? The speeches were interpreted under the referential of Located Phenomenon of Joel Martins. In the stories the use of the words "proportional management" is evidenced as synonymous, the nursing role is confusing in the decision making regarding the LET but it is relieved at the moment of care at the end of life. It is concluded that nurses are the ones who must assume a more protagonic role in the care of the person in this situation, participating actively in the decision making of the family-patient binomial. It is recommended the creation of protocols for the LET, detailing the definition of the LET along with the role of nursing and the health team, with the aim of not prolonging life unnecessarily, not increasing family hope and ensuring care at the end of life.

Application of asymmetric flow field-flow fractionation (AF4) and multiangle light scattering (MALS) for the evaluation of changes in the product molar mass during PVP-b-PAMPS synthesis.

The use of polymers for the delivery of drugs has increased dramatically in the last decade. To ensure the desired properties and functionality of such substances, adequate characterization in terms of the molar mass (M) and size is essential. The aim of this study was to evaluate the changes in the M and size of PVP-b-PAMPS when the amounts of the synthesis reactants in the two-step radical reaction were varied. The determination of the M and size distributions was performed by an asymmetric flow field-flow fractionation (AF4) system connected to multiangle light scattering (MALS) and differential refractive index (dRI) detectors. The results show that the M of the polymers varies depending on the relative amounts of the reactants and that AF4-MALS-dRI is a powerful characterization technique for analyzing polymers. Using AF4, it was possible to separate the product of the first radical reaction (PVP-CTA) into two populations. The first population had an elongated, rod-like or random coil conformation, and the second had a conformation corresponding to homogeneous spheres or a microgel structure. PVP-b-PAMPS had only one population, which had a rod-like conformation. The molar masses of PVP-CTA and PVP-b-PAMPS found in this study were higher than those reported in previous studies.

Co-elution phenomena in polymer mixtures studied by asymmetric flow field-flow fractionation.

Most polymers generally have complex characteristics. Analysis and understanding of these characteristics is crucial as they, for instance, influence functionality. Separation and analysis of samples of polymers, biopolymers in particular, is challenging since they often display broad distributions in size, structure and molar mass (M) and/or a tendency to form aggregates. Only few analytical techniques are suitable for the task. AF4-MALS-dRI is highly suited for the task, but the analysis can nevertheless be especially challenging for heterogeneous mixtures of polymers that exhibit wide size distributions or aggregation. For such systems, systematic and thorough method development is clearly a requirement. This is the purpose of the present work, where we approach the problem of heterogeneous polymer samples systematically by analyzing mixtures of two different polymers which are also characterized individually. An often observed phenomenon in AF4 of samples with a high polydispersity is a downturn in M vs. elution time, especially common at high retention. This result is often dismissed as an artifact attributed to various errors in detection and data processing. In this work, we utilize AF4-MALS-dRI to separate and analyze binary mixtures of the well-known polysaccharides pullulan and glycogen, or pullulan and poly(ethylene oxide), respectively, in solution. The results show that an observed downturn - or even an upturn - in M can be a correct result, caused by inherent properties of the analyzed polymers.

Production of starch nanoparticles by dissolution and non-solvent precipitation for use in food-grade Pickering emulsions.

The aim of this study was to investigate non-solvent precipitation of starch to produce nanoparticles that could be used in Pickering emulsions. The material used was waxy maize, modified with octenyl succinic anhydride. Different methods of non-solvent precipitation were investigated, and a method based on direct mixing of an 8% starch solution and ethanol (ratio 1:1) was found to produce the smallest particles. The particle size was measured using AFM and AF4, and was found to be in the range 100-200nm. However, both larger particles and aggregates of nanoparticles were observed. The emulsion produced using the precipitated starch particles had a droplet size that between 0.5 and 45µm, compared to emulsions produced from waxy maize granules, in which had a size of 10-100µm. The drop in size contributed to increased stability against creaming. The amount of starch used for emulsion stabilization could also be substantially reduced.

The effect of baking and enzymatic treatment on the structural properties of wheat starch.

In this study, bread was baked with and without the addition of α-amylase. Starch was extracted from the baked bread and its molecular properties were characterized using (1)H NMR and asymmetric flow field-flow fractionation (AF4) connected to multi-angle light scattering (MALS) and other detectors. The approach allows determination of molar mass, root- mean-square radius and apparent density as well as the average degree of branching of amylopectin. The results show that starch size and structure is affected as a result of the baking process. The effect is larger when α-amylase is added. The changes include both a decrease molar mass and size as well as an increase in apparent density. Moreover, an increase in average degree of branching and the number of reducing ends H-1(ß-r) and H-1(α-r) can be observed.

Obesidad infantil en municipios rurales de altura / Child obesity in rural municipalities at altitude

PREGUNTA DE INVESTIGACIÓN: ¿cuáles son los conocimientos y prácticas de alimentación, nutrición y cuidado de madres y/o cuidadores y su asociación con sobrepeso y obesidad en niños menores de 23 meses que viven en municipios rurales de altura en Bolivia? OBJETIVO GENERAL: determinar las características de cuidado y prácticas alimentarias de niños menores de 23 meses de edad con sobrepeso y obesidad que viven en municipios rurales productores de papa que participan en el proyecto Ios Andes en Bolivia, datos de línea de base, desde septiembre a noviembre de la gestión 2012. MATERIAL Y MÉTODOS: es un estudio descriptivo transversal y analítico. Se estudiaron todos los niños de 0 a 23 meses (290) considerados en la línea de base del Proyecto Ios Andes realizado en Bolivia, también en Ecuador y Perú, cuyo tamaño muestral fue de 450 niños distribuidos en 75 comunidades rurales de la región andina de Bolivia. Se aplicaron encuestas sobre prácticas y conocimientos de alimentación y cuidado infantil a madres y/o cuidadores y se tomaron medidas de peso y talla a sus niños menores de dos años durante los meses de septiembre a noviembre del 2012. En una sub-muestra se realizó un recordatorio de 24 horas con pesada de alimentos para determinar consumo y adecuación de alimentos y nutrientes de los niños menores. Los datos fueron analizados en relación al indicador peso para talla en los puntos de corte que indican sobrepeso y obesidad. RESULTADOS: el porcentaje de sobrepeso y obesidad encontrada fue de 10% más elevado que la media nacional; no se encontraron asociaciones relevantes de conocimientos, practicas alimentarias y adecuación de nutrientes. CONCLUSIONES: se resalta la presencia de obesidad en edades tempranas en zonas rurales con vulnerabilidad a la inseguridad alimentaria, recomendando el desarrollo de investigaciones específicas para identificar determinantes de esta condición.

RESEARCH QUESTION: wich are the understanding and practices of feeding, nutrition and caring mothers and/or nursemaids and their association with overweight and obesity in children under two years of age living in Bolivian rural municipalities ofhigh altitude? OBJECTIVE: To determine knowledge and feeding and child care of mothers or care givers and the association with overweight and obesity in children under two years of age living in Bolivian rural municipalities of high altitude METHODOLOGY: It is a descriptive cross-sectional study. All children under 2 years old (290) of a baseline line survey of the Andes Project were included, the whole survey sample was of 450 children under three years of age living in 75 communities of rural communities in the Bolivian Andean region. Anthropometric measures of children under two years were collected and feeding and care knowledge and practices of their mothers or caregivers. The survey was done during September to November 2012. In a sub sample a 24 hour dietary recall was taken weighing all food mentioned. For the analysis, weight to height Z score with the cut off points related to overweight and obesity was considered. RESULTS: The study found 10% of overweight and obesity, which is above the media in the country. None of knowledge, practices or nutrition adequacy was found relevant for obesity. CONCLUSIONS: Presence of obesity early in life time was found. It is recommendable to develop survey focused on obesity to find out characteristics that could cause this condition.