Hereditary angioedema in Spain: medical care and patient journey.

BACKGROUND: Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1INH) is a genetic rare disease characterized by recurrent, transient and unpredictable episodes of cold, non-pruriginous oedema without associated urticaria. The characteristics of the disease have a considerable impact on the quality of life of patients. The aim of this study was to increase understanding of the patient journey of HAE in Spain. METHODS: A multidisciplinary committee of 16 HAE experts (allergy, immunology, emergency department, hospital pharmacy and nursing) and 3 representatives of the Spanish Hereditary Angioedema Patient Association (AEDAF) who were patients or caregivers participated in the study. A review of the publications on HAE treatment was performed. Semi-structured interviews were performed to HAE experts, patients, or caregivers. Three meetings with the experts, patients and caregivers were held to share, discuss, and validate data obtained from literature and interviews and to build the model. RESULTS: Throughout the project, the patient journey has been drawn up, dividing it into the stages of pre-diagnosis, diagnosis and treatment/follow-up. Some areas for improvement have been identified. Firstly, there is a need to enhance awareness and training on HAE among healthcare professionals, with a particular emphasis on primary care and emergency department personnel. Secondly, efforts should be made to minimize patient referral times to allergy/immunology specialists, ensuring timely access to appropriate care. Thirdly, it is crucial to encourage the study of the relatives of diagnosed patients to early identify potential cases. Fourthly, equitable access to self-administered treatments should be ensured, facilitated by systems that enable medication delivery at home and proper education and training for patients. Equitable access to long-term prophylactic treatment should also be prioritized for all patients in need. To standardize HAE management, the development of consensus guidelines that reduce variability in clinical practice is essential. Lastly, promoting research studies to enhance knowledge of the disease and align its treatment with new developments in the healthcare field should be encouraged. CONCLUSIONS: The knowledge of the patient journey in HAE allowed us to identify improvement areas with the final aim to optimize the disease management.

Improving the Sustainability of Catalytic Glycolysis of Complex PET Waste through Bio-Solvolysis.

This work addresses a novel bio-solvolysis process for the treatment of complex poly(ethylene terephthalate) (PET) waste using a biobased monoethylene glycol (BioMEG) as a depolymerization agent in order to achieve a more sustainable chemical recycling process. Five difficult-to-recycle PET waste streams, including multilayer trays, coloured bottles and postconsumer textiles, were selected for the study. After characterization and conditioning of the samples, an evaluation of the proposed bio-solvolysis process was carried out by monitoring the reaction over time to determine the degree of PET conversion (91.3-97.1%) and bis(2-hydroxyethyl) terephthalate (BHET) monomer yield (71.5-76.3%). A monomer purification process, using activated carbon (AC), was also developed to remove the colour and to reduce the metal content of the solid. By applying this purification strategy, the whiteness (L*) of the BHET greatly increased from around 60 to over 95 (L* = 100 for pure white) and the Zn content was significantly reduced from around 200 to 2 mg/kg. The chemical structure of the purified monomers was analyzed via infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC), and the composition of the samples was measured by proton nuclear magnetic resonance (1H-NMR), proving a high purity of the monomers with a BHET content up to 99.5% in mol.

A Preliminary Study on the Use of Highly Aromatic Pyrolysis Oils Coming from Plastic Waste as Alternative Liquid Fuels.

In this work, the low-temperature pyrolysis of a real plastic mixture sample collected at a WEEE-authorised recycling facility has been investigated. The sample was pyrolysed in a batch reactor in different temperature and residence time conditions and auto-generated pressure by following a factorial design, with the objective of maximising the liquid (oil) fraction. Furthermore, the main polymers constituting the real sample were also pyrolysed in order to understand their role in the generation of oil. The pyrolysis oils were characterised and compared with commercial fuel oil number 6. The results showed that in comparison to commercial fuel oil, pyrolysis oils coming from WEEE plastic waste had similar heating values, were lighter and less viscous and presented similar toxicity profiles in fumes of combustion.

Oil Production by Pyrolysis of Real Plastic Waste.

The aim of this paper is for the production of oils processed in refineries to come from the pyrolysis of real waste from the high plastic content rejected by the recycling industry of the Basque Country (Spain). Concretely, the rejected waste streams were collected from (1) a light packaging waste sorting plant, (2) the paper recycling industry, and (3) a waste treatment plant of electrical and electronic equipment (WEEE). The influence of pre-treatments (mechanical separation operations) and temperature on the yield and quality of the liquid fraction were evaluated. In order to study the pre-treatment effect, the samples were pyrolyzed at 460 °C for 1 h. As pre-treatments concentrate on the suitable fraction for pyrolysis and reduce the undesirable materials (metals, PVC, PET, inorganics, cellulosic materials), they improve the yield to liquid products and considerably reduce the halogen content. The sample with the highest polyolefin content achieved the highest liquid yield (70.6 wt.% at 460 °C) and the lowest chlorine content (160 ppm) among the investigated samples and, therefore, was the most suitable liquid to use as refinery feedstock. The effect of temperature on the pyrolysis of this sample was studied in the range of 430-490 °C. As the temperature increased the liquid yield increased and solid yield decreased, indicating that the conversion was maximized. At 490 °C, the pyrolysis oil with the highest calorific value (44.3 MJ kg-1) and paraffinic content (65% area), the lowest chlorine content (128 ppm) and more than 50 wt.% of diesel was obtained.

Physical Violence during Pregnancy and Its Implications at Birth: Analysis of a Population Survey, 2019.

Physical partner violence is widely recognized as a global health problem, especially in pregnant women. This study determines the association between physical violence during pregnancy in Peruvian women aged 15 to 49 years with low birth weight and abortion according to the Demographic and Family Health Survey (ENDES) 2019. An analytical cross-sectional observational study was carried out based on the data from the ENDES 2019. Two dependent variables referring to birth outcomes were included: abortion and low birth weight. The independent variable was physical violence during pregnancy by her current or former husband/partner. A total of 15,305 women were included in the study. The prevalence of physical violence during pregnancy was 6.43%. Regarding the adverse outcomes of pregnancy, the prevalences of abortion and low birth weight were 20.84% and 6.01%, respectively. Women suffering physical violence during pregnancy were more likely to have an abortion but not low birth weight. In conclusion, it was found that 6 in 100 Peruvian women of childbearing age were victims of violence during pregnancy. Likewise, it was observed that women who were victims of violence during pregnancy had a higher probability of having an abortion but not low birth weight.

Spanish validation of the parenting version of the "Spence Child Anxiety Scale" (SCAS-P) in a clinical sample / Validación española de la versión para padres de la “Escala de ansiedad infantil de Spence” (SCAS-P) en una muestra clínica

The child version of the Spence Children’s Anxiety Scale (SCAS-C) has demonstrated good psychometric properties, but research has scarcely focused on the parent version of the questionnaire (SCAS-P). We aimed to validate the Spanish version of the SCAS-P in a clinical sample (N= 137) of children and adolescents through their parents’ responses. The Spanish version of the SCAS-P showed good internal consistency for the total scale and for most subscales (Cronbach´s alpha between .49 y .83) and excellent test-retest reliability for all subscales (r between .71 and .91). Furthermore, convergent and divergent validity were supported by higher correlations with other measures of anxiety (r= .51), and lower correlations with measures of depression (r= .43) and externalizing problems (r= .34). For the first time in an exclusively clinical sample, the original factor structure of the SCAS-P based on six correlated factors was partially confirmed. The validation of the SCAS-P in a clinical sample provides professionals with a tool that better reflects the characteristics of their patients (AU)

La versión infantil de la “Escala de ansiedad infantil de Spence” (SCAS-C) posee buenas propiedades psicométricas, pero existe poca investigación sobre la versión para padres. Nuestro objetivo fue validar la versión española del SCAS-P en una muestra clínica (N= 137) de niños y adolescentes a través de las respuestas de sus padres. El SCAS-P mostró una buena consistencia interna para la escala total y para la mayoría de las subescalas (α de Cronbach entre 0,49 y 0,83) y una excelente fiabilidad test-retest para todas las subescalas (r entre 0,71 y 0,91). Además, la validez convergente y divergente fueron respaldadas por correlaciones significativas con otras puntuaciones de ansiedad (r= 0,51), y correlaciones más bajas con puntuaciones de depresión (r= 0,43) y problemas exteriorizados (r= 0,34), respectivamente. Por primera vez en una muestra exclusivamente clínica, se confirmó parcialmente la estructura factorial original del SCAS-P basada en seis factores correlacionados. La validación del SCAS-P en población clínica aporta a los profesionales una herramienta que refleja mejor las características de sus pacientes (AU)

Psychometric Properties of the Children's Version of the Spence Children's Anxiety Scale (SCAS) in a Spanish Clinical Sample.

The Spence Children's Anxiety Scale (SCAS) has demonstrated good psychometric properties in several countries and cultures. Nevertheless, most of the previous studies that explore these properties have combined clinical and community samples. We aimed to validate the Spanish version of the SCAS in a large clinical sample (N = 130) of children and adolescents. The Spanish adaptation of the SCAS showed good internal consistency for the total scale, and good test-retest reliability for all the subscales. Furthermore, its convergent and discriminant validity were supported by significant correlations with other anxiety questionnaires (Screen for Child Anxiety Related Emotional Disorders [SCARED], Youth Self-Report [YSR] subscales for anxiety disorders and internalizing symptomatology), and lower or non-significant correlations with depression symptoms and externalizing symptoms scales respectively. For the first time in a purely clinical sample, the original factor structure of the SCAS based on six correlated factors was confirmed. Future studies need to evaluate whether the factorial structure of the present instrument is the most suitable for use in clinical populations.

Psychometric properties of the children's version of the Spence Children's Anxiety Scale (SCAS) in a Spanish clinical sample

The Spence Children's Anxiety Scale (SCAS) has demonstrated good psychometric properties in several countries and cultures. Nevertheless, most of the previous studies that explore these properties have combined clinical and community samples. We aimed to validate the Spanish version of the SCAS in a large clinical sample (N = 130) of children and adolescents. The Spanish adaptation of the SCAS showed good internal consistency for the total scale, and good test-retest reliability for all the subscales. Furthermore, its convergent and discriminant validity were supported by significant correlations with other anxiety questionnaires (Screen for Child Anxiety Related Emotional Disorders [SCARED], Youth Self-Report [YSR] subscales for anxiety disorders and internalizing symptomatology), and lower or non-significant correlations with depression symptoms and externalizing symptoms scales respectively. For the first time in a purely clinical sample, the original factor structure of the SCAS based on six correlated factors was confirmed. Future studies need to evaluate whether the factorial structure of the present instrument is the most suitable for use in clinical populations

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Spanish Validation of the School Anxiety Scale-Teacher Report (SAS-TR).

This study aimed to examine the factorial structure and psychometric properties of the School Anxiety Scale-Teacher Report (SAS-TR) in a community sample of 315 Spanish children aged 5 to 12 years. Thirty-seven teachers from eleven schools completed the SAS-TR and the Strengths and Difficulties Questionnaire (SDQ) for each child. Confirmatory factor analysis supported the original two-factor structure, but a better fit model was obtained after removing four items. The scale was found to have high internal consistency (α = 0.91) and satisfactory test-retest reliability (ICC = 0.87) for the Spanish sample. Convergent validity was supported by positive significant correlations between the SAS-TR and the Emotional Symptoms subscale of the SDQ. Lower correlations between the SAS-TR and the SDQ Conduct Problems subscale supported the divergent validity. Overall, the findings suggest that the Spanish version of the SAS-TR is a reliable and valid instrument for teachers to assess anxiety in Spanish children.

Alternative non-chromatographic method for alcohols determination in Clostridium acetobutylicum fermentations.

An economic, simple, quantitative, and non-chromatographic method for the determination of alcohols using microdiffusion principle has been adapted and validated for acetone-butanol-ethanol (ABE) fermentation samples. This method, based on alcohols oxidation using potassium dichromate in acid medium, and detection by spectrophotometry, was evaluated varying, both, temperature (35°C, 45°C, and 55°C) and reaction time (0 to 125min). With a sample analysis time of 90min at 45°C, a limit of detection (LOD), and a limit of quantification (LOQ) of 0.10, and 0.40g/L, respectively. The proposed method has been successfully applied to determine butanol and ethanol concentrations in ABE fermentation samples with the advantage that multiple samples can be analyzed simultaneously. The measurements obtained with the proposed method were in good agreement with those obtained with the Gas Chromatography Method (GCM). This proposed method is useful for routine analysis of alcohols and screening samples in laboratories and industries.

Marco legislativo del suministro de agua en México / Legislative framework for the water supply in Mexico

In this study, water sanitation laws and methods (both Mexican and international) are compared, and the feasibility of incorporating recommendations issued by international organizations into Mexican legislation is assessed. When climate, demographic, or industry changes occur, there is an apparent need to broaden the range of substances and organisms being measured and regulated in the water. This comparative analysis identifies the following challenges: improving equipment sensitivity and specificity; removing contaminants that interfere with the process; increasing pathogen concentration of the sample; reducing manpower, equipment, and infrastructure requirements; identifying priority pathogens; adopting a flexible evaluation system; comparing and evaluating similar efforts carried out by other countries; and lastly, collating local regulations with international ones.

[Legislative framework for the water supply in Mexico]. / Marco legislativo del suministro de agua en México.

In this study, water sanitation laws and methods (both Mexican and international) are compared, and the feasibility of incorporating recommendations issued by international organizations into Mexican legislation is assessed. When climate, demographic, or industry changes occur, there is an apparent need to broaden the range of substances and organisms being measured and regulated in the water. This comparative analysis identifies the following challenges: improving equipment sensitivity and specificity; removing contaminants that interfere with the process; increasing pathogen concentration of the sample; reducing manpower, equipment, and infrastructure requirements; identifying priority pathogens; adopting a flexible evaluation system; comparing and evaluating similar efforts carried out by other countries; and lastly, collating local regulations with international ones.

Alteraciones del desarrollo neurológico en niños nacidos de madres con VIH

El desarrollo neurológico es una parte fundamental en el sano crecimiento de un niño; sin embargo, existen factores que pueden detener su desarrollo y causar deterioro, entre ellos factores infecciosos y socioculturales. Los niños que nacen de una madre infectada con el virus de inmunodeficiencia humana (VIH) en algunos casos adquieren la infección y, en otros, logran escapar de ella. Independientemente de su condición de infectados. Existe un subgrupo de niños que adicionalmente tiene exposición farmacológica in útero a los potentes antirretrovirales usados por las madres infectadas durante la gestación. Se sabe que los niños infectados por el VIH tienen una amplia variedad de trastornos cognoscitivos y motores y, en la medida en que progresa la inmunodeficiencia, el riesgo de tener infecciones oportunistas a nivel cerebral aumenta. Está demostrado que aun los niños no infectados, pero nacidos de madres infectadas, no están exentos de presentar alteraciones cognoscitivas y motoras. Los diferentes problemas neurológicos que enfrentan los niños nacidos de madres infectadas por el VIH, no sólo se explican por la existencia de infecciones en el niño o la madre, sino por la presencia de factores adversos de tipo sociocultural, los cuales pueden afectar el desarrollo cerebral en grados diversos. Ante esta situación es importante que el médico reconozca en forma temprana las alteraciones neurológicas que se presentan, con el propósito de proporcionar un manejo oportuno e incluso para poder prevenir su evolución.

Neurological development is a fundamental part of a child's healthy growth, however, there are factors that can stop his development or that can cause deterioration, amongst them infectious and socio-cultural factors. In some cases, children that are born from a mother infected with the Human Immunodeficiency Virus (HIV) acquire the infection and in others they can escape it. Apart from the condition of their infection status, there is a subgroup of children that additionally have in uterus pharmacological exposure to antiretrovirals, used by their mothers during gestation. It is well known that children infected with HIV have a vast variety of cognitive and motor disturbances, and that as the immunodeficiency progresses, they have a risk of opportunistic infections at cerebral level. It has been demonstrated that even children without infection, but born from infected mothers are not exempt from presenting cognitive and motor disturbances. The different neurological problems that children born from HIV+ mothers present are not only explained by the child's or mother's infection, but by the presence of adverse factors, socio-cultural ones, that can affect cerebral development on different levels. Due to this situation it is important to recognize neurological alterations as early as possible with the aim of providing a timely management and even to prevent them.

Bilingual children referred for psychiatric services: associations of language disorders, language skills, and psychopathology.

OBJECTIVE: To investigate (1) the prevalence of language deficits and disorders and (2) the relationship of bilingual language skills and psychopathology, in Spanish-English bilingual children referred for child and adolescent psychiatry services. METHOD: Bilingual language skills, emotional/behavioral problems, sociodemographics, immigration variables, and nonverbal IQ were studied in 50 consecutively referred children. RESULTS: Estimated prevalence was high for language deficits (48%) and disorders (41%), with most cases (>79%) being of the mixed receptive-expressive type. In children with clinically significant emotional/behavioral problems, bilingual language skills were strongly and inversely correlated with problem scores, particularly global problems (r = -0.67, p < .001); social, thought, and attention problems (r > or = -0.54; p < .004); delinquency (r = -0.66, p < .001); and aggression (r = -0.52, p < .01). These correlations remained significant after IQ adjustment. CONCLUSIONS: Prior findings from monolingual children were confirmed in this bilingual sample, namely (1) the high prevalence of mixed receptive-expressive and other language disorders and delays and (2) the close tie between poor language skills and emotional/behavioral problems. The data strongly suggest the clinical importance and feasibility of language assessment and the significance of receptive problems in bilingual children referred for psychiatric services. A safe approach is to fully assess language skills, rather than misattributing these children's language delays to normal bilingual acquisition processes.

Características clínicas y epidemiológicas de pacientes pediátricos con infección por VIH/SIDA: informe de 124 pacientes / Clinical and epidemiological characteristics of 124 children with HIV/AIDS

Introducción. La epidemia de VIH/SIDA continúa expandiéndose, por lo que se calcula que en las regiones más afectadas por la enfermedad puede aumentar la mortalidad infantil hasta en 75 por ciento. El objetivo del artículo es describir las características clínicas y epidemiológicas de los niños con infección por VIH/SIDA al momento de su diagnóstico.Material y métodos. Se realizó un estudio descriptivo de los pacientes que cumplieron los criterios diagnósticos de infección por VIH del Centro para el Control y Prevención de Enfermedades atendidos en el Instituto Nacional de Pediatría del año de 1986 a 1999.Resultados. Se incluyeron 124 pacientes desde recién nacidos hasta los 18 años de edad. La transmisión vertical fue la vía más frecuente de infección (77 por ciento). En 50 por ciento de los niños las manifestaciones clínicas de la infección se presentaron entre el primero y el sexto mes de vida. Cerca de 90 por ciento de los pacientes se diagnosticaron en etapas de SIDA. Las principales causas de muerte fueron las infecciones, de las cuales las más frecuentes fueron las de tipo bacteriano.Conclusión. El reconocimiento de las manifestaciones clínicas de infección por VIH/SIDA en los niños tiene gran trascendencia para que el médico diagnostique de manera temprana el síndrome.