Impact of Geospatial Food Access on Acute Pancreatitis Outcomes.

BACKGROUND AND AIM: Food access is an important social determinant of health and refers to geographical and infrastructural aspects of food availability. Using publicly available data on food access from the United States Department of Agriculture (USDA), geospatial analyses can identify regions with variable food access, which may impact acute pancreatitis (AP), an acute inflammatory condition characterized by unpredictable outcomes and substantial mortality. This study aimed to investigate the association of clinical outcomes in patients with AP with geospatial food access. METHODS: We examined AP-related hospitalizations at a tertiary center from January 2008 to December 2018. The physical addresses were geocoded through ArcGIS Pro2.7.0 (ESRI, Redlands, CA). USDA Food Access Research Atlas defined low food access as urban areas with 33% or more of the population residing over one mile from the nearest food source. Regression analyses enabled assessment of the association between AP outcomes and food access. RESULTS: The study included 772 unique patients with AP residing in Massachusetts with 931 AP-related hospitalizations. One hundred and ninety-eight (25.6%) patients resided in census tracts with normal urban food access and 574 (74.4%) patients resided in tracts with low food access. AP severity per revised Atlanta classification [OR 1.88 (95%CI 1.21-2.92); p = 0.005], and 30-day AP-related readmission [OR 1.78(95%CI 1.11-2.86); p = 0.02] had significant association with food access, despite adjustment for demographics, healthcare behaviors, and comorbidities (Charlson Comorbidity Index). However, food access lacked significant association with AP-related mortality (p = 0.40) and length of stay (LOS: p = 0.99). CONCLUSION: Low food access had a significant association with 30-day AP-related readmissions and AP severity. However, mortality and LOS lacked significant association with food access. The association between nutrition, lifestyle, and AP outcomes warrants further prospective investigation.

Disparities in race, ethnicity, sex, and age inclusion in pancreatic cancer screening studies: a systematic review and meta-analysis.

BACKGROUND AND AIMS: Substantial differences exist in pancreatic cancer outcomes across ethnoracial stratifications. We sought to assess racial, ethnic, sex, and age reporting and inclusion of participants in pancreatic cancer screening studies. METHODS: A systematic search of Cochrane Library, Ovid Embase, Google Scholar, Ovid MEDLINE, PubMed, Scopus, and Web of Science Core Collection from inception to 2022 was conducted. Original studies on pancreatic cancer screening were identified and assessed for reporting and inclusion on race, ethnicity, sex, and age. The pooled proportions of study participants for these characteristics were calculated and compared with population-based benchmarks. RESULTS: Among 27 eligible pancreatic cancer screening studies, 26 reported data on either sex, race, or ethnicity, with a total of 5273 participants. Information on participant sex was reported by 26, race by 12, and ethnicity by 8 studies. Participants in these studies were almost all white (pooled proportion, 93.1%; 95% confidence interval [CI], 89.7-96.4) and non-Latino (pooled proportion, 97.4%; 95% CI, 94.0-100), and these groups were over-represented when compared with the general population. Female participants were well represented, with a pooled proportion of 63.2% (95% CI, 59.9-66.6). When reported, mean or median participant age was <60 years. Meta-regression revealed higher proportions of female participants in studies from the United States (P = .002). No association between increasing participation of racial or ethnic under-represented populations and study quality, ascending year of publication, or source of study funding was noted. CONCLUSIONS: Substantial disparities in race, ethnicity, sex, and age reporting and inclusion in pancreatic cancer studies were noted, even among high-quality and publicly funded studies.

Revisión sistemática de la literatura sobre medidas aerodinámicas de la fonación / Systematic literature review on aerodynamic measures of the phonation

Objetivo: El presente estudio muestra una revisión sistemática de la literatura relacionada con las aplicaciones clínicas e investigativas de las medidas aerodinámicas de la fonación: presión subglótica, flujo transglótico y resistencia glótica. Metodología: La revisión se realizó en las bases de datos PubMed y Web Of Science con una ventana temporal 2000-2017. Todos los artículos revisados obtuvieron nivelI. Luego de realizar una evaluación crítica de la evidencia científica, fueron catalogados como estudios clínicos aleatorizados con diseños experimentales. Resultados: Se entregan a partir de la asociación de las medidas aerodinámicas con seis categorías de análisis: a)como método objetivo de evaluación clínica; b)estudios con profesionales de la voz cantada y hablada; c)aplicaciones clínicas e investigativas en patologías laríngeas funcionales; d)investigaciones en diferentes grupos etarios; e)estudios en laringes caninas, y f)estudios en ejercicios con tracto vocal semiocluido. Conclusiones: Se demuestra la objetividad de aplicar medidas aerodinámicas en los estudios de la voz patológica y profesional; las medidas aerodinámicas de la fonación pueden aplicarse en población tanto pediátrica como adulta, y en adultos mayores

Objective: The present study shows a systematic review of the literature, related to the clinical and investigative implementations of aerodynamic measurements of phonation: subglottic pressure, transglottic airflow and glottal resistance. Method: The review was performed in PubMed and Web of Science databases with a time window 2000-2017. All articles reviewed obtained levelI. After performing a critical assessment of the scientific evidence, articles were classified as randomized clinical studies with experimental designs. Results: They are delivered from the association of aerodynamic measurements with six categories of analysis: a)as an objective method for clinical evaluation; b)studies with professional singing and speaking voice users; c)clinical and research implementations in functional laryngeal pathologies; d)research in different age groups; e)studies in canine larynx; and f)studies in voice exercises with semi-occluded vocal tract. Conclusions: The objectivity of implementing aerodynamic measures in pathological and professional voice studies is demonstrated; the aerodynamic measures of phonation can be applied in the pediatric population, as well as in adults and the elderly

[Systematic review of the efectiveness of community-based interventions to decrease neonatal mortality]. / Revisión sistemática sobre la efectividad de intervenciones basadas en la comunidad en la disminución de la mortalidad neonatal.

We evaluated the efficacy/effectiveness of community-based interventions to decrease neonatal mortality. A systematic review of randomized controlled trials, cluster randomized trials and cohort studies of interventions on pregnant women, neonates (up to 28 days after birth) or both was made. Thirty four studies were evaluated (n=844,989): 20 in pregnant women (n=406,172), 6 in neonates (n=24,994), and 8 in both (n=413,823). Risk of bias was generally low. There was heterogeneity among interventions. Interventions such as maternal health education and maternal and neonatal home care were associated to a decrease in neonatal mortality in half of the 6 studies of each group. Supplementation with multiple micronutrients, kangaroo mother care, and maternal supplementation with vitamin A did not decrease neonatal mortality. A few heterogeneous community-based interventions demonstrated a decrease in neonatal mortality.

Revisión sistemática sobre la efectividad de intervenciones basadas en la comunidad en la disminución de la mortalidad neonatal / Systematic review of the efectiveness of community-based interventions to decrease neonatal mortality

Se evalúa la eficacia/efectividad de las intervenciones basadas en la comunidad, destinadas a disminuir la mortalidad neonatal. Se realizó una revisión sistemática de ensayos controlados aleatorizados, ensayos aleatorizados de comunidad y estudios de cohortes de intervenciones dirigidas a la mujer gestante, al neonato (hasta 28 días de nacido) o a ambos. Se evaluaron 34 estudios (n=844,989): 20 en mujeres gestantes (n=406,172); 6 en neonatos (n=24,994), y 8 en ambos grupos (n=413,823). El riesgo de sesgo fue generalmente bajo. Hubo heterogeneidad entre los tipos de intervenciones. Las intervenciones educación materna en salud y cuidado en casa de madres y neonatos estuvieron asociadas con disminución de mortalidad neonatal en la mitad de los seis estudios de cada grupo. La suplementación materna con multimicronutrientes, el cuidado de madre canguro y la suplementación materna prenatal con vitamina A no disminuyeron la mortalidad neonatal. Pocas intervenciones comunitarias heterogéneas han demostrado disminuir la mortalidad neonatal...

We evaluated the efficacy/effectiveness of community-based interventions to decrease neonatal mortality. A systematic review of randomized controlled trials, cluster randomized trials and cohort studies of interventions on pregnant women, neonates (up to 28 days after birth) or both was made. Thirty four studies were evaluated (n=844,989): 20 in pregnant women (n=406,172), 6 in neonates (n=24,994), and 8 in both (n=413,823). Risk of bias was generally low. There was heterogeneity among interventions. Interventions such as maternal health education and maternal and neonatal home care were associated to a decrease in neonatal mortality in half of the 6 studies of each group. Supplementation with multiple micronutrients, kangaroo mother care, and maternal supplementation with vitamin A did not decrease neonatal mortality. A few heterogeneous community-based interventions demonstrated a decrease in neonatal mortality...

Evaluación de la seroprotección contra sarampión, rubéola y hepatitis B en niños menores de cinco años del Perú, 2011 / Evaluation of the seroprotection against measles, rubella and hepatitis B in children under 5 years of age in Peru, 2011

Objetivos. Estimar la prevalencia de anticuerpos contra sarampión, rubéola y hepatitis B en niños de 1 a 4 años del Perú. Materiales y métodos. Se realizó una encuesta nacional basada en la aplicación de un cuestionario y obtención de muestra de sangre capilar en papel de filtro para el estudio de anticuerpos contra sarampión, rubéola y hepatitis B en niños de 1 a 4 años. Se utilizó un muestreo probabilístico, estratificado y multietápico con inferencia a nivel nacional y siete ámbitos de estudio: Lima metropolitana, resto de costa urbana, costa rural, sierra urbana, sierra rural, selva urbana y selva rural. Las muestras de sangre capilar fueron procesadas siguiendo protocolos estandarizados para la determinación de anticuerpos mediante técnica de ELISA utilizando reactivos comerciales. Resultados. Se encontró una prevalencia nacional de 91,6% (IC95%: 90,6-92,7%), 91,3% (IC 95%: 90,3-92,4%) y 95,9% (IC 95%: 95,0-96,8%) para anticuerpos contra sarampión, rubéola y hepatitis B respectivamente. No se evidenció diferencias significativas de las prevalencias entre los diferentes ámbitos de estudio y en los diferentes estratos socioeconómicos de los conglomerados. Conclusiones. En niños de 1 a 4 años se ha estimado una prevalencia nacional de anticuerpos contra sarampión y rubéola entre 90-93%, mientras que para anticuerpos contra hepatitis B (anti-HBsAg) entre 95-97%.

Objectives. To estimate the prevalence of antibodies against measles, rubella and hepatitis B in children aged between 1 and 4 years in Peru. Materials and methods. A national survey was conducted based on a questionnaire and capillary blood sample taken on filter paper in order to study antibodies against measles, rubella and hepatitis B in children from 1 to 4 years of age. A stratified, multistage, probability sampling design was used to be representative at the national level and at level of seven ambits, including the Metropolitan Lima Area, the rest of the urban coast, the rural coast, the urban highlands, the rural highlands, the urban jungle and the rural jungle. The capillary blood samples were processed according to the standardized protocols for detection of antibodies using the ELISA technique and commercial reagents. Results. The survey showed a national prevalence of antibodies against measles, rubella and hepatitis B of 91.6% (CI 95%: 90.6%; 92.7%), 91.3% (CI 95%: 90.3%; 92.4%) and 95.9% (CI 95%: 95.0%; 96.8%) respectively. There was no evidence of significant differences in the prevalence among the ambits of study or among the socioeconomic strata of the conglomerates for any of the three types of antibodies. Conclusions. In children from 1 to 4 years of age, the national prevalence of antibodies against measles and Rubella was between 90-93%, while the prevalence of antibodies against Hepatitis B (anti-HBsAg) was between 95-97%.

Terapia con tracto vocal semi-ocluido: un estudio de caso / Voice therapy with semi-occluded vocal tract: a case study

Introducción: Los ejercicios de tracto vocal semi-ocluido hacen referencia a una serie de posturas que buscan alargar u ocluir el tracto vocal, generando de esta forma un cambio en el patrón vibratorio de los pliegues vocales. El mecanismo que explicaría los efectos percibidos después y durante el uso de estos ejercicios es el incremento de la inertancia del tracto vocal. Objetivo: El propósito de este trabajo es mostrar la aplicación de una secuencia de ejercicios de tracto vocal semi-ocluido como parte de un programa de tratamiento vocal y su efecto terapéutico en la fatiga vocal. Método: Estudiante de canto diagnosticado con fatiga vocal, presenta en el examen laringoscópico acumulación de mucus espeso en la glotis fonatoria y contracción laríngea antero-posterior. El plan terapéutico incluyó una secuencia de tareas fonatorias utilizando tubos de resonancia, programa de hidratación laríngea y eliminación del hábito de carraspeo. Resultados: Después de un mes se observa eliminación de la fatiga vocal, eliminación de la dificultad en los extremos de la tesitura, disminución de la mucosidad en la laringe y necesidad de aclarar la voz. Conclusiones: Los ejercicios con tracto vocal semi-ocluido pueden ser una herramienta efectiva en sujetos que presentan fatiga vocal. Estos ejercicios minimizan.

Introduction: Semi-occluded vocal tract exercises, involve a series of postures with extended and/or occluded vocal tract, producing a change in the vibration pattern of the vocal folds. The mechanism that explains the perceived effects during and after using these exercises is the increased vocal tract inertance. Objective: The purpose of this work is to show the application of a semi-occluded vocal tract exercise sequence as part of a voice treatment program and its therapeutic effect on vocal fatigue. Method: Singing student diagnosed with vocal fatigue presents mucus accumulation in phonatory glottis and antero-posterior contraction during a laringoscopy examination. The treatment plan included a phonatory sequence with resonance tubes, laryngeal hydration program and elimination of the clearing throat habit. Results: After one month of treatment, elimination of vocal fatigue, elimination of the difficulty production in the high vocal range, decreased mucus in the larynx and decreased clearing throat habit is observed. Conclusion: Semi-occluded vocal tract exercises can be an effective tool in subjects with vocal fatigue. These exercises minimize laryngeal muscular effort to promote vocal economy.

[Evaluation of the seroprotection against measles, rubella and hepatitis B in children under 5 years of age in Peru, 2011]. / Evaluación de la seroprotección contra sarampión, rubéola y hepatitis B en niños menores de cinco años del Perú, 2011.

OBJECTIVES: To estimate the prevalence of antibodies against measles, rubella and hepatitis B in children aged between 1 and 4 years in Peru. MATERIALS AND METHODS: A national survey was conducted based on a questionnaire and capillary blood sample taken on filter paper in order to study antibodies against measles, rubella and hepatitis B in children from 1 to 4 years of age. A stratified, multistage, probability sampling design was used to be representative at the national level and at level of seven ambits, including the Metropolitan Lima Area, the rest of the urban coast, the rural coast, the urban highlands, the rural highlands, the urban jungle and the rural jungle. The capillary blood samples were processed according to the standardized protocols for detection of antibodies using the ELISA technique and commercial reagents. RESULTS: The survey showed a national prevalence of antibodies against measles, rubella and hepatitis B of 91.6% (CI 95%: 90.6%; 92.7%), 91.3% (CI 95%: 90.3%; 92.4%) and 95.9% (CI 95%: 95.0%; 96.8%) respectively. There was no evidence of significant differences in the prevalence among the ambits of study or among the socioeconomic strata of the conglomerates for any of the three types of antibodies. CONCLUSIONS: In children from 1 to 4 years of age, the national prevalence of antibodies against measles and Rubella was between 90-93%, while the prevalence of antibodies against Hepatitis B (anti-HBsAg) was between 95-97%.

Calentamiento vocal en profesionales de la voz / Vocal warm up in voice professionals

El calentamiento vocal está constituido por una serie de ejercicios corporales, respiratorios y vocales con la finalidad de calentar la musculatura de los pliegues vocales, musculatura respiratoria, articulatoria y resonancial antes de una actividad más intensa para evitar la sobrecarga, el uso inadecuado o un cuadro de fatiga vocal. Dentro de los efectos fisiológicos del calentamiento vocal se describen el aumento de la temperatura muscular, el aumento del flujo sanguíneo, la disminución de la viscosidad y resistencia de los pliegues vocales, un incremento en la entrega de oxígeno, un aumento de la velocidad de evacuación de desechos de reacciones oxidativas y una disminución del riesgo de daño en el trabajo muscular, entre muchos otros. Desde el punto de vista subjetivo, después del calentamiento vocal la cualidad de la voz es mejor, requiere menos esfuerzo, y aumenta el grado de control y de flexibilidad. Se señala, además, que el calentamiento vocal tiene un efecto positivo en personas con alteraciones de la voz de variadas etiologías. Aunque los ejercicios específicos en las rutinas de calentamiento generalmente varían, éstos incluyen principalmente ejercicios de alineamiento corporal, entrenamiento respiratorio, ejercicios de emisión y ejercicios de resonancia. El calentamiento vocal efectivo es altamente individual, ya que cada voz responde en forma diferente a diferentes duraciones de calentamiento y en diferentes etapas de desarrollo vocal. Como objetivo final, el calentamiento vocal contribuye a la salud de la voz evitando el mal uso, disminuyendo el riesgo de fatiga vocal y evitando compensaciones musculares innecesarias, y aumenta la longevidad del órgano fonador en los profesionales de la voz (AU)

Vocal warm up consists of a series of body, breathing, and vocal exercises to heat the vocal folds and the muscles involved in breathing, articulation and resonance before more intense activity to prevent overloading, misuse or vocal fatigue. Some of the many physiological effects of vocal warm up are increased muscle temperature, blood flow and oxygen delivery, decreased viscosity and vocal fold resistance, a faster oxidative reaction disposal rate, and a reduced risk of muscle damage. From a subjective point of view, after a vocal warm up, voice quality is better, requires less effort, and control and flexibility are increased. Vocal warm up also has a positive effect on people with voice disorders of various etiologies. Although specific exercises in vocal warm up routines often vary, they mainly include body alignment exercises, breathing training, and resonance and phonation exercises. Effective vocal warm up is highly individual because each voice responds differently to distinct lengths of warm up exercises and at different stages of voice development. The main goal of vocal warm up is to contribute to vocal health by avoiding voice misuse, decreasing the risk of vocal fatigue, avoiding unnecessary muscle compensation and increasing voice longevity in voice professionals (AU)

La voz del cantante: una integración de ciencia y arte / The singer´s voice: a science and art integration

La fisiología y la técnica de la voz cantada, es un campo poco abordado por los especialistas de la voz. Para poder comprender todos los procesos involucrados, no sólo se requiere conocimiento teórico, sino también una experimentación personal práctica. De esta forma, se posibilita una adecuada evaluación e intervención fonoaudiológica, en pacientes cantantes que presentan alteraciones de la voz. En este artículo se exponen los aspectos más relevantes y diferenciadores de la voz cantada, considerando parámetros respiratorios, de emisión y resonancia.

The phisiology and technique of the singed voice, is poorly understood by the voice therapists. To understand the processes involved, not only it is necessary theorical knowledge, but also an experimental personal practice. Base on this, it is possible to do a successfully voice treatment and evaluations, to singer patients who suffering voice disorders. In this rewiew are discussed the most important aspects of the singed voice, considering respiratory, emission and resonance parameters and its influence on the singed voice therapy.