Exploring Texture and Biomechanics of Food Oral Processing in Fork-Mashable Dishes for Patients with Mastication or Swallowing Impairments.

Texture-modified diets (TMDs) are a primary compensatory treatment for hospitalized older patients with swallowing and mastication disorders. Nevertheless, the lack of a protocol for evaluating their objective textural properties hampers their industrialization and optimal patient care. OBJECTIVES: This study aimed (a) to evaluate the textural properties (maximum force, cohesiveness, and adhesiveness) and biomechanics of food oral processing (mastication cycles, time, and frequency) of ten fork-mashable dishes (Texture E BDA/IDDSI level 6), (b) to explore the impact of oral processing on texture, and (c) to measure the properties of the ready-to-swallow bolus (RSB) in healthy adults. METHODS: The textural properties (maximum force, cohesiveness, and adhesiveness) of ten dishes were analyzed with a texture analyzer before and after oral processing (RSB) in five healthy adults (30 ± 3.9, 3 women). Surface electromyography was used to measure mastication cycles, time, and frequency. RESULTS: The pre-mastication Texture Profile Analysis (TPA)-averaged values of maximum force ranged from 0.65 to 2.73 N, cohesiveness was 0.49-0.87, and adhesiveness was 0.01-0.95 N·s. Masticatory Cycles (46.87-19.13 MC) and time (36.73-15.80 S) from whole samples to RSB greatly and significantly differed among dishes, although frequency did not (1.68-1.11 MC/T). Post-mastication RSB TPA-averaged values of maximum force ranged from 0.70 to 2.24 N; cohesiveness, 0.49-0.73; and adhesiveness, 0.01-1.14 N·s. CONCLUSIONS: Despite all dishes being classified by the same qualitative descriptor (BDA level E/IDDSI level 6), there was a large and significant variation in their textural properties (maximum force, cohesiveness, and adhesiveness) when measured in SI units. In addition, in healthy adults, the masticatory cycles and time to achieve RSB greatly differed, whereas masticatory frequency remained quite constant.

[Cross-sectional study on sleep habits and new technologies use in high school students.] / Estudio transversal sobre hábitos de sueño y nuevas tecnologías en estudiantes de ciclos formativos.

OBJECTIVE: During lasts years, the use of information and communication technologies (ICTs) have boomed up, as well as their related- harmful behaviours. Parallel, time and quality of sleep has reduced along current society, which implies negatively in health in medium and long-terms. The present study aims to evaluate the association between lifestyle habits and quality of sleep of a subpopulation of young students. METHODS: An observational transversal study has been performed in Certificate of Medium and Higher Education from a High school of Alcázar de San Juan (Ciudad Real, Spain), who filled up a survey related to their lifestyle habits and the use of ICTs. Furthermore, the survey also included several variables related to quality of sleep by using Pittsburgh test. Bivariate comparisons using student test or Mann-Whitney U test, or Chi-square or exact test depending on the variable were performed. Afterwards, logistic regression was also done. RESULTS: The study sample were 286 students (43.4% women) were included being 22.2±7.3 years old on average. 99.7% of them owned mobile phone, using it 42 hours per week. Average total score of Pittsburgh test was 6.4±3.5, being higher in women (7.36±3.8) than in men (5.62±3.1). Moreover, 51.7% of surveyed students suffered from sleep disorders, being associated to several risk factors, such us using mobile phone while lying and without light (OR=2.04; CI95% [1.12-3.73]), using mobile phone in the middle of the night (OR=1.9; CI95% [1.06-3.42]) and drinking and smoking (OR=2.28; CI95% [1.14-4.55]). On the other hand, practising sports was defined as protector factor (OR=0.43; CI95% [0.26-0.72]). CONCLUSIONS: More than half of surveyed suffer from sleep disorders, mainly derived from the inadequate use of ICTs, showing differences between genders.

OBJETIVO: Durante los últimos años se ha incrementado el uso de nuevas tecnologías de la información y comunicación (TIC), así como los comportamientos nocivos en relación a su uso. Paralelamente, se ha descrito un descenso en el tiempo y calidad del sueño, lo cual repercute negativamente en la salud a medio y largo plazo. El objetivo del presente estudio fue evaluar la asociación de los diferentes hábitos con la calidad del sueño de una subpoblación de jóvenes estudiantes. METODOS: Se realizó un estudio observacional transversal de ciclos formativos en un instituto de educación secundaria de Alcázar de San Juan (Ciudad Real), basado en una encuesta sobre hábitos de vida y uso de nuevas tecnologías, además de diferentes variables relacionadas con el sueño, evaluadas mediante el índice de Pittsburgh. Se hicieron comparaciones bivariadas mediante t de student o U de Mann Whitney, o test de Chi-cuadrado (o test exacto) según variables. Posteriormente se realizó regresión logística. RESULTADOS: La muestra estuvo compuesta por 286 estudiantes con una edad media de 22,2±7,3 y siendo mujeres un 43,4%. El 99,7% tenía teléfono móvil, el cual utilizaban de media 42 horas a la semana. La puntuación media del test de Pittsburgh fue de 6,4±3,5, siendo mayor en las mujeres (7,36±3,8) que en los hombres (5,62±3,1). El 51,7% de los encuestados presentaban trastornos de sueño, siendo los factores asociados el uso del móvil acostado y sin luz (OR=2,04; IC95% [1,12-3,73]), el uso del móvil en mitad de la noche (OR=1,9; IC95% [1,06-3,42]), el consumo de tabaco y alcohol (OR=2,28; IC95% [1,14-4,55]) y hacer deporte como factor protector (OR=0,43 IC95% [0,26-0,72]). CONCLUSIONES: Más de la mitad de los encuestados presentan trastornos de sueño, fundamentalmente debido a un uso inadecuado de las TIC, existiendo diferencias claras entre hombres y mujeres.

Estudio transversal sobre hábitos de sueño y nuevas tecnologías en estudiantes de ciclos formativos / Cross-sectional study on sleep habits and new technologies use in high school students

Fundamentos: Durante los últimos años se ha incrementado el uso de nuevas tecnologías de la información y comunicación(TIC), así como los comportamientos nocivos en relación a su uso. Paralelamente, se ha descrito un descenso en el tiempo y calidaddel sueño, lo cual repercute negativamente en la salud a medio y largo plazo. El objetivo del presente estudio fue evaluar la asociaciónde los diferentes hábitos con la calidad del sueño de una subpoblación de jóvenes estudiantes.Métodos: Se realizó un estudio observacional transversal de ciclos formativos en un instituto de educación secundaria deAlcázar de San Juan (Ciudad Real), basado en una encuesta sobre hábitos de vida y uso de nuevas tecnologías, además de diferentesvariables relacionadas con el sueño, evaluadas mediante el índice de Pittsburgh. Se hicieron comparaciones bivariadas mediante t destudent o U de Mann Whitney, o test de Chi-cuadrado (o test exacto) según variables. Posteriormente se realizó regresión logística.Resultados: La muestra estuvo compuesta por 286 estudiantes con una edad media de 22,2±7,3 y siendo mujeres un 43,4%.El 99,7% tenía teléfono móvil, el cual utilizaban de media 42 horas a la semana. La puntuación media del test de Pittsburgh fue de6,4±3,5, siendo mayor en las mujeres (7,36±3,8) que en los hombres (5,62±3,1). El 51,7% de los encuestados presentaban trastornosde sueño, siendo los factores asociados el uso del móvil acostado y sin luz (OR=2,04; IC95% [1,12-3,73]), el uso del móvil en mitad de lanoche (OR=1,9; IC95% [1,06-3,42]), el consumo de tabaco y alcohol (OR=2,28; IC95% [1,14-4,55]) y hacer deporte como factor protector(OR=0,43 IC95% [0,26-0,72]).Conclusiones: Más de la mitad de los encuestados presentan trastornos de sueño, fundamentalmente debido a un uso inade-cuado de las TIC, existiendo diferencias claras entre hombres y mujeres.(AU)

Background: During lasts years, the use of information and communication technologies (ICTs) have boomed up, as well astheir related- harmful behaviours. Parallel, time and quality of sleep has reduced along current society, which implies negatively inhealth in medium and long-terms. The present study aims to evaluate the association between lifestyle habits and quality of sleep ofa subpopulation of young students.Methods: An observational transversal study has been performed in Certificate of Medium and Higher Education from a High schoolof Alcázar de San Juan (Ciudad Real, Spain), who filled up a survey related to their lifestyle habits and the use of ICTs. Furthermore, thesurvey also included several variables related to quality of sleep by using Pittsburgh test. Bivariate comparisons using student test orMann-Whitney U test, or Chi-square or exact test depending on the variable were performed. Afterwards, logistic regression was also done.Results: The study sample were 286 students (43.4% women) were included being 22.2±7.3 years old on average. 99.7% of themowned mobile phone, using it 42 hours per week. Average total score of Pittsburgh test was 6.4±3.5, being higher in women (7.36±3.8)than in men (5.62±3.1). Moreover, 51.7% of surveyed students suffered from sleep disorders, being associated to several risk factors,such us using mobile phone while lying and without light (OR=2.04; CI95% [1.12-3.73]), using mobile phone in the middle of the night(OR=1.9; CI95% [1.06-3.42]) and drinking and smoking (OR=2.28; CI95% [1.14-4.55]). On the other hand, practising sports was defined asprotector factor (OR=0.43; CI95% [0.26-0.72]).Conclusions: More than half of surveyed suffer from sleep disorders, mainly derived from the inadequate use of ICTs, showingdifferences between genders.(AU)

[Donor/recipient age index (DoRAIn) as an independent predictor of long-term living-donor renal graft function]. / Índice de edad donador/receptor (DoRAIn) como un predictor independiente de la función del injerto de donante vivo renal a largo plazo.

PROBLEM: The effect of donor/recipient age disparity on living-donor renal graft function is controversial. The objective of this study is to find new clinical predictors of renal graft function and evaluate the effect of donor/recipient age disparity in our series. METHODS: A retrospective review of our institutional renal transplantation database was performed. We calculated the glomerular filtration rate of our patients with the Chronic Kidney Disease Epidemiology Collaboration formula. Our receptors were categorized using a cut-off of 60 ml/min calculated glomerular filtration rate. An index called "Donor/Recipient Age Index" was created based on the interaction between donor/recipient ages. Univariable and multivariable regression analysis were performed. The Mantel-Cox model was used for statistical analysis. RESULTS: A total of 220 donor/recipient pairs were selected from January 2005 to August 2013. Only 186 pairs completed the one-year follow-up. The mean age of the donors was 35.3 ± 10.4 years and 31.6 ± 11.7 years for the recipients. The Donor/Recipient Age Index significantly predicted a glomerular filtration rate < 60 ml/min at one-year follow-up in univariable (p = 0.02) and multivariable (p = 0.033) regression models. CONCLUSION: We propose the Donor/Recipient Age Index as a significant predictor of long-term graft function.

Alphanumeric paging in an academic military hospital setting.

OBJECTIVE: To determine whether implementation of an alphanumeric-paging system would improve physician work environment. DESIGN: Surveys were distributed to all internal medicine residents, faculty, and nurses before and after implementation of an alphanumeric-paging system. MEASUREMENTS: User satisfaction with the paging system was measured using a Likert format survey. RESULTS: Physician preintervention (before deployment of the alphanumeric pager system) perceptions were inflated with regard to the impact of the implementation of the new pager system on delivery of care (average survey score of 1.65 vs. 2.07, p=0.031) and its ability to minimize interruptions (1.62 vs. 2.36, p=0.013), but both pre- and postintervention (after deployment of the alphanumeric pager system) perceptions were positive. Physician perceptions were significantly more positive with respect to time to locate the pager number (average survey score of 1.77 vs. 1.07, p=0.001), and the percentage of pages requiring a callback (average percentage of 71-80% vs. 50-60%, p=0.016). For nursing staff, preintervention perceptions were significantly more positive with regard to time saved (3.33 vs. 2.11, p=0.025) and in improving delivery of patient care (3.44 vs. 2.39, p = 0.034). CONCLUSIONS: Study participants rated the alphanumeric paging system highly. Such systems have the potential to improve delivery of patient care, minimize interruptions in learning, improve physician efficiency, and improve time management of both physicians and nursing staff.

Ethics training for military medical trainees: the Brooke Army Medical Center experience.

Biomedical ethics training during graduate medical education programs is required by the Accreditation Council for Graduate Medical Education. Apart from this requirement, medical ethics education is an integral component of military medical practice. Although ethics education and training are required, tools to assess the effectiveness of ethics education are not well developed. Furthermore, although biomedical ethics education is mandated for new Army physician trainees, there has not been a systematic objective assessment of the effectiveness of that training. We report the concept underlying the design and implementation of a military biomedical ethics seminar for new Army physician trainees. Combining a didactic component and case analysis through small-group discussions, we emphasized providing tools to analyze ethical dilemmas both in the medical center environment and in the operational medicine environment. A total of 47 Army interns participated in the seminar. Eighty-nine percent of participants agreed or strongly agreed that the ethics orientation met expectations. Seventy-two percent agreed or strongly agreed that the information presented would affect their practice. Ninety-six percent thought that the small-group discussions were effective, and 80% thought that the presentations enhanced knowledge from medical school.