Effectiveness of Health Action Interventions in Enhancing Diet Quality and Glycemic Control Among Individuals With Type 2 Diabetes Mellitus: A Systematic Review of Randomized Clinical Trials.

CONTEXT: Diet quality is directly related to glycemic control in individuals with type 2 diabetes mellitus (T2DM). The use of dietary indices can provide a comprehensive understanding of the relationship between diet quality and clinical outcomes. OBJECTIVE: The aim was to evaluate the relationship between diet quality, measured using dietary indices, and its impact on improving glycemic control in individuals with T2DM through health interventions. DATA SOURCE: This study was conducted using 6 databases, including Web of Science, MEDLINE (via PubMed), Embase, Bireme, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), as well as the gray literature (Google Academic). DATA EXTRACTION: Randomized clinical trials that evaluated the effectiveness of health interventions in adult and older adult individuals with T2DM and presented data on diet quality evaluated using dietary indices and the percentage of glycated hemoglobin (%HbA1c) were included. DATA ANALYSIS: A total of 3735 articles were retrieved, 4 of which were included in the study selection stages. The quality indices assessed in the studies were the Alternate Healthy Eating Index (AHEI), Healthy Eating Index-2010 (HEI-2010), Diet Quality Index-International (DQI-I), and Diet Quality Index-Revised (DQI-R). A reduction in %HbA1c was observed in 2 studies, which correlated with the AHEI and DQI-I scores in the intervention groups. The approach of using food labels to improve diet quality reduced %HbA1c by 0.08% in the intervention group compared with the control group. Only 1 study found no significant association between the DQI-R index and %HbA1c. Additionally, negative correlations were observed between body weight and the AHEI and DQI-I scores. CONCLUSION: Health interventions improved diet quality, glycemic control, and weight loss in individuals with T2DM. SYSTEMATIC REVIEW REGISTRATION: PROSPERO no. CRD42023430036.

Lymphoepithelioma-like carcinoma: a rare case of rectal cancer.

Lymphoepithelioma-like carcinoma (LELC) is a histological variant that resembles nasopharyngeal lymphoepithelioma and occurs in various locations such as the salivary glands and lung. LELCs in the digestive tract are rare, accounting for only 2% of cases, being exceptional in the rectum. We present the case of an 84-year-old man with rectorrhagia, whitish malodorous discharge and constipation of one month's duration. Rectal examination identified a tumour. Colonoscopy revealed a rectal lesion that was confirmed by biopsy as malignant, and MRI showed an extensive rectal tumour. Histopathology revealed undifferentiated carcinoma with acute inflammatory infiltrate, consistent with LELC. Immunohistochemistry was positive for keratins 5/6, 18, 20, CEA and BER.EP4, while in situ hybridisation for Epstein-Barr virus (EBV) RNA was negative. The multidisciplinary decision included neoadjuvant radiotherapy and anterior rectal resection. The patient remains in complete response two years after treatment. Histologically, LELC is characterised by an acute inflammatory infiltrate interspersed with poorly differentiated neoplastic cells. The stomach is the most commonly affected region in the gastrointestinal tract, with more than 80% of gastric LELCs associated with EBV. To date, only four cases of rectal LELC have been reported, and its association with EBV was demonstrated in only one case. There are no standard treatments for rectal LELC, underscoring the need to gather more cases to understand its pathogenesis and develop effective treatment strategies.

Relación entre la dieta, aspectos nutricionales y la calidad del sueño en población pediátrica / Relationship between diet, nutritional aspects and sleep quality in a pediatric population

La relación entre la dieta y el sueño ha sido escasamente estudiada en la población pediátrica. El objetivo de esta revisión fue analizar de forma narrativa la relación existente entre la dieta, determinados aspectos nutricionales y la calidad del sueño en esta población. Se seleccionaron estudios que midieran la dieta y valorasen el estado nutricional y el sueño en población infantil mediante la utilización de distintas herramientas. El riesgo de sesgo de los 14 estudios seleccionados se determinó con herramientas validadas. La adhesión a algunos patrones dietéticos como el mediterráneo, el alto consumo de frutas y verduras, la ingesta de triptófano o la sustitución de los ácidos grasos saturados por grasas insaturadas se relacionaron con una mejor calidad del sueño. El consumo de los productos ultraprocesados y la ingesta alta de azúcares simples dificultan un descanso adecuado. Por otro lado, se observó una asociación entre un índice de masa corporal alto y la falta de sueño en los jóvenes menores de 14 años. En conclusión, los estudios recogidos mostraron una asociación significativa entre algunos patrones dietéticos, grupos de alimentos y nutrientes con la calidad del sueño. Los factores dietéticos “poco saludables” se asociaron a una peor calidad del sueño. Sin embargo, hábitos y dietas más saludables y recomendados se relacionaron con una mejora de la higiene del sueño. Por otro lado, la falta de horas de descanso en la población juvenil se relaciona con el aumento de peso.(AU)

The relationship between diet and sleep has been studied in adults. However, there is little evidence in the pediatric population. The objective of this review was to analyze in a narrative way the relationship between diet, some nutritional aspects and sleep quality in population under 14 years. A quick review was performed in MEDLINE (PubMed) and Cochrane with a search strategy combining MeSH terms and keywords. Studies were selected to estimate diet and evaluate nutritional status and sleep in children using different tools. The risk of bias from the 14 selected studies was determined with validated tools (AMSTAR 2, Newcastle Ottawa scale [NOS] and Risk of Bias [Rob2]). Adherence to some dietary patterns such as the Mediterranean, high consumption of fruits and vegetables, tryptophan intake or substitution of saturated fatty acids by unsaturated fats were associated with better sleep quality. The consumption of ultra-processed products, the “unhealthy fast food” or the high intake of simple sugars hinder an adequate rest. On the other hand, an association between a high body mass index and lack of sleep was observed in young people under 14. In conclusion, the collected studies showed a significant association between some dietary patterns, food groups and nutrients with sleep quality. “Unhealthy” dietary factors were associated with poorer sleep quality. However, healthier and recommended habits and diets were associated with improved sleep hygiene. On the other hand, the lack of hours of rest in the youth population increases height, weight and BMI. Further research is needed in this direction.(AU)

Effect of the ketogenic diet as a treatment for refractory epilepsy in children and adolescents: a systematic review of reviews.

CONTEXT: Epilepsy is one of the most prevalent neurological disorders in childhood. Antiepileptic drugs are the preferred treatment. However, 30% of children continue suffering seizures. A ketogenic diet (KD) is one of the emerging alternative treatments. OBJECTIVE: This review aims to analyze the current evidence regarding the use of a KD for the treatment of refractory epilepsy (RE) in childhood. DATA SOURCES: A systematic review of reviews was performed, based on MEDLINE (PubMed) as at January 2021. DATA EXTRACTION: The data extracted included the first author's last name; the year of publication; the country; the study design; the population; the diagnosis, concept, and description of KD types; and major outcome. RESULTS: Twenty-one reviews were included, 8 with systematic methodology (2 of them included a meta-analysis) and 13 with unsystematic methodology. The main difference between the 2 types of reviews is the reproducibility of their methodology. Therefore, the results of each type of review were analyzed separately. Each type of review described 4 categories of KD: classic KD, modified Atkins diet (MAD), use of medium-chain triglycerides (MCTs), and low glycemic index treatment (LGIT). In terms of effectiveness, the considered systematic reviews reported reductions in the frequency of seizures greater than 50% in about half of the patients. Reviews without systematic methodology reported that 30%-60% of the children showed a 50% or greater reduction in seizures. The most frequently described adverse effects in the 8 systematic reviews were: vomiting (6/8), constipation (6/8), and diarrhea (6/8); and in the unsystematic reviews: vomiting and nausea (10/13), constipation (10/13), and acidosis (9/13). CONCLUSION: KD can be an effective treatment for RE, with a more than 50% reduction in the frequency of seizures and cognitive improvement being achieved in half of the pediatric patients. The effectiveness of the various types of KD is comparable, and the KD can be adapted to the needs of the patient. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42021244142.

Patrones y factores dietéticos y su asociación con la ansiedad en población adulta: propuesta de recomendaciones basada en una revisión de alcance de revisiones sistemáticas y metaanálisis / Dietary patterns and factors and their association with the anxiety in adult population: proposed recommendations based on a scoping review of systematic reviews and meta-analyses

Un alto porcentaje de la población sufre ansiedad, trastorno que puede verse influenciado por los hábitos dietéticos. El objetivo de esta revisión fue recopilar la evidencia existente sobre los patrones y factores dietéticos, y su asociación con la ansiedad para proponer unas recomendaciones clínicamente aplicables. Se realizó una revisión de alcance (Scoping Review) de revisiones sistemáticas y metaanálisis en la base de datos MEDLINE (PubMed) hasta enero de 2021, informando de los principales hallazgos según PRISMA (2020). Para construir la estrategia de búsqueda, se emplearon el lenguaje MeSH, palabras clave (“dieta”, “nutrientes”, “estilo de vida saludable”, “ansiedad”) y filtros, combinándose mediante operadores booleanos. Se seleccionaron 12 artículos, siete revisiones sistemáticas con metaanálisis y cinco revisiones sistemáticas. Se obtuvieron diversos resultados en los que se evaluaba la relación entre la ansiedad y diferentes aspectos de la dieta. Las principales asociaciones encontradas se observaron entre un mayor consumo de verduras crudas y frutas, la sustitución de cereales refinados por integrales, la ingesta de AGP omega-3 y omega-6 y el incremento del consumo de minerales y vitaminas, triptófano y antioxidantes. De acuerdo con las revisiones sistemáticas y metaanálisis incluidos como resultados, se propusieron diez recomendaciones sobre el consumo de alimentos y la ingesta de nutrientes que deberían priorizarse en estos pacientes. Según la literatura revisada, se concluye que existen patrones y factores dietéticos que podrían ejercer una mayor influencia protectora sobre la ansiedad. Esta propuesta de recomendaciones dietéticas basadas en la evidenciapermitirá a los profesionales sanitarios disponer de unas pautas actualizadas que sirvan como una primera guía. (AU)

A high percentage of the population suffers from anxiety, a disorder that can be influenced by dietary habits. The aim of this review was to compile the existing evidence on dietary patterns and factors, and their association with anxiety to propose clinically applicable recommendations. A scoping review of systematic reviews and meta-analyses was conducted in the MEDLINE database (PubMed) until January 2021, reporting the main findings based on PRISMA (2020). To construct the search strategy, MeSH language, keywords (“diet”, “nutrients”, “healthy lifestyle”, “anxiety”) and filters were used, combined using Boolean operators. Twelve articles, seven systematic reviews with meta-analysis and five systematic reviews were selected. Several results were obtained evaluating the relationship between anxiety and different aspects of diet. The main associations found were between increased consumption of raw vegetables and fruits, substitution of refined cereals by whole grains, intake of omega-3 and omega-6 fats, and increased intake of minerals and vitamins, tryptophan and antioxidants. Based on the systematic reviews and meta-analyses included as findings, ten recommendations on food consumption that should be considered as a priority for these patients were proposed. Based on the literature reviewed, it is concluded that there are dietary patterns and factors that could have a stronger positive influence on anxiety. This proposal of evidence-based dietary recommendations may allow healthcare professionals to have updated recommendations to provide a first orientation. (AU)

Dietary intake, nutritional adequacy and food sources of vitamins involved in the methionine-methylation cycle from Spanish children aged one to <10 years: results from the EsNuPI study.

Background: Methionine-methylation cycle and the derived critical functions during infancy are key regulated by folates, vitamins B12, and B6. At present in Spain, there is an absence of studies that assess the intakes and dietary sources of total folates and B12 by children consuming all types of milks and those regularly consuming adapted milk formulas. Thus, our aim was to evaluate folates intakes alongside with vitamins B6 and B12 while describing their major dietary contributors in Spanish children aged one to <10 years. Methods: A total of 1,448 children aged between 1 and 10 years (49.7% girls and 50.3% boys) from the EsNuPI, a prospective cross-sectional study, were allocated into two cohorts: one Spanish Reference Cohort (SRS) of the general population (n = 707), and another including children consuming adapted milks called Adapted Milk Consumers Cohort (AMS) (n = 741) completed two 24 h dietary recalls used to estimate their nutrient intakes and to compare them to the European Food Safety Authority (EFSA) Population Reference Intakes. Results: The median intake of vitamin B6 was 1.35 (1.06-1.70) mg/day in the SRS and 1.45 (1.17-1.79) mg/day in the AMS, being significantly higher in the AMS for all age-groups. Prevalence of adequacy for vitamin B6 in the SRS and AMS was 97.7 and 98.7%, respectively. Total folates intakes in the AMS were significantly higher (p ≤ 0.001) in all age groups than in the SRS, independently of age. In addition, the prevalence of adequacy for folates intakes in all groups was more than 60%. Vitamin B12 intake increased with age independently of the type of milk consumed. The prevalence of adequacy for vitamin B12 was highly compliant by all population groups. The major contributors to vitamin B6 were milk and dairy products being significantly higher in AMS than SRS (p ≤ 0.001). The highest contributors to folates intakes were milk and dairy products, cereals, vegetables, and fruits in both groups whereas for vitamin B12 in the SRS sample were milk and dairy products followed by meat and meats products and for adapted milks, were milk and dairy products, followed by eggs, then meat and meats products. Conclusion: A satisfactory prevalence of adequacy for vitamins B6, and B12 amongst the Spanish children population was observed, which was not the case for folates, regardless of the dietary group evaluated. Nevertheless, a possible strategy to increase folate intake among the youngest children is to increase the consumption of milk and dairy products within a healthier dietary pattern, as these may contribute significantly to the vitamin needs of the infant population.

[Dietary patterns and factors and their association with the anxiety in adult population: proposed recommendations based on a scoping review of systematic reviews and meta-analyses]. / Patrones y factores dietéticos y su asociación con la ansiedad en población adulta: propuesta de recomendaciones basada en una revisión de alcance de revisiones sistemáticas y metaanálisis.

Introduction: A high percentage of the population suffers from anxiety, a disorder that can be influenced by dietary habits. The aim of this review was to compile the existing evidence on dietary patterns and factors, and their association with anxiety to propose clinically applicable recommendations. A scoping review of systematic reviews and meta-analyses was conducted in the MEDLINE database (PubMed) until January 2021, reporting the main findings based on PRISMA (2020). To construct the search strategy, MeSH language, keywords ("diet", "nutrients", "healthy lifestyle", "anxiety") and filters were used, combined using Boolean operators. Twelve articles, seven systematic reviews with meta-analysis and five systematic reviews were selected. Several results were obtained evaluating the relationship between anxiety and different aspects of diet. The main associations found were between increased consumption of raw vegetables and fruits, substitution of refined cereals by whole grains, intake of omega-3 and omega-6 fats, and increased intake of minerals and vitamins, tryptophan and antioxidants. Based on the systematic reviews and meta-analyses included as findings, ten recommendations on food consumption that should be considered as a priority for these patients were proposed. Based on the literature reviewed, it is concluded that there are dietary patterns and factors that could have a stronger positive influence on anxiety. This proposal of evidence-based dietary recommendations may allow healthcare professionals to have updated recommendations to provide a first orientation.

Introducción: Un alto porcentaje de la población sufre ansiedad, trastorno que puede verse influenciado por los hábitos dietéticos. El objetivo de esta revisión fue recopilar la evidencia existente sobre los patrones y factores dietéticos, y su asociación con la ansiedad para proponer unas recomendaciones clínicamente aplicables. Se realizó una revisión de alcance (Scoping Review) de revisiones sistemáticas y metaanálisis en la base de datos MEDLINE (PubMed) hasta enero de 2021, informando de los principales hallazgos según PRISMA (2020). Para construir la estrategia de búsqueda, se emplearon el lenguaje MeSH, palabras clave ("dieta", "nutrientes", "estilo de vida saludable", "ansiedad") y filtros, combinándose mediante operadores booleanos. Se seleccionaron 12 artículos, siete revisiones sistemáticas con metaanálisis y cinco revisiones sistemáticas. Se obtuvieron diversos resultados en los que se evaluaba la relación entre la ansiedad y diferentes aspectos de la dieta. Las principales asociaciones encontradas se observaron entre un mayor consumo de verduras crudas y frutas, la sustitución de cereales refinados por integrales, la ingesta de AGP omega-3 y omega-6 y el incremento del consumo de minerales y vitaminas, triptófano y antioxidantes. De acuerdo con las revisiones sistemáticas y metaanálisis incluidos como resultados, se propusieron diez recomendaciones sobre el consumo de alimentos y la ingesta de nutrientes que deberían priorizarse en estos pacientes. Según la literatura revisada, se concluye que existen patrones y factores dietéticos que podrían ejercer una mayor influencia protectora sobre la ansiedad. Esta propuesta de recomendaciones dietéticas basadas en la evidenciapermitirá a los profesionales sanitarios disponer de unas pautas actualizadas que sirvan como una primera guía.

[Relationship between diet, nutritional aspects and sleep quality in a pediatric population]. / Relación entre la dieta, aspectos nutricionales y la calidad del sueño en población pediátrica.

The relationship between diet and sleep has been studied in adults. However, there is little evidence in the pediatric population. The objective of this review was to analyze in a narrative way the relationship between diet, some nutritional aspects and sleep quality in population under 14 years. A quick review was performed in MEDLINE (PubMed) and Cochrane with a search strategy combining MeSH terms and keywords. Studies were selected to estimate diet and evaluate nutritional status and sleep in children using different tools. The risk of bias from the 14 selected studies was determined with validated tools (AMSTAR 2, Newcastle Ottawa scale [NOS] and Risk of Bias [Rob2]). Adherence to some dietary patterns such as the Mediterranean, high consumption of fruits and vegetables, tryptophan intake or substitution of saturated fatty acids by unsaturated fats were associated with better sleep quality. The consumption of ultra-processed products, the "unhealthy fast food" or the high intake of simple sugars hinder an adequate rest. On the other hand, an association between a high body mass index and lack of sleep was observed in young people under 14. In conclusion, the collected studies showed a significant association between some dietary patterns, food groups and nutrients with sleep quality. "Unhealthy" dietary factors were associated with poorer sleep quality. However, healthier and recommended habits and diets were associated with improved sleep hygiene. On the other hand, the lack of hours of rest in the youth population increases height, weight and BMI. Further research is needed in this direction.

Association between an oxidative balance score and mortality: a prospective analysis in the SUN cohort.

PURPOSE: We aimed to prospectively investigate the association of an overall oxidative balance score (OBS) with all-cause death and cause-specific mortality among participants in the Seguimiento Universidad de Navarra (SUN) Study, a Mediterranean cohort of Spanish graduates. METHODS: Using baseline information on 12 a priori selected dietary and non-dietary lifestyle pro- and antioxidants exposures-vitamins C and E, ß-carotenes, selenium, zinc, heme iron, polyphenols, total antioxidant capacity, body mass index, alcohol, smoking, and physical activity-we constructed an equally weighted OBS categorized into quartiles, with higher scores representing greater antioxidant balance. Cox proportional hazards models were fitted to evaluate the association between the OBS and mortality. RESULTS: A total of 18,561 participants (mean [SD] age, 38.5 [12.4] years; 40.8% males) were included in the analysis. During a median follow-up of 12.2 years (interquartile range 8.3-14.9), 421 deaths were identified, including 80 deaths from cardiovascular disease (CVD), 215 from cancer, and 126 from other causes. After adjustment for potential confounders, the hazard ratios and 95% confidence interval (CIs) between the highest quartile (predominance of antioxidants) vs. the lowest quartile (reference category) were 0.35 (95% CI 0.22-0.54, P-trend < 0.001) for all-cause mortality, 0.18 (95% CI 0.06-0.51, P-trend = 0.001) for CVD mortality, 0.35 (95% CI 0.19-0.65, P-trend = 0.002) for cancer mortality, and 0.45 (95% CI 0.20-1.02, P-trend = 0.054) for other-cause mortality. CONCLUSION: Our findings suggest a strong inverse association between the OBS and all-cause, CVD, and cancer mortality. Individuals exposed to both antioxidant dietary and lifestyle factors may potentially experience the lowest mortality risk. STUDY REGISTRY NUMBER: Dynamic Mediterranean Prospective Cohort: the SUN Project; NCT02669602. https://clinicaltrials.gov/ct2/show/NCT02669602 . https://proyectosun.es.

Adherence to Oxidative Balance Scores is Associated with a Reduced Risk of Breast Cancer; A Case-Control Study.

We aimed to examine whether anthropometric indices, dietary factors, and nutrient intakes of women with and without breast cancer (BrCa) are associated with the oxidative balance score (OBS). This case-control study was carried out among 253 patients with BrCa and 267 healthy subjects aged >18 years. The OBS was calculated by using the following 13 dietary and non-dietary anti- and prooxidant components: dietary antioxidants (selenium, fiber, ß-carotene, vitamin D, vitamin C, vitamin E, and folate), dietary prooxidants (iron and saturated and polyunsaturated fatty acids), and nondietary anti- (physical activity) and prooxidants (smoking and obesity). The binary logistic regression was used to determine the association OBS with BrCa. After adjusting for potential confounders in the final model, there was evidence that the odds of BrCa decreased with increasing categories of the OBS (OR = 0.53, 95% CI 0.28 - 0.98; P-trend = 0.021). When we made stratified analysis by menopausal status, OBS was inversely associated with odds of BrCa in premenopausal women after adjusting for potential confounders. No significant association was found between OBS and odds of BrCa among post-menopausal women. Our data suggest that OBS scores were associated with decreased BrCa risk in the overall population.

Associations of the Paleolithic Diet Pattern Scores and the Risk of Breast Cancer among Adults: A Case-Control Study.

Evidence suggests the role of changing traditional lifestyle patterns such as Paleolithic to modern lifestyle in the incidence and epidemic of chronic diseases. Thus, this study aimed to investigate the association between Paleolithic diet (PD) and risk of Breast Cancer (BC) in adult Iranian women. This matched case-control study included 253 women with BC and 267 healthy women aged >18 years. PD score was evaluated using a validated 168-item quantitative food frequency questionnaire. Conditional logistic regression model was used to estimate odds ratios (ORs) and 95% confidence intervals (95%CIs), and dose-response was investigated. Mean of PD score was 39.00 ± 6.39. Among the food groups of the PD components, BC patients significantly had lower consumption of healthy food groups as vegetables, fruits, fish, and nuts, higher intakes of sugar-sweetened beverages as well as grains and starches. After adjustment for potential confounders, comparing the highest quartile of PD scores with the lowest quartile, a decrease in the risk of BC was observed for all women (OR: 0.26; 95% CI: 0.13-0.53), as well as those premenopausal (OR: 0.29; 95% CI: 0.11), and postmenopausal (OR: 0.17; 95% CI: 0.05 - 0.56). Our findings show that adherence to the PD pattern significantly reduces the risk of BC in the population studied. However, prospective studies are needed to further investigate this association.

Construyendo conciencia de sostenibilidad en estudiantes de negocios: percepciones de docentes universitarios / Enhancing Sustainability Awareness Among Business Students: Insights from University Professors

Antecedentes: la educación superior, especialmente en negocios, se destaca como un medio crucial para promover un accionar profesional centrado en la sostenibilidad, enfatizando la necesidad de enfoques pedagógicos y estrategias didácticas innovadoras. Objetivo: este estudio tiene como finalidad explorar las percepciones de docentes universitarios de carreras de negocios acerca de cuáles son las metodologías de enseñanza-aprendizaje más convenientes para fomentar la conciencia de sostenibilidad entre sus estudiantes. Método: en este trabajo cualitativo exploratorio se usó un muestreo por conveniencia por el cual se seleccionó y entrevistó a 19 profesores de desempeño destacados que imparten cursos en una universidad privada y acreditada de Lima, Perú. Resultados: los profesores consideran fundamental un desarrollo transversal y continuo de contenidos relacionados con la sostenibilidad en la malla curricular. Además, valoran el empleo de metodologías de aprendizaje vivencial, así como el desarrollo del diálogo y la reflexividad sobre el futuro rol de sus estudiantes como líderes organizacionales que promuevan modos de producción más conscientes y sostenibles. Conclusiones: la educación en sostenibilidad en carreras de negocios cobra sentido en la medida de que la conducta que adopten los futuros líderes empresariales dependerá del éxito en la implantación de modos de producción más conscientes y sostenibles. Sin embargo, para que esta formación sea efectiva son necesarias adaptaciones en el diseño de las mallas curriculares y en la forma tradicional de conducir los procesos de enseñanza-aprendizaje en el aula, migrando desde enfoques centrados en el docente hacia enfoques metodológicos centrados en el estudiante. Palabras clave: sostenibilidad, metodologías de enseñanza, educación para el desarrollo sostenible (EDS), percepciones docentes, actitudes hacia la sostenibilidad.

Background: Higher education, especially in business, stands out as a crucial means to promote professional action focused on sustainability, emphasizing the need for innovative pedagogical approaches and teaching strategies. Objective: The aim of this study is to examine the perceptions of business university professors concerning the most effective teaching and learning methodologies for fostering sustainability awareness among their students. Method: This exploratory qualitative study, employs convenience sampling to select and interview 19 outstanding professors from a private accredited university in Lima, Peru. Results: The professors emphasize the importance of a cross-cutting and ongoing integration of sustainability-related content into the curriculum. Additionally, they place value on the utilization of experiential learning methodologies and the cultivation of dialogue and reflexivity regarding the future roles of their students as organizational leaders who champion more conscientious and sustainable modes of production. Conclusions: sustainability education in business careers makes sense to the extent that the behavior adopted by future business leaders will depend on the success in the implementation of more conscious and sustainable modes of production. However, for this training to be effective, adaptations are needed in the design of curricula and in the traditional way of conducting the teaching-learning processes in the classroom, migrating from teacher-centered approaches to student-centered methodological approaches. Keywords: sustainability, teaching methods, professors perceptions, education for sustainable development (ESD), sustainability attitudes.

The Quality Index for Nutrition in Nursing Homes (QUINN). A new tool for evaluating diet quality in long-term care homes.

Introduction: Background: the assessment of diet quality (DQ) is fundamental to the study of disease-diet associations, and it is necesary to implement an easy to-apply tool in nursing homes (NHs). Our objective was to propose and apply a novel diet quality indicator (DQIn) using an a priori approach for NHs. Methods: the QUality Index for Nutrition in Nursing homes (QUINN) was implemented in a public NH located in Valladolid, Spain, during a 5-week period (n = 137 subjects). The choice of the QUINN components was based on a rapid review. The QUINN was based on 15 dietary components - 12 were basic (vegetables, fruits, legumes, olive oil, cereals, dairy, white fish and seafood, white-meat, eggs/positive; other fats, red and processed meat, and sweets/negative), and 3 were supplementary (fruits and vegetables variety, oily-fish, and whole-grains/positive). Each component was classified into 4-categories (0, 1, 2 o 3 points; range: 0-45 points). Results: the QUINN was tested on a menu offered by a NH giving a result of 34 points (good diet). The components with the highest scores were related to the Mediterranean diet (high consumption of legumes, olive oil, white fish and shellfish; low intake of other fats; and a wide variety of fruits and vegetables), together with cereals, white meat, dairy, and eggs. The components that required a major change were red- and processed-meats, sweets, and whole grains. Conclusion: the menu of this Spanish NH showed a good DQ according to the QUINN. The assessment of the DQ in NHs using QUINN will allow the proposal of interventions aimed at improving their diet.

Introducción: Antecedentes: la valoración de la calidad de la dieta es fundamental para el estudio de las asociaciones enfermedad-dieta, y es necesario implantar una herramienta de fácil aplicación en las residencias de ancianos. Nuestro objetivo fue proponer y aplicar un nuevo indicador de calidad de la dieta (diet quality indicator, DQIn) utilizando un enfoque a priori para su utilización en residencias de ancianos. Métodos: el Índice de Calidad Nutricional en Residencias de Ancianos (QUality Index for Nutrition in Nursing homes, QUINN) se aplicó en una residencia pública de Valladolid durante un periodo de 5 semanas (n = 137 sujetos). La elección de los componentes del QUINN se basó en una revisión rápida. En el QUINN se consideraron 15 componentes dietéticos, 12 básicos (verduras, frutas, legumbres, aceite de oliva, cereales, lácteos, pescado blanco y marisco, carnes blancas, huevos/positivos; otras grasas, carnes rojas y procesadas, y dulces/negativos) y 3 adicionales (variedad de frutas y verduras, pescado azul, y cereales integrales/positivos). Cada componente se clasificó en 4 categorías (0, 1, 2 o 3 puntos; rango: 0-45 puntos). Resultados: el QUINN se aplicó en el menú ofertado por una residencia de ancianos dando un resultado de 34 puntos (dieta de buena calidad). Los componentes con mayor puntuación estaban relacionados con la dieta mediterránea (alto consumo de legumbres, aceite de oliva, pescado blanco y marisco, bajo consumo de otras grasas y variedad de frutas y verduras), junto con los cereales, las carnes blancas, los lácteos y los huevos. Los componentes que requerían un cambio importante fueron las carnes rojas y procesadas, los dulces y los cereales integrales. Conclusión: el menú de esta residencia de ancianos situada en España mostró una calidad de la dieta buena según el QUINN. La evaluación de la calidad de la dieta en las residencias de ancianos mediante el QUINN permitirá proponer intervenciones para mejorar la dieta.

Principales modelos de triaje extrahospitalario básico y avanzado / Main models of basic and advanced outpatient triage

Objetivo: describir los diferentes modelos de triaje extrahospitalario básico (TB) y avanzado (TA) más utilizados, sus conceptos básicos y sus procedimientos de actuación. Objetivos específicos: analizar sus parámetros, principales características, ventajas, inconvenientes, eficacia y tiempo de realización.Método: se efectuó una revisión panorámica según la metodología PRISMA, en MEDLINE (PubMed), SciELO, Google Scholar y la página del Consejo Español de Triage Prehospitalario y Hospitalario, hasta enero de 2021. Se incluyeron resultados sobre los principales modelos de triaje extrahospitalarios aplicados en incidentes de múltiples víctimas y catástrofes. Se excluyeron los relacionados con el coronavirus y con población pediátrica.Resultados: se recuperaron 465 referencias, de las cuales se seleccionaron finalmente 16. Los métodos de TB más empleados fueron START, SHORT, CareFlight y Sieve, y de TA el META. La mayoría de los modelos de TB derivaba del método START, que es el más conocido y aplicado a nivel mundial, aunque requiere más tiempo junto con Sieve, al contrario que SHORT y especialmente CareFlight que es el más rápido. El SHORT es el que tiene mayor sensibilidad y especificidad; por su parte, el SALT fue el más completo porque incluye las compresiones torácicas y la autoadministración de inyectables. En general, el modelo META fue superior al resto al realizar un mejor triaje de las víctimas.Conclusiones: la mayoría de métodos de triaje son válidos y útiles, siendo el META superior a los basados en el START. La elección del método dependerá del tipo de incidente, del sector donde se encuentre la víctima y de la formación del personal.(AU)

Objectives: to describe the different models of basic (BT) and advanced (AT) outpatient triage more widely used, their basic concepts and protocols of action. Secondary objectives: to analyse their parameters, main characteristics, advantages, drawbacks, efficacy and completion time.Method: a panoramic review was conducted according to the PRISMA methodology, in MEDLINE (PubMed), SciELO, Google Scholar and the Spanish Council of Outpatient and Hospital Triage website, until January 2021. The study included results about the main models of outpatient triage applied in incidents with multiple victims and catastrophes. Those associated with coronavirus and pediatric population were excluded.Results: for this study, 465 references were retrieved, and 16 out of these were finally selected. The most widely used BT methods were START, SHORT, CareFlight and Sieve, and META for AT. Most BT models are derived from the START method, which is the most widely known and applied at global level, even though it requires more time, the same as Sieve, and unlike SHORT and particularly CareFlight, which is the fastest. The SHORT method has the highest sensitivity and specificity; on the other hand, the SALT method is the most complete, because it includes chest compressions and self-administration of injectable drugs. Overall, the META model was superior to the rest, in terms of performing a better triage of victims.Conclusions: most triage methods are valid and useful; META is superior to those based on START. The choice of method will depend on the type of incident, its setting, and staff training.(AU)

The Quality Index for Nutrition in Nursing Homes (QUINN). A new tool for evaluating diet quality in long-term care homes / El índice de calidad de la nutrición en las residencias de ancianos (QUINN). Una nueva herramienta para evaluar la calidad de la dieta en las residencias de ancianos

Antecedentes: la valoración de la calidad de la dieta es fundamental para el estudio de las asociaciones enfermedad-dieta, y es necesario implantar una herramienta de fácil aplicación en las residencias de ancianos. Nuestro objetivo fue proponer y aplicar un nuevo indicador de calidad de la dieta (diet QUALITY indicator, DQIn) utilizando un enfoque a priori para su utilización en residencias de ancianos. Métodos: el Índice de Calidad Nutricional en Residencias de Ancianos (QUALITY Index for NUTRITION in NURSING homes, QUINN) se aplicó en una residencia pública de Valladolid durante un periodo de 5 semanas (n = 137 sujetos). La elección de los componentes del QUINN se basó en una revisión rápida. En el QUINN se consideraron 15 componentes dietéticos, 12 básicos (verduras, frutas, legumbres, aceite de oliva, cereales, lácteos, pescado blanco y marisco, carnes blancas, huevos/positivos; otras grasas, carnes rojas y procesadas, y dulces/negativos) y 3 adicionales (variedad de frutas y verduras, pescado azul, y cereales integrales/positivos). Cada componente se clasificó en 4 categorías (0, 1, 2 o 3 puntos; rango: 0-45 puntos). Resultados: el QUINN se aplicó en el menú ofertado por una residencia de ancianos dando un resultado de 34 puntos (dieta de buena calidad). Los componentes con mayor puntuación estaban relacionados con la dieta mediterránea (alto consumo de legumbres, aceite de oliva, pescado blanco y marisco, bajo consumo de otras grasas y variedad de frutas y verduras), junto con los cereales, las carnes blancas, los lácteos y los huevos. Los componentes que requerían un cambio importante fueron las carnes rojas y procesadas, los dulces y los cereales integrales. Conclusión: el menú de esta residencia de ancianos situada en España mostró una calidad de la dieta buena según el QUINN. La evaluación de la calidad de la dieta en las residencias de ancianos mediante el QUINN permitirá proponer intervenciones para mejorar la dieta. (AU)

Background: the assessment of diet QUALITY (DQ) is fundamental to the study of disease-diet associations, and it is necesary to implement an easy to-apply tool in NURSING homes (NHs). Our objective was to propose and apply a novel diet QUALITY indicator (DQIn) using an a priori approach for NHs. Methods: the QUALITY Index for NUTRITION in NURSING homes (QUINN) was implemented in a public NH located in Valladolid, Spain, during a 5-week period (n = 137 subjects). The choice of the QUINN components was based on a rapid review. The QUINN was based on 15 dietary components — 12 were basic (vegetables, fruits, legumes, olive oil, cereals, dairy, white fish and seafood, white-meat, eggs/positive; other fats, red and processed meat, and sweets/negative), and 3 were supplementary (fruits and vegetables variety, oily-fish, and whole-grains/positive). Each component was classified into 4-categories (0, 1, 2 o 3 points; range: 0-45 points). Results: the QUINN was tested on a menu offered by a NH giving a result of 34 points (good diet). The components with the highest scores were related to the Mediterranean diet (high consumption of legumes, olive oil, white fish and shellfish; low intake of other fats; and a wide variety of fruits and vegetables), together with cereals, white meat, dairy, and eggs. The components that required a major change were red- and processed-meats, sweets, and whole grains. Conclusion: the menu of this Spanish NH showed a good DQ according to the QUINN. The assessment of the DQ in NHs using QUINN will allow the proposal of interventions aimed at improving their diet. (AU)

Dietary Intake, Nutritional Adequacy, and Food Sources of Selected Antioxidant Minerals and Vitamins; and Their Relationship with Personal and Family Factors in Spanish Children Aged 1 to <10 Years: Results from the EsNuPI Study

Minerals and vitamins involved in the antioxidant defense system are essential for healthy growth and proper development during infancy. Milk and dairy products are of particular importance for improving the supply of these nutrients to children. Indeed, the present study aimed to evaluate the nutrient intake and food sources of zinc (Zn), selenium (Se), retinol and carotenoids (sources of vitamin A), and vitamins C and E, and to analyze their relationships with personal and familiar factors in Spanish children from the EsNuPI study. One subpopulation representative of the Spanish population from 1 to <10 years old (n = 707) (reference group, REF) who reported consuming all types of milk over the last year, and another subpopulation of the same age who reported consuming fortified milk formulas (FMFs) (including follow-on formula, young child formula, growing up milk, toddler's milk, and enriched and fortified milk) (n = 741) (fortified milk consumers, FMCs) completed two 24 h dietary recalls used to estimate their nutrient intakes and to compare them to the European Food Safety Authority (EFSA) Dietary Reference Values (DRVs). The REF reported higher median intakes than FMCs for Se (61 µg/kg vs. 51 µg/kg) and carotenoids (1079 µg/day vs. 998 µg/day). Oppositely, FMCs reported higher intakes than REF for Zn (7.9 mg/day vs. 6.9 mg/day), vitamin A (636 µg/day vs. 481 µg/day), vitamin E (8.9 mg/day vs. 4.5 mg/day), vitamin C (113 mg/day vs. 71 mg/day), and retinol (376 µg/day vs. 233 µg/day). In the REF group, more than 50% of the children met the EFSA recommendations for Zn (79.6%), Se (87.1%), vitamin A (71.3%), and vitamin C (96.7%), respectively. On the other hand, 92.2% were below the EFSA recommendations for vitamin E. In the FMC group, more than 50% of the children met the EFSA recommendations for Zn (55.2%), Se (90.8%), vitamin A (75.7%), vitamin E (66.7%), and vitamin C (100%). We found statistically significant differences between subpopulations for all cases except for Se. In both subpopulations, the main sources of all antioxidant nutrients were milk and dairy products. For carotenoids, the main sources were vegetables and fruits followed by milk and dairy products. A high percentage of children had vitamins A and E intakes below the recommendations, information of great importance to stakeholders. More studies using intakes and biomarkers are needed, however, to determine an association with diverse factors of oxidative damage.

Biorefinery Approach Applied to the Production of Food Colourants and Biostimulants from Oscillatoria sp.

In this study, a biorefinery based on Oscillatoria sp. is developed to produce high-value compounds such as C-phycocyanin, used in food colourant applications, and biostimulants, used in agriculture-related applications. First, the Oscillatoria biomass production was optimized at a pilot scale in an open raceway reactor, with biomass productivities equivalent to 52 t/ha·year being achieved using regular fertilizers as the nutrient source. The biomass produced contained 0.5% C-phycocyanins, 95% of which were obtained after freeze-thawing and extraction at pH 6.5 and ionic strength (FI) 100 mM, with a purity ratio of 0.71 achieved in the final extract. This purity ratio allows for use of the extract directly as a food colourant. Then, the extract's colourant capacity on different beverages was evaluated. The results confirm that C-phycocyanin concentrations ranging from 22 to 106 mg/L produce colours similar to commercial products, thus avoiding the need for synthetic colourants. The colour remained stable for up to 12 days. Moreover, the safety of the extracted C-phycocyanin was confirmed through toxicity tests. The waste biomass was evaluated for use as a biostimulant, with the results confirming a relevant auxin-like positive effect. Finally, an economic analysis was conducted to evaluate different scenarios. The results confirm that the production of both C-phycocyanin and biostimulants is the best scenario from an economic standpoint. Therefore, the developed biomass processing scheme provides an opportunity to expand the range of commercial applications for microalgae-related processes.

Folliculitis decalvans: a case report of satisfactory recovery after implementing

ABSTRACT Introduction: Folliculitis decalvans is a rare skin disease characterized by the presence of painful papules and pustules with an underlying neutrophilic infiltrate, usually on the scalp. Its treatment is lengthy and challenging, and recurrence is relatively common. Although its etiology is unknown, several theories explaining its development have been proposed, including colonization by Staphylococcus aureus. Case description: This is the case of a 26-year-old male healthcare worker who visited the outpatient service after experiencing a 4-year history of painful pustules on the scalp; initially these lesions were located in the occipital region, but then also started to appear in the temporal and parietal regions. After being treated for bacterial folliculitis and having several recurrences, a skin biopsy was performed, which allowed diagnosing him with folliculitis decalvans. Once the diagnosis was made, isotretinoin (20mg) treatment was implemented for a year and a half, achieving complete remission of the lesions. Conclusion: Although this case has some limitations, such as the lack of histopathology images and some control laboratory tests, it clearly shows the difficulties faced when treating this type of skin disorders and presents an overview of the use of isotretinoin, evidencing that although this drug is well tolerated, possible adverse reactions from drug interactions with trimethoprim/sulfamethoxazole may arise. In addition, this case is of great importance since the possible presence of a familial cluster of folliculitis decalvans could be confirmed, if further genetic testing is performed.

RESUMEN Introducción. La folliculitis decalvans es una enfermedad dermatológica rara caracterizada por la presencia de pápulas y pústulas dolorosas que están acompañadas de un infiltrado de neutrófilos subyacente. Esta condición suele aparecer en el cuero cabelludo, su recurrencia es relativamente común y su tratamiento, largo y difícil. Aunque su etiología es desconocida, se han propuesto muchas teorías que intentan explicar su aparición, siendo la colonización por Staphylococcus aureus una de ellas. Presentación del caso. Hombre de 26 años que se desempeñaba como trabajador de la salud y consultó por un cuadro clínico de 4 años de evolución caracterizado por la aparición de pústulas dolorosas en la región occipital, las cuales posteriormente se extendieron a la región temporal y parietal. Después de tratarlo como una foliculitis infecciosa y tras múltiples recurrencias, se realizó una biopsia de las lesiones que permitió diagnosticarlo con folliculitis decalvans. Se instauró un tratamiento consistente de 20mg de isotretinoina al día por un año y medio, con el cual se logró la resolución de la folicutis. Sin embargo, dos años después tuvo un relapso, pero, según el paciente, esto pudo ocurrir por el consumo de derivados lácteos, ya que, según indicó, cuando suspende el consumo de esta clase de productos no aparecen más lesiones luego de 2-3 semanas. Conclusión. Aunque este caso tiene algunas limitaciones como la ausencia de imágenes histopatológicas y algunos laboratorios de control, muestra las dificultades para tratar este tipo de condiciones dermatológicas y presenta un panorama del uso de la isotretinoina, ya que evidencia que este medicamento tiene una buena tolerancia, pero presenta interacciones medicamentosas adversas con la trimetoprima/sulfametoxazol. Además, este caso es de gran importancia, ya que, si se realizan más pruebas genéticas, podría confirmarse la posible presencia de un grupo familiar de foliculitis decalvante.

Dietary Intake of Individual (Intrinsic and Added) Sugars and Food Sources from Spanish Children Aged One to <10 Years­Results from the EsNuPI Study

Currently, in Spain there are no studies assessing the intakes and sources of intrinsic and added sugars by both children consuming standard milks and children regularly consuming adapted milk formulas. Our goal was to evaluate current sugar intake levels (intrinsic and added) and their major dietary sources within the EsNuPI study participants by applying two 24-h dietary recalls that were completed by 1448 children (1 to <10 years) divided into two subsamples: One "Spanish Reference Sample" (SRS) of the general population (n = 707) and another sample which included children consuming adapted milks including follow-on milk, toddler's or growing up milk and fortified and enriched milks, here called "Adapted Milk Consumers Sample" (AMS) (n = 741). Estimates of intrinsic and added sugar intakes from the Spanish EsNuPI population as well as the adherence to recommendations varied notably according to age segment, but no major differences between subsamples were found. Younger children (1 to <3 years) showed the highest added sugar contribution to total energy intake (TEI) (SRS: 12.5% for boys and 11.7% for girls; AMS: 12.2% for boys and 11.3% for girls) and the lowest adherence to recommendations set at <10% TEI (SRS: 27.4% for boys and 37.2% for girls; AMS: 31.3% for boys and 34.7% for girls). Adherence increased with age but remains inadequate, with approximately one in two children from the older age segment (6 to <10 years) exceeding the recommendations. Main food sources of intrinsic sugars for both subsamples were milk and dairy products, fruits, vegetables and cereals, while for added sugars, these were milk and dairy products (mainly yogurts), sugars and sweets (mainly sugary cocoa and nougat), bakery products (mainly cookies) and cereals (mainly bread and wheat flour). However, for the AMS, the groups milk and dairy products and cereals showed a significantly lower contribution to intrinsic sugar intake but a significantly higher contribution to that of added sugars. These results demonstrate that sugar intake and the adherence to recommendations in the studied population varied notably according to age but not to the type of milk consumed. In addition, our results highlight the need to monitor the consumption of added sugars by the infant population, as well as the need to make efforts to facilitate this task, such as harmonizing the recommendations regarding free/added sugars and the inclusion of information on their content on the nutritional labeling of products in order to incorporate them into food composition databases.