Loncheras de preescolares en cuatro instituciones educativas privadas de Lima, Perú, 2016-2017: tipos, contenidos, calorías y macronutrientes

Introducción: La modernización alimentaria ha llevado a una mayor disponibilidad de alimentos industrializados y una menor preferencia de alimentos más saludables. Esto afecta la alimentación de los preescolares a través de las loncheras preparadas en casa. Objetivo: Evaluar el aporte nutricional según el tipo de loncheras (composición básica adecuada y básica inadecuada) de los niños en etapa preescolar en cuatro instituciones educativas privadas del distrito de San Juan de Miraflores ubicado en Lima, Perú. Métodos: Estudio de tipo transversal analítico. Se realizó una encuesta al encargado de la preparación de la lonchera. Además, se inspecciono, pesó y se tomó fotografías de los alimentos y de las etiquetas de los productos industrializados. Se determinó su composición calórica usando tablas de composición de alimentos nacionales e internacionales, tipificando las loncheras como básica adecuada e inadecuada según las pautas del Ministerio de Salud del Perú (MINSA). Para los análisis estadísticos se utilizó estadística descriptiva y la prueba de Mann-Whitney-Wilcoxon. Resultados: De 183 personas encargadas de preparar la lonchera del preescolar, el 83.6% fueron madres de familia. Solo el 5.5% de las loncheras fueron clasificadas como “composición básica adecuada”. Entre los alimentos más comúnmente encontrados destacan el pan, plátano, huevo, yogurt, galletas y cereales. Las loncheras aportan entre 61 y 989 calorías, las de composición básica adecuada cubren mayor cantidad de proteínas. Finalmente, cubren el 24% del valor calórico total del niño y el 8% de fibra. Conclusiones: La mayoría de loncheras fue de composición básica inadecuada. La más frecuente se caracteriza por contener bebida y/o complemento no adecuado, y se recomienda que las estrategias educativas y promocionales deberían considerar esto en su formulación. Estos programas deben involucrar a quien preparar el alimento, al preescolar, la escuela y la comunidad.Introduction: Food modernization has led to greater availability of industrialized foods, and a lower preference for healthier foods. This affects the feeding of preschoolers through lunch boxes prepared at home. Objective: To evaluate the nutritional contribution according to the type of lunch boxes in four private educational institutions of the district of San Juan de Miraflores, located in Lima, Peru. Methods: Analytical cross-sectional study. A survey was made to the team preparing the lunch box. In addition, we inspected, weighed and took photographs of the food and the labels of the industrialized products. Its caloric use was determined using national and international composition tables, typifying the lunch boxes as an adequate basic and under the guidelines of the Ministry of Health of Peru (MINSA). For the statistical analysis of the descriptive test and the Mann-Whitney-Wilcoxon test. Results: Of 183 people in charge of preparing the pre-school lunch box, 83.6% were mothers. Only 5.5% of the lunch boxes were classified as "basic low". Among the most popular foods found include bread, banana, egg, yogurt, cookies and cereals. The lunch boxes provide between 61 and 989 calories, the most suitable cleaning functions cover more protein. Finally, they cover 24% of the child's total caloric value and 8% fiber. Conclusions: Most of the hours went down. The most frequent is characterized by containing drink and / or not adequate complement, and you recommend that the educational and promotional strategies be considered in their formulation. These programs should involve whoever prepares the food, the preschool, the school and the community.Tesi

Characteristics of the lunch box of pre-school children and nutritional knowledge of the carer: A pilot study in Lima, Peru, 2016

Cartas al EditorRevisión por pare

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Loncheras de preescolares en cuatro instituciones educativas privadas de Lima, Perú, 2016-2017: tipos, contenidos, calorías y macronutrientes

Introducción: La modernización alimentaria ha llevado a una mayor disponibilidad de alimentos industrializados y una menor preferencia de alimentos más saludables. Esto afecta la alimentación de los preescolares a través de las loncheras preparadas en casa. Objetivo: Evaluar el aporte nutricional según el tipo de loncheras (composición básica adecuada y básica inadecuada) de los niños en etapa preescolar en cuatro instituciones educativas privadas del distrito de San Juan de Miraflores ubicado en Lima, Perú. Métodos: Estudio de tipo transversal analítico. Se realizó una encuesta al encargado de la preparación de la lonchera. Además, se inspecciono, pesó y se tomó fotografías de los alimentos y de las etiquetas de los productos industrializados. Se determinó su composición calórica usando tablas de composición de alimentos nacionales e internacionales, tipificando las loncheras como básica adecuada e inadecuada según las pautas del Ministerio de Salud del Perú (MINSA). Para los análisis estadísticos se utilizó estadística descriptiva y la prueba de Mann-Whitney-Wilcoxon. Resultados: De 183 personas encargadas de preparar la lonchera del preescolar, el 83.6% fueron madres de familia. Solo el 5.5% de las loncheras fueron clasificadas como “composición básica adecuada”. Entre los alimentos más comúnmente encontrados destacan el pan, plátano, huevo, yogurt, galletas y cereales. Las loncheras aportan entre 61 y 989 calorías, las de composición básica adecuada cubren mayor cantidad de proteínas. Finalmente, cubren el 24% del valor calórico total del niño y el 8% de fibra. Conclusiones: La mayoría de loncheras fue de composición básica inadecuada. La más frecuente se caracteriza por contener bebida y/o complemento no adecuado, y se recomienda que las estrategias educativas y promocionales deberían considerar esto en su formulación. Estos programas deben involucrar a quien preparar el alimento, al preescolar, la escuela y la comunidad.Introduction: Food modernization has led to greater availability of industrialized foods, and a lower preference for healthier foods. This affects the feeding of preschoolers through lunch boxes prepared at home. Objective: To evaluate the nutritional contribution according to the type of lunch boxes in four private educational institutions of the district of San Juan de Miraflores, located in Lima, Peru. Methods: Analytical cross-sectional study. A survey was made to the team preparing the lunch box. In addition, we inspected, weighed and took photographs of the food and the labels of the industrialized products. Its caloric use was determined using national and international composition tables, typifying the lunch boxes as an adequate basic and under the guidelines of the Ministry of Health of Peru (MINSA). For the statistical analysis of the descriptive test and the Mann-Whitney-Wilcoxon test. Results: Of 183 people in charge of preparing the pre-school lunch box, 83.6% were mothers. Only 5.5% of the lunch boxes were classified as "basic low". Among the most popular foods found include bread, banana, egg, yogurt, cookies and cereals. The lunch boxes provide between 61 and 989 calories, the most suitable cleaning functions cover more protein. Finally, they cover 24% of the child's total caloric value and 8% fiber. Conclusions: Most of the hours went down. The most frequent is characterized by containing drink and / or not adequate complement, and you recommend that the educational and promotional strategies be considered in their formulation. These programs should involve whoever prepares the food, the preschool, the school and the community.esi

Characteristics of the lunch box of pre-school children and nutritional knowledge of the carer: A pilot study in Lima, Peru, 2016

Cartas al Edito

Phylogenomics and the rise of the angiosperms

International audienceAngiosperms are the cornerstone of most terrestrial ecosystems and human livelihoods 1,2 . A robust understanding of angiosperm evolution is required to explain their rise to ecological dominance. So far, the angiosperm tree of life has been determined primarily by means of analyses of the plastid genome 3,4 . Many studies have drawn on this foundational work, such as classification and first insights into angiosperm diversification since their Mesozoic origins 5–7 . However, the limited and biased sampling of both taxa and genomes undermines confidence in the tree and its implications. Here, we build the tree of life for almost 8,000 (about 60%) angiosperm genera using a standardized set of 353 nuclear genes 8 . This 15-fold increase in genus-level sampling relative to comparable nuclear studies 9 provides a critical test of earlier results and brings notable change to key groups, especially in rosids, while substantiating many previously predicted relationships. Scaling this tree to time using 200 fossils, we discovered that early angiosperm evolution was characterized by high gene tree conflict and explosive diversification, giving rise to more than 80% of extant angiosperm orders. Steady diversification ensued through the remaining Mesozoic Era until rates resurged in the Cenozoic Era, concurrent with decreasing global temperatures and tightly linked with gene tree conflict. Taken together, our extensive sampling combined with advanced phylogenomic methods shows the deep history and full complexity in the evolution of a megadiverse clade

Phylogenomics and the rise of the angiosperms.

Angiosperms are the cornerstone of most terrestrial ecosystems and human livelihoods1,2. A robust understanding of angiosperm evolution is required to explain their rise to ecological dominance. So far, the angiosperm tree of life has been determined primarily by means of analyses of the plastid genome3,4. Many studies have drawn on this foundational work, such as classification and first insights into angiosperm diversification since their Mesozoic origins5-7. However, the limited and biased sampling of both taxa and genomes undermines confidence in the tree and its implications. Here, we build the tree of life for almost 8,000 (about 60%) angiosperm genera using a standardized set of 353 nuclear genes8. This 15-fold increase in genus-level sampling relative to comparable nuclear studies9 provides a critical test of earlier results and brings notable change to key groups, especially in rosids, while substantiating many previously predicted relationships. Scaling this tree to time using 200 fossils, we discovered that early angiosperm evolution was characterized by high gene tree conflict and explosive diversification, giving rise to more than 80% of extant angiosperm orders. Steady diversification ensued through the remaining Mesozoic Era until rates resurged in the Cenozoic Era, concurrent with decreasing global temperatures and tightly linked with gene tree conflict. Taken together, our extensive sampling combined with advanced phylogenomic methods shows the deep history and full complexity in the evolution of a megadiverse clade

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline