Influence of animal fat substitution by vegetal fat on Mortadella-type products formulated with different hydrocolloids

Meat has played a crucial role in human evolution and is an important component of a healthy and well-balanced diet on account of its nutritional properties, its high biological value as a source of protein, and the vitamins and minerals it supplies. We studied the effects of animal fat reduction and substitution by hydrogenated vegetal fat, sodium alginate and guar gum. Fatty acid composition, lipid oxidation, color and instrumental texture as well as the sensorial difference between low, substituted-fat and the traditional formulations for mortadella-type products were analyzed. Both substitution and reduction of animal fat decreased the saturated fatty acids percentage from 40% down to 31%. A texture profile analysis showed differences between the formulations. Furthermore, lipid oxidation values were not significant for treatments as regards the type and quantity of fat used while the use of sodium alginate and guar gum reduced the amounts of liquid released after cooking. Animal fat substitution does cause, however, a difference in overall sensorial perception compared with non-substituted products. The results confirm the viability of substituting vegetal fat for animal fat

A just world on a safe planet: a Lancet Planetary Health–Earth Commission report on Earth-system boundaries, translations, and transformations

The health of the planet and its people are at risk. The deterioration of the global commons—ie, the natural systems that support life on Earth—is exacerbating energy, food, and water insecurity, and increasing the risk of disease, disaster, displacement, and conflict. In this Commission, we quantify safe and just Earth-system boundaries (ESBs) and assess minimum access to natural resources required for human dignity and to enable escape from poverty. Collectively, these describe a safe and just corridor that is essential to ensuring sustainable and resilient human and planetary health and thriving in the Anthropocene. We then discuss the need for translation of ESBs across scales to inform science-based targets for action by key actors (and the challenges in doing so), and conclude by identifying the system transformations necessary to bring about a safe and just future. Our concept of the safe and just corridor advances research on planetary boundaries and the justice and Earth-system aspects of the Sustainable Development Goals. We define safe as ensuring the biophysical stability of the Earth system, and our justice principles include minimising harm, meeting minimum access needs, and redistributing resources and responsibilities to enhance human health and wellbeing. The ceiling of the safe and just corridor is defined by the more stringent of the safe and just ESBs to minimise significant harm and ensure Earth-system stability. The base of the corridor is defined by the impacts of minimum global access to food, water, energy, and infrastructure for the global population, in the domains of the variables for which we defined the ESBs. Living within the corridor is necessary, because exceeding the ESBs and not meeting basic needs threatens human health and life on Earth. However, simply staying within the corridor does not guarantee justice because within the corridor resources can also be inequitably distributed, aggravating human health and causing environmental damage. Procedural and substantive justice are necessary to ensure that the space within the corridor is justly shared. We define eight safe and just ESBs for five domains—the biosphere (functional integrity and natural ecosystem area), climate, nutrient cycles (phosphorus and nitrogen), freshwater (surface and groundwater), and aerosols—to reduce the risk of degrading biophysical life-support systems and avoid tipping points. Seven of the ESBs have already been transgressed: functional integrity, natural ecosystem area, climate, phosphorus, nitrogen, surface water, and groundwater. The eighth ESB, air pollution, has been transgressed at the local level in many parts of the world. Although safe boundaries would ensure Earth-system stability and thus safeguard the overall biophysical conditions that have enabled humans to flourish, they do not necessarily safeguard everyone against harm or allow for minimum access to resources for all. We use the concept of Earth-system justice—which seeks to ensure wellbeing and reduce harm within and across generations, nations, and communities, and between humans and other species, through procedural and distributive justice—to assess safe boundaries. Earth-system justice recognises unequal responsibility for, and unequal exposure and vulnerability to, Earth-system changes, and also recognises unequal capacities to respond and unequal access to resources. We also assess the extent to which safe ESBs could minimise irreversible, existential, and other major harms to human health and wellbeing through a review of who is affected at each boundary. Not all safe ESBs are just, in that they do not minimise all significant harm (eg, that associated with the climate change, aerosol, or nitrogen ESBs). Billions of people globally do not have sufficient access to energy, clean water, food, and other resources. For climate change, for example, tens of millions of people are harmed at lower levels of warming than that defined in the safe ESB, and thus to avoid significant harm would require a more stringent ESB. In other domains, the safe ESBs align with the just ESBs, although some need to be modified, or complemented with local standards, to prevent significant harm (eg, the aerosols ESB). We examine the implications of achieving the social SDGs in 2018 through an impact modelling exercise, and quantify the minimum access to resources required for basic human dignity (level 1) as well as the minimum resources required to enable escape from poverty (level 2). We conclude that without social transformation and redistribution of natural resource use (eg, from top consumers of natural resources to those who currently do not have minimum access to these resources), meeting minimum-access levels for people living below the minimum level would increase pressures on the Earth system and the risks of further transgressions of the ESBs. We also estimate resource-access needs for human populations in 2050 and the associated Earth-system impacts these could have. We project that the safe and just climate ESB will be overshot by 2050, even if everybody in the world lives with only the minimum required access to resources (no more, no less), unless there are transformations of, for example, the energy and food systems. Thus, a safe and just corridor will only be possible with radical societal transformations and technological changes. Living within the safe and just corridor requires operationalisation of ESBs by key actors across all levels, which can be achieved via cross-scale translation (whereby resources and responsibilities for impact reductions are equitably shared among actors). We focus on cities and businesses because of the magnitude of their impacts on the Earth system, and their potential to take swift action and act as agents of change. We explore possible approaches for translating each ESB to cities and businesses via the sequential steps of transcription, allocation, and adjustment. We highlight how different elements of Earth-system justice can be reflected in the allocation and adjustment steps by choosing appropriate sharing approaches, informed by the governance context and broader enabling conditions. Finally we discuss system transformations that could move humanity into a safe and just corridor and reduce risks of instability, injustice, and harm to human health. These transformations aim to minimise harm and ensure access to essential resources, while addressing the drivers of Earth-system change and vulnerability and the institutional and social barriers to systemic transformations, and include reducing and reallocating consumption, changing economic systems, technology, and governance

Complications related to less-invasive haemodynamic monitoring ‡

Background. The aim of this study was to evaluate the type and incidence of complications during insertion, maintenance, and withdrawal of central arterial catheters used for transpulmonary thermodilution haemodynamic monitoring (PiCCO (TM)). Methods. We conducted a prospective, observational, multicentre study in 14 European intensive care units (six countries). A total of 514 consecutive patients in whom haemodynamic monitoring by PiCCO (TM) was indicated were studied. Results. Five hundred and fourteen PiCCO catheters (475 in femoral, 26 in radial, nine in axillary, and four in brachial arteries) were inserted. Arterial access was obtained on the first attempt in 86.4% of the patients. Minor problems such as oozing after insertion (3.3%) or removal of the catheter (3.5%) were observed, but no episodes of serious bleeding (more than 50 ml) were recorded. Small local haematomas were observed after insertion (4.5%) and after removal (1.2%) of the catheter. These complications were not more frequent in patients with coagulation abnormalities. The incidence of site inflammation and catheter-related infection was 2% and 0.78%, respectively. Other complications such as ischaemia (0.4%), pulse loss (0.4%), or femoral artery thrombosis (0.2%) were rare, transient, and all resolved with catheter removal or embolectomy, respectively. Conclusions. In this series of patients, central arterial catheters used for PiCCO (TM) monitoring were demonstrated to be a safe alternative for advanced haemodynamic monitoring

Infecciones del tracto urinario bajo en adultos y embarazadas: consenso para el manejo empírico

Introducción: La infección no complicada del tracto urinario bajo y la bacteriuria asintomática son causas frecuentes de consulta médica ambulatoria y en el servicio de urgencias en Colombia y el mundo. La falta de pautas y consenso para el manejo, así como la emergencia de resistencia a las múltiples opciones terapéuticas disponibles en los uropatógenos provenientes de la comunidad, hacen necesario elaborar unas recomendaciones que orienten al clínico sobre el abordaje óptimo de estas entidades. Objetivo: Definir un consenso sobre el manejo empírico de la bacteriuria asintomática y la infección del tracto urinario (ITU) bajo en adultos y mujeres embarazadas en Colombia. Metodología: Se lleva a cabo una metodología de consenso con expertos en urología, infectología, medicina interna, ginecología y microbiología basada en la revisión de las referencias bibliográficas disponibles en los términos de búsqueda relacionados, haciendo énfasis en estudios locales. Resultados: Se elaboró un algoritmo de manejo para el tratamiento empírico de la ITU baja no complicada en adultos con antisépticos urinarios como nitrofurantoína y fosfomicina trometamol como primera línea, con recomendaciones terapéuticas específicas para el tratamiento de la bacteriuria asintomática en mujeres embarazadas. Adicionalmente, se formuló un algoritmo de decisión para el procesamiento de cultivos de orina. La recurrencia o recaída frecuente justifica remisión a urología e infectología. Conclusiones: Se generan recomendaciones prácticas de fácil implementación en el diagnóstico y manejo de la ITU bajo en adultos y embarazadas, y de los casos donde es necesario tratar la bacteriuria asintomática, con opciones terapéuticas efectivas y de espectro reducido

HIV testing history and access to treatment among migrants living with HIV in Europe

Introduction: Migrants are overrepresented in the European HIV epidemic. We aimed to understand the barriers and facilitators to HIV testing and current treatment and healthcare needs of migrants living with HIV in Europe. Methods: A cross-sectional study was conducted in 57 HIV clinics in nine countries (Belgium, Germany, Greece, Italy, The Netherlands, Portugal, Spain, Switzerland and United Kingdom), July 2013 to July 2015. HIV-positive patients were eligible for inclusion if they were as follows: 18 years or older; foreign-born residents and diagnosed within five years of recruitment. Questionnaires were completed electronically in one of 15 languages and linked to clinical records. Primary outcomes were access to primary care and previous negative HIV test. Data were analysed using random effects logistic regression. Outcomes of interest are presented for women, heterosexual men and gay/bisexual men. Results: A total of 2093 respondents (658 women, 446 heterosexual men and 989 gay/bisexual men) were included. The prevalence of a previous negative HIV test was 46.7%, 43.4% and 82.0% for women, heterosexual and gay/bisexual men respectively. In multivariable analysis previous testing was positively associated with: receipt of post-migration antenatal care among women, permanent residency among heterosexual men and identifying as gay rather than bisexual among gay/bisexual men. Access to primary care was found to be high (>83%) in all groups and was strongly associated with country of residence. Late diagnosis was common for women and heterosexual men (60.8% and 67.1%, respectively) despite utilization of health services prior to diagnosis. Across all groups almost three-quarters of people on antiretrovirals had an HIV viral load <50 copies/mL. Conclusions: Migrants access healthcare in Europe and while many migrants had previously tested for HIV, that they went on to test positive at a later date suggests that opportunities for HIV prevention are being missed. Expansion of testing beyond sexual health and antenatal settings is still required and testing opportunities should be linked with combination prevention measures such as access to PrEP and treatment as prevention. © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society