Sleep is essential for the health of midlife women, yet the barriers (factors that impede) and facilitators (factors that support) to achieving adequate sleep, particularly among working-class women in Mexico City and broader Latin American contexts, remains insufficiently understood. This study aims to provide a nuanced understanding of the factors influencing sleep among working-class midlife women in Mexico City. A mixed-methods approach, combining quantitative data (epidemiologic measures) and qualitative data (ethnographic interviews), was employed among women enrolled in a Mexico City cohort. We used epidemiologic data to describe sleep and its correlates in a sample of 120 women, incorporating both self-reported (questionnaires and sleep diaries) and behavioral (actigraphy-based) measures of sleep. A subset of 30 women participated in in-depth ethnographic interviews to explore determinants of sleep, including barriers, facilitators and coping strategies to compensate for sleep loss. Our findings reveal that many women experienced poor sleep, with 43% reporting insomnia-related difficulties and 53% experiencing short sleep duration. Barriers included family-related stress, particularly caregiving responsibilities, economic instability, and mental health challenges. In response to sleep loss, women often resorted to coping mechanisms, such as caffeine consumption and napping, and the use of natural remedies. This study highlights the critical role social factors, including family dynamics and caregiving roles, in shaping sleep health outcomes. Sleep, as an inherently social behavior, is strongly influenced by these contextual factors. These findings underscore the importance of considering psychosocial and cultural contexts in interventions aimed at promoting healthy sleep in midlife women.

Maternal diet during pregnancy has been associated with obesity among offspring. The extent to which trimester-specific dietary patterns are associated with markers of adiposity during adolescence remains unclear. We examined associations between prenatal diet patterns with adolescent offspring measures of adiposity and adipokines in 384 mother–adolescent dyads from the Mexico City ELEMENT cohort. Trimester-specific diet patterns were derived from principal component analysis of food frequency questionnaire data. Adolescent anthropometry and serum leptin and adiponectin were measured at 10–17 years. Three maternal diet patterns were identified: Prudent Diet (PD), high in fish and vegetables, the High Meat and Fat Diet (HMFD), high in pork and processed meats, and the Transitioning Mexican Diet (TMD), high in corn tortillas and sugar-sweetened beverages. Multiple linear regression was used to estimate sex-stratified associations among quartiles of diet patterns with adiposity and adipokines, adjusting for maternal marital status, education, and parity. First trimester TMD was associated with greater anthropometric measures and higher leptin in females, while third trimester HMFD was associated higher body fat percentage, triceps thickness, waist circumference, and leptin, but lower adiponectin among males. Contrary to expectation, there were positive associations between the trimester 1 PD pattern and anthropometric measurements in females, and for trimester 2 HMFD and TMD patterns with adipokines among males. Findings suggest maternal diet patterns may influence offspring adiposity markers during adolescence in a sex-specific manner.

Introduction: An increasing number of Canadian paramedic services are creating Community Paramedic programs targeting treatment of long-term care (LTC) patients on-site. We explored the characteristics, clinical course and disposition of LTC patients cared for by paramedics during an emergency call, and the possible impact of Community Paramedic programs. Methods: We completed a health records review of paramedic call reports and emergency department (ED) records between April 1, 2016 and March 31, 2017. We utilized paramedic dispatch data to identify emergency calls originating from LTC centers resulting in transport to one of the two EDs of the Ottawa Hospital. We excluded patients with absent vital signs, a Canadian Triage and Acuity Scale (CTAS) score of 1, and whose transfer to hospital were deferrable or scheduled. We stratified remaining cases by month and selected cases using a random number generator to meet our apriori sample size. We collected data using a piloted standardized form. We used descriptive statistics and categorized patients into groups based on the ED care received and if the treatment received fit into current paramedic medical directives. Results: Characteristics of the 381 included patients were mean age 82.5 years, 58.5% female, 59.7% hypertension, 52.6% dementia and 52.1% cardiovascular disease. On arrival at hospital, 57.7% of patients waited in offload delay for a median time of 45 minutes (IQR 33.5-78.0). We could identify 4 groups: 1) Patients requiring no treatment or diagnostics in the ED (7.9%); 2) Patients receiving ED treatment within current paramedic medical directives and no diagnostics (3.2%); 3) Patients requiring diagnostics or ED care outside current paramedic directives (54.9%); and 4) patients requiring admission (34.1%). Most patients were discharged from the ED (65.6%), and 1.1% died. The main ED diagnoses were infection (18.6%) and musculoskeletal injury (17.9%). Of the patients that required ED care but were discharged, 64.1% required x-rays, 42.1% CT, and 3.4% ultrasound. ED care included intravenous fluids (35.7%), medication (67.5%), antibiotics (29.4%), non-opioid analgesics (29.4%) and opioids (20.7%). Overall, 11.1% of patients didn't need management beyond current paramedic capabilities. Conclusion: Many LTC patients could receive care by paramedics on-site within current medical directives and avoid a transfer to the ED. This group could potentially grow using Community Paramedics with an expanded scope of practice.

Introduction: Emergency department (ED) crowding, long waits for care, and paramedic offload delay are of increasing concern. Older adults living in long-term care (LTC) are more likely to utilize the ED and are vulnerable to adverse events. We sought to identify existing programs that seek to avoid ED visits from LTC facilities where allied health professionals are the primary providers of the intervention and, to evaluate their efficacy and safety. Methods: We completed this systematic review based on a protocol we published apriori and following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. We systematically searched Medline, CINAHL and EMBASE with terms relating to long-term care, emergency services, hospitalization and allied health personnel. Two investigators independently selected studies and extracted data using a piloted standardized form and evaluated the risk of bias of included studies. We report a narrative synthesis grouped by intervention categories. Results: We reviewed 11,176 abstracts and included 22 studies. Most studies were observational and few assessed patient safety. We found five categories of interventions including: 1) use of advanced practice nursing; 2) a program called Interventions to Reduce Acute Care Transfers (INTERACT); 3) end-of-life care; 4) condition specific interventions; and 5) use of extended care paramedics. Of the 13 studies that reported ED visits, all (100%) reported a decrease, and of the 16/17 that reported hospitalization, 94.1% reported a decrease. Patient adverse events such as functional status and relapse were seldom reported (6/22) as were measures of emergency system function such as crowding/inability of paramedics to transfer care to the ED (1/22). Only 4/22 studies evaluated patient mortality and 3/4 found a non-statistically significant worsening. When measured, studies reported decreased hospital length of stay, more time spent with patients by allied health professionals and cost savings. Conclusion: We found five types of programs/interventions which all demonstrated a decrease in ED visits or hospitalization. Many identified programs focused on improved primary care for patients. Interventions addressing acute care issues such as those provided by community paramedics, patient preferences, and quality of life indicators all deserve more study.

Introduction: Children account for a low proportion of paramedic transports. Evidence suggests that many pediatric transports are of low acuity, but there are few studies comparing these patients to those that self-present to the ED. Our primary objective was to determine if illness severity was associated with presentation by ambulance among pediatric patients. Methods: We undertook a single centre, retrospective cohort study at a tertiary care pediatric centre. All patients presenting to the ED in 2015 by any route other than air ambulance were eligible. Patients were divided into two groups based on the route of presentation – ambulance or self-presentation. The primary outcome was disposition decision; the secondary outcome was CTAS level. To determine whether patient discharge disposition or CTAS was associated with the method of arrival, we conducted generalized estimating equations (GEE) to account for correlation within patients with multiple ED visits. Results: Of the 69,092 visits, 69,034 were eligible and analyzed. Of those, 4478 (6.5%) arrived by ambulance, while 64,556 (93.5) self-presented. Those arriving by ambulance had a median age of 10 years [IQR: 2-5 years] vs. 4 years [IQR: 1.75-10 years] in the self-presenting group and were 52.6% male (vs. 52.8%). Two percent of the ambulance cohort were admitted to the ICU (vs. 0.2%), and 16.6% were admitted to the ward (vs. 5%). Patients presenting by ambulance had higher CTAS scores – 5.3% CTAS 1 (vs. 0.3%), 16.4% CTAS 2 (vs. 7.0%), 61.2% CTAS 3 (vs. 45.8%), and 17.1% CTAS 4-5 (vs. 46.9%). The odds of arriving by ambulance were 10.2 x higher for patients admitted to the ICU (OR = 10.2, 95%CI: 7.9 to 13.3) vs. those discharged home. The odds of arriving by ambulance were 64.2 x (OR = 64.2, 95% CI: 48.6 to 84.7) higher for patients CTAS 1 patients vs. CTAS 5 patients. The top 3 complaints among ambulance patients were neurological (22.5%), respiratory (22.7%), and orthopaedic (11.3%). Among self-presenting patients, the top three were general/minor (20.4%), respiratory (16.4%), and gastrointestinal (14.3%). Conclusion: Children presenting to the ED via ambulance are at higher risk for admission to the ward and critical care unit. It is important that paramedics have sufficient training to ensure adequate skills to manage critically ill children. Given the low proportion but higher severity of illness of pediatric transports, further research and consideration must be given to how best to enable paramedics in the management of children.

The purpose of this study was to compare epidemiological trends in suicide for the three regions of the United Kingdom (England and Wales, Northern Ireland, and Scotland) and for Ireland from 1960 to 1990. The data on suicide rates were obtained from the World Health Organization statistical base, supplemented by data from the statistical offices of the four regions. While the suicide rates in Ireland, Northern Ireland and Scotland increased during the period under study, English/Welsh suicide rates first declined and then held steady. In Ireland, both male and female suicide rates increased, whereas in the other regions only male suicide rates rose. According to age, in England and Wales, suicide rates rose for male teenagers and young males, while for the other regions male suicide rates increased in general for all age groups. Social indicators (unemployment, marriage and birth rates) were quite successful in predicting male suicide rates in all four regions and in predicting female suicide rates in England and Wales and in Ireland. The results emphasize the importance of studying several regions in epidemiological studies in order to identify which trends are general and which are unique to one nation. In the present study, the epidemiological trends for suicide in England and Wales were quite different from those in the other three regions. In particular, the steady overall suicide rate in England and Wales and the rising suicide rate for young males alone differ from the trends observed in the other regions and raise importante questions about the causes of the social suicide rate in these four regions.

Dilute aqueous solutions of dopamine buffered to an alkaline pH and in the presence of dissolved oxygen undergo to a series of autoxidation and rearrangement reactions that lead to the formation of a dark insoluble material called polydopamine (PDA) with melanin reminiscent properties. In this work we carried out this reaction in the presence of the photosynthetic reaction center (RC), a transmembrane pigment-protein complex responsible for the first light-induced reactions in the photosynthetic process. We have found that PDA grows in colloidal form around the RC and in the appropriate conditions the protein is entrapped in the PDA matrix without loss of functionality. The protein is still capable to perform its natural photocycle leading to the generation of photocurrents and the ubiquinone acceptor complex function is modulated by the PDA/RC ratio.

Bioelectronics requires versatile, efficient, and low-cost interfaces between the biological entities and the conductive unit. Conductive polymers represent a valid choice to assemble such interfaces able to extract or impinge charges between the biological units and the conductive electronic systems. A drawback in the use of such systems is that the polymerization reaction often takes place in environments whose chemical and physical characteristics clash with the mild conditions required for living biological systems. In the present work, we successfully prove that the conductive polymer poly(gallic acid) can be synthesized in medium designed for bacterial growth, characterised by the presence of several adverse conditions including numerous chemicals, high ionic strength, and almost neutral pH. The gallic acid successfully polymerizes within few hours and with a 40% yield, by exploiting the catalytic activity of the enzyme laccase from the polypore mushroom Trametes versicolor. The resulting polymer is characterised by absorption and Nuclear Magnetic Resonance spectroscopies. The viability of Rhodobacter sphaeroides culture, assessed via the coffee-ring technique, shows an important, but not complete detrimental effect of the gallic acid on the bacterial growth.