Introduction: In public discourse and media, as well as in medical settings, dementia is often portrayed as a tragedy, a perspective that contributes to stigma. Descriptions using metaphors like decaying fruit, or statements labeling dementia as death in life’’ and a tsunami for healthcare systems,’’ not only perpetuate negative emotions like fear and helplessness, but also promote social distance. These dehumanizing expressions can intensify the suffering of those living with dementia and those around them, besides complicating understanding of the condition, exacerbating social isolation, and hindering timely medical attention. Questioning the narrative of dementia as a tragedy does not imply denying or underestimating the challenges and suffering associated with this condition. However, diagnosis should not hinder the recognition of moments of pleasure, the potential for internal growth of the person living with dementia and those around them, as well as the persistence of connection and dignity. The philosophy of ambiguity offers a useful framework for countering a stigmatizing narrative and addressing dementia with a more compassionate and nuanced approach. The philosophy of ambiguity, primarily expounded by Simone de Beauvoir, invites us to recognize the coexistence of multiple realities and the simultaneous presence of contradictions. This is reflected in the complex contradictions and paradoxes present in our experiences, both personal and social. Health itself is an ambiguous concept, representing not only the absence of illness but also a dynamic and multifaceted state, culturally and contextually influenced. By focusing on preserved abilities, we can contribute to the well-being of those living with dementia, reinforcing their dignity and self-esteem. The success of this approach depends on having adequate social support and an effective healthcare system. Understanding dementia in a broad social and cultural context allows us to overcome the traditional Manichean view that categorizes it strictly as either tragedy or well-being. It is crucial for medical personnel to use empathetic and respectful communication to maintain dignity and foster hope in those living with dementia. Listening carefully and avoiding stigmatizing language are fundamental to recognizing individual worth and creating a more compassionate and humane care environment.

Summary: Sexuality, often one of the least understood aspects of human behavior, encounters numerous prejudices, particularly in Latin American countries characterized by a repressive and machismo-infused education influenced by religious values, such as Catholicism. This cultural backdrop places women at a distinct disadvantage. According to the World Health Organization (WHO), sexuality encompasses various dimensions including sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction. Attitudes toward sexuality are shaped by past experiences, including affective, cognitive, and behavioral aspects. Societal norms for sexual activity, in the context of older adults have changed significantly. Research emphasizes the crucial role of sexual satisfaction in older adults’ overall health. The interaction of sexuality, communication, and relationship conflicts directly affects partnership satisfaction and well-being. Lack of sexual satisfaction is linked to emotional distress and physical issues, highlighting the need for medical attention and overcoming reluctance to seek help. These findings emphasize the complexity of older adults’ sexuality and the importance of a comprehensive approach considering social, cultural, and gender factors.

Objectives: To understand the attitudes of older adults receiving care at a Psychogeriatric clinic and to contrast them with the degree of sexual satisfaction they experience.

Methods: An observational, prospective, cross-sectional, descriptive, and non-comparative study was carried out to explore the attitudes of older adults with psychiatric comorbidities receiving care at a specialized clinic in Mexico City. Two questionnaires were employed to investigate biases and attitudes regarding the practice of sexuality, as well as satisfaction with their life and sexual expression: the Questionnaire of Attitudes towards Sexuality in Old Age and the Sexual Satisfaction Inventory, respectively.

Results: Participants were recruited from the Psychogeriatrics clinic of the National Institute of Psychiatry (n = 52). The average age of participants was 69.4 ± 6.4 years, with an average of 10.4 ± 5.1 years of education. Two questionnaires were utilized to assess attitudes and sexual satisfaction (Questionnaire of Attitudes Towards Sexuality in Old Age and the Sexual Satisfaction Inventory, respectively).

A statistically significant difference was found in sexual satisfaction between men and women. Men exhibited higher levels of overall sexual satisfaction (X¯ = 109.2, S.D. = 25.0) compared to women (X¯ = 87.0, S.D. = 35.7), with W = 424, p = 0.01. Women tended to harbor more negative attitudes (X¯ = 15.5, S.D. = 6.8) towards sexuality than men (X¯ = 19.5, S.D. = 6.6), with W = 399 and p = 0.01.

The correlation between sexual satisfaction and attitudes towards sexuality in older adults was analyzed using the Spearman correlation coefficient. A result of –0.1 was obtained, indicating a weak and negative correlation between the two variables evaluated (p = 0.5).

A linear regression analysis was conducted using the sexual satisfaction score (dependent variable), attitudes score (independent), and sex as a dichotomous independent factor (male or female). The contribution of sex to the model was statistically significant (p = 0.01), with an expected Sexual Satisfaction Inventory score 26.5 points lower in women compared to men. The proposed model accounted for approximately 14.0% of the variability.

Conclusions: Despite not finding a correlation between attitudes and sexual satisfaction, the gender disparities in satisfaction levels indicate that attitudes may exert differential influence on men and women. These findings underscore the significance of integrating the gender dimension when addressing sexual satisfaction in older adults. Moreover, there appears to be a restricted perspective on individual sexuality, emphasizing the imperative to overcome cultural and religious stigmas that could impact the mental health and sexual well-being of this demographic.

Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women’s well-being and ensure healthcare system preparedness during future public health crises.

This article examines three novels that use fiction to revise the figure of the Argentine author Leopoldo Lugones: Ricardo Piglia’s Respiración artificial (1980), C. E. Feiling’s Un poeta nacional (1993), and César Aira’s Lugones (2020). These three novels present different portrayals of Lugones, which also mirror their opposing views of the Argentine literary tradition. Piglia, Feiling, and Aira look back at the so-called national poet when self-fashioning themselves as writers and outlining a literary project in a (post)dictatorial scenario. In a cultural field marked by the effects of state terror and neoliberal reform policies, these fictional renderings of Lugones become a means of reflecting on the political past and the future of literature. Ultimately, I argue that Respiración artificial, Un poeta nacional, and Lugones devise a figure of the Argentine author decoupled from the mission of consolidating a national identity that Lugones epitomized for nearly half a century.

Mass vaccination campaigns have been used effectively to limit the impact of communicable disease on public health. However, the scale of the coronavirus disease (COVID-19) vaccination campaign is unprecedented. Mass vaccination sites consolidate resources and experience into a single entity and are essential to achieving community (“herd”) immunity rapidly, efficiently, and equitably. Health care systems, local and regional public health entities, emergency medical services, and private organizations can rapidly come together to solve problems and achieve success. As medical directors at several mass vaccination sites across the United States, we describe key mass vaccination site concepts, including site selection, operational models, patient flow, inventory management, staffing, technology, reporting, medical oversight, communication, and equity. Lessons learned from experience operating a diverse group of mass vaccination sites will help inform not only sites operating during the current pandemic, but also may serve as a blueprint for future outbreaks of highly infectious communicable disease.

Background: Estimating the burden of intestinal colonization with antibiotic-resistant gram-negative bacteria (AR-GNB) is critical to understanding their global epidemiology and spread. We aimed to determine the prevalence of, and risk factors for, intestinal colonization due to AR-GNB in population-based hospital and community settings in Chile. Methods: Between December 2018 and May 2019, we enrolled randomly selected hospitalized adults in 4 tertiary-care public hospitals (Antofagasta, Santiago, Curico and Puerto Montt), and adults residing in a community-based cohort in the rural town of Molina. Following informed consent, we collected rectal swabs and epidemiological information through a standardized questionnaire. Swabs were plated onto MacConkey agar with 2 µg/mL ciprofloxacin or ceftazidime. All recovered morphotypes were identified, and antibiotic susceptibility testing was performed via disk diffusion. The primary outcome was the prevalence of colonization with fluoroquinolone (FQ)- or third-generation cephalosporin (3GC)–resistant GNB. The secondary outcome was the prevalence of colonization with multidrug-resistant (MDR) GNB, defined as GNB resistant to ≥3 antibiotic classes. Categories were not mutually exclusive. Bivariate and multivariate analyses were performed to describe risk factors for colonization with these categories. Results: In total, 775 hospitalized adults and 357 community participants were enrolled, with a median age of 60 years (IQR, 42–72) and 55 years (IQR, 48–62) years, respectively. Among hospitalized participants, the prevalence of colonization with FQ- or 3GC-resistant GNB was 47% (95% CI, 43%–50%) and 41% (95% CI, 38%–45%), respectively, whereas the prevalence of MDR-GNB colonization was 27% (95% CI, 24%–31%). In the community setting, the prevalence of colonization with either FQ-, 3GC-resistant GNB, or MDR-GNB was 40% (95% CI, 34%–45%), 29% (95% CI, 24%– 34%), and 5% (95% CI, 3%–8%), respectively. Independent risk factors for hospital MDR-GNB colonization included the hospital of admission, unit of hospitalization (intensive care units carried the highest risk), in-hospital antimicrobial exposure, comorbidities (Charlson index), and length of stay. In the community setting, recent antibiotic exposure (<3 months) predicted colonization with either FQ- or 3GC-resistant GNB, and alcohol consumption was inversely associated with MDR GNB colonization. Conclusions: A high burden of colonization with AR-GNB was observed in this sample of hospitalized and community-dwelling adults in Chile. The high burden of colonization with GNB resistant to commonly used antibiotics such as FQ and 3GC found in community dwellers, suggests that the community may be a relevant source of antibiotic resistance. Efforts to understand relatedness between resistant strains circulating in the community and the hospital are needed.

Funding: None

Disclosures: None

Little is known about who would benefit from Internet-based personalised nutrition (PN) interventions. This study aimed to evaluate the characteristics of participants who achieved greatest improvements (i.e. benefit) in diet, adiposity and biomarkers following an Internet-based PN intervention. Adults (n 1607) from seven European countries were recruited into a 6-month, randomised controlled trial (Food4Me) and randomised to receive conventional dietary advice (control) or PN advice. Information on dietary intake, adiposity, physical activity (PA), blood biomarkers and participant characteristics was collected at baseline and month 6. Benefit from the intervention was defined as ≥5 % change in the primary outcome (Healthy Eating Index) and secondary outcomes (waist circumference and BMI, PA, sedentary time and plasma concentrations of cholesterol, carotenoids and omega-3 index) at month 6. For our primary outcome, benefit from the intervention was greater in older participants, women and participants with lower HEI scores at baseline. Benefit was greater for individuals reporting greater self-efficacy for ‘sticking to healthful foods’ and who ‘felt weird if [they] didn’t eat healthily’. Participants benefited more if they reported wanting to improve their health and well-being. The characteristics of individuals benefiting did not differ by other demographic, health-related, anthropometric or genotypic characteristics. Findings were similar for secondary outcomes. These findings have implications for the design of more effective future PN intervention studies and for tailored nutritional advice in public health and clinical settings.

Polyphenols are a wide family of phytochemicals present in diverse foods. They might play a role in cancer development and progression. In vivo and in vitro studies have suggested beneficial properties and potential mechanisms. We aimed to evaluate the association between total and main classes of polyphenol intake and breast cancer (BC) risk in the Seguimiento Universidad de Navarra project – a prospective Mediterranean cohort study. We included 10 713 middle-aged, Spanish female university graduates. Polyphenol intake was derived from a semi-quantitative FFQ and matching food consumption data from the Phenol-Explorer database. Women with self-reported BC were asked to return a copy of their medical report for confirmation purposes; death certificates were used for fatal cases. Cox models were fitted to estimate multivariable-adjusted hazard ratios (HR) and 95 % CI for the association between tertiles (T) of polyphenol intake and BC. After 10·3 years of median follow-up, 168 probable incident BC cases were identified, out of which 100 were confirmed. We found no association between polyphenol intake and the overall BC risk. Nevertheless, we observed a significant inverse association between total polyphenol intake and BC risk for postmenopausal women, either for probable or only for confirmed cases (HRT3 v. T1 0·31 (95 % CI 0·13, 0·77; Ptrend=0·010)). Also, phenolic acid intake was inversely associated with postmenopausal BC. In summary, we observed no significant association between total polyphenol intake and BC risk. Despite a low number of incident BC cases in our cohort, higher total polyphenol intake was associated with a lower risk of postmenopausal BC.

A method for the fabrication of interconnected ceramic sponges was used in the present work, designed by using a combination of two different, aqueous gel casting and sacrificial template, using aluminum nitride powder (99.97%) with a mean size of 2.4 micrometers. Two types of sponges were made by using two different monomers, acrylamide and methacrylamide, the resultants sponges have 60% of porosity after being sintered and pyrolyzed at temperature of 1673 K using an inert atmosphere of argon for 1 h. The hydrolysis evolution of this ceramic powder during the gelcasting process was studied by measuring the pH during the stirring time, the microstructure changes during the time of exposure were observed in a SEM. XRD were made to study the present phases after the gel was eliminated by thermal treatment at 873 K using an oxidizing atmosphere, observing a formation of up to 4 %wt. of cubic alumina phase which was made after the hydrolysis products. Infrared spectroscopy was used to study the changes in the ceramic powder.

Traditionally, personalised nutrition was delivered at an individual level. However, the concept of delivering tailored dietary advice at a group level through the identification of metabotypes or groups of metabolically similar individuals has emerged. Although this approach to personalised nutrition looks promising, further work is needed to examine this concept across a wider population group. Therefore, the objectives of this study are to: (1) identify metabotypes in a European population and (2) develop targeted dietary advice solutions for these metabotypes. Using data from the Food4Me study (n 1607), k-means cluster analysis revealed the presence of three metabolically distinct clusters based on twenty-seven metabolic markers including cholesterol, individual fatty acids and carotenoids. Cluster 2 was identified as a metabolically healthy metabotype as these individuals had the highest Omega-3 Index (6·56 (sd 1·29) %), carotenoids (2·15 (sd 0·71) µm) and lowest total saturated fat levels. On the basis of its fatty acid profile, cluster 1 was characterised as a metabolically unhealthy cluster. Targeted dietary advice solutions were developed per cluster using a decision tree approach. Testing of the approach was performed by comparison with the personalised dietary advice, delivered by nutritionists to Food4Me study participants (n 180). Excellent agreement was observed between the targeted and individualised approaches with an average match of 82 % at the level of delivery of the same dietary message. Future work should ascertain whether this proposed method could be utilised in a healthcare setting, for the rapid and efficient delivery of tailored dietary advice solutions.