Análisis de los conocimientos sobre el desayuno saludable y su relación con los hábitos de estilo de vida y el rendimiento académico en la enseñanza secundaria obligatoria

ObjectivesThe main objective of the study is to analyze whether students of Compulsory Secondary Education (ESO) of Badajoz city known foods that are part of a healthy breakfast. It also intends to see the relationship of this knowledge with lifestyle habits and academic performance.Materials and methodA representative sample of 1197 secondary students in the city of Badajoz (Spain) (50.1% female) was calculated their Body Mass Index (BMI) and were asked to fill in a questionnaire, previously validated in a pilot study, which included sociodemographic items as well as others related with life style habits. They were also asked to choose among a series of food, which of them were a part of a healthy breakfast.Results49.2% of adolescents know foods which are a part of a healthy breakfast. Very low correlations were obtained between all the variables analyzed and knowledge of foods that make up a healthy breakfast.However, within a few variables are significant differences (P < .05) between subgroups, such as families of students with low cultural level of aided schools, repeaters, without reading habit, passing lot of time with friends, who have been on a diet, make less than 3 meals a day and spend less than 10 minutes for breakfast and know the amount of fruit that should be consumed daily.ConclusionsLife style habits of adolescents are not related to the knowledge about the foods that are part of a healthy breakfast     

Comparación de los libros de historia de vida digitales y convencionales sobre el estado de ánimo,la comunicación,la cognición y la calidad de vida en personas con demencia en residencias: un estudio piloto

IntroductionPerson-centered care (PCC) includes life story, a form of reminiscence therapy that can be useful in the treatment of dementia. We compared the efficacy of using a digital or conventional life story book (LSB) on depressive symptoms, communication, cognition, and quality of life.Material and methodsThirty one persons with dementia living in 2 PCC nursing homes were randomly assigned to receive reminiscence therapy based on the Neural Actions digital LSB (n = 16) or a conventional LSB (n = 15). Both groups performed 2 weekly sessions of 45 min for 5 weeks. Depressive symptoms were evaluated with the Cornell scale (CSDD); communication with the Holden scale (HCS), cognition with the Mini Mental State Examination (MMSE) and quality of life with the quality of life scale for Alzheimer's (QoL-AD). The results were analyzed using ANOVA of repeated measures with the jamovi 2.3 program.ResultsBoth LSB improved communication skills (η² = 0.115; p < 0.001), with no differences between groups. No effects on quality of life, cognition, or mood were found.ConclusionsIn PCC centres digital or conventional LSB can be useful in the treatment of people with dementia by facilitating communication. Its role on quality of life, cognition or mood is uncertain.     

Relación del factor de crecimiento de fibroblastos 21 con indicadores de masa y función muscular en personas mayores con sobrepeso u obesidad. Estudio exploratorio

BackgroundAge-related decreases in muscle mass and function are associated with the development of metabolic impairments, particularly in the context of obesity. Fibroblast growth factor 21 (FGF-21) has been suggested as a common mediator of both processes. No known studies have examined the association between FGF-21 and muscle mass and function in overweight or obese older adults. With this in mind, this study aimed to investigate the association between plasma levels of FGF-21 and muscle mass and function outcomes in overweight or obese older adults.Materials and methodsExploratory study, which included 39 adults of 60-70 years old with body mass indexes > 25 kg/m². As study outcomes, measurements were made of appendicular muscle mass (AMM), grip strength, 5 times sit-to-stand test (5xSTT), as well as plasma levels of FGF-21, fasting glucose, and insulin. The homeostatic model assessment index (HOMA-IR) was also calculated to determine the presence of insulin resistance.ResultsSignificant relationships were found between plasma levels of FGF-21 vs 5xSTT (rho = 0.49; P < .05). Moreover, FGF-21 levels were significantly higher in those with insulin resistance (P < .05), as well as with having lower levels of AMM (P < .05).ConclusionThere is a relationship between the plasma levels of FGF-21 and muscle function outcomes in overweight or obese older adults. Future studies should investigate the potential causalities between these relationships.     

Rehabilitación geriátrica multidisciplinar en el paciente con fractura de cadera y demencia

Hip fracture and dementia rates increase with age, and both groups of patients suffer increased morbidity and mortality and functional impairment. The management of these patients is a challenge for the orthogeriatric and rehabilitation team process, as despite the evidence on the benefit, the results analysed are still worse than in patients without cognitive impairment. For this reason, and due to the limitation in health resources, many of them have problems in accessibility to them, or are limited to a less intense rehabilitation. There are insufficient studies on the best rehabilitation interventions in this group of patients, but it is suggested: 1) to use a multidisciplinary rehabilitation model adapted to the patient with dementia, and 2) to redefine results of the rehabilitation of these patients not only in terms of functional improvement, without highlighting other concepts, such as quality of life, decrease in complications or improved social support.     

Concentraciones deficientes de vitamina D en pacientes con obesidad mórbida. Estudio de caso-control

ObjectivesRecent studies show a high prevalence of vitamin D deficiency in the general population, especially in the elderly. There are also studies reporting the same observations in the morbidly obese, although few of these studies have compared morbidly obese individuals with non-obese persons. The objectives of this study were to estimate the prevalence of vitamin D deficiency and secondary hyperparathyroidism in both groups and to assess whether there is a relationship between obesity and vitamin D deficiency.MethodsThis study was carried out in 138 patients in the Guadalajara University Hospital (Spain) between December 2008 and December 2009. Of these, 50.7% were morbidly obese and 49.3% were not obese. Fasting blood samples were taken from both groups for determination of 25-hydroxyvitamin D, intact parathyroid hormone, calcium, albumin and phosphorus, among other biochemical parameters.ResultsThe mean concentration of 25-hydroxyvitamin D was 16.6±8.12 ng/ml in the morbidly obese group and 21.9±7.34 ng/ml in the non-obese group (p<0.0001). The prevalence of vitamin D deficiency was 80% in morbidly obese patients and 41% in non-obese patients (p<0.0001). There were no statistically significant differences in concentrations of parathyroid hormone, calcium or phosphorus between the two groups.ConclusionsA high prevalence of vitamin D deficiency was found in both groups studied, although the concentration of 25-hydroxyvitamin D was significantly lower in the morbidly obese. Morbid obesity is closely linked to vitamin D deficiency. To prevent this deficiency, determination of 25-hydroxyvitamin D should be included in clinical practice guidelines for the treatment of obesity.     

Calidad de vida y satisfacción con el tratamiento de sujetos con diabetes tipo 2: resultados en España del estudio PANORAMA

ObjectivesFew studies are available on quality of life and treatment satisfaction of patients with type 2 diabetes mellitus (T2DM). Both of them were the primary objectives of the PANORAMA (NCT00916513) study. Metabolic control, treatment patterns, and management by healthcare professionals were also evaluated.Material and methodsThis multicenter, cross-sectional, observational study randomly recruited>40 year-old patients with T2DM from Spanish healthcare centers. HbA1c was measured using the same technique in all patients, who also completed quality of life (EQ-5D and ADDQoL) and treatment satisfaction (DTSQ) questionnaires and the Hypoglycemia Fear Survey (HFS-II).ResultsFifty-four investigators recruited 751 patients, 60.3% of whom had HbA1c levels <7%. Approximately 25% of patients on monotherapy had HbA1c values ≥ 7%, Patients with longer disease duration and more complex treatments, especially with insulin, showed the poorer control. Despite good overall treatment satisfaction (mean 29.3±6.1, 0 to 36-point scale), patients with a poorer metabolic control, previous hypoglycemia episodes, and more complex therapies had a worse QoL and a greater fear of suffering hypoglycemia.ConclusionsDespite advances in metabolic control, there are still areas to improve. Early addition of safe drugs to monotherapy would help achieve control objectives without increasing the risk of hypoglycemia, and delaying the start of insulin therapy. This would also improve QoL and treatment satisfaction.     

Prevalencia de alteraciones del metabolismo hidrocarbonado en una población infanto-juvenil con obesidad grave

IntroductionThere is currently a disproportionate increase in childhood and adolescent obesity worldwide, together with other disorders involving substantial cardiometabolic risk in adulthood, such as alterations in carbohydrate metabolism.ObjectiveTo establish the prevalence of prediabetes, defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) after an oral glucose tolerance test, and the prevalence of type 2 diabetes mellitus (DM-2) in a pediatric population with severe obesity. Additionally, we aimed to assess clinical metabolic differences between prediabetic obese patients and obese subjects without prediabetes.Material and methodsA cross-sectional study was carried out in children and adolescents with severe obesity (>97th percentile). The variables studied were age, sex, height, weight, body mass index, waist circumference, fasting plasma glucose and oral glucose tolerance test, insulinemia, insulin resistance assessed by the homeostasis model assessment (HOMA) index, glycated hemoglobin (HbA_1c), triglycerides, high-density lipoprotein cholesterol (HDL), and systolic and diastolic blood pressure.ResultsA total of 133 patients were included: 67 boys (50.4%) and 66 girls (49.6%), with a mean age of 12.17±3.27 years. Fourteen patients (10.52%) had prediabetes (10 IFG, 3 IGT, 1 IFG+IGT): 7 girls and 8 boys, with a mean age of 13.2±3.3 years. One patient had DM2 (0.75%). Patients with prediabetes had significantly higher concentrations of fasting glucose (98±10.76 vs 88.53±6.3 mg/d; p=0.001), insulinemia (35.38±14.22 vs 22.95±14.30 μU/ml; p=0.009) and HOMA index (8.10±3.24 vs 4.89±3.27; p=0.004) than patients without impaired carbohydrate metabolism. These patients also had higher values of HbA_1c, triglycerides, blood pressure and HDL concentrations, although differences were not statistically significant.ConclusionsThe prevalence of prediabetes (IFG/IGT) in children with severe obesity was high (10.52%). These patients should therefore be investigated to establish early diagnosis and appropriate treatment. Obese patients with prediabetes have significantly higher levels of insulin and insulin resistance than individuals without impaired carbohydrate metabolism.     

Innovando en la toma de decisiones compartida con pacientes hospitalizados: descripción y evaluación de una herramienta de registro de nivel de intensidad terapéutica

Background and aimShared decision-making between patients and healthcare professionals is crucial to guarantee adequate coherence between patient values and preferences, caring aims and treatment intensity, which is key for the provision of patient-centred healthcare. The assessment of such interventions are essential for caring continuity purposes. To do this, reliable and easy-to-use assessment systems are required. This study describes the results of the implementation of a hospital treatment intensity assessment tool.Material and methodsThe pre-implementation and post-implementation results were compared between two cohorts of patients assessed for one month.ResultsSome record of care was registered in 6.1% of patients in the pre-implementation group (n = 673) compared to 31.6% of patients in the post-implementation group (n = 832) (P < .01), with differences between services. Hospital mortality in both cohorts is 1.9%; in the pre-implementation group, 93.75% of deceased patients had treatment intensity assessment.ConclusionsIn hospital settings, the availability of a specific tool seems to encourage very significantly shared decision-making processes between patients and healthcare professionals —multiplying by more than 5 times the treatment intensity assessment. Moreover, such tools help in the caring continuity processes between different teams and the personalisation of caring interventions to be monitored. More research is needed to continue improving shared decision-making for hospital patients     

Evaluación de los parámetros de hipoacusia laboral en trabajadores activos y su relación con los niveles de glucemia basal

IntroductionHearing loss due to noise is considered within the prevention plans of the most common occupational diseases. In addition to evaluation of working conditions, other personal factors increasing the risk of hypoacusis, such as diabetes, should be taken into account.ObjectivesTo explore hearing loss in the workplace and its relationship to impaired fasting baseline blood glucose levels.MethodsAn observational, cross-sectional study enrolling 1636 workers from service companies was conducted. Full audiometric evaluation was performed at different frequencies: high frequency (HF), early loss index (ELI), speech average loss (SAL), and monaural and binaural loss. Results were categorized by baseline blood glucose levels: G1 (< 100 mg/dl), G2 (100-125 mg/dl), and G3 (> 125 mg/dl).ResultsBased on both HF and ELI, 11% of workers had clear indication of deafness. Women with G3 levels showed significant differences in the results of HF and ELI indexes as compared to the G1 group (P = .038 and .046, respectively). A positive association was found between hearing loss and G3 blood glucose levels in HF (OR: .338; p = .002), ELI (OR: .407; p = .007), and the monaural test in the left ear (OR: 4.77 × 10-5; p = .006).ConclusionsDespite the methodological limitations of this study, there is evidence for an increased risk of high frequency hearing loss in workers with high baseline blood glucose levels.     

Producción de fosfolipasa y proteinasa en cepas de Malassezia pachydermatis aisladas de perros con otitis y sin otitis

BackgroundMalassezia pachydermatis is part of the skin microbiota of dogs and cats. M. pachydermatis has been associated with external otitis and seborrhoeic dermatitis, reported more often in dogs than in cats. When the physical, chemical or immunological mechanisms of the skin are altered, M. pachydermatis could act as a pathogen. Thus, several virulence factors, such as the ability to produce esterase, lipase, lipoxygenase, protease, chondroitin sulphatase, and hyaluronidase, have been studied.AimsIn the present study, we aim to identify the phospholipase activity measured at pH 6.3, and the proteinase activity measured at pH 6.3 and pH 6.8 (pH from ears of dogs with external otitis) of M. pachydermatis strains isolated from dogs with and without external otitis.MethodsThe phospholipase activity was measured using a semi-quantitative method with egg yolk, and the proteinase activity with a semi-quantitative method using bovine serum albumin agar. The study was performed on 96 isolates of M. pachydermatis, 43 isolated from dogs without clinical symptoms of otitis, and 52 isolated from dogs with otitis.ResultsIn our study, 75.8% of the isolates showed phospholipase activity at pH 6.3, and 81 and 97.9% of them showed proteinase activity measured at pH 6.3 and 6.8, respectively. A higher phospholipase activity was detected in strains isolated from dogs with otitis. The proteinase activity was increased at a pH of 6.8 (97.9%) in comparison to a pH of 6.3 (81%).ConclusionsOur results suggest that the phospholipase activity may play an important role in the invasion of host tissues in chronic canine otitis cases. The proteinase activity results obtained in this study suggest that a reduction in the pH of the treatment may improve its efficacy in the resolution of M. pachydermatis otitis.     

Intervenciones basadas en el ejercicio y el entorno para la prevención de caídas en personas con deterioro cognitivo que viven en centros de cuidado: revisión sistemática y metaanálisis

This systematic review aims to report the effectiveness of interventions based on exercise and/or physical environment for reducing falls in cognitively impaired older adults living in long-term care facilities.In July 2014, a literature search was conducted using main databases and specialised sources. Randomised controlled trials assessing the effectiveness of fall prevention interventions, which used exercise or physical environment among elderly people with cognitive impairment living in long-term care facilities, were selected. Two independent reviewers checked the eligibility of the studies, and evaluated their methodological quality. If it was adequate, data were gathered.Fourteen studies with 3,539 participants using exercise and/or physical environment by a single or combined approach were included. The data gathered from studies that used both interventions showed a significant reduction in fall rate.Further research is needed to demonstrate the effectiveness of those interventions for preventing falls in the elderly with cognitive impairment living in long-term care establishments.     

Evaluación de la utilización de las prestaciones específicas de los sistemas de infusión subcutánea de insulina y su relación con el control metabólico en pacientes con diabetes tipo 1

Background and objectivePatients with type 1 diabetes (T1DM) treated with continuous subcutaneous insulin infusion (CSII) have available several specific features of these devices. The aim of this study was to evaluate the relationship between real use of them and the degree of glycemic control in patients using this therapy.Patients and methodsForty-four T1DM patients on CSII therapy with or without real-time continuous glucose monitoring (CGM) were included. Data from 14 consecutive days were retrospectively collected using the therapy management software CareLink Personal/Pro^® and HbA1c measurement performed at that period. The relationship between the frequency of usie of specific features of insulin pumps (non-sensor augmented or sensor-augmented) and glycemic control was analyzed.ResultsMean HbA1c in the group was 7.5 ± .8%. Mean daily number of boluses administered was 5.1 ± 1.8, with 75.4% of them being bolus wizards (BW). Daily number of boluses was significantly greater in patients with HbA1c < 7.5% than in those with HbA1c > 7.5% (5.3 ± 1.6 vs. 4.3 ± 1.6, P = .056). There was a trend to greater use of BW in patients with better control (82.8 ± 21.4% vs. 69.9 ± 29.1%, P = .106). HbA1c was lower in patients using CGM (n = 8) as compared to those not using sensor-augmented pumps (7.6 ± .8 vs 7.1 ± .7, P = .067), but the difference was not statistically significant.ConclusionsMore frequent use of BW appears to be associated to better metabolic control in patients with T1DM using pump therapy. In standard clinical practice, augmentation of insulin pump with CGM may be associated to improved glycemic control.