ACTIVE-FIT program: Assessment of sleep quality and its relationship with physical activity in patients with relapsing-remitting multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) causes sleep disturbances in up to 70 % of individuals. These problems are linked to fatigue, mood and cognitive performance, thereby affecting the quality of life in people with MS (PwMS). The frequent and debilitating side effects of sleep medications prompt the exploration of alternative therapies. Physical activity has shown benefits in improving sleep, reducing fatigue, and enhancing quality of life. Combined with a controlled exercise program tailored for PwMS, the study aims to analyze the impact of moderate physical exercise on sleep quality, cognitive function, quality of life, mood, and fatigue. METHODS: A single-center prospective cohort study was designed to assess the impact of a 12-week physical exercise program on patients with relapsing-remitting multiple sclerosis. Changes in sleep and activity parameters are evaluated using an actigraph and cognitive, quality of life, fatigue and mood changes are assessed through specific questionnaires before, during, and after the exercise program application. RESULTS: 23 patients completed the study (women = 84.6 %) Mean age was 37.2 years (SD 7.5). The mean EDSS score was 1.9, and 80.8 % were diagnosed within the last six years. Significant improvements were noted in sleep efficiency between baseline and final measurements (χ2 = 27.5; p.adj = 0.004), sleep latency (χ2 = 275; p.adj = 0.000), sleep duration (χ2 = 251; p.adj = 0.001) and in the number of awakenings (χ2 = 269.5; p.adj = 0.000), with a decreased in total time in bed from 8.5 h to 7.35 h post-intervention. Regarding activity variables, an increase in caloric expenditure and an increase in the time participants engaged in light activity were observed. We found significant improvements in fatigue, quality of life and mood. Concerning neuropsychological exploration results, improvements were observed in all studied parameters, with statistically significant improvement in Verbal SRT (χ2 = 43; p = 0.022). CONCLUSION: Our study showed a positive impact of a 12-week physical exercise program on sleep performance, cognition and mood in PwMS. The observed improvements underscore the potential of tailored exercise interventions in promoting a more comprehensive and holistic care paradigm for PwMS.

Mental health among adolescents exposed to social inequality in Latin America and the Caribbean: a scoping review.

Background and objective: Adolescents from Latin America and the Caribbean grow up in a context of social inequality, which diminishes their well-being and leads to impaired emotional-cognitive development. To understand the problem, it is important to synthesize the available research about it. This study aims to explore the knowledge about adolescents' mental health in Latin America and the Caribbean exposed to social inequality. Methods: A systematic scoping review was conducted encompassing a search in five databases (Medline, CINAHL, PsycINFO, Scopus, and LILACS) in June 2022. Articles of various typologies were included without time limit. After two rounds of screening, relevant data were manually extracted and synthesized into self-constructed themes using thematic analysis. Results: Out of 8,825 retrieved records, 42 papers were included in the final review, with a predominance of quantitative approaches. The synthesis revealed two main analytical themes: (a) defining social inequality, wherein intersecting inequalities produce discrimination and determine conditions for social vulnerability; (b) social inequality and mental health, which highlights the association between socio-structural difficulties and emotional problems, amplifying vulnerability to mental ill health and poor mental health care. Conclusion: The scientific evidence reveals that social inequality is related to impaired well-being and mental ill health on the one hand and a lack of access to mental health care on the other hand.

A Psychological Examination of the Status Syndrome and Its Application for Promoting Well-Being.

The status syndrome proposed by Marmot is located at the closest level of influence within the Social Determinants of Health (SDH) framework, connecting the body's response to the mental states that arise from the subjective experience of social status. Marmot defines these psychological states through concepts of autonomy and social integration articulated in the Capability Approach (CA). These elements are further explored and expanded upon with the Self-Determination Theory (SDT), an empirically based framework with an extensive tradition of practical application. This lays the groundwork not only for understanding what makes a social environment conducive to well-being but also for shedding light on ways to promote it. The article goes beyond theoretical discussions by introducing a structured model based on the principles of the SDT for health promotion interventions. The model emphasizes the importance of providing a supportive atmosphere and is organized into four distinct phases aimed at aligning interventions with individual motivations, and cultural contexts. Ultimately, the goal is to engage individuals to actively participate in their own well-being while addressing the complexities associated with social inequalities in developed societies.

Kinetic and structural assessment of the reduction of human 2-Cys peroxiredoxins by thioredoxins.

We have studied the reduction reactions of two cytosolic human peroxiredoxins (Prx) in their disulfide form by three thioredoxins (Trx; two human and one bacterial), with the aim of better understanding the rate and mechanism of those reactions, and their relevance in the context of the catalytic cycle of Prx. We have developed a new methodology based on stopped-flow and intrinsic fluorescence to study the bimolecular reactions, and found rate constants in the range of 105 -106 m-1 s-1 in all cases, showing that there is no marked kinetic preference for the expected Trx partner. By combining experimental findings and molecular dynamics studies, we found that the reactivity of the nucleophilic cysteine (CN ) in the Trx is greatly affected by the formation of the Prx-Trx complex. The protein-protein interaction forces the CN thiolate into an unfavorable hydrophobic microenvironment that reduces its hydration and results in a remarkable acceleration of the thiol-disulfide exchange reactions by more than three orders of magnitude and also produces a measurable shift in the pKa of the CN . This mechanism of activation of the thiol disulfide exchange may help understand the reduction of Prx by alternative reductants involved in redox signaling.

Assessment of Tissue Expression of the Oxytocin-Vasopressin Pathway in the Placenta of Women with a First-Episode Psychosis during Pregnancy.

Psychosis refers to a mental health condition characterized by a loss of touch with reality, comprising delusions, hallucinations, disorganized thought, disorganized behavior, catatonia, and negative symptoms. A first-episode psychosis (FEP) is a rare condition that can trigger adverse outcomes both for the mother and newborn. Previously, we demonstrated the existence of histopathological changes in the placenta of pregnant women who suffer an FEP in pregnancy. Altered levels of oxytocin (OXT) and vasopressin (AVP) have been detected in patients who manifested an FEP, whereas abnormal placental expression of these hormones and their receptors (OXTR and AVPR1A) has been proven in different obstetric complications. However, the precise role and expression of these components in the placenta of women after an FEP have not been studied yet. Thus, the purpose of the present study was to analyze the gene and protein expression, using RT-qPCR and immunohistochemistry (IHC), of OXT, OXTR, AVP, and AVPR1a in the placental tissue of pregnant women after an FEP in comparison to pregnant women without any health complication (HC-PW). Our results showed increased gene and protein expression of OXT, AVP, OXTR, and AVPR1A in the placental tissue of pregnant women who suffer an FEP. Therefore, our study suggests that an FEP during pregnancy may be associated with an abnormal paracrine/endocrine activity of the placenta, which can negatively affect the maternofetal wellbeing. Nevertheless, additional research is required to validate our findings and ascertain any potential implications of the observed alterations.

Assessment of Plasma and Cerebrospinal Fluid Biomarkers in Different Stages of Alzheimer's Disease and Frontotemporal Dementia.

Alzheimer's disease (AD) is the primary type of dementia, followed by frontotemporal lobar degeneration (FTLD). They share some clinical characteristics, mainly at the early stages. So, the identification of early, specific, and minimally invasive biomarkers is required. In this study, some plasma biomarkers (Amyloid ß42, p-Tau181, t-Tau, neurofilament light (NfL), TAR DNA-binding protein 43 (TDP-43)) were determined by single molecule array technology (SIMOA®) in control subjects (n = 22), mild cognitive impairment due to AD (MCI-AD, n = 33), mild dementia due to AD (n = 12), and FTLD (n = 11) patients. The correlations between plasma and cerebrospinal fluid (CSF) levels and the accuracy of plasma biomarkers for AD early diagnosis and discriminating from FTLD were analyzed. As result, plasma p-Tau181 and NfL levels correlated with the corresponding CSF levels. Additionally, plasma p-Tau181 showed good accuracy for distinguishing between the controls and AD, as well as discriminating between AD and FTLD. Moreover, plasma NfL could discriminate dementia-AD vs. controls, FTLD vs. controls, and MCI-AD vs. dementia-AD. Therefore, the determination of these biomarkers in plasma is potentially helpful in AD spectrum diagnosis, but also discriminating from FTLD. In addition, the accessibility of these potential early and specific biomarkers may be useful for AD screening protocols in the future.

Real-world costs and dynamics of surveillance in patients who underwent surgery for low-risk branch duct intraductal papillary mucinous neoplasms.

Surveillance costs and appropriateness of surgery of "low-risk" BD-IPMNs are relevant issues. In this study we evaluated the rate of correct indication for pancreatectomy defined as high grade dysplasia (HGD) at histology in 961 patients who underwent surveillance for a median of 5.1 years. Undertreatment and overtreatment were defined as invasive cancer and low grade dysplasia (LGD) at histology, respectively. Of the 66 patients (6.9%) who were operated, only 16 (23.8%) had a HGD while 40 (59.7%) had a LGD and 10 (14.9%) an invasive cancer, without differences regarding timing of surgery. The mean surveillance cost was € 194.9 ± 107.6 per patient-year, with a median cost of € 277.1 ± 148.2 in the correct surgery group compared with € 222.7 ± 111.6 and € 197 ± 102.7 in the overtreatment and undertreatment groups. The surveillance mean cost from diagnosis to surgery was € 854.8. Rate of appropriate surgery in BD-IPMNs under surveillance is low.

Estado nutricional, fuerza de prensión manual y condición funcional en adultos mayores institucionalizados

Los cambios propios de la edad podrían indirectamente afectar al estado nutricional en los adultos mayores, siendo la dependencia funcional un episodio desalentador. El objetivo de la investigación fue evaluar el estado nutricional, el nivel de prensión manual y la condición funcional en adultos mayores institucionalizados en el Centro Especializado para adultos mayores dependiente del Instituto de Previsión Social de la ciudad de San Bernardino en el periodo septiembre y octubre del 2018. Para ello se diseñó un estudio descriptivo de corte transversal con datos primarios, se incluyeron a adultos mayores albergados en el Centro Especializado para adultos mayores de San Bernardino. Se midieron datos demográficos, estado nutricional por MNA, fuerza de prensión manual por dinamometría y condición funcional a través de la EFAM. Se utilizó estadística descriptiva. El trabajo fue presentado al Comité de ética de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción. Se analizaron datos de 26 adultos mayores, cuya edad media fue 76±5 años. El 61,5% eran mujeres, prevaleció un estado nutricional normal en el 84,6%, y se encontró una mayor tendencia a presentar muy mala fuerza de prensión manual en mujeres, 22,2%. Mayor frecuencia de adultos mayores sin riesgo de dependencia, 80,8%. Hombres con mayor dependencia que las mujeres, 60%. En la muestra de estudio se observó estado nutricional normal, y fuerza de prensión muy mala en mujeres. Los adultos mayores del Centro Especializado para adultos mayores del Instituto de Previsión Social presentan condición funcional autovalente sin riesgo.

Age-specific changes could indirectly affect nutritional status in older adults, with functional dependence being a discouraging episode. To evaluate the nutritional status, the level of manual grasping and the functional condition in institutionalized older adults in the Specialized Center for the elderly dependent on the Social Pressure Institute from the city of San Bernardino in the period of September to October, 2018. Transversal descriptive study with primary data, in which older adults housed in the Specialized Center for Older Adults of San Bernardino were included. Demographic data, nutritional status by MNA, hand grip strength by dynamometry and functional condition through EFAM were measured. Descriptive statistics was used. The work was presented to the Ethics Committee of the Faculty of Medical Sciences of the National University of Asunción. Data from 26 older adults were analyzed, the average age was 76±5 years, and 61.5% were women. A normal nutritional status prevailed in 84.6%, there was a greater tendency to present very bad hand grip strength in women, 22.2% and greater frequency of older adults without risk of dependence, 80.8%. Men had greater dependence than women, 60%. In the study, a normal nutritional status was observed in the sample as well as a very bad grip strength in women. Older adults of the Specialized Center for the elderly of the Social Security Institute present a self-sustaining functional condition without risk.

Evaluación de riesgo de apnea obstructiva del sueño y de la adherencia al tratamiento farmacológico en pacientes con hipertensión arterial / Risk assessment of obstructive sleep apnea and adherence to pharmacological treatment in patients with arterial hypertension

Introducción:existe una sospecha sobre la relación bidireccional entre la apnea obstructiva del sueño (AOS) y la hipertensión arterial (HTA). Ambas ejercen una acción sinérgica sobre desenlaces cardiovasculares porlo quees trascendente ponderar la prevalencia de riesgo para AOS en los hipertensos. En este último grupo también hemos investigado la tasa de adherencia a los fármacos prescritos. Metodología:mediante un estudio de casos y controles y con la aplicación del cuestionario STOP-BANG se han discriminado las categorías de riesgo para apnea de sueño en las dos cohortes. Para el análisis de la adherencia a fármacos antihipertensivos se utilizó el cuestionario abreviado de Morisky. Resultados:se incluyeron a 590 individuos (295 casos y 295 controles. Se observó alto riesgo para AOS en el grupo de hipertensos (36,6%) comparado con el 14,2% del grupo control. Por otro lado, el sexo masculino OR 7,77 (IC95% 4,33-13,84), la obesidad OR 5,03 (IC95% 3,11-8,13) y la HTA OR 4,31 (IC95% 2,64-7,03) se ponderan significativos en un modelo de ajuste logístico aquí estudiado. El 61,69% de los hipertensos refería adherencia al tratamiento farmacológico prescrito. Discusión:el tamizaje de AOS es factible con un cuestionario aplicable en la práctica clínica diaria. De la probabilidad clínica pre-test hay que partir hacia métodos diagnósticos específicos para el diagnóstico de AOS, enfatizando casos de HTA resistente, HTA nocturna y HTA enmascarada. Se deberían realizar estudios locales que nos ayuden a comprender las causas de la falta de adherencia a fármacos antihipertensivos en una fracción importante de los individuos con HTA

Introduction:there is a suspicion about the bidirectional relationship between obstructive sleep apnea (OSA) and arterial hypertension (AHT). Both have a synergistic action on cardiovascular outcomes, so it is important to assess the prevalence of risk for OSA in hypertensive patients. In this last group we have also investigated the rate of adherence to prescribed drugs.Metodology:through a case-control study and with the application of the STOP-BANG questionnaire, the risk categories for sleep apnea in the two cohorts have been discriminated. For the analysis of adherence to antihypertensive drugs, the abbreviated Morisky questionnaire was used. Results:590 individuals were included (295 cases and 295 controls. A high risk for OSA was observed in the hypertensive group (36.6%) compared to 14.2% in the control group. On the other hand, the male sex OR 7.77 (95%CI 4.33-13.84), obesity OR 5.03 (95%CI 3.11-8.13) and hypertensionOR4.31(95%CI 2.64-7.03) they areweighted significant in a logistic adjustment model studied here.61.69% of hypertensive patients reported adherence to the prescribed pharmacological treatment.Discussion:OSA screening is feasible with a questionnaire applicable in daily clinical practice. From the pre-test clinical probability, specific diagnostic methods for the diagnosis of OSA must be started, emphasizing cases of resistant AHT, nocturnal AHT, andmasked AHT. Local studies should be carried out to help us understand the causes of non-adherence to antihypertensive drugs in a significant fraction of individuals with AHT

Assessment of Lipid Peroxidation in Alzheimer's Disease Differential Diagnosis and Prognosis.

Alzheimer's disease (AD) and other dementias are becoming increasingly common in the older population, and the number of people affected is expected to increase in a few years. Nowadays, biomarkers used in early AD diagnosis are expensive and invasive. Therefore, this research field is growing. In fact, peroxidation by-products derived from the oxidation of brain lipids (arachidonic (AA), docosahexanoic (DHA) and adrenic acid (AdA)) could be potential biomarkers, participating in the mechanisms of inflammation, neurotoxicity and cell death in AD pathology. Previous studies have shown specificity between lipid peroxidation compounds and other dementias (e.g., Lewy bodies (DLB), frontotemporal dementia (FTD)), but more research is required. Lipid peroxidation compounds (prostaglandins, isoprostanes, isofurans, neuroprostanes, neurofurans, dihomo-isoprostanes and dihomo-isofurans) were analysed by liquid chromatography and mass spectrometry in plasma samples from participants classified into a healthy group (n = 80), a mild cognitive impairment due to AD group (n = 106), a mild dementia due to AD group (n = 70), an advanced dementia due to AD group (n = 11) and a group of other non-AD dementias (n = 20). Most of these compounds showed statistically significant differences between groups (p < 0.05), showing higher levels for the healthy and non-AD groups than the AD groups. Then, a multivariate analysis was carried out on these compounds, showing good diagnosis indexes (AUC 0.77, sensitivity 81.3%, positive predictive value 81%). Moreover, evaluating AD disease prognosis, two compounds (15-F2t-IsoP and 14(RS)-14-F4t-NeuroP) and three total parameters (isoprostanes, isofurans and neurofurans) showed significant differences among groups. Some compounds derived from the oxidation of AA, DHA and AdA have demonstrated their potential use in differential AD diagnosis. Specifically, 15-F2t-IsoP, 14(RS)-14-F4t-NeuroP and the total parameters for isoprostanes, isofurans and neurofurans have shown prognostic value for AD from its earliest stages to its most severe form.

Colorectal Cancer Screening in Castilla La Mancha, Spain: The Influence of Social, Economic, Demographic and Geographic Factors.

Colorectal cancer (CRC) is a health problem with a significant social impact, accounting for 700,000 deaths a year globally. CRC survival rates are increasing as a result of early detection and improvements in society and labor conditions. Differences in CRC have been found depending on place of residence (urban or rural), socioeconomic situation and unemployment, although studies in this regard are limited. The aims of the present study were to determine whether differences exist in diagnostic delay according to place of residence, to analyze the association between socioeconomic level and colonoscopy results and to evaluate CRC risk according to place of residence, income level and unemployment. Retrospective, descriptive and observational study based on colonoscopies performed between May 2015 and November 2018, analyzing relationships between colonoscopy findings of a population screening program and various socioeconomic and demographic variables included in the study (sex, age, place of residence, average annual income, unemployment rate, etc.), and determining any association between such factors and related increases in adenocarcinoma risk. A total of 1422 patients were included in the study. The difference in participation according to sex was greater in rural population (63,4% men/36,6% women in rural areas, 58% men/42% women in urban areas). The mean delayed diagnosis was 59,26 days in both groups. Adenocarcinoma risk was 1.216 times higher in rural population. High-grade dysplasic lesions and adenocarcinoma were more common in municipalities with income < 9000€. However, advanced stage adenocarcinoma was higher in municipalities with income > 9000€. Adenocarcinoma risk was 1,088 times higher in municipalities with an unemployment rate of > 10%. Living in rural areas is not a barrier to access to health care, with no disadvantages identified regarding diagnosis and treatment, thanks to public health policies and the large number of small municipalities near the referral hospital in Cuenca.

Assessment of Screening Approach in Early and Differential Alzheimer's Disease Diagnosis.

BACKGROUND: Alzheimer's disease (AD) is the leading cause of dementia in the elderly population. Currently, diagnosis is based on invasive and expensive techniques, so there is a growing need to look for other possible tests, as well as carry out clinical validation. Studies from the literature showed potential diagnosis models, including some AD risk factors (age, gender, ApoE-ε4 genotype) and other variables (biomarkers levels, neuroimaging). Specifically, a recent model was performed from lipid peroxidation compounds in plasma samples to identify patients with early AD. However, there is a lack of studies about clinical validation of these preliminary diagnosis models. METHODS: Plasma samples from participants classified into AD (n = 61), non-AD (n = 17), and healthy (n = 44) were analyzed. In fact, lipid peroxidation compounds were determined by liquid chromatography and mass spectrometry. Then, a previously developed diagnosis model was clinically validated, evaluating some diagnosis indexes. RESULTS: The validation of the preliminary diagnosis model showed satisfactory diagnosis indexes (accuracy 77%, sensitivity 89%, specificity 61%, diagnostic odds ratio 12.5, positive predictive value 76%). Next, a useful screening tool, including the ApoE genotype, was developed, identifying patients with a higher risk of developing AD and improving the corresponding diagnosis indexes (accuracy 82%, sensitivity 81%, specificity 85%, diagnostic odds ratio 23.2, positive predictive value 90.5%). CONCLUSION: A new screening approach could improve the early, minimally invasive, and differential AD diagnosis in the general population.

Evolución clínica en pacientes tratados con Esencias Florales de Bach y costo del tratamiento / Clinical Evolution and Cost of Treatment in Patients Treated with Bach Flower Essences

Introducción: La Medicina Natural y Tradicional constituye hoy en día una necesidad, no como opción terapéutica, sino por su valor intrínseco, al tratar al paciente de forma holística, además de su inocuidad y bajo costo. Objetivo: Evaluar la evolución clínica en pacientes tratados con Esencias florales de Bach y costo del tratamiento. Métodos: Se realizó un estudio de evaluación de la evolución de pacientes con diagnóstico clínico de Psoriasis, Vitíligo y Liquen plano, los cuales fueron tratados con Esencias florales de Bach en el período de marzo del 2016 a marzo del 2018, en Consulta Multidisciplinaria Dermatología- Medicina Natural Tradicional- Psicología, del Policlínico Docente Héroes del Moncada; del municipio de Cárdenas, Matanzas. Los datos fueron recopilados y procesados en el software Excel, atendiendo a variables demográficas, se tuvieron en cuenta los criterios de inclusión, exclusión y consentimiento informado de pacientes vírgenes de tratamiento convencional. Las esencias florales utilizadas fueron: Crab Apple, Willow, Verbain, Impatiems, Walnut, Cherry Plum, Sweet Chestnut, Chicory, Clematis, Beech, Star of Bethlehem, While Chestnut y Larch de forma oral y tópica. Resultados: En el sexo femenino predominó el Vitíligo y Psoriasis. La ansiedad estuvo presente en 17 pacientes, en cuanto a la evolución, 14 pacientes asintomáticos y 14 mejorados. El costo de las Esencias florales oral fue gratuito y el tópico muy bajo. Conclusiones: La evolución clínica fue favorable y el costo del tratamiento muy bajo, lo cual demostró la efectividad de la terapia floral en la muestra(AU)

Introduction: Natural and traditional medicine is nowadays a necessity, not as a therapeutic option, but because of its intrinsic value, since it allows to treat the patient holistically, in addition to its innocuousness and low cost. Objective: To assess the clinical evolution and cost of treatment in patients treated with Bach flower essences. Methods: A study was carried out to assess the evolution of patients with a clinical diagnosis of psoriasis, vitiligo and lichen planus, who were treated with Bach flower essences in the period from March 2016 to March 2018, at a multidisciplinary consultation of dermatology, traditional natural medicine and psychology from Héroes del Moncada Teaching Polyclinic in Cárdenas Municipality, Matanzas Province. The data were collected and processed in the EXCEL software, taking into account demographic variables, together with inclusion and exclusion criteria, as well as informed consent of patients who had not received any conventional treatment. The flower essences used, orally and topically, were crab apple, willow, verbain, impatiens, walnut, cherry plum, sweet chestnut, chicory, clematis, beech, star of Bethlehem, white chestnut and larch. Results: The female sex predominated in cases of vitiligo and psoriasis. Anxiety was present in seventeen patients. Regarding evolution, fourteen patients were asymptomatic and the same amount achieved improvement. The cost of the oral flower essences was free and that of the topical ones was very low. Conclusions: Clinical evolution was favorable and the cost of treatment was very low, which demonstrated the effectiveness of flower therapy in the sample studied(AU)

Association of all forms of malnutrition and socioeconomic status, educational level and ethnicity in Colombian children and non-pregnant women.

OBJECTIVE: To examine the association of all forms of malnutrition and socioeconomic status (SES), educational level and ethnicity in children <5 years, non-pregnant adolescent women (11-19 years) and non-pregnant adult women (20-49 years) in Colombia. DESIGN: Cross-sectional analysis of data from the 2010 Colombian National Nutrition Survey. The prevalence of malnutrition was compared across categories of SES, educational level and ethnicity. SETTING: Colombia. PARTICIPANTS: The sample for the current analysis comprised children <5 years, non-pregnant adolescent women (11-19 years) and non-pregnant adult women (20-49 years). RESULTS: In children <5 years, a low SES and maternal educational level were significantly associated with a lower prevalence of overweight/obesity compared with high levels of SES and maternal education, that is, the prevalence of overweight/obesity was 1·4 and 1·6 times lower in categories of low SES and educational levels, respectively. In contrast, the prevalence of wasting, stunting and anaemia was higher in the lowest SES and maternal educational categories (the prevalence was between 1·1 and 1·8 times higher for these indicators). In women, the lowest SES (11 and 19 years) and educational levels (20 and 49 years) exhibited a higher prevalence in all forms of malnutrition compared with their counterparts in the highest categories (i.e. overweight/obesity, stunting and anaemia). Additionally, indigenous or Afro-Colombian children and women had the highest prevalence of malnutrition in comparison with other ethnicities. CONCLUSIONS: These results suggest that public policies should address all forms of malnutrition that occur in the most vulnerable populations in Colombia using multiple strategies.

Implementation of an assessment checklist for patients with spondyloarthritis in daily practice.

OBJECTIVES: To analyse the feasibility and changes in the collection of clinical measures after the implementation in daily practice of a checklist designed for an optimal evaluation and monitoring of patients with spondyloarthritis (SpA). METHODS: An observational prospective study was performed. The feasibility of the assessment checklist (paper/on-line format) for patients with SpA was tested (time to complete the checklist, simplicity, amenity clarity, usefulness). Through a medical files review, changes in the number of the checklist variables collected were analysed previous to the implementation of the checklist and 6 months later. A descriptive and bivariate analysis was performed. RESULTS: A total 6 hospitals and 11 rheumatologists participated. The median time to checklist completion was 15 (12-20) minutes, and the mean scores for the rest of variables of the feasibility test were in general positives. A total of 83 and 68 medical files pre-implementation and post-implementation were reviewed respectively. We observed a significant increase in the collection of many of the checklist variables after the implementation. The record of BASDAI increased from 46.2% to 73.1% (p=0.001), physical activity from 48.2% to 88.2% (p<0.0001), physician global (VAS) from 28.0% to 73.5% (p<0.0001), patient global (VAS) from 48.8% to 85.3% (p<0.0001), morning stiffness from 62.8% to 84.8% (p=0.003), ASDAS from 12.2% to 32.8% (p=0.002), BASFI from 43.7% to 65.7% (p=0.008), or DAS28 from 24.7% to 46.3% (p=0.006). These changes were observed irrespectively of SpA classification. CONCLUSIONS: The implementation of an assessment checklist in daily practice is feasible and improves the assessment of SpA patients.

The Genetic Architecture of Parkinson Disease in Spain: Characterizing Population-Specific Risk, Differential Haplotype Structures, and Providing Etiologic Insight.

BACKGROUND: The Iberian Peninsula stands out as having variable levels of population admixture and isolation, making Spain an interesting setting for studying the genetic architecture of neurodegenerative diseases. OBJECTIVES: To perform the largest PD genome-wide association study restricted to a single country. METHODS: We performed a GWAS for both risk of PD and age at onset in 7,849 Spanish individuals. Further analyses included population-specific risk haplotype assessments, polygenic risk scoring through machine learning, Mendelian randomization of expression, and methylation data to gain insight into disease-associated loci, heritability estimates, genetic correlations, and burden analyses. RESULTS: We identified a novel population-specific genome-wide association study signal at PARK2 associated with age at onset, which was likely dependent on the c.155delA mutation. We replicated four genome-wide independent signals associated with PD risk, including SNCA, LRRK2, KANSL1/MAPT, and HLA-DQB1. A significant trend for smaller risk haplotypes at known loci was found compared to similar studies of non-Spanish origin. Seventeen PD-related genes showed functional consequence by two-sample Mendelian randomization in expression and methylation data sets. Long runs of homozygosity at 28 known genes/loci were found to be enriched in cases versus controls. CONCLUSIONS: Our data demonstrate the utility of the Spanish risk haplotype substructure for future fine-mapping efforts, showing how leveraging unique and diverse population histories can benefit genetic studies of complex diseases. The present study points to PARK2 as a major hallmark of PD etiology in Spain. © 2019 International Parkinson and Movement Disorder Society.

CORTRAK Superuser Competency Assessment and Training Recommendations.

BACKGROUND: Blind insertion of feeding tubes remains unsafe. Electromagnetic placement devices such as the CORTRAK Enteral Access System allow operators to interpret placement of feeding tubes in real time. However, pneumothoraces have been reported and inadequate user expertise is a concern. OBJECTIVE: To explore factors influencing competency of CORTRAK-assisted feeding tube insertion. METHODS: A prospective, observational pilot study was conducted. Data collection included demographics, self-confidence, clinical judgment regarding CORTRAK-assisted feeding tube insertion, and general self-efficacy. CORTRAK-assisted feeding tube insertions were performed with the Anatomical Box and CORMAN task trainers. RESULTS: Twenty nurses who had inserted a mean of 53 CORTRAK feeding tubes participated. Participants inserted a mean of 2 CORTRAK feeding tubes weekly; each had inserted a feeding tube in the past 7 days. All superusers were competent; 1 required remediation for improper receiver unit placement. Mean (SD) scores were 35 (3.68) on a 40-point scale for self-efficacy, 4.6 (0.68) on a 5-point scale for self-reported feeding tube insertion confidence, and 4.85 (0.49) on a 5-point scale for demonstrated confidence. Participants estimated that 8 CORTRAK-assisted insertions were needed before they felt competent as super users. Confidence with the CORTRAK tracing was estimated to require 10 feeding tube insertions. Six participants continued to assess placement by auscultation, suggesting low confidence in their interpretation of the tracing. CONCLUSIONS: At least 3 observations should be performed to assess initial competency; the number should be individualized to the operator. Interpretation of the insertion tracing is complex and requires multiple performance opportunities to gain competency and confidence for this high-risk skill.

Salud laboral con perspectiva de género / Occupational health with a gender perspective

Resumen Los factores sociales como la educación, la situación laboral, el nivel de ingresos, el sexo y el origen étnico tienen una clara influencia en la salud de una persona. En todos los países, ya sean de ingresos bajos, medios o altos, existen grandes diferencias en cuanto al estado de salud entre los distintos grupos sociales. Este ensayo se abordará mediante la perspectiva de género para analizar cómo se comporta la epidemiología laboral en el sector femenino; el objetivo es exponer de una manera sucinta y objetiva información referente a las principales ocupaciones femeninas extradomésticas y las diferencias con respecto a la situación de los hombres. Se encontró que en México existe una diferencia salarial donde las mujeres enfrentan una desventaja; en relación con los accidentes laborales en mujeres mexicanas, los principales diagnósticos fueron traumatismos superficiales, luxaciones, esguinces y desgarros, seguidos de heridas y fracturas, entre otros; de acuerdo con la ocupación, las principalmente afectadas fueron las empleadas barredoras, trabajadoras de limpieza, empleadas de ventas, despachadoras y cocineras, entre otras.

Abstract Social factors, such as education, employment status, income level, gender and ethnic origin, have a clear influence on a person's health. In all countries, whether low, medium or high income, there are great differences in the state of health among different social groups. This essay is approached through the gender perspective for the analysis of how labor epidemiology behaves in the feminine sector; the objective is to present in a succinct and objective way the information referring to the main extra-domestic female occupations and the differences regarding the situation of men. It was found that in Mexico there is a salary difference where women face a disadvantage. In relation to work accidents in Mexican women, the main diagnoses were superficial trauma, dislocations, sprains and tears, followed by injuries and fractures, among others; according to their occupations, they were mainly sweepers, cleaning workers, sales employees, dispatchers and cooks, among others.