Intermittent fasting for health care, a review / El ayuno intermitente, ¿un éxito o una desventaja para el cuidado de la salud?

The incidence of obesity and overweight in the world has been increasing in recent years due to poor diet and lack of physical activity; people suffering obesity and overweight, related with malnutrition due to excess, often resort to calorie restriction diets that are usually not very effective. In this context, intermittent fasting (IF) has become popular due to the possibilities for weight loss that it offers. This diet consists of alternating periods of fasting with unrestricted eating; however, its effectiveness and consequences are unknown to most users. This narrative review analyzes whether intermittent fasting contributes to the improvement of body and metabolic composition. The purpose of the review was to examine the available data on the contribution of intermittent fasting to the improvement of body and metabolic composition, in order to provide information and to define the parameters that condition safe achievement of its benefits. IF dieting triggers adaptive cell responses that cause a decrease in lipid oxidative stress markers in individuals with obesity and prediabetes. Metabolic alterations have been found to go hand in hand with the alteration of circadian rhythms; if IF contributes to this effect, it may assist in treating and preventing obesity and associated diseases. However, there are also disadvantages, such as the loss of lean muscle mass by wasting, and increased hypoglycemia(AU)

La incidencia de obesidad y sobrepeso en el mundo ha ido en aumento en los últimos años debido a la mala alimentación y la falta de actividad física; Las personas que padecen obesidad y sobrepeso, relacionadas con la desnutrición por exceso, suelen recurrir a dietas de restricción calórica que suelen ser poco efectivas. En este contexto, el ayuno intermitente (AI) se ha popularizado debido a las posibilidades de pérdida de peso que ofrece. Esta dieta consiste en alternar períodos de ayuno con alimentación sin restricciones; sin embargo, su eficacia y consecuencias son desconocidas para la mayoría de los usuarios. Esta revisión narrativa analiza si el ayuno intermitente contribuye a la mejora de la composición corporal y metabólica. El objetivo de la revisión fue examinar los datos disponibles sobre la contribución del ayuno intermitente a la mejora de la composición corporal y metabólica, con el fin de aportar información y definir los parámetros que condicionan la consecución segura de sus beneficios. Se ha encontrado que las alteraciones metabólicas van de la mano con la alteración de los ritmos circadianos; si AI contribuye a este efecto, puede ayudar a tratar y prevenir la obesidad y las enfermedades asociadas. Sin embargo, también existen desventajas, como la pérdida de masa muscular magra por atrofia y el aumento de la hipoglucemia(AU)

Recommendations to Develop a Laparoscopic Surgical Simulation Training Program. Insights Gained After 12 Years of Training Surgeons / Recomendaciones para desarrollar un programa de formación en simulación quirúrgica laparoscópica. Perspectivas obtenidas tras 12 años de formación de cirujanos / Recomendações para o desenvolvimento de um programa de formação em simulação cirúrgica laparoscópica. Perspectivas obtidas após 12 anos de formação de cirurgiões

Introduction. The use of simulation in surgery has made it possible to shorten learning curves through deliberate practice. Although it has been incorporated long ago, there are still no clear recommendations to standardize its development and implementation. This manuscript aims to share recommendations based on our experience of more than twelve years of employing and improving a methodology in laparoscopic surgical simulation. Topics for Reflection. To transfer surgical skills to a trainee, we base our methodology on a three-pillar framework: The hardware and infrastructure (tools to train with), the training program itself (what to do), and the feedback (how to improve). Implementing a cost-effective program is feasible: the hardware does not need to be high fidelity to transfer skills, but the program needs to be validated. These pillars have evolved over time by incorporating technology: the on-site guidance from experts has changed to a remote and asynchronous modality by video recording the trainee's execution, and by enabling remote and asynchronous feedback. The feedback provider does not necessarily have to be an expert clinician in the subject, but a person previously trained to be a trainer. This allows for deliberate practice until mastery has been reached and learning curves are consolidated. Conclusions. Recommendations based on the experience of our center have been presented, explaining the framework of our strategy. Considering these suggestions, it is hoped that our simulation methodology can aid the development and implementation of effective simulationbased programs for other groups and institutions.

Introducción. El uso de la simulación en cirugía ha permitido acortar las curvas de aprendizaje mediante la práctica deliberada. A pesar de que se ha incorporado previamente, aún no existen recomendaciones claras para estandarizar su desarrollo e implementación. Este manuscrito pretende compartir recomendaciones basadas en nuestra experiencia, con más de doce años empleando y mejorando una metodología en la simulación quirúrgica laparoscópica. Temas de reflexión. Para transferir las habilidades quirúrgicas a un aprendiz, basamos nuestra metodología en un marco de tres pilares: El hardware y la infraestructura (herramientas con las que entrenar), el programa de entrenamiento (qué hacer), y la retroalimentación (cómo mejorar). La implementación de un programa rentable es factible: el hardware no necesita ser de alta fidelidad para transferir las habilidades, pero el programa necesita ser validado. Estos pilares han evolucionado a lo largo del tiempo incorporando tecnología: la presencia de expertos ha evolucionado a una modalidad remota y asincrónica mediante la grabación en vídeo de la ejecución del alumno, y permitiendo su retroalimentación. Aquel que entrega retroalimentación no tiene que ser necesariamente un clínico experto en la materia, sino una persona previamente formada como instructor. Esto permite una práctica deliberada hasta dominar la habilidad y establecer curvas de aprendizaje. Conclusiones. Se han presentado recomendaciones basadas en la experiencia de nuestro centro, explicando el marco de nuestra estrategia. Teniendo en cuenta estas sugerencias, se espera que nuestra metodología de simulación pueda ayudar al desarrollo e implementación de programas efectivos basados en la simulación a otros grupos e instituciones.

Introdução. O uso de simulação em cirurgia tornou possível encurtar as curvas de aprendizagem por meio da prática deliberada. Embora tenha sido incorporado anteriormente, ainda não há recomendações claras para padronizar seu desenvolvimento e implementação. Este manuscrito pretende compartilhar recomendações com base em nossa experiência, com mais de doze anos usando e aprimorando uma metodologia em simulação cirúrgica laparoscópica. Temas de reflexão. Para transferir habilidades cirúrgicas para um aprendiz, baseamos nossa metodologia em uma estrutura de três pilares: o hardware e a infraestrutura (ferramentas para treinar), o programa de treinamento (o que fazer) e feedback (como melhorar). A implementação de um programa rentável é viável: o hardware não precisa ser de alta fidelidade para transferir as habilidades, mas o programa precisa ser validado. Esses pilares evoluíram ao longo do tempo incorporando a tecnologia: a presença de especialistas evoluiu para uma modalidade remota e assíncrona por meio da gravação em vídeo do desempenho do aluno e permitindo seu feedback. Quem dá feedback não precisa ser necessariamente um clínico especialista na área, mas sim uma pessoa previamente treinada como instrutor. Isso permite a prática deliberada até que a habilidade seja dominada e estabeleça curvas de aprendizado. Conclusões. Foram apresentadas recomendações baseadas na experiência do nosso centro, explicando o enquadramento da nossa estratégia. Levando em consideração essas sugestões, espera-se que nossa metodologia de simulação possa ajudar outros grupos e instituições a desenvolver e implementar programas eficazes baseados em simulação.

Clinical simulation with dramatization, a teaching-learning strategy for undergraduate students of nutrition and dietetics

At present, education in Health Sciences requires interaction with real patients, which is made more complex due to the need to ensure their health safety. For this reason, new teaching methodologies are now being implemented, which help to improve and protect safe care. Objective: This study was carried out using a quantitative approach with a non-experimental, descriptive design. Materials and Methods: The sample was non-probabilistic and consisted of 87 undergraduate students. A questionnaire was used, with 18 statements divided into 3 dimensions: dimension 1, simulation structure, with six questions reflecting aspects related to its implementation; dimension 2, learning, with seven questions related to aspects of effective communication, trust, learning and respect for diversity; dimension 3, feedback for learning, with five questions, including feedback by the teacher and the simulated patient, as well as their own views with regard to participating in another similar experience again. A five-point Likert scale was used. Results: The three dimensions studied, simulation structure, learning and feedback for learning, report a high level of positive perceptions. Conclusion: The simulation strategy is an educational tool in health-related careers that enhances the clinical competencies of the students as well as the relevant theoretical and practical skills and abilities in their learning process, promoting integration of the knowledge acquired in previous subjects(AU)

En la actualidad, la formación en Ciencias de la Salud requiere de la interacción con pacientes reales, lo que se hace más complejo por la necesidad de velar por la seguridad de su salud. Por ello, ahora se están implementando nuevas metodologías docentes que ayudan a mejorar y proteger la atención segura. Objetivo: Este estudio se llevó a cabo con un enfoque cuantitativo con un diseño no experimental, descriptivo. Materiales y métodos: La muestra fue no probabilística a conveniencia y estuvo conformada por 87 estudiantes de pregrado. Se utilizó un cuestionario, con 18 enunciados divididos en 3 dimensiones: dimensión 1, estructura de simulación, con seis preguntas que reflejan aspectos relacionados con su implementación; la dimensión 2, aprendizaje, con siete preguntas relacionadas con aspectos de comunicación efectiva, confianza, aprendizaje y respeto a la diversidad; dimensión 3, retroalimentación para el aprendizaje, con cinco preguntas, que incluye la retroalimentación del docente y del paciente simulado, así como sus propias opiniones con respecto a participar nuevamente en otra experiencia similar. Se utilizó una escala tipo Likert de cinco puntos. Resultados: Las tres dimensiones estudiadas, estructura de simulación, aprendizaje y retroalimentación para el aprendizaje, reportan un alto nivel de percepciones positivas. Conclusión: La estrategia de simulación es una herramienta educativa en carreras afines a la salud que potencia las competencias clínicas de los estudiantes, así como las destrezas y habilidades teóricas y prácticas pertinentes en su proceso de aprendizaje, favoreciendo la integración de los conocimientos adquiridos en materias anteriores(AU)

Consumo de frutas, verduras y legumbres en universitarios chilenos / Consumption of fruits, vegetables and legumes among Chilean university students

RESUMEN Recomendaciones internacionales indican que se deben consumir diariamente 400 g/día o su equivalente a 5 porciones de frutas, verduras o legumbres. Nuestro objetivo fue determinar la frecuencia de consumo de frutas, verduras y legumbres en estudiantes universitarios chilenos. Materiales y Métodos: Estudio transversal. Fueron evaluados estudiantes universitarios (n= 1454) del norte, centro y sur de Chile. Ellos completaron una encuesta alimentaria que se utiliza para determinar hábitos alimentarios saludables (frutas, verduras y legumbres). El 78% era de sexo femenino. Al analizar la frecuencia de consumo de frutas, verduras y legumbres según universidad, sólo frutas y verduras mostraron de diferencia estadísticamente significativa (p< 0,01). El 70% de los estudiantes no cumple con la recomendación de consumo de frutas; 72% con la de verduras y 77% con la de legumbres. En mujeres, un 6,3% del total de la muestra cumple con la recomendación de frutas y en hombres el valor alcanza al 8,4%; en verduras se observa que la recomendación alcanza al 29,5% en mujeres y 21,3% en hombres, y en legumbres, es 2,4% en mujeres y 5% en hombres. Se observa un bajo consumo de frutas, verduras y legumbres en universitarios muy lejos de las recomendaciones internaciones.

ABSTRACT International recommendations indicate that 400 g/ day or its equivalent to 5 servings of fruits, vegetables or legumes should be consumed daily. Our aim was to determine patterns of consumption of fruits, vegetables and legumes among Chilean university students. Materials and Methods: Cross-sectional study. University students (n= 1454) from the north, center and south of Chile were evaluated. A self-assessment survey was used to evaluate healthy eating habits (fruits, vegetables and legumes). Seventy-eight percent of participants were women. When analyzing the consumption frequency of fruits, vegetables and legumes according to different universities, only fruits and vegetables showed a statistically significant difference (p< 0.01). Seventy percent of students do not meet recommended amounts for fruit consumption; 72% for vegetables and 77% for legumes. Among women, 6.3% of the total sample met the recommendation for fruit, while, for men, the value was 8.4%; for vegetables, we observed that 29.5 and 21.3% of women and men, respectively, met the recommendation; for legumes, 2.4% of women and 5% of men met the recommendation. There was a low consumption of fruits, vegetables and legumes among university students, with levels far from the international recommendations.

Caracterización del estado nutricional, hábitos alimentarios y estilos de vida de estudiantes universitarios chilenos: estudio multicéntrico / Lifestyles, body mass index and sleep patterns among university students

Background Health surveys in Chile show a worrisome high prevalence of unhealthy lifestyles among adults. Aim To characterize the nutritional status, food intake and sleep patterns in university students of both genders. Material and Methods Cross sectional study in seven Chilean universities. Students from six universities answered a feeding habits survey, the Pittsburgh Sleep Quality Index, Insomnia Severity Index and Epworth Sleepiness Scale. All were weighed and their height was measured. Results A total of 1,418 students aged 21 ± 3 years (22% males) were evaluated. Three percent were classified as underweight, 68% as normal weight, 24% as overweight and 4% as obese. Thirty three percent of males and 28% of females smoked. Twenty six percent consumed at least one glass of alcoholic beverages on the weekend, and only 18% of males and 5% of females were physically active. Men consumed unhealthy foods with a significantly higher frequency than females. Twenty seven percent had mild daytime somnolence, 24% had moderate daytime somnolence, 50% had subclinical insomnia, 19% moderate insomnia, and 1.4% had severe insomnia. Conclusions In this group of students a high frequency of unhealthy lifestyles and malnutrition caused by excess was observed. Also a high prevalence of insomnia, daytime somnolence, and inadequate sleep amounts were recorded.