A call for urgent action to safeguard our planet and our health in line with the helsinki declaration.

In 2015, the Rockefeller Foundation-Lancet Commission launched a report introducing a novel approach called Planetary Health and proposed a concept, a strategy and a course of action. To discuss the concept of Planetary Health in the context of Europe, a conference entitled: "Europe That Protects: Safeguarding Our Planet, Safeguarding Our Health" was held in Helsinki in December 2019. The conference participants concluded with a need for action to support Planetary Health during the 2020s. The Helsinki Declaration emphasizes the urgency to act as scientific evidence shows that human activities are causing climate change, biodiversity loss, land degradation, overuse of natural resources and pollution. They threaten the health and safety of human kind. Global, regional, national, local and individual initiatives are called for and multidisciplinary and multisectorial actions and measures are needed. A framework for an action plan is suggested that can be modified for local needs. Accordingly, a shift from fragmented approaches to policy and practice towards systematic actions will promote human health and health of the planet. Systems thinking will feed into conserving nature and biodiversity, and into halting climate change. The Planetary Health paradigm ‒ the health of human civilization and the state of natural systems on which it depends ‒ must become the driver for all policies.

Accounting for musical perception through equivalence relations and abstraction: an experimental approach

The present study aimed to establish equivalence classes between musical chords, the corresponding chord grids, and the labels for each chord type (major, minor and 7th). Seven adults participated in a computerized matching-to-sample procedure. During training sessions, participants learned relations between chords of the same root note and either their corresponding chord grids or the words labeling their type. Equivalence relations between grids and words were then verified, and a generalization test assessed abstraction of the chord type with previously untrained chords. Phase 1 used chords having C as the root note. Phases 2 and 3 were programmed similarly, using chords having E and G as their root notes. Most participants had positive results on equivalence tests. Across the experimental phases, the percentage of correct choices in the generalization tests increased gradually for four out of seven participants. A behavioral account of musical perception through the concept of abstraction is discussed (AU)

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Nutritional practices in very low birth weight infants: a national survey / ¿Cuál es la nutrición que administramos a nuestros recién nacidos de muy bajo peso en las unidades neonatales?: una encuesta nacional

Background: Significant efforts have been made to improve the nutritional support of very preterm infants. Large surveys may help to know the nutritional practices for preterm infants in neonatal units and identify if they are in line with the current guidelines. Methods: A multicentre nationwide web-based survey on clinical feeding practices in very low birth weight (VLBW) infants was conducted in tertiary neonatal hospitals that admit infants with a birth weight < 1,500 g and/or a gestational age of < 32 weeks. Results: The questionnaire was completed by 53 units (response rate, 59%). Over 90% of the units surveyed start amino-acid administration immediately after birth and more than half use novel intravenous fish oil-based lipid emulsions. Enteral nutrition is started within 24 hours of birth in 65% of units and 86% of these are medium-sized or large. Feeding volumes are increased at a rate of 10-30 ml/kg/day in > 90% of units. Monitoring of serum phosphorus was measured more frequently than albumin (p = 0.009) or triglycerides (p = 0.037), but only 28% of centres regularly measure pre-albumin as a nutritional biomarker. Human milk fortification and iron supplementation, starting at four weeks of age, are almost universal. However, only 30% of units administer 800 IU/day of vitamin D. Nearly 50% of the units discharge infants on preterm formula. Conclusion: Most Spanish neonatology units use early amino-acid supplementation and over half use novel fish oil-based lipid emulsions. Post-discharge nutrition practices and vitamin administration vary greatly (AU)

Antecedentes: se han realizado esfuerzos significativos para mejorar la nutrición en los recién nacidos muy prematuros. Las grandes encuestas pueden ayudar a conocer cuál es la nutrición que reciben los recién nacidos prematuros en las unidades neonatales e identificar si están en línea con las directrices actuales. Métodos: se llevó a cabo una encuesta multicéntrica a nivel nacional sobre las prácticas clínicas empleadas en la alimentación en los recién nacidos de muy bajo peso en hospitales de nivel III que ingresan recién nacidos con un peso al nacer < 1.500 g y/o una edad gestacional < 32 semanas. Resultados: el cuestionario fue completado por 53 unidades neonatales (tasa de respuesta del 59%). Más del 90% de las unidades estudiadas inician la administración de aminoácidos inmediatamente después del nacimiento y más de la mitad utilizan nuevas emulsiones lipídicas intravenosas que contienen aceite de pescado. La nutrición enteral se inicia en las primeras 24 horas de nacimiento en el 65% de las unidades y el 86% de ellas son medianas o grandes. El volumen de alimentación aumenta a una velocidad de 10-30 ml/kg/día en > 90% de las unidades. El fósforo sérico se monitoriza con mayor frecuencia que la albúmina (p = 0,009) o los triglicéridos (p = 0,037), pero solo el 28% de los centros miden regularmente la prealbúmina como biomarcador nutricional. La fortificación de la leche humana y la suplementación con hierro, a partir de las cuatro semanas de edad, es casi universal. Sin embargo, solo el 30% de las unidades administran 800 UI/día de vitamina D. Casi el 50% de las unidades utilizan leche de fórmula del prematuro al alta de las unidades. Conclusión: la mayoría de las unidades neonatales españolas administran precozmente los suplementos de aminoácidos y más de la mitad emplean emulsiones de lípidos a base de aceite. Hay una importante variación en las prácticas nutricionales posteriores al alta y en la administración de vitaminas (AU)

The effect of nebulised magnesium sulphate in the management of childhood moderate asthma exacerbations as adjuvant treatment

BACKGROUND: After the bronchodilator effect of magnesium was shown, the use of magnesium in treatment of asthma exacerbations became common. With the results of recent studies, the use of intravenous magnesium in severe asthma exacerbations took its place. We aimed to examine the effects of adding isotonic magnesium sulphate instead of isotonic saline into nebulised salbutamol on the Modified Pulmonary Index Score (MPIS) and the hospitalisation rate in moderate asthma exacerbations. METHODS: Our study population included 100 children age between 3 and 15 years with asthma admitted to emergency department due to moderate asthma exacerbations. The patients were randomised to placebo or magnesium, with 50 patients in each arm. All patients received 1mg/kg of systemic methylprednisolone at the beginning of treatment and thereafter received either nebulised salbutamol (0.15mg/kg/dose) and 1ml magnesium sulphate (15%)+1.5ml isotonic saline on three occasions at roughly 20min intervals (Magnesium group) or nebulised salbutamol (0.15mg/kg/dose) and 2.5ml isotonic saline mixture on three occasions at roughly 20min intervals (Placebo group). The MPIS of patients on 0th min, 20th min, 40th and 120th min were calculated and compared. The primary outcome was to compare MPIS values at the end of 120th min. RESULTS: Both groups have similar demographic, allergic characteristics and baseline MPIS scores. When the MPIS scores in the 120th min and admission rates in the 200th min, there was no significant difference between the two groups. CONCLUSIONS: The use of nebulised magnesium sulphate in moderate asthma exacerbation as adjuvant treatment showed no benefit to standard treatment in our study

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Beneficios del masaje infantil. Percepción de las madres en un centro de Atención Primaria / Benefits of the infant massage noticed by mothers in a Primary Care

OBJETIVOS. El objetivo principal del estudio fue confirmar los beneficios del masaje infantil (MI) que perciben las madres. Como objetivos secundarios se planteó conocer datos sociodemográficos de las madres que realizan el MI en casa y el tipo de lactancia predominante. MATERIAL Y MÉTODOS. Estudio descriptivo longitudinal que incluyó a las madres que acudían al taller de masaje infantil de un centro de Atención Primaria de la provincia de León, con una muestra final de 49 madres. El periodo de recogida de datos fue de febrero de 2014 a febrero de 2015. Se entregó una encuesta diseñada para este estudio que recogía: tipo de lactancia, variables sociodemográficas (edad materna, estudios y etnia), los beneficios del masaje, si lo realizan en casa y si acuden acompañadas por su pareja. Para el análisis estadístico se utilizó el programa SPSS.13. RESULTADOS. Los beneficios más percibidos por las madres son el aumento del vínculo materno filial y la relajación, con un 95.9 % de respuesta positiva, seguido del aumento de la calidad del sueño en un 65.3 %. La disminución del llanto y la reducción de los cólicos tuvieron un 63.3 %. El 93.3 % de las madres realizan el masaje en casa. El tipo de lactancia predominante es la materna, con un 53.1 %. CONCLUSIONES. Las madres perciben los beneficios del masaje infantil en sus bebés y realizan la técnica en casa (AU)

OBJECTIVES. The main objective of the study was to confirm the infant massage benefits noticed by mothers. As for secondary objectives, the aim was to establish the sociodemographic characteristics of the mothers who practice the infant massage at home and the main type of feeding. MATERIAL AND METHODS. Longitudinal descriptive study which included the mothers who came to the infant massage workshop in a Primary Care Centre in León, with a sample composed of 49 mothers. Data were collected from February 2014 to February 2015. A questionnaire designed for this study was given, which contained: sociodemographic characteristics (mothers’ age, studies and ethnic group), benefits of the infant massage, if they did it at home and if the couple came to the workshop. For the statistical analysis, the software manager SPSS.13. was used. RESULTS. The main noticed benefits were increasing mother-child bond and relaxation, with a 95.9 % of positive answer, followed by the increasing of the sleep quality, in a 65.3 %. Less crying and decreasing of the colic had a 63.3 %. Most of the mothers, 93.3 %, did the massage at home. The main type of feeding was breast-feeding, 53.1 %. CONCLUSIONS. Mothers noticed the benefits of the infant massage and they do it at home (AU)

Consumo alimentar em pacientes hospitalizados: associação com o estado nutricional e a anemia / Food consumption in hospitalized patients: association with nutritional status and anemia

Introdução: A anemia é um importante indicador de desnutrição e de ingestão alimentar inadequada podendo afetar pessoas de todas as faixas etárias. Objetivos: Analisar o consumo alimentar por meio do consumo de ferro (Fe), folato (B9 ou ácido fólico) e/ou cianocobalamina (B12), e a associação entre estado nutricional e anemia em pacientes hospitalizados. Métodos: A coleta foi realizada com pacientes institucionalizados adultos e idosos de ambos os sexos, visando averiguar determinantes de anemia nos mesmos, composta por dados clínicos, antropométricos e bioquímicos. Resultados: A amostra totalizou 123 pacientes, e revelou que mais de 80% dos estudados encontravam-se anêmicos. Não foi observada relação entre anemia e estado nutricional dos pacientes. Houve associação entre as vitaminas estudadas e a anemia. O índice de inadequação foi acentuado em todos os nutrientes referidos, destacando o folato (B9) com 93,19%. Conclusão: O resultado retrata que não houve relação do estado nutricional com a anemia, apesar dos índices elevados, porém foi encontrada associação da ingestão alimentar inadequada com a anemia (AU)

Introduction: Anemia is an important indicator of malnutrition and inadequate food intake can affect people of all age groups. Objective: Analyze food consumption through the iron intake (Fe), folate (B9 or folic acid) and / or cyanocobalamin (B12), and the association between nutritional status and anemia in hospitalized patients. Methods: Data collection was conducted with institutionalized adults and elderly patients of both sexes, aiming to investigate determinants of anemia on them, consisting of clinical, anthropometric and biochemical data. Results: The sample comprised 123 patients and found that more than 80% of the examined are anemic. No relationship was found between anemia and nutritional status of patients. There was a correlation between the studied vitamins and anemia. The inadequacy index was accentured in all nutrients mentioned, highlighting folate (B9) with 93.19%. Conclusion: The result depicts that there was no relationship between nutritional status and anemia, despite the high rates, but war correlated the inadequate food intake with anemia (AU)

Perfil epidemiológico de pacientes colombianos con artritis reumatoide evaluados en una clínica especializada de atención integral / Epidemiological profile of colombian patients with rheumatoid arthritis in a specialized care clinic

Introducción. Existen pocos estudios que reporten el perfil epidemiológico de pacientes con AR que asisten a clínicas especializadas de atención integral. Nuestro objetivo es describir las características clínicas y sociodemográficas, y las comorbilidades de pacientes con AR en una clínica de atención integral. Métodos. Estudio transversal en una cohorte de pacientes según criterios de clasificación ACR/EULAR-2010 que han ingresado a la clínica de AR desde octubre del 2012 hasta mayo del 2014 remitidos del primer nivel de atención. Se describen las frecuencias para las variables sociodemográficas, comorbilidades, estado de actividad de la enfermedad, estado funcional, biomarcadores y modalidades terapéuticas. Resultados. Se incluyó a 1.652 pacientes con promedio de edad de 58 años y tiempo de evolución de 9 años. El factor reumatoide fue positivo en el 80% y los anticuerpos antipéptido citrulinados en el 63% de los pacientes. El 43,6% de los pacientes presentaban comorbilidades asociadas: hipertensión arterial (20,4%), osteoporosis (17,3%) y síndrome de Sjögren (10,4%). El 50% de los pacientes se encontraba en moderada y alta actividad de la enfermedad medido por DAS-28 y el promedio ± desviación estándar del valor del puntaje HAQ al ingreso fue de 0,64 ± 1,12. El 73% del total de pacientes estaban en tratamiento con modificadores de la enfermedad por vía oral, de los cuales el 63,6% estaba con metotrexato. El 42,4% de los pacientes recibían tratamiento con glucocorticoides (dosis promedio 6,3mg). Conclusiones. Se reporta el comportamiento epidemiológico de un grupo de pacientes con AR. Es significativa la presencia de comorbilidades que influyen en el riesgo de morbimortalidad de estos pacientes. La definición del perfil epidemiológico de esta población permitirá el diseño de preguntas de investigación que permitan resolver problemas relevantes en el contexto clínico de esta patología (AU)

Introduction. Few studies report the epidemiological profile of RA patients attending clinics for comprehensive care. We describe the clinical, socio-demographic characteristics and comorbidities of a cohort of patients with RA. Methods. Cross-sectional study in a cohort of patients according to ACR criteria/EULAR 2010 classification who have entered to the AR clinic since October 2012 until May 2014, referred from primary care. Frequencies for socio-demographic, comorbidity, state of disease activity, functional status, biomarkers and therapeutic modalities variables are described. Results. In total, 1652 patients were included with a mean age of 58 years and a duration of 9 years. Rheumatoid factor was positive in 80% and anti-citrullinated peptide antibody in 63% of patients. In total, 43.6% of patients had comorbidities: Hypertension (20.4%), osteoporosis (17.3%) and Sjögren's syndrome (10.4%). Fifty percent of the patients had moderate and high disease activity level measured by DAS-28 score, and the mean HAQ score was 0.64 (DS 1.12). Seventy three percent of patients were treated with oral disease modified anti rheumatic treatment and 63.6% of them were with methotrexate. 42.4% of the patients were treated with glucocorticoids (mean dose 6.3mg). Conclusions. The epidemiological behavior of a group of RA patients is reported. The presence of comorbidities is significant affecting the risk of morbidity and mortality in these patients. The definition of the epidemiological profile of this population will allow the design of research questions to resolve outstanding problems in the clinical context of this pathology (AU)

Estudio preliminar de la efectividad de la terapia asistida con perros en personas de la tercera edad / Effectiveness of dog-assisted therapy in the elderly. A preliminary study

Introducción. Las terapias asistidas con animales están cada vez más presentes en diferentes ámbitos educativos y sanitarios. El objetivo del presente estudio es valorar la efectividad de este tipo de intervenciones en la población de edad avanzada residente en centros privados. Material y métodos. Se diseñó un programa de intervención asistida por un perro en el que participaron 16 usuarios de una residencia geriátrica, divididos en un grupo experimental y un grupo control, durante 12 semanas. Resultados. Se evaluaron diferentes variables físicas y psicológicas antes y después de la intervención y, mientras que en el grupo control no se encontraron diferencias significativas, en el grupo experimental aparecieron mejoras posteriores a la intervención. Conclusiones. Los resultados obtenidos refuerzan la hipótesis de que las terapias asistidas con animales pueden resultar beneficiosas para las personas de la tercera edad residentes en centros geriátricos (AU)

Introduction. Animal-assisted therapy is increasingly present in several educational and health areas. The aim of this study is to assess the effectiveness of such interventions in the elderly population living in residential settings. Materials and methods. A 12-week dog-assisted intervention program was designed, with 16 participants from a nursing home divided into an experimental group and a control group. Results. Several physical and psychological variables were assessed before and after the intervention. While there were no significant differences in the control group, the experimental group improved significantly after participating in the program. Discussion. The results support the hypothesis that animal-assisted interventions may be beneficial for residents in elderly care homes (AU)

Estado nutricional antropométrico y bioquímico, infestación parasitaria, estratificación social. Efectos de suplementación con zinc en niños de guarderías públicas venezolanas / Anthropometric and biochemical nutritional status, parasitic infestation, social stratification. The effects of zinc supplementation in children of Venezuelan public kindergartens

Fundamentos: Las deficiencias nutricionales calórico-proteicas y de micronutrientes impiden el crecimiento y el desarrollo normal de los individuos, limitando el rendimiento escolar, laboral e incrementando el riesgo de morbimortalidad poblacional. El objetivo fue hacer una suplementación con zinc (Zn) y establecer el estado nutricional antropométrico, bioquímico, así como determinar el consumo de alimentos, las condiciones socioeconómicas y la posible relación con los parámetros nutricionales e infestación parasitaria en niños preescolares. Métodos: Se realizó un estudio experimental, longitudinal prospectivo doble ciego, con un muestreo no probabilístico por cuotas. Participaron 47 niños de los HOGAIN del Edo Lara con los indicadores Talla/Edad y Peso/Edad con valores igual o por debajo del percentil 10. Resultados: El déficit nutricional osciló entre 25%-33%, aunque el 66% de los niños con un consumo inadecuado de energía y nutrientes presentaron un estado nutricional antropométrico normal; la ingesta de proteínas, fibra y vitamina A fue superior al rango considerado como aceptable. Los alimentos más consumidos fueron los cereales y lácteos siendo estos la principal fuente de proteínas vegetal y animal respectivamente. No hubo diferencias significativas entre las medias antropométricas de ambos grupos. La prevalencia de niños con déficit disminuyó después de la suplementación en todos los indicadores antropométricos excepto T/E. Después de la suplementación, el porcentaje de anémicos y deficientes de Zn disminuyó en un 6% y 15%. Conclusiones: Más del 80% de la población estudiada se encuentra en situación de pobreza. En el grupo suplementado se observa un efecto positivo en los indicadores antropométricos, y disminuye la prevalencia de deficientes de Zn. Se recomienda extender el periodo de suplementación, o tomar en consideración la deficiencia de otros micronutrientes (AU)

Background: Deficiencies in caloric-protein nutrient and micronutrients impede normal growth and development of individuals, limiting school and work performance and increasing the risk of population morbidity and mortality. The aim was to make a zinc (Zn) supplementation and to establish anthropometric and biochemical nutritional status, as well to determine food consumption, socioeconomic conditions and possible relationship with nutritional parameters and parasite infestation in preschool children. Methods: A prospective longitudinal double-blind stydy was conducted, with non-probabilistic sampling by quotas. Participants were 47 children from HOGAIN in Lara State with height/age and weight/age indicators, with values equal or below the 10th percentile. Results: The nutritional deficit ranged from 25%-33%, although 66% of children with inadequate energy and nutrient intake had normal anthropometric nutritional status; the intake of protein, fiber and vitamin A was higher than the range considered acceptable. The most consumed foods were cereals and dairy products, being these the main source of vegetable and animal proteins respectively. There were no significant differences between the anthropometric means of both groups. The prevalence of children with deficits decreased after supplementation in all anthropometric indicators except T / E. After supplementation, the percentage of anemic and deficient Zn decreased by 6% and 15%. Conclusions: More than 80% of the population studied is in poverty. In the supplemented group, a positive effect was observed on the anthropometric indicators, and the prevalence of Zn deficiency decreased. It is recommended to extend the period of supplementation, or to take into account the deficiency of other micronutrients (AU)

The revised Declaration of Helsinki: cosmetic or real change?

The Declaration of Helsinki, adopted by the World Medical Association's General Assembly in 1964, is the most important set of guidelines about research on human participants. It both reflects and shapes the ethos of international research ethics. It is a living instrument and is reviewed and revised regularly. Its latest revision was in 2013. There are four substantial changes, reflected in the new Paragraph 15 (which deals with compensation for trial related injuries), Paragraph 33 (relating to placebos), Paragraph 20 (relating to vulnerable groups) and the new Paragraph 34 (relating to post-trial provisions). This article analyses these changes, and asks whether they indicate any shift in the overall philosophy of the Declaration. We conclude that these changes, though significant, are not tectonic. They accord with the spirit that has motivated the Declaration through all its iterations, and indicate a steady, incremental evolution towards a holistic code of research ethics for research on human participants. Patient autonomy, though crucial, is no longer the only concern of the Declaration; distributive justice and beneficence are motivating forces too. While the Declaration is aware of the need to facilitate research, it is equally aware of the need to protect the vulnerable, and of the practical difficulties involved in that protection.

Efecto de 8 semanas de corriente TENS modificada y la corriente rusa, sobre la fuerza muscular y la composición corporal / Efeito de 8 semanas de corrente TENS modificada e corrente russa sobre a força e composição corporal / Effects of 8 weeks of modified TENS current and russian current, on muscle strength and body composition

Objetivo. Comparar el efecto de 2 métodos de electroestimulación en las siguientes variables: fuerza y antropometría. Método. Se realizó una investigación experimental, aleatoria y simple ciego. Se evaluó a 18 sujetos, distribuidos en: Grupo Corriente TENS Modificada (CTM: n = 6), Grupo Corriente Rusa (CR: n = 6) y Grupo Control (TC: n = 6, sometido a corriente TENS Convencional, considerada en la presente investigación como placebo). Resultados. Al cabo de 8 semanas, solo CTM incrementó la fuerza máxima (p < 0.035) y redujo el grosor del pliegue subcutáneo de la pierna derecha (p < 0.03). Conclusiones. La técnica de electroestimulación con corriente TENS Modificada es efectiva para el entrenamiento muscular (AU)

Objetivo. Comparar o efeito de 2 métodos de eletroestimulação nas seguintes variáveis: força e antropometria. Método. Um estudo experimental, randomizado, cego simples. Foram avaliados 18 indivíduos, distribuídos em: grupo de corrente TENS modificada (CTM: n = 6), grupo corrente russa (CR: n = 6) e grupo controle (TC: n = 6, submetido a corrente TENS convencional, considerada nesta investigação como placebo). Resultados. Após 8 semanas, CTM aumentou a força máxima (p < 0,035) e reduziu a espessura de pregas subcutâneas da coxa direita (p < 0,03). Conclusões. A técnica de eletroestimulação com corrente TENS modificada é eficaz para treinamento muscular (AU)

Objective. To compare the effect of two methods of electrostimulation on the following variables: strength and anthropometry. Method. An experimental, randomized, and simple blind investigation was performed. Eighteen subjects were evaluated distributed into a Modified TENS Current Group (CTM: n = 6), Russian Current Group (CR: n = 6), and a Control Group (TC: n = 6, submitted to traditional TENS current, considered as placebo in this research). Results. After 8 weeks, only CTM obtained an increase in maximal strength (p < 0.035), and a reduction in the subcutaneous fat thickness of the right thigh (p < 0.03). Conclusions. A Modified TENS Current is effective for muscular training (AU)

Reasoning and action: implementation of a decision-making program in sport

The objective of this study was to apply a decision training programme, based on the use of video-feedback and questioning, in real game time, in order to improve decision-making in volleyball attack actions. A three-phase quasi-experimental design was implemented: Phase A (pre-test), Phase B (Intervention) and Phase C (Retention). The sample was made up of 8 female Under-16 volleyball players, who were divided into two groups: experimental group (n = 4) and control group (n = 4). The independent variable was the decision training program, which was applied for 11 weeks in a training context, more specifically in a 6x6 game situation. The player had to analyze the reasons and causes of the decision taken. The dependent variable was decision-making, which was assessed based on systematic observation, using the «Game Performance Assessment Instrument» (GPAI) (Oslin, Mitchell, & Griffin, 1998). Results showed that, after applying the decision training program, the experimental group showed a significantly higher average percentage of successful decisions than the control group F(1, 6) = 11.26; p = .015; η2 p = .652; 95% CI [056, 360]. These results highlight the need to complement the training process with cognitive tools such as video-feedback and questioning in order to improve athletes’ decision-making (AU)

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Electroestimulación neuromuscular intradiálisis, fuerza muscular, capacidad funcional y composición corporal / Intradialysis neuromuscular electro stimulation muscle strength, functional capacity and body composition

Introducción: La capacidad funcional disminuida y la importante atrofia muscular caracterizan a los pacientes en hemodiálisis (HD). El ejercicio físico intradiálisis y recientemente la electroestimulación neuromuscular (EMS), representan dos serias opciones terapéuticas para mejorar esta deteriorada condición física. Actualmente, no existen estudios publicados sobre el papel de la EMS y la composición corporal en los pacientes en HD. Objetivo: Analizar que efecto produce un programa de EMS sobre la fuerza muscular, capacidad funcional, parámetros nutricionales y composición corporal en nuestros pacientes en HD. Material y Métodos: Estudio unicéntrico, prospectivo de 12 semanas de duración. Los pacientes incluidos realizaron un programa adaptativo de EMS en ambos cuádriceps intradiálisis mediante el dispositivo Compex R Theta 500i. Analizamos: 1.- Parámetros nutricionales (Albumina, pre albúmina, triglicéridos, colesterol total y fracciones, ferritina y Proteína C reactiva). 2.- Datos musculares: Composición muscular cuadriceps, Fuerza extensión máxima cuádriceps (FEMQ) y handgrip (HG) brazo dominante. 3.- Test funcionales: “Sit to stand to sit” (STS10) y “six- minutes walking test” (6MWT). 4.- Composición corporal mediante biompedancia electrica (BIA). Resultados: 13 pacientes incluidos: (69.2% hombres). Edad media: 65.7 años y 33.9 meses en HD. I.Charlson medio 9.1. La principal etiología de la ERC fue la DM ( 38.5%). Al final del estudio se observó una mejoría en (*p<0.05): FEMQ* ( 11.7±7.1 vs 13.4±7.4 Kg), STS10 (39.3±15.5 vs 35.8±13.7 seg), 6MWT* (9.9%, 293.2 vs 325.2 m). En relación a la composición corporal, se observó únicamente un aumento significativo del área muscular (AMQ*: 128.6 ± 30.2 vs 144.6 ± 22.4 cm2) y una disminución del área grasa (AGQ*: 76.5 ± 26.9 vs 62.1 ± 20.1 cm2) a nivel quadricipital, sin cambios en el resto de datos analizados (% grasa abdominal, peso graso, peso magro, agua corporal total). No se objetivaron cambios relevantes en los parámetros nutricionales y de adecuación dialítica. Conclusiones: 1.- La electroestimulación neuromuscular intradialísis mejoró la fuerza muscular, la capacidad funcional y la composición muscular del cuadriceps de nuestros pacientes en HD. 2.- Nuestros resultados remarcan el carácter local de la electroes-timulación neuromuscular, dada la ausencia de cambios relevantes en el resto de los parámetros nutricionales y datos corporales analizados. 3.- No obstante, son necesarios futuros estudios mejor diseñados, de cara a discernir si la electroestimulación neuromuscular podría ser una nueva alternativa terapéutica para evitar la atrofia muscular y el deterioro progresivo de la condición física de éstos pacientes (AU)

Background: The reduced functional capacity and significant muscle atrophy characterized patients on hemodialysis. Intradialytic exercise and recently neuromuscular electrostimulation (EMS) represent two serious therapeutical options to improve the deteriorated physical condition. Until date, there are no published studies about the role of EMS and body composition in HD patients. Objectives: Analyze the effect a program of EMS on muscle strength, functional capacity, nutritional parameters and body composition in our HD patients. Methods: A 12 weeks single-center, prospective study. Patients included in the study performed an intradialysis EMS adaptive program in both quadriceps using the Compex R Theta 500i device. We analyzed: 1.- Nutritional parameters (albumin, pre-albumin, triglycerides, total cholesterol and fractions, ferritin and C-reactive protein). 2.- Muscular data: Muscular composition, Maximum length quadriceps strength (MLQS) and “hand-grip” (HG) dominant arm. 3.- Functional capacity test: “Sit to stand to sit” (STS10) and “six- minutes walking test” (6MWT). 4.- Body composition. Results: 13 HD patients included: 69.2 % men. Mean age 65.7 years and 33.9 months on HD. A significant (* p < 0,05) improvement was observed in MLQS* (11.7±7.1 vs 13.4±7.4 Kg), STS10* (39.3±15.5 vs 35.8±13.7 seg), 6MWT* (9.9%, 293.2 vs 325.2 m). There was a signi-ficant increase in the quadriceps muscular area (QMA*: 128.6 ± 30.2 vs 144.6 ± 22.4 cm2) and decrease of fat quadricipital area (FQA*: 76.5 ± 26.9 vs 62.1 ± 20.1 cm2). No significant changes were observed in nutritional parameters, body composition (body fat percentage, lean and fat mass, total body water) or dialysis adecuacy data. Conclusions: 1.- Intradialysis quadriceps EMS improved muscle strength, functional capacity and the quadriceps muscle composition in our HD patients. 2.- Our results underline the local aspects on EMS, given the absence of relevant changes on nutritional parameters and body composition. 3.- Future studies are manadatory in order to establish if EMS could be a new alternative to prevent muscle atrophy and the progressive deterioration of the physical condition of these patients (AU)

Perfil de eficacia y seguridad de Echinacea purpurea en la prevención de episodios de resfriado común: estudio clínico aleatorizado, doble ciego y controlado con placebo / Safety and efficacy profile of Echinacea purpurea to prevent common cold episodes: a randomized, double-blind, placebo-controlled trial

Objetivo: Investigar la seguridad y la eficacia de un extracto de Echinacea purpurea en la prevención del resfriado común en una amplia población durante un período de 4 meses. Método: 755 sujetos sanos recibieron un extracto etanólico de E. purpurea(95% parte aérea florida y 5% de raíz) fresca o placebo. A los participantes se les solicitó registrar en un diario los acontecimientos adversos y evaluar los síntomas relacionados con el resfriado, durante todo el período del estudio. Se tomaron muestras de las secreciones nasales de los participantes que padecieron resfriados agudos y fueron examinadas en busca de virus. Resultados: Ocurrieron un total de 293 acontecimientos adversos en el grupo al que se le asignó la equinácea y 306 en el grupo placebo. El 9% de los participantes experimentó acontecimientos adversos, que se consideraron al menos posiblemente, relacionados con el extracto (reacciones adversas), frente al 10% en el grupo placebo. Por lo tanto, la seguridad de la equinácea no fue inferior a la del placebo. La equinácea redujo el número total de episodios de resfriados, los días acumulados de resfriado y los episodios comedicados con analgésicos y antiinflamatorios. Asimismo inhibió los resfriados virales confirmados por deteccion del virus y previno especialmente las infecciones de los virus con membrana (p<0,05) La equinácea demostró mayor eficacia en las infecciones recurrentes y los efectos preventivos aumentaron cuando se cumplió estrictamente con el tratamiento y con el protocolo. Conclusión: La toma profiláctica de E. purpurea durante un período de 4 meses proporcionó una relación beneficio/riesgo positiva (AU)

Objective: To investigate the safety (risk) and efficacy (benefit) of Echinacea purpurea extract in the prevention of common cold episodes in a large population over a 4-month period. Methods: 755 healthy subjects were allocated to receive either an alcohol extract from freshly harvested E. purpurea (95% herba and 5% root) or placebo. Participants were required to record adverse events and to rate cold-related issues in a diary throughout the investigation period. Nasal secretions were sampled at acute colds and screened for viruses. Results: A total of 293 adverse events occurred with Echinacea and 306 with placebo treatment. Nine and 10% of participants experienced adverse events, which were at least possibly related to the study drug (adverse drug reactions).Thus, the safety of Echinacea was noninferior to placebo. Echinacea reduced the total number of cold episodes, cumulated episode days within the group, and pain-killer medicated episodes. Echinacea inhibited virally confirmed colds and especially prevented enveloped virus infections (p < 0.05). Echinacea showed maximal effects on recurrent infections, and preventive effects increased with therapy compliance and adherence to the protocol. Conclusions: Compliant prophylactic intake of E. purpurea over a 4-month period appeared to provide a positive risk to benefit ratio (AU)

[Improving patient safety in perioperative care for major surgeries]. / A betegbiztonság javításának lehetoségei nagy sebészeti mutétek perioperatív szakában.

The Helsinki Declaration was created and signed by the European Board of Anaesthesiology (EBA) and the European Society of Anaesthesiology (ESA). It was initiated in June 2010, and it implies a European consensus on those medical practices which improve patient safety and provide higher quality perioperative care. Authors focus on four elements of this initiative, which can be easily implemented, and provide almost instant benefit: use of preoperative checklist, prevention of perioperative infections, goal-directed fluid therapy and perioperative nutrition. The literature review emphasizes that well organized perioperative care plays the most important role in improving patient safety.

Contribución al estudio de los efectos sistémicos neurovegetativos del masaje terapéutico mediante el análisis espectral de la variabilidad de la frecuencia cardiaca / Contribution to the study of autonomic systemic effects of therapeutic massage by power spectral analysis of heart rate variability

Objetivo. Analizar las modificaciones que el masaje terapéutico produce en la actividad neurovegetativa sistémica del organismo a través del estudio de la modificación de la actividad autónoma cardiaca. Material y método. Estudio comparativo sobre 15 mujeres de la variabilidad de la frecuencia cardiaca (VFC) (intervalo R-R) obtenida mediante fotopletismografía durante 2 sesiones de 20 minutos de duración: control y masaje. Dicha VFC fue medida en 4 ocasiones diferentes sobre duraciones de 5 minutos cada una. La sesión de masaje consistió en effleurage superficial y presiones deslizadas de gran amplitud. Además, las participantes debían cumplimentar inmediatamente después de la sesión de control y de la de masaje el cuestionario de la escala visual analógica (EVA) de bienestar. Resultados. Para comparar los resultados obtenidos se ha utilizado el t-test pareado de Student y se ha empleado el coeficiente de correlación de Pearson para cuantificar la fuerza de la relación existente entre distintos tiempos en cada uno de los parámetros. Se observa un aumento estadísticamente significativo de la VFC (potencia total) y también un aumento de la actividad parasimpática en la sesión de masaje durante los 5 últimos minutos del mismo (respecto a valores basales), superior a la sesión control. Esta respuesta, sin embargo, tiende a disminuir 5 minutos después de la interrupción del mismo. Finalmente, la puntuación de la EVA de bienestar aumentó significativamente después del masaje, pero su ganancia no se correlaciona con la evolución de las variables fisiológicas. Conclusiones. El masaje aplicado sobre sujetos sanos tiene efecto sobre el sistema neurovegetativo (AU)

Goal: To analyze the changes produced by therapeutic massage on systemic autonomic activity by analyzing the modification of cardiac autonomic activity. Material and methods: A comparative study was performed on 15 women on the variability of heart rate variability (HRV) (RR interval) obtained by photoplethysmography for 2 20-minute sessions: control and massage. HRV was measured at 4 different times for periods of 5 minutes each. The massage session consisted of effleurage massage and wide-ranging sliding pressure. In addition, the participants had to fill out the well-being visual analogue scale (Well Being VAS) questionnaire immediately after the control and massage session. Results: The paired Student’s t-test was used to compare the results obtained. Pearson correlation coefficient was used to quantify the relationship existing between the different times in each one of the parameters. A statistically significant increase was observed in HRV (total power) as well as an increase in parasympathetic activity in the massage session during the last 5 minutes (relative to baseline) compared to control session. However, this response tends to decrease 5 minutes after its interruption/timeout. Finally, the Well Being VAS score shows a significant increase after the massage. However, its gain is not correlated to the changes in the physiological variables. Conclusions: The massage applied on healthy subjects affects the autonomic nervous system (AU)

The role of an independent and interdisciplinary assessment of research studies with human subjects in Europe and worldwide.

The author reviews the history of human experimentation beginning as documented by holes in human sculls 6000 years before, addressing the first controlled experiments by James Lind and Edward Jenner in the 18th century and ending with the inhuman experiments in Nazi Camps and the Tuskegee case in Alabama in the 20th century. Resting on the Declaration of Helsinki, quite a number of declarations, scientific, national and international guidelines was issued since aiming at enhancing medical research as well as protecting the subjects from harm. Now a dense ethical, legal, scientific and social network exists for investigator initiated and commercial trials for a rich market of the Pharmaceutical Industry. However, pitfalls still occur (e.g., the cases of thalidomide, VIOXX and TGN 1412) as examples that can only be prevented by even more stringent rules and well informed, conscientious, compassionate and responsible performance of all parties involved.