Dietary intake of dicarbonyl compounds and changes in body weight over time in a large cohort of European adults.

Dicarbonyl compounds are highly reactive precursors of advanced glycation end products (AGE), produced endogenously, present in certain foods and formed during food processing. AGE contribute to the development of adverse metabolic outcomes, but health effects of dietary dicarbonyls are largely unexplored. We investigated associations between three dietary dicarbonyl compounds, methylglyoxal (MGO), glyoxal (GO) and 3-deoxyglucosone (3-DG), and body weight changes in European adults. Dicarbonyl intakes were estimated using food composition database from 263 095 European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home in Relation to Anthropometry participants with two body weight assessments (median follow-up time = 5·4 years). Associations between dicarbonyls and 5-year body-weight changes were estimated using mixed linear regression models. Stratified analyses by sex, age and baseline BMI were performed. Risk of becoming overweight/obese was assessed using multivariable-adjusted logistic regression. MGO intake was associated with 5-year body-weight gain of 0·089 kg (per 1-sd increase, 95 % CI 0·072, 0·107). 3-DG was inversely associated with body-weight change (-0·076 kg, -0·094, -0·058). No significant association was observed for GO (0·018 kg, -0·002, 0·037). In stratified analyses, GO was associated with body-weight gain among women and older participants (above median of 52·4 years). MGO was associated with higher body-weight gain among older participants. 3-DG was inversely associated with body-weight gain among younger and normal-weight participants. MGO was associated with a higher risk of becoming overweight/obese, while inverse associations were observed for 3-DG. No associations were observed for GO with overweight/obesity. Dietary dicarbonyls are inconsistently associated with body weight change among European adults. Further research is needed to clarify the role of these food components in overweight and obesity, their underlying mechanisms and potential public health implications.

Dietary amino acids and risk of stroke subtypes: a prospective analysis of 356,000 participants in seven European countries.

PURPOSE: Previously reported associations of protein-rich foods with stroke subtypes have prompted interest in the assessment of individual amino acids. We examined the associations of dietary amino acids with risks of ischaemic and haemorrhagic stroke in the EPIC study. METHODS: We analysed data from 356,142 participants from seven European countries. Dietary intakes of 19 individual amino acids were assessed using validated country-specific dietary questionnaires, calibrated using additional 24-h dietary recalls. Multivariable-adjusted Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of ischaemic and haemorrhagic stroke in relation to the intake of each amino acid. The role of blood pressure as a potential mechanism was assessed in 267,642 (75%) participants. RESULTS: After a median follow-up of 12.9 years, 4295 participants had an ischaemic stroke and 1375 participants had a haemorrhagic stroke. After correction for multiple testing, a higher intake of proline (as a percent of total protein) was associated with a 12% lower risk of ischaemic stroke (HR per 1 SD higher intake 0.88; 95% CI 0.82, 0.94). The association persisted after mutual adjustment for all other amino acids, systolic and diastolic blood pressure. The inverse associations of isoleucine, leucine, valine, phenylalanine, threonine, tryptophan, glutamic acid, serine and tyrosine with ischaemic stroke were each attenuated with adjustment for proline intake. For haemorrhagic stroke, no statistically significant associations were observed in the continuous analyses after correcting for multiple testing. CONCLUSION: Higher proline intake may be associated with a lower risk of ischaemic stroke, independent of other dietary amino acids and blood pressure.

Body mass index and cancer risk among adults with and without cardiometabolic diseases: evidence from the EPIC and UK Biobank prospective cohort studies.

BACKGROUND: Whether cancer risk associated with a higher body mass index (BMI), a surrogate measure of adiposity, differs among adults with and without cardiovascular diseases (CVD) and/or type 2 diabetes (T2D) is unclear. The primary aim of this study was to evaluate separate and joint associations of BMI and CVD/T2D with the risk of cancer. METHODS: This is an individual participant data meta-analysis of two prospective cohort studies, the UK Biobank (UKB) and the European Prospective Investigation into Cancer and nutrition (EPIC), with a total of 577,343 adults, free of cancer, T2D, and CVD at recruitment. We used Cox proportional hazard regressions to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between BMI and incidence of obesity-related cancer and in turn overall cancer with a multiplicative interaction between BMI and the two cardiometabolic diseases (CMD). HRs and 95% CIs for separate and joint associations for categories of overweight/obesity and CMD status were estimated, and additive interaction was quantified through relative excess risk due to interaction (RERI). RESULTS: In the meta-analysis of both cohorts, BMI (per ~ 5 kg/m2) was positively associated with the risk of obesity-related cancer among participants without a CMD (HR: 1.11, 95%CI: 1.07,1.16), among participants with T2D (HR: 1.11, 95% CI: 1.05,1.18), among participants with CVD (HR: 1.17, 95% CI: 1.11,1.24), and suggestively positive among those with both T2D and CVD (HR: 1.09, 95% CI: 0.94,1.25). An additive interaction between obesity (BMI ≥ 30 kg/m2) and CVD with the risk of overall cancer translated into a meta-analytical RERI of 0.28 (95% CI: 0.09-0.47). CONCLUSIONS: Irrespective of CMD status, higher BMI increased the risk of obesity-related cancer among European adults. The additive interaction between obesity and CVD suggests that obesity prevention would translate into a greater cancer risk reduction among population groups with CVD than among the general population.

Lipopolysaccharide-binding protein and future Parkinson's disease risk: a European prospective cohort.

INTRODUCTION: Lipopolysaccharide (LPS) is the outer membrane component of Gram-negative bacteria. LPS-binding protein (LBP) is an acute-phase reactant that mediates immune responses triggered by LPS and has been used as a blood marker for LPS. LBP has recently been indicated to be associated with Parkinson's disease (PD) in small-scale retrospective case-control studies. We aimed to investigate the association between LBP blood levels with PD risk in a nested case-control study within a large European prospective cohort. METHODS: A total of 352 incident PD cases (55% males) were identified and one control per case was selected, matched by age at recruitment, sex and study center. LBP levels in plasma collected at recruitment, which was on average 7.8 years before diagnosis of the cases, were analyzed by enzyme linked immunosorbent assay. Odds ratios (ORs) were estimated for one unit increase of the natural log of LBP levels and PD incidence by conditional logistic regression. RESULTS: Plasma LBP levels were higher in prospective PD cases compared to controls (median (interquartile range) 26.9 (18.1-41.0) vs. 24.7 (16.6-38.4) µg/ml). The OR for PD incidence per one unit increase of log LBP was elevated (1.46, 95% CI 0.98-2.19). This association was more pronounced among women (OR 2.68, 95% CI 1.40-5.13) and overweight/obese subjects (OR 1.54, 95% CI 1.09-2.18). CONCLUSION: The findings suggest that higher plasma LBP levels may be associated with an increased risk of PD and may thus pinpoint to a potential role of endotoxemia in the pathogenesis of PD, particularly in women and overweight/obese individuals.

Duration of the patient interval in breast cancer and factors associated with longer delays in low-and middle-income countries: A systematic review with meta-analysis.

OBJECTIVE: Breast cancer survival is lower in low- and middle-income countries (LMICs) partially due to many women being diagnosed with late-stage disease. The patient interval refers to the time elapsed between the detection of symptoms and the first consultation with a healthcare provider and is considered one of the core indicators for early diagnosis and treatment. The goal of the current research was to conduct a meta-analysis of the duration of the patient interval in LMICs and investigate the socio-demographic and socio-cultural factors related to longer delays in presentation. METHODS: We conducted a systematic review with meta-analysis (pre-registered protocol CRD42020200752). We searched seven information sources (2009-2022) and included 50 articles reporting the duration of patient intervals for 18,014 breast cancer patients residing in LMICs. RESULTS: The longest patient intervals were reported in studies from the Middle East (3-4 months), followed by South-East Asia (2 months), Africa (1-2 months), Latin America (1 month), and Eastern Europe (1 month). Older age, not being married, lower socio-economic status, illiteracy, low knowledge about cancer, disregarding symptoms or not attributing them to cancer, fear, negative beliefs about cancer, and low social support were related to longer delays across most regions. Longer delays were also related to use of alternative medicine in the Middle East, South-East Asia, and Africa and distrust in the healthcare system in Eastern Europe. CONCLUSIONS: There is large variation in the duration of patient intervals across LMICs in different geographical regions. Patient intervals should be reduced and, for this purpose, it is important to explore their determinants taking into account the social, cultural, and economic context.

Sex Moderates the Relationship Between Social Support and Cardiovascular Prevention Behaviors in Middle-aged and Older Adults.

BACKGROUND: Most risk factors for cardiovascular disease (CVD) are modifiable, suggesting that the burden of CVD could be substantially reduced through cardiovascular screening and healthier lifestyle. People who have social support are more likely to adhere to cardiovascular prevention recommendations, but it is not clear whether the benefit of social support is equal for men and women. PURPOSE: We investigated whether sex moderates the relationship between social support and adherence to cardiovascular prevention recommendations in a nationally representative sample. METHODS: Participants were 17,287 adults (n = 10,264 middle-aged adults 40-64 years old and n = 7,023 older adults ≥ 65 years old) who participated in the National Health Survey of Spain in 2017. Social support was measured with the Functional Social Support Questionnaire of Duke-UNC. Adherence to cardiovascular screening recommendations was assessed based on self-reported testing of cholesterol, blood pressure, and blood sugar by a health professional in the past 12 months. Adherence to recommended health-related behaviors was assessed based on the guidelines of the European Society of Cardiology regarding diet, alcohol consumption, smoking, and physical activity. RESULTS: Multiple regression models adjusted for socio-demographic and cardiovascular history and risk variables showed that social support was more strongly associated with adherence to cardiovascular prevention recommendations in men than in women. In particular, low social support levels were especially detrimental for both middle-aged men (screening: B = 0.13, 95% CI [0.06-0.20], p < .001; behaviors: B = 0.33 [0.26-0.41], p < .001) and older men (screening: B = 0.10 [0.04-0.17], p = .001; behaviors: B = 0.16 [0.08-0.25], p < .001), whereas older women had comparatively high adherence, which was unrelated to social support (screening: B = 0.02 [-0.03 to 0.08], p = .433; behaviors: B = 0.03 [-0.03 to 0.10], p = .342). CONCLUSIONS: Social support is more strongly associated with cardiovascular prevention in men than in women, such that men who lack social support have the lowest adherence to cardiovascular screening and lifestyle recommendations.

To help prevent cardiovascular disease, experts recommend screening for cardiovascular risk factors and leading a healthy lifestyle. Previous research has found that people who have social support are more likely to adhere to such cardiovascular prevention recommendations. In this study, using data form a nationally representative survey, we investigated whether the relationship between social support and adherence to cardiovascular prevention recommendations is different for men and women. Participants were 17,287 adults from the National Health Survey of Spain, who reported their cardiovascular screening history (i.e., whether they had their cholesterol, blood pressure, and blood sugar levels tested by a health professional in the past 12 months) and their lifestyle habits regarding diet, alcohol consumption, smoking, and physical activity. Social support was more strongly associated with cardiovascular prevention in men than in women, such that men who lacked social support had the lowest adherence to cardiovascular screening and lifestyle recommendations.

Socio-economic inequalities in lung cancer mortality in Spain: a nation-wide study using area-based deprivation.

BACKGROUND: Lung cancer is the main cause of cancer mortality worldwide and in Spain. Several previous studies have documented socio-economic inequalities in lung cancer mortality but these have focused on specific provinces or cities. The goal of this study was to describe lung cancer mortality in Spain by sex as a function of socio-economic deprivation. METHODS: We analysed all registered deaths from lung cancer during the period 2011-2017 in Spain. Mortality data was obtained from the National Institute of Statistics, and socio-economic level was measured with the small-area deprivation index developed by the Spanish Society of Epidemiology, with the census tract of residence at the time of death as the unit of analysis. We computed crude and age-standardized rates per 100,000 inhabitants by sex, deprivation quintile, and type of municipality (rural, semi-rural, urban) considering the 2013 European standard population (ASR-E). We further calculated ASR-E ratios between the most deprived (Q5) and the least deprived (Q1) areas and mapped census tract smoothed standardized lung cancer mortality ratios by sex. RESULTS: We observed 148,425 lung cancer deaths (80.7% in men), with 73.5 deaths per 100,000 men and 17.1 deaths per 100,000 women. Deaths from lung cancer in men were five times more frequent than in women (ASR-E ratio = 5.3). Women residing in the least deprived areas had higher mortality from lung cancer (ASR-E = 22.2), compared to women residing in the most deprived areas (ASR-E = 13.2), with a clear gradient among the quintiles of deprivation. For men, this pattern was reversed, with the highest mortality occurring in areas of lower socio-economic level (ASR-E = 99.0 in Q5 vs. ASR-E = 86.6 in Q1). These socio-economic inequalities remained fairly stable over time and across urban and rural areas. CONCLUSIONS: Socio-economic status is strongly related to lung cancer mortality, showing opposite patterns in men and women, such that mortality is highest in women residing in the least deprived areas and men residing in the most deprived areas. Systematic surveillance of lung cancer mortality by socio-economic status may facilitate the assessment of public health interventions aimed at mitigating cancer inequalities in Spain.

Measuring feelings about choices and risks: The Berlin Emotional Responses to Risk Instrument (BERRI).

We introduce a brief instrument specifically validated for measuring positive and negative feelings about risks-the Berlin Emotional Responses to Risk Instrument (BERRI). Based on seven studies involving diverse adults from three countries (n = 2120), the BERRI was found to robustly estimate anticipatory affective reactions derived from subjective evaluations of positive (i.e., assured, hopeful, and relieved) and negative emotions (i.e., anxious, afraid, and worried). The brief BERRI outperformed a 14-item assessment, uniquely tracking costs/benefits associated with cancer screening among men and women (Studies 1 and 2). Predictive validity was further documented in paradigmatic risky choice studies wherein options varied over probabilities and severities across six contexts (health, social, financial, technological, ethical, and environmental; Study 3). Studies 4-6, conducted during the Ebola epidemic and COVID-19 pandemic, indicated BERRI responses were sensitive to subtle effects caused by emotion-related framing manipulations presented in different cultures and languages (the United States, Spain, and Poland). Study 7 indicated BERRI responses remained stable for 2 weeks. Although the BERRI can provide an estimate of overall affect, choices were generally better explained by the unique influences of positive and negative affect. Overall, results suggest the novel, brief instrument can be an efficient tool for high-stakes research on decision making and risk communication.

The patient, diagnostic, and treatment intervals in adult patients with cancer from high- and lower-income countries: A systematic review and meta-analysis.

BACKGROUND: Longer time intervals to diagnosis and treatment are associated with worse survival for various types of cancer. The patient, diagnostic, and treatment intervals are considered core indicators for early diagnosis and treatment. This review estimated the median duration of these intervals for various types of cancer and compared it across high- and lower-income countries. METHODS AND FINDINGS: We conducted a systematic review with meta-analysis (prospectively registered protocol CRD42020200752). Three databases (MEDLINE, Embase, and Web of Science) and information sources including grey literature (Google Scholar, OpenGrey, EThOS, ProQuest Dissertations & Theses) were searched. Eligible articles were published during 2009 to 2022 and reported the duration of the following intervals in adult patients diagnosed with primary symptomatic cancer: patient interval (from the onset of symptoms to first presentation to a healthcare professional), diagnostic interval (from first presentation to diagnosis), and treatment interval (from diagnosis to treatment start). Interval duration was recorded in days and study medians were combined in a pooled estimate with 95% confidence intervals (CIs). The methodological quality of studies was assessed using the Aarhus checklist. A total of 410 articles representing 68 countries and reporting on 5,537,594 patients were included. The majority of articles reported data from high-income countries (n = 294, 72%), with 116 (28%) reporting data from lower-income countries. Pooled meta-analytic estimates were possible for 38 types of cancer. The majority of studies were conducted on patients with breast, lung, colorectal, and head and neck cancer. In studies from high-income countries, pooled median patient intervals generally did not exceed a month for most cancers. However, in studies from lower-income countries, patient intervals were consistently 1.5 to 4 times longer for almost all cancer sites. The majority of data on the diagnostic and treatment intervals came from high-income countries. Across both high- and lower-income countries, the longest diagnostic intervals were observed for hematological (71 days [95% CI 52 to 85], e.g., myelomas (83 days [47 to 145])), genitourinary (58 days [50 to 77], e.g., prostate (85 days [57 to 112])), and digestive/gastrointestinal (57 days [45 to 67], e.g., colorectal (63 days [48 to 78])) cancers. Similarly, the longest treatment intervals were observed for genitourinary (57 days [45 to 66], e.g., prostate (75 days [61 to 87])) and gynecological (46 days [38 to 54], e.g., cervical (69 days [45 to 108]) cancers. In studies from high-income countries, the implementation of cancer-directed policies was associated with shorter patient and diagnostic intervals for several cancers. This review included a large number of studies conducted worldwide but is limited by survivor bias and the inherent complexity and many possible biases in the measurement of time points and intervals in the cancer treatment pathway. In addition, the subintervals that compose the diagnostic interval (e.g., primary care interval, referral to diagnosis interval) were not considered. CONCLUSIONS: These results identify the cancers where diagnosis and treatment initiation may take the longest and reveal the extent of global disparities in early diagnosis and treatment. Efforts should be made to reduce help-seeking times for cancer symptoms in lower-income countries. Estimates for the diagnostic and treatment intervals came mostly from high-income countries that have powerful health information systems in place to record such information.

Anticipated help-seeking for cancer symptoms before and after the coronavirus pandemic: results from the Onco-barometer population survey in Spain.

BACKGROUND: The patient interval-the time patients wait before consulting their physician after noticing cancer symptoms-contributes to diagnostic delays. We compared anticipated help-seeking times for cancer symptoms and perceived barriers to help-seeking before and after the coronavirus pandemic. METHODS: Two waves (pre-Coronavirus: February 2020, N = 3269; and post-Coronavirus: August 2020, N = 1500) of the Spanish Onco-barometer population survey were compared. The international ABC instrument was administered. Pre-post comparisons were performed using multiple logistic and Poisson regression models. RESULTS: There was a consistent and significant increase in anticipated times to help-seeking for 12 of 13 cancer symptoms, with the largest increases for breast changes (OR = 1.54, 95% CI 1.22-1-96) and unexplained bleeding (OR = 1.50, 1.26-1.79). Respondents were more likely to report barriers to help-seeking in the post wave, most notably worry about what the doctor may find (OR = 1.58, 1.35-1.84) and worry about wasting the doctor's time (OR = 1.48, 1.25-1.74). Women and older individuals were the most affected. CONCLUSIONS: Participants reported longer waiting times to help-seeking for cancer symptoms after the pandemic. There is an urgent need for public interventions encouraging people to consult their physicians with symptoms suggestive of cancer and counteracting the main barriers perceived during the pandemic situation.

Physical comorbidities as a marker for high risk of psychological distress in cancer patients.

AIMS: Physical and psychiatric comorbidities are common in cancer patients and could impact their treatment and prognosis. However, the evidence base regarding the influence of comorbidities in the management and health service use of patients is still scant. In this research we investigated how physical comorbidities are related to the mental health and help-seeking of cancer patients. METHODS: Data were obtained from the representative National Health Survey of Spain (2017). Participants were respondents who reported a cancer diagnosis (n = 484). These were also matched with controls without cancer history (n = 484) based on age, gender, and region. Four alternative physical comorbidities indices were created based on information regarding 28 chronic conditions. Outcomes of interest were psychological distress and having consulted a mental healthcare professional in the year before the survey. RESULTS: Thirty percent of cancer patients reported significant psychological distress but only 10% had consulted a professional. After adjusting for sociodemographic variables, among cancer patients each additional comorbidity was associated with 9% higher odds of reporting high psychological distress (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 1.01-1.16) and 21% higher odds of having consulted a mental healthcare professional (OR = 1.21, 95% CI: 1.09-1.34). The effects of comorbidities depended on the type of index and were different in controls without cancer history. CONCLUSION: Physical comorbidities in cancer patients are associated with higher risk of psychological distress and higher demand for mental health services. We encourage further research on this issue as it could improve mental health screening and management in oncologic care.

Intimate partner violence during pregnancy and risk of fetal and neonatal death: a meta-analysis with socioeconomic context indicators.

OBJECTIVE: The objective of the study was to summarize the results from observational studies examining the risk of fetal and neonatal death (perinatal death) as a function of the experience of intimate partner violence during pregnancy and examine the influence of socioeconomic context indicators on this association. DATA SOURCES: Bibliographic searches were conducted in PubMed, EMBASE, CINAHL, and LILACS until March 2019. STUDY ELIGIBILITY CRITERIA: We considered observational studies that provided data on the association between intimate partner violence during pregnancy and perinatal death. STUDY APPRAISAL AND SYNTHESIS METHODS: Information collected included study characteristics, type, and prevalence of intimate partner violence and the reported association between intimate partner violence and perinatal death. Quality of the included studies was assessed using the Newcastle-Ottawa scale. Two reviewers independently conducted all review procedures; disagreements were resolved by a third reviewer. Meta-analyses were conducted based on the specific type of intimate partner violence (physical, psychological, sexual, unspecified) and also based on any type of intimate partner violence, considering 1 effect size per study, regardless of the type of intimate partner violence analyzed. Meta-regression analyses were performed to assess the possible effects of socioeconomic context. The proportion of deaths attributable to the exposure of intimate partner violence based on the crude data from the 3 cohort studies available also was calculated. RESULTS: Seventeen studies were included. The random-effects model showed a statistically significant increase in the odds of perinatal death among women exposed to unspecified intimate partner violence (odds ratio, 3.18; 95% confidence interval, 1.88-5.38), physical intimate partner violence (odds ratio, 2.46; 95% confidence interval, 1.76-3.44), and any type of intimate partner violence during pregnancy (odds ratio, 2.89; 95% confidence interval, 2.03-4.10). Meta-regression analysis showed stronger associations in countries with higher gross domestic product (odds ratio, 1.03; 95% confidence interval, 1.02-1.04) and a higher percentage of health expenditure (odds ratio, 1.27; 95% confidence interval, 1.09-1.46). The proportion of deaths attributable to exposure to intimate partner violence in cohort studies was attributable proportion, 60%; 95% confidence interval, 15-81%. CONCLUSION: Pregnant women who experience intimate partner violence during pregnancy may be about 3 times more likely to suffer perinatal death compared with women who do not experience intimate partner violence. It should be a priority to include intimate partner violence screenings or other detection strategies in pregnancy monitoring or family-planning programs because these could help avoid preventable perinatal deaths.

Compliance with supportive periodontal/peri-implant therapy: A systematic review.

AIM: The present systematic review aimed at assessing the degree of compliance with supportive periodontal/peri-implant therapy as well as identifying patient-related factors that could potentially play a role on patient compliance. METHODS: Electronic and manual literature searches were carried out to assess patient compliance during maintenance. Main outcomes were compliance definition, degree of compliance and patient-related factors. Owing to the heterogeneity of the data reported across the studies, descriptive statistics were performed to shed light on compliance rate and the patient-related factors. RESULTS: A total of 39 articles were included. No consensus regarding the definition of "compliance" was found in the analysed literature. The percentage of fully compliers and non-compliers ranged between 3.3%-86.8% and 1.69%-64.4%, respectively. Smoking habit and history of periodontal disease were found to be associated with patients' compliance. Inadequate information/motivation was found as the main patient-reported reason for non-compliance. CONCLUSIONS: Despite the high variability across studies, compliance with the supportive periodontal/peri-implant maintenance therapy was found to be unsatisfactory. Attitudes, psychological traits and construct associated with compliance remain largely unknown, and still, lack of information and motivation are paramount to be addressed during the periodontal/implant therapy to increase patient compliance.

The experience-based format of probability improves probability estimates: The moderating role of individual differences in numeracy.

People with low statistical numeracy have difficulties understanding numerical information. For instance, they often misunderstand the probability of experiencing side effects, which could reduce adherence to medical treatments. We investigated whether presenting information about probability using a method based on the direct experience of events influences the accuracy of probability estimates compared to viewing a static numerical description of the same information. Participants completed a numeracy test and were randomly assigned to one of two conditions. In the description-based probability condition, participants were presented with 24 binomial distributions consisting of a target stimulus "X" and a distractor stimulus "·" in the form of odds (the distribution "7 × 13 ·" is an example of a 35% probability: here the target [distractor] stimulus was present 7[13] times in a 20-stimulus distribution). In the experience-based probability condition, participants observed the same information but the stimuli were randomly arranged and displayed sequentially. Participants in both conditions estimated the probability of the target stimulus in each trial. In the experience-based format participants with low numeracy made more accurate probability estimates in comparison to the description-based format. In contrast, accuracy in participants with high numeracy was similar in the two formats.

[Obesity as a risk factor in COVID-19: Possible mechanisms and implications]. / La obesidad como factor de riesgo en personas con COVID-19: posibles mecanismos e implicaciones.

Recent reports suggest that obesity is a risk factor for more severe coronavirus disease. This article summarizes the available scientific evidence on the role of obesity in COVID-19. We focus on implications for younger patients and the proposed biological mechanisms that could explain both the higher risk observed and the possible higher contagiousness of people with obesity. We consider implications of the pandemic for people with obesity in relation to: difficulties in managing hospitalized patients, implications of confinement for the control and treatment of obesity, and the stigma people with obesity suffer, that could increase should the relationship between obesity and COVID-19 be confirmed. Understanding the role of obesity in COVID-19 should be a public health priority, given the high prevalence of this condition in our country.

Effectiveness of interventions to improve cancer treatment and follow-up care in socially disadvantaged groups.

OBJECTIVE: To identify and characterize the interventions that aimed to improve cancer treatment and follow-up care in socially disadvantaged groups. To summarize the state of the art for clinicians and researchers. METHODS: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies were randomized controlled trials and quasi-experimental studies with a control group (usual care or enhanced usual care) conducted in Organization for Economic Co-operation and Development (OECD) member countries and published until 2016. RESULTS: Thirty-one interventions were identified, the majority of which were conducted in the United States in patients with breast cancer. Most interventions aimed to decrease social inequalities based on ethnicity/race and/or socioeconomic level, with fewer interventions targeting inequalities based on geographical area. The most frequently assessed outcomes were quality of life (n = 20) and psychosocial factors (n = 20), followed by treatment adherence or satisfaction (n = 12,), knowledge (n = 11), pain management (n = 10), and lifestyle habits (n = 3). CONCLUSIONS: The impact of interventions designed to improve cancer treatment and follow-up care in socially disadvantages groups is multifactorial. Multicomponent-intervention approaches and cultural adaptations are common, and their effectiveness should be evaluated in the populations of interest. More interventions are needed from outside the Unite States and in patients with cancers other than breast cancer, targeting gender or geographical inequalities and addressing key outcomes such as treatment adherence or symptom management.

Еffects of fortified milk on cognitive abilities in school-aged children: results from a randomized-controlled trial.

BACKGROUND: Micronutrients such as vitamins and minerals and long-chain polyunsaturated omega-3 fatty acids (PUFAs) are essential for children's brain development and cognitive functions. The current study investigated whether milk fortified with micronutrients and PUFA can result in improved cognitive function in mainstream school children. METHODS: One-hundred-and-nineteen children (age 8-14, 58 boys) were randomly allocated to a fortified milk group or a regular full milk control group. Participants consumed 0.6L/day of the milk for 5 months. We recorded relevant biochemical, anthropometric, and cognitive measures (working memory and processing speed) at the start of the study and at follow-up after 5 months. RESULTS: The fortified milk significantly increased docosahexaenoic acid (DHA) (change from baseline of 28% [95% CI 17-39%] vs. -6% [95% CI - 13 to 0%] in the control group) and serum 25OH-vitamin D concentrations (41% [95% CI 30-52%] vs. 21% [95% CI 11-30%] in the control group). The fortified milk improved working memory on one of two tests (32% [95% CI 17-47%] vs. 13% [95% CI 6-19%] in the control group). The fortified milk also indirectly increased processing speed on one of two tests; this effect was small and completely mediated by increases in 25OH-vitamin D concentrations. CONCLUSIONS: These results suggest that fortifying milk with micronutrients and PUFA could be an effective and practical way to aid children's cognitive development.

Social support buffers the negative effects of stress in cardiac patients: a cross-sectional study with acute coronary syndrome patients.

Cardiac patients who have social support generally have better prognosis than patients who lack social support. Several theoretical mechanisms have been proposed to explain this protective effect, including the capacity of social support to buffer the negative effects of stress. We tested this buffering effect in a study of patients hospitalized for acute coronary syndrome (ACS) in Spain. Several days after the cardiac event patients answered a questionnaire measuring stressful events during their lifetime, perceived social support around the time of the cardiac event, and depression symptoms in the past week. Results showed that stressful life events were related to depressive symptoms and worse renal function post-ACS only among patients with low perceived social support. Among patients who reported enough social support, lifetime stress was not related to depressive symptoms. No similar effects were observed on other prognostic indicators such as troponin levels or the number of obstructed arteries. These results suggest that social support can buffer the negative effects of stress on the mental and physical well-being of cardiac patients.

Graphical and numerical skills in pre- and postgraduate medical students from a private university. / Habilidad gráfica y numérica en estudiantes de medicina de pre y posgrado de una universidad privada.

Introduction: Physicians and medical students need to understand numerical and graphical health data in order to provide patients with correct information. Objective: The graphical and numerical skills of medical students and residents from a private university in Lima, Peru, were determined in this investigation. Method: Cross-sectional, descriptive study. The Objective Numeracy, Subjective Numeracy and Graph Literacy Scales were applied to medical students at their two final years of medical school and to medical residents. Results: Of 169 participants, 52.07% were sixth-year and 18.34% were seventh-year students and 29.58% were residents. Mean objective numeracy score was 7.34, mean subjective numeracy was 34.12 and mean graph literacy was 10.35. A multiple linear regression analysis showed that Subjective and Objective Numeracy Scales highest means were associated with the male gender and training on research methodology (p < 0.05). Graph Literacy Scale highest means were associated with the male gender and younger age (p-value < 0.05). Conclusion: Numeracy and Graph Literacy Scales mean scores were high in medical students.

Introducción: Los médicos y estudiantes de medicina necesitan comprender los datos numéricos y gráficos sobre salud para proveer información correcta a los pacientes. Objetivo: Determinar las habilidades gráficas y numéricas en estudiantes y residentes de medicina de una universidad privada de Lima, Perú. Método: Estudio descriptivo, transversal. Se aplicaron las escalas de Habilidad Numérica Objetiva, de Habilidad Numérica Subjetiva y de Habilidad Gráfica a estudiantes de medicina de los dos últimos años de la carrera de medicina y a residentes de medicina. Resultados: De 169 participantes, 52.07 % fueron estudiantes de sexto año, 18.34 % de séptimo y 29.58 % residentes. La media en la habilidad numérica objetiva fue de 7.34, en la subjetiva de 34.12 y en la habilidad gráfica de 10.35. De la regresión lineal múltiple se obtuvo que las medias más altas en las escalas de Habilidad Numérica Subjetiva y Objetiva estuvieron asociadas con el sexo masculino y la capacitación sobre metodología en investigación (p < 0.05). En la Escala de Habilidad Gráfica, las medias más altas estuvieron asociadas con el sexo masculino y menor edad (p < 0.05). Conclusión: Las medias de las escalas de Habilidad Gráfica y Habilidad Numérica en estudiantes de medicina fueron altas.

Numeracy Predicts Risk of Pre-Hospital Decision Delay: a Retrospective Study of Acute Coronary Syndrome Survival.

BACKGROUND: Many patients delay seeking medical attention during acute coronary syndromes (ACS), profoundly increasing their risk for death and major disability. Although research has identified several risk factors, efforts to improve patient decision making have generally been unsuccessful, prompting a call for more research into psychological factors. PURPOSE: The purpose of this study is to estimate the relationship between ACS decision delay and numeracy, a factor closely related to general decision making skill and risk literacy. METHODS: About 5 days after experiencing ACS, 102 survivors (mean age = 58, 32-74) completed a questionnaire including measures of numeracy, decision delay, and other relevant factors (e.g., anxiety, depression, symptom severity, knowledge, demographics). RESULTS: Low patient numeracy was related to longer decision delay, OR = 0.64 [95 % confidence interval (CI) 0.44, 0.92], which was in turn related to higher odds of positive troponin on arrival at the hospital, OR = 1.37 [95 % CI 1.01, 2.01]. Independent of the influence of all other assessed factors, a patient with high (vs. low) numeracy was about four times more likely to seek medical attention within the critical first hour after symptom onset (i.e., ORhigh-low = 3.84 [1.127, 11.65]). CONCLUSIONS: Numeracy may be one of the largest decision delay risk factors identified to date. Results accord with theories emphasizing potentially pivotal roles of patient deliberation, denial, and outcome understanding during decision making. Findings suggest that brief numeracy assessments may predict which patients are at greater risk for life-threatening decision delay and may also facilitate the design of risk communications that are appropriate for diverse patients who vary in risk literacy.