Evaluation of comparative advantages in the profitability and competitiveness of the small-scale dairy system of Tulancingo Valley, Mexico.

This article combines a Policy Analysis Matrix with a sensitivity and poverty line analysis with the objective of evaluating the economic contribution of comparative advantages to the private profitability and competitiveness of small-scale dairy systems. For 1 year, socioeconomic data were collected from 82 farms selected from four strata via statistical sampling. Two scenarios were established to determine the quantitative contribution of comparative advantages: (1) a simulated scenario, which accounted for the cost of purchasing the total food and the opportunity cost of the family labour force (FLF), and (2) an actual production scenario, which accounted for the cost of producing food and eliminating the payment of the FLF and included other income. The E3 and E4 producers were the most profitable and competitive in the simulated scenario and actual production scenario. Of the four scales evaluated, the E2 and E1 producers were the most efficient in taking advantage of the economic contribution provided by the comparative advantages in their own production of food and employment of the FLF, in addition to accounting for other income, a condition that increased their profitability by 171 and 144% and competitiveness by 346 and 273%, respectively. The poverty results indicated that only E3 and E4 producers were non-vulnerable in the simulated scenario and actual production scenario. The purchase of food was the comparative advantage with the greatest sensitivity to cost increases in the two scenarios analysed, which exacerbated the effect on the E1 and E2 producers.

[Effectiveness of two aerobic exercise programs in the treatment of metabolic syndrome: a preliminary study]. / Efectividad de dos modalidades de ejercicio aeróbico en el tratamiento de pacientes con síndrome metabólico (SM). Estudio preliminar.

The effectiveness of two aerobic exercise programs on the modification of the metabolic syndrome (MS) components and its influence in reducing cardiovascular risk was evaluated in 16 sedentary women (30-66 years old). Patients were randomly divided into two exercise groups: continuous training (CE: 45 minutes at 65-70% of heart rate reserve or HRR) or interval training (IE: 5 x 3 minute intervals at 80-85% HRR with two minutes of active recovery at 65-70% HRR), and each participant gave previous informed consent. The components of MS were assessed according to the criteria for women of the National Cholesterol Education/Third Treatment Adult Panel, and cardiovascular risk factors at baseline and 16 weeks later. Data analyses were performed with the Wilcoxon signed test and the Mann-Whitney U-test (SPSS v. 12.0 Windows: p < 0.05). Both exercise programs were effective in the modification of a number of MS components (triglycerides, systolic/diastolic blood pressure), however IE had a higher percentage of patients without MS diagnosis at the end of the study (62.5%). The CE improved the physical fitness by increasing the VO2peak and METs and decreasing heart rate recovery, which is reflected on the reduction of cardiovascular risk.

Recommendations for increasing yield of the edible Pinus pinea L. pine nuts.

In Pinus pinea, cone to pine nut yield (total pine nut weight expressed as percentage of cone weight), an important crop trait, is decreasing worldwide. This phenomenon is of great concern, since the nuts of this species are highly demanded. Cone weight, seed and pine nut morphometry, and pine nut yield were monitored in a non-native area in Chile for 10 years. For this purpose, 560 cones, and the seeds and pine nuts contained in them, were counted, measured and weighed in a multi-environment study involving seven plantations. Seed and pine nut damage was evaluated. Two contrasting categories of cone weight (heavy/light) were defined. Cone to pine nut yield (PY) and other traits were calculated and compared between categories using a mixed linear model. Regression trees were used to explain PY variability. Cone weight was higher than in the species' native range (474 g vs 300 g on average). Pine nut number per cone and PY were significantly higher in the heavy cone category than in the light cone category (125 vs 89 units, and 4.05 vs 3.62%, respectively), The percentage of damaged seeds was lower in heavy than in light cones (9.0% vs 15.9%). Thus, PY depended on seed and pine nut morphometry as well as on seed health. Management practices, such as fertilization and irrigation, could be used to boost production of heavy cones and consequently increase PY.

Effectiveness of Training in Evidence-Based Practice on the Development of Communicative Skills in Nursing Students: A Quasi-Experimental Design.

BACKGROUND: Communication skills (CSs) and evidence-based practice (EBP) are key foundations for offering personalized and quality nursing care. CS that results in open communication is fundamental for applying EBP. OBJECTIVES: The objective of the study was to assess the relationship between the acquisition of EBP competencies and learning CS after taking an EBP course in the nursing degree. METHODS: Pre-test-post-test quasi-experimental study without a control group. The study population comprised fourth-year undergraduate nursing students. Before and after an EBP course, students completed a questionnaire on CS competence (HP-CSS) and EBP competence (EBP-COQ). The EBP course lasts for 15 weeks, with 150 h of work for the student. Out of these 150 h, 60 are conducted in person, while the remaining 90 h are for independent or group work, utilizing the flipped classroom methodology. Bivariate, correlational, pairwise Student's t-test, and linear regression multivariate analyses were performed. RESULTS: The sample was composed of 153 students. After completing the EBP course, there was a statistically significant improvement in informative communication (p = 0.046) and assertiveness (p = 0.018). However, there were no observed changes in empathy, respect, and the total score of the CS competence. The results from the multivariate analysis showed that the dimensions of attitude towards EBP and EBP knowledge had a positive relation to three of the four dimensions of the CS and overall competence. Regarding the students' variables and characteristics, admission through special programs for athletes and older students (p < 0.001) and being female (p = 0.004) were positively statistically associated with empathy. CONCLUSIONS: EBP training positively affects the development of CS in nursing students, as shown by significant improvements in the total scores of the CS and the dimensions of informative communication and assertiveness after the intervention. This study demonstrates the initial applicability and usefulness of an EBP training program for the development of CS in nursing students.

Dendrochronological Analysis of Pinus pinea in Central Chile and South Spain for Sustainable Forest Management.

Pinus pinea is an important Mediterranean species due to its adaptability and tolerance to aridity and its high-quality pine nuts. Different forest types located in Mediterranean native and non-native environments provide the opportunity to perform comparative studies on the species' response to climate change. The aims of this study were to elucidate growth patterns of the species growing in native and exotic habitats and to analyze its response to climatic fluctuations, particularly drought, in both geographical contexts. Understanding stone pine (Pinus pinea) growth responses to climate variability in native and exotic habitats by comparing natural stands and plantations may provide useful information to plan adequate management under climate change. By doing so, we enhance the understanding of P. pinea's adaptability and provide practical approaches to its sustainable management. In this study, we reconstructed and compared the stem radial growth of seven stone pine stands, two in southern Spain and five in central-southern Chile, growing under different climatic conditions. We quantified the relationships between growth variability and climate variables (total rainfall, mean temperature, and SPEI drought index). Growth was positively correlated with autumn rainfall in plantations and with autumn-winter rainfall in natural stands. Growth was also enhanced by high autumn-to-spring rainfall in the driest Chilean plantation, whereas in the wettest and coolest plantation, such correlation was found in winter and summer. A negative impact of summer temperature was found only in one of the five Chilean plantations and in a Spanish site. The correlation between SPEI and tree-ring width indices showed different patterns between and within countries. Overall, exotic plantations showed lower sensitivity to climate variability than native stands. Therefore, stone pine plantations may be useful to assist in mitigating climate change.

Mexican Clinical Practice Guidelines for Adult Overweight and Obesity Management.

PURPOSE: To develop Mexico's first methodologically rigorous clinical practice guideline for the management of adult overweight and obesity. The target audiences are interdisciplinary healthcare professionals across healthcare systems who are the first point of contact for patients with obesity in Mexico, patients, and health system decision makers. RECENT FINDINGS: A review of recent international obesity clinical practice guidelines and an expert consensus process identified: i) common recommendations appropriate for implementation in Mexico and ii) knowledge gaps requiring the formulation of new recommendations. In all, 20 new recommendations and 20 good practice statements were developed using the GRADE Evidence-to-Decision Framework and expert consensus. Overweight and obesity negatively impact the health and well-being of individuals and populations in Mexico. This guideline aims to establish a new evidence-based, patient-centered, non-stigmatizing, and practical treatment and management framework, based on the fundamental principles of chronic disease prevention and management.

What lies beneath: Fabry nephropathy in a female patient with severe cerebrovascular disease.

Fabry disease is an X-linked inborn error of metabolism, which is caused by the deficiency of α-galactosidase A, leading to progressive accumulation of neutral glycosphingolipids and a-galactosyl breakdown products in most body fluids and several tissues, resulting in the clinical manifestations. The onset of Fabry disease symptoms in females is not observed as early as in males. We report a novel presentation of Fabry disease in a female patient with medical history of relapsing strokes and brain magnetic resonance angiography showing signs of microangiopathy and multiple lacunar strokes that were first diagnosed as Moyamoya disease (a chronic progressive cerebrovascular disease). The patient subsequently displayed increased levels of serum creatinine and proteinuria. Diagnosis of Fabry disease was made by a renal biopsy and was confirmed by molecular studies showing a missense mutation: c1066C > T (het) [R356W]. The diagnosis was delayed by 21 years with respect to her first symptom (stroke), probably because her initial clinical presentation was neurological and diagnosed as Moyamoya disease. Other factors that contributed to the delay of the diagnosis were the lack of acute or chronic pain (neuropathic pain) and angiokeratomas. Some similarities in the pathogenic aspects of the patient's vascular lesions lead us to speculate that this patient has Fabry disease, with a phenotype that had not yet been described. It is necessary to be aware of this possibility to avoid misdiagnosis of Fabry disease as Moyamoya disease.

[Decrease of liver fat content by aerobic exercise or metformin therapy in overweight or obese women]. / Disminucion del contenido de grasa hepatica mediante ejercicio aerobico comparado con met formina en mujeres con sobrepeso u obesidad.

INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is characterized by high intrahepatic triglyceride level. It is associated with an increased prevalence of cardiovascular disease, independently of underlying cardiometabolic risk factors. Metformin is used as a pharmacological treatment; the adherence is low because of the presence of adverse effects. Aerobic exercise could be an alternative therapy, but its effectiveness compared with metformin has not been established in the treatment of NAFLD. The aim of this study was to establish the effectiveness of aerobic exercise and its influence in reducing cardiovascular risk in overweight or obese women with NAFLD. MATERIAL AND METHODS: Sedentary women 25-60 years old with body mass index (BMI) > 24.9 kg/m2 and liver fat content < 50 HU, were randomly divided into two parallel groups: exercise group (EG) or metformin group (MG). The EG performed an aerobic exercise program of 60 min/5 days/ week at 60-85% of heart rate reserve; the MG took 1 g/day of metformin each morning. The duration of the intervention was 12 weeks. The liver fat content, metabolic and cardiorespiratory- fitness parameters were evaluated at the beginning and end of the program. The study complied with the Helsinki ethics codes for human research. RESULTS: The study included a sample of 16 women, with 8 per group. The treatments modified the liver fat content by 14.6% (CI95% 0.92, 28.36) and 10.37% (CI95% -1.74, 22.48) for the EG and MG, respectively. In the EG, the insulin levels and HOMA-IR decreased (P < 0.05), and the cardiovascular fitness improved. CONCLUSIONS: An aerobic exercise program of 12 weeks with a volume training of 300 min/week and a moderate to vigorous intensity (60-85% VO2peak) modified the liver fat content and improved cardiovascular risk factors during the intervention. Exercise contributed to a holistic approach by modifying a number of the components of metabolic syndrome, cardiorespiratory-fitness, and cardiovascular risk.

Roles, relationships, and motor aggressions: Keys to unveiling the emotions of a traditional sporting game.

International organizations such as the UN and UNESCO set priority goals for education in the 21st century. This article shows the educational contribution of the Traditional Sporting Game (TSG) of Bear Guardian and Hunters that involves the three-chained roles. The three roles test players who share a unique social interaction ritual. This study was part of a training experience for university students in physical activity and sports sciences in the theory and practice of motor games subject at INEFC, University of Lleida (Spain). This research investigated the emotional intensity in these three roles, the emotional meaning units, and their correspondence with the emotional triad. This study is a mixed-methods research. After playing the game involved, 131 university students (46 women and 85 men) aged 18-35 years (M = 20.19, SD = 2.42) answered the validated GES-II scale indicating the intensity and causes of five basic emotions. The data were analyzed using different strategies (qualitative data: content analysis; quantitative data: descriptive statistical analysis, inferential and association rules). The methodology employed has revealed part of this game's secret (intimate and subjective) code: the affectivity invisible to external observation. Among the findings, we highlight: (a) each role originates different intensities and units of emotional meaning; (b) the three roles feedback, need and complement each other in this socio-affective network of interdependent relationships; (c) the Bear is the central role of the game. The emotional meanings concerning the motor aggression of the Bear operate as a magnet that attracts four itineraries of association rules of meanings and emotional triads. In the hands of intelligent, prepared and sustainable teachers, this game can help students learn to live together and educate them to control and respectfully channel motor aggression. In this way, students will be active actors in the process of civilization in favor of sustainable development.

Effectiveness of the flipped classroom methodology on the learning of evidence-based practice of nursing students: Quasi-experimental design.

BACKGROUND: International organizations recognize the importance of evidence-based practice (EBP) for nurses. The objective of teaching EBP in the Nursing degree is to train future nurses on this subject. Different teaching models exist for this, from less active traditional models to more active ones such as the flipped classroom. OBJECTIVE: To compare the degree of EBP competence of undergraduate nursing students after an EBP course, through the application of a traditional methodology versus a flipped classroom methodology. DESIGN: Quasi-experimental study of non-equivalent groups. SETTING: The study was composed by a group of students who received training on EBP with the traditional model (face-to-face), and another intervention group with whom the flipped classroom model was utilized, using the online teaching platform EBP-eToolkit. PARTICIPANTS: The study was conducted with 4th-year Nursing degree students enrolled in the course evidence-based practice, in academic years 2019/20 and 2021/2022. METHODS: Before and after the course, the students completed a questionnaire about EBP competence (EBP-COQ), and an objective test was given at the end of the year. RESULTS: A sample of 152 students in the face-to-face group (control), and 143 students in the flipped classroom group (intervention) participated. The intervention group significantly improved its competence on attitude (p = 0.01, η2 = 0.022), skills (p = 0.019, η2 = 0.018), and global competence in EBP (p = 0.003, η2 = 0.030), with respect to those who were taught using the traditional method. However, there were no significant differences in the impact on knowledge, neither through the self-report dimension of the EBP-COQ (p = 0.188) nor the final test score, control group 6.89 (SD: 1.35) and flipped classroom group 7.12 (SD: 1.53) (p = 0.206). CONCLUSIONS: The flipped classroom model is adequate for the teaching of EBP to undergraduate nursing students. It produced a slight increase in attitude, as well as in skills and global competence in EBP. Nevertheless, this increase was not significantly different from face-to-face learning in terms of impact on EBP knowledge.

[Poorly differentiated neuroendocrine carcinoma of the colon with liver metastases]. / Carcinoma neuroendocrino de colon poco diferenciado con metástasis hepáticas.

Neuroendocrine tumors of the gastrointestinal tract are highly infrequent. We report the case of a 57-year-old woman who presented with toxic syndrome, vomiting and a 3-month history diarrhea, with a final diagnosis of poorly-differentiated neuroendocrine tumor. Based on this case, we review the clinical characteristics, diagnostic procedures, prognostic factors and therapeutic possibilities in this type of tumor. Neuroendocrine tumors should be considered in the diagnosis of colonic tumors with hyperechoic liver metastases.

Training student volunteers as community resource navigators to address patients' social needs: A curriculum toolkit.

Introduction: Few resources are available to train students to provide patients assistance for obtaining needed community-based services. This toolkit outlines a curriculum to train student volunteers to become "community resource navigators" to serve patients via telephone at partner health sites. Methods: University students co-designed the Help Desk navigator program and training for volunteer navigators as part of an academic-community partnership with a local Federally Qualified Health Center (FQHC). The multi-modal curricula consisted of five components: didactic instruction on social determinants of health and program logistics, mock patient calls and documentation, observation of experienced navigator interaction with patients, supervised calls with real patients, and homework assignments. In 2020, training materials were adapted for virtual delivery due to the COVID-19 pandemic. Trainees completed a survey after completion to provide qualitative feedback on the training and preparedness. Results: The training was offered for the first cohort of 11 student volunteer navigators in 2019, revised and then offered for 13 undergraduate and nursing students over 6 weeks in 2020. In the training evaluation, trainees described the new knowledge and skills gained from the training, the long-term benefits toward their educational and professional career goals, and helpful interactive delivery of the training. Trainees also highlighted areas for improvement, including more time learning about community resources and practicing challenging patient conversations. Conclusions: Our peer-to-peer, multi-modal training prepares student volunteers to become community resource navigators. Student, eager for meaningful clinical experiences, are an untapped resource that can help patients with their social needs.

The impact of the COVID-19 pandemic on depression and stress levels in pregnant women: a national survey during the COVID-19 pandemic in Mexico.

BACKGROUND: COVID-19 outbreak has been associated with a wide variety of psychiatric manifestations such as panic, anxiety, and depression. We aim to assess the impact of the COVID - 19 pandemic on the levels of stress and depression of pregnant women in Mexico. METHODS: A cross-sectional web survey was carried out in pregnant women in 10 states of the Mexican Republic during the COVID-19 pandemic among public and private hospitals. The perception of stress was assessed using the Perceived Stress Scale, while depressive symptoms were evaluated using the Edinburgh Postnatal Depression Scale. RESULTS: A total of 549 surveys were applied, of which 96.1% (n = 503) were included in the data analysis. The mean participant's age was 28.1 years old. The mean perceived stress scale score was 24. 33.2% (n = 167) of participants had a score equal to 27 points or more and were considered highly stressed. The mean depression score was 9. A total of 17.5% (n = 88) participants had more than 14 points on the Edinburgh's depression scale, and were considered depressed. Stress levels were higher at later gestational ages (p = .008). CONCLUSIONS: COVID-19 pandemic has caused mental health issues in pregnant women reflected by high perceived stress levels and depression.

A Community Resource Navigator Model: Utilizing Student Volunteers to Integrate Health and Social Care in a Community Health Center Setting.

INTRODUCTION: While unmet social needs are major drivers of health outcomes, most health systems are not fully integrated with the social care sector to address them. In this case study, we describe the development and implementation of a model utilizing student volunteer community resource navigators to help patients connect with community-based organizations (CBOs). We then detail initial implementation outcomes and practical considerations for future work. METHODS: We used the Ten Essential Public Health Services Framework to guide program planning of a student "Help Desk" model for a community health center. Planning included a literature review, observation of exemplar programs, development of a CBO directory, and evaluation of the center's patient population, clinical workflows, and data infrastructure. We piloted the model for two months. After pilot completion, we reviewed patient data to understand the feasibility of the student "Help Desk" model. We utilized planning and pilot execution materials, as well as pilot data, to develop and discuss practical considerations. RESULTS: Design and implementation complemented ongoing social needs screening and referral to CBOs by center case managers. Patients were asked if they would accept telephone follow-up by volunteers two and four weeks after the clinic visit. Of 61 patients screened, 29 patients were referred for follow-up. Ninety percent were reached at least once during the follow-up period, and 48% of patients referred reported connecting to at least one CBO. Only 27% of patients required escalation back to case managers, and no emergency escalation was needed for any patients. Students, faculty advisors, and community health center frontline staff and leadership supported the scale up and continuation of the "Help Desk" model at the community health center. DISCUSSION: Successful implementation required multi-sectoral collaboration, well-defined scope of practice, and data interoperability. Student volunteers are untapped resources to support integrated health and social care.

Changes on the health care of people with multiple sclerosis from Latin America during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has resulted in uncertain access to medical treatment for people with multiple sclerosis (pwMS) all over the world. However, there is no data regarding its impact on access to health care of pwMS from Latin America. OBJECTIVES: We investigated and described changes in health care delivery for pwMS from Latin America during the COVID-19 pandemic. METHODS: PwMS from 18 patient organizations of the region completed a web-based survey hosted from May to October 2020. RESULTS: A total of 602 pwMS completed the questionnaire. Changes in disease-modifying therapies (DMTs) use: 6.7% of pwMS on continuous DMTs claimed to stopped them; 14.1% of those on infusion therapies declared to postpone their dosing; 68.8% declared delaying the initiation of a DMT. Disruptions in accessing rehabilitation services were reported by 65.7%. Changes in laboratory and MRI monitoring were reported by 30% and 33%, respectively. In a multivariable-adjusted logistic regression model, changes in laboratory monitoring were significantly associated with increased odds of postponing MRI monitoring (OR 4.09 CI95% 2.79-6.00, p < 0.001). CONCLUSIONS: The COVID-19 pandemic has disrupted all aspects of the routine care for pwMS from Latin America. Consequences are yet to be determined.

The Effect of Traditional Opposition Games on University Students' Mood States: The Score and Group Type as Key Aspects.

Playing traditional games has a direct impact on the mood states of the players, and this is the reason why physical education is an ideal setting for teaching how to recognize them and be aware about how they can swing. The objective of the study was to determine if participating in traditional opposition games causes changes to the participants' mood states. A total of 102 students participated. Each participant recorded the intensity of the mood state experienced at the beginning and at the end of the sessions, using the validated Profile of Mood States (POMS) instrument. The pedagogical experience was planned as 4 sessions with 6 and 5 opposition games each: (a) with competition in mixed groups, equally and unequally mixed; (b) without competition in mixed groups, equally and unequally mixed; (c) with competition in same-gender groups; and (d) without competition in same-gender groups. When comparing the different mood states according to session (with or without competition), the mood states of the depression, fatigue, and vigor dimensions were significantly different (p < 0.05), with higher scores in the sessions with competition for the mood states of vigor (Mcompetition = 7.27 and Mno_competition = 3.10) and fatigue (Mcompetition = 4.08 and Mno_competition = 1.80). Also, when comparing the mood states depending on session grouping and group type, the results showed differences in the scores obtained for the dimensions fatigue and anger, and general mood state (p < 0.05). These differences were found at the start of the session and at the end, with the dimension fatigue being the only one with differences in both situations when comparing the same-gender, equally-mixed, and unequally-mixed groups for the two types of traditional opposition games compared. In addition, after an analysis of the mood states depending on gender was performed, the results and therefore the significant differences found, were very similar to those obtained according to group type. Lastly, it was concluded that the type of group (equal, mixed & same gender), and gender were decisive, causing variations in the mood states of the students. This provides valuable information for teaching professionals about the structuring and organization of PE sessions, aiming to promoting positive motor experiences.

Joy in Movement: Traditional Sporting Games and Emotional Experience in Elementary Physical Education.

Through games a motivating learning climate is provided, generating mainly positive emotions among the students by the very nature of the game. However, while the early stages are the most important for emotional well-being development, research about scientific knowledge of emotional physical education in children is still scarce. The aims of this study were to analyze the intensity of emotions (positive or negative) produced when players took part in games of different social structure, with or without competition (winner or loser), with or without sport experience and to examine the explanations given by the participants for these emotional experiences. Participants (N = 152) were recruited from two Spanish elementary school. We applied Student's t-test and one-factor ANOVA. Students' subjective comments were classified through content analysis in macro-categories and we used the Chi-square Automatic Interaction Detector (CHAID, implemented in SPSSTM Answer Tree® 13.0). The application of a mixed-methods approach identified statistically significant differences in four variables: (a) the type of emotion, (b) motor domain, (c) type of outcome (winning, losing, and non-competitive), and (d) sport experience. The intensity of positive emotions was higher (M = 3.71, SD = 0.893) than negative emotions (M = 1.18, SD = 0.253, p < 0.001). Furthermore, negative emotions were felt with different intensities (F 3 = 3.82, p = 0.011, ES = 0.071), depending on the motor action domain. Comments referring to negative emotions were more frequent in individual games. Winning was associated significantly (p < 0.05) with the highest intensity ratings of positive emotions, whereas losing produced the highest values for negative emotions. The intensity ratings for positive or negative emotions not were different between non-competitive games and competitive games. The sport experience relativizes the mean of emotional intensity, both positive and negative. The present study brings the value of considering games as a key role to promote a physical education addressed to the education of social-emotional well-being in schoolchildren, as the basis of academic training. Furthermore, the results could benefit teachers as well as coaches have scientific input to organize teaching content, generating the desired motor behaviors together with positive experiences.

Does FMI Correlate Better than BMI with the Occurrence of Metabolic Changes in Obese Patients? Study Based on 2007 Consecutive Mexican Patients.

BACKGROUND: The body mass index (BMI) is the most commonly used anthropometric indicator. However, it does not discern among the different body components. The body fat content, expressed as fat mass index (FMI), is an accurate way to estimate adiposity. Since most metabolic diseases are associated with excess fat tissue, our aims were to comparatively analyze the frequency of associated metabolic abnormalities in patients with different obesity degrees based on BMI and FMI and to determine the best cut-off value of both indicators to predict metabolic abnormalities. METHODS: From a cohort of 2007 patients, BMI and FMI were calculated using DXA. Individuals were classified into the different obesity degrees according to the reference ranges from the World Health Organization (WHO) and the National Health and Nutrition Examination Survey (NHANES). A comparative analysis between BMI, FMI, and their correlation to the presence of metabolic alterations was performed. RESULTS: BMI underestimated the degree of obesity when compared with FMI. Spearman's rank-order correlation for both indexes resulted in very high coefficients (rho Spearman's = 0.857; p = 0.0001). The prevalence of metabolic alterations increased as BMI and FMI also increased. Despite the high positive statistical correlation between BMI and FMI, it was seen that some comorbidities were more specifically related to one particular index. CONCLUSIONS: There were no significant differences between the BMI and the FMI for predicting the degree of obesity. Likewise, there were no significant differences between them for the prediction of metabolic alterations.

Mucopolysaccharidoses in Brazil: what happens from birth to biochemical diagnosis?

Mucopolysaccharidoses (MPS) form a group of inherited metabolic disorders characterized by intralysosomal storage of glycosaminoglycans. This study aimed to investigate the path followed by Brazilian patients from birth to diagnosis. An interview was conducted with patient's parents or guardians with subsequent review of patient's medical records. One hundred thirteen patients with MPS were included (MPS I: 18, MPS II: 43, MPS IIIA: 2, MPS IIIB: 3, MPS IIIC: 1, MPS IVA: 15, MPS IVB: 1, MPS VI: 29, MPS VII: 1) from 97 families. Median age at the onset of signs/symptoms was 18 months (MPS I: 18, MPS II: 24, MPS IVA: 8, MPS VI: 8). Skeletal abnormalities (for MPS IVA and MPS VI), joint contractures (for MPS II), and typical facial features (for MPS I) were the most frequently reported first signs/symptoms. Several health professionals were involved in patient's care as of the onset of symptoms until biochemical diagnosis was established. Median age at diagnosis was 76 months (MPS I: 75, MPS II: 95, MPS IVA: 75, MPS VI: 52). Considering the group as a whole, there was a 4.8-year delay between the onset of signs/symptoms and the establishment of the diagnosis. Considering that specific therapies are available for some of these disorders and that early treatment is likely to change more favorably the natural history of the disease, efforts should be made to minimize this delay. We believe that this situation can be improved by measures that both increase awareness of health professionals about MPS and improve access to diagnostic tests.

Exercise Induces White Adipose Tissue Browning Across the Weight Spectrum in Humans.

While the effect of exercise on white adipose tissue browning and metabolic improvement in rodents is clear, there are few studies in humans with inconclusive results. Thus, the aim of the study was to assess whether an exercise intervention promotes subcutaneous adipose tissue browning in humans, and whether this response is associated with metabolic improvement in three groups of individuals defined by body mass index (BMI) (kg/m2). Sedentary adult subjects with different BMI were enrolled in a 12-week bicycle-training program (3 times per week, intensity 70-80% HRmax). Brown and beige gene expression in subcutaneous adipose tissue (scWAT) biopsies, and serum glucose, insulin, lipid, adipokine, and myokine levels were compared before and after the exercise intervention. Thirty-three non-diabetic subjects (mean age 30.4 ± 4.6 years; 57.57% female; 13 normal weight, 10 overweight and 10 with obesity) completed the exercise intervention. Without any significant change in body composition, exercise improved several metabolic parameters, most notably insulin resistance and particularly in the overweight group. Circulating adiponectin, apelin, and irisin exercise-induced changes predicted 60% of the insulin sensitivity improvement. After exercise UCP1, TBX1, CPT1B scWAT expression significantly increased, along with P2RX5 significant positive staining. These changes are compatible with scWAT browning, however, they were not associated with glucose metabolism improvement. In conclusion, 12-weeks of exercise training produced brown/beige gene expression changes in abdominal scWAT of non-diabetic individuals with different BMI, which did not contribute to the metabolic improvement. However, this result should not be interpreted as a lack of effect of browning on metabolic parameters. These findings suggest that a bigger effect is needed and should not preclude the development of more effective strategies of browning. Furthermore, exercise-induced changes in adiponectin, apelin, and irisin predicted insulin sensitivity improvement, supporting the important role of adipokines and myokines in metabolism homeostasis.