The bidirectional longitudinal association between academic performance and cardiovascular disease risk factors in adolescents.

INTRODUCTION: The limited prior research examining the association between academic performance and cardiovascular disease (CVD) risk factors in youth did not explore the reciprocal association between these constructs, and analyzed CVD risk factors individually. Thus, the aim of the present study was to explore the bidirectional longitudinal association between clustered CVD risk score and academic performance in adolescents over a 24-month interval. METHODS: A total of 237 adolescents (45.6% girls), aged 13.9 ± 0.3 years old at baseline, from DADOS (Deporte, ADOlescencia y Salud) study were included in this study. A clustered CVD risk score was created by calculating the mean age- and gender-standardized z-scores of waist circumference, systolic blood pressure, total cholesterol to high-density lipoprotein cholesterol ratio, triglycerides, homeostatic model assessment of insulin resistance, and cardiorespiratory fitness (inversed). Academic performance was assessed through the final academic grades and the test of educational abilities. RESULTS: Our results showed that the clustered CVD risk score at baseline was not associated with academic performance 24 months later (all p > .05). Nevertheless, except for physical education, academic grades at baseline were inversely associated with clustered CVD risk score at follow-up in adolescents (ß ranged from -0.140 to -0.102; all p < .05). No associations were found between academic abilities at baseline and clustered CVD risk score at follow-up (all p > .05). CONCLUSION: Academic grades could help predict CVD risk 24 months later during adolescence. Education professionals should foster adolescents' academic performance not only to improve academic results but also to maximize future cardiovascular health benefits.

Mediating role of physical fitness on the association between diet and health-related quality of life in adolescents.

Objective: The aim of this study was to analyse whether the association between adherence to the Mediterranean diet and health-related quality of life (HRQoL) is mediated by physical fitness components (i.e., cardiorespiratory fitness, lower-limb strength, upper-limb strength and motor competence) in adolescents. Methods: This is a cross-sectional study including mediation analyses. This study involved 181 adolescents (86 girls) aged 15.8 ± 0.3 years recruited from secondary schools and sport clubs located in Castellon (Spain). Adherence to the Mediterranean diet was evaluated using the KIDMED questionnaire. HRQoL was assessed with the KIDSCREEN-10 questionnaire. Cardiorespiratory fitness was assessed using the 20-m shuttle run test. Lower-limb strength was assessed through the standing broad jump test. Upper-limb strength was evaluated using a handgrip dynamometer. Motor competence was assessed using the 4 × 10 m shuttle run test. Mediation analyses were performed for each physical fitness component in order to assess its mediating effect on the association between adherence to the Mediterranean diet and HRQoL. Indirect effects (IE) with confidence intervals (CI) not including zero were interpreted as statistically significant. Results: Cardiorespiratory fitness and lower-limb strength had a mediating effect on the positive association between adherence to the Mediterranean diet and HRQoL (IE = 0.11, 95 % CI = 0.01; 0.27 and IE = 0.07, 95 % CI = 0.01; 0.19). Upper-limb strength and motor competence did not act as mediators in the association between adherence to the Mediterranean diet and HRQoL (IE = 0.00, 95 % CI = -0.04; 0.07 and IE = 0.01, 95 % CI = -0.03; 0.07, respectively). Conclusion: Our findings showed that the positive association of adherence to the Mediterranean diet on adolescents' HRQoL was mediated by physical fitness. Educational and public health strategies aiming to improve Spanish adolescents' HRQoL should focus on diet and physical fitness.

Detection of the Uveal Melanoma-Associated Mutation GNAQ Q209P from Liquid Biopsy Using CRISPR/Cas12a Technology.

Uveal melanoma (UM) is a rare ocular tumor characterized by high metastasis risk and poor prognosis. The in-depth characterization of UM's molecular profile is critical for better disease classification and prognosis. Furthermore, the development of detection tools to monitor UM evolution upon treatment is of great interest for designing optimal therapeutic strategies. However, commonly used techniques, such as ddPCR or NGS, are costly, and they involve sophisticated equipment and complex experimental design. The development of alternative sensing methods that are fast, simple, and inexpensive would be of great benefit to improve UM's diagnosis and management, especially when combined with liquid biopsy. Samples from liquid biopsy can be obtained with minimal invasiveness, and the detection of circulating tumor DNA (ctDNA) in UM patients' plasma has proven useful for the diagnosis of metastasis, prognosis prediction, and disease monitoring. In this context, CRISPR/Cas12a-derived molecular sensors, thanks to their high specificity and sensitivity and their potential for point of care diagnosis, are particularly interesting. Here, we developed a CRISPR/Cas12a-based approach for the specific detection of the UM-related mutation GNAQ Q209P that relies on the design of highly specific crRNAs. Coupled with allele-specific PCR, it constitutes a sensitive platform for liquid biopsy detection, capable of sensing GNAQ Q209P in plasma samples with a low ctDNA concentration and fractional abundance. Finally, our method was validated using plasma samples from metastatic UM patients.

The bidirectional longitudinal association between health-related quality of life and academic performance in adolescents: DADOS study.

PURPOSE: Although previous evidence has suggested a relationship between health-related quality of life (HRQoL) and academic performance, the directionality of this association is understudied and remains to be clarified. Thus, the primary objective of this study was to explore the bidirectional association between HRQoL and academic performance in adolescents between two timepoints with a 24-month interval. A secondary aim was to analyze whether this association varies between boys and girls. METHODS: This is a bidirectional longitudinal analysis with 257 adolescents (13.9 ± 0.3 years at baseline) from the DADOS study. HRQoL was measured using the KIDSCREEN-10 questionnaire. Academic performance was assessed through academic grades and the Spanish version of the Science Research Associates Test of Educational Ability. RESULTS: Cross-lagged analyses revealed that HRQoL at baseline was not associated with academic performance 24 months later, while all the academic grades and the overall score of academic abilities at baseline were positively associated with HRQoL at follow-up in adolescents. Results of the stratified analyses by sex were largely similar. Specifically, in girls, math, language, physical education, and grade point average at baseline were positively associated with HRQoL 24 months later, while in boys, all the academic grades indicators (except physical education), numeric ability, and the overall score of academic abilities at baseline were positively associated with HRQoL at follow-up. CONCLUSION: These findings suggest that academic performance in early adolescence may predict HRQoL 24 months later. Health and education professionals could benefit from collaborating to achieve both improved academic performance and HRQoL in youth.

Risk of depression mediates the association between cardiorespiratory fitness and academic performance in adolescent boys and girls: DADOS study.

This study aims to analyze the mediating role of risk of depression in the association between cardiorespiratory fitness and academic performance in a sample of adolescents and to test the moderation effect of sex. A total of 263 adolescents (125 girls, 13.9 ± 0.3 years) from the DADOS (Deporte, ADOlescencia y Salud) study were included in the analysis. Cardiorespiratory fitness was assessed by the 20-m shuttle run test. Academic performance was assessed through the final academic grades and the test of educational abilities. Risk of depression was evaluated through the Behavior Assessment System for Children and Adolescents. Mediation analyses were performed to determine the direct and indirect associations between cardiorespiratory fitness, risk of depression, and academic performance. Indirect effects with confidence intervals not including zero were interpreted as statistically significant, and percentages of mediation were calculated in order to know how much of the association was explained by the mediation. Our findings indicated a significant mediating effect of risk of depression in the association between cardiorespiratory fitness with final grades in math, language, and grade point average (percentages of mediation: 26%, 53%, and 29%, respectively). These analyses were not moderated by sex (all confidence intervals included 0). CONCLUSION: Risk of depression acts as a possible underlying mechanism in the association between cardiorespiratory fitness and academic grades in adolescents. Educational and health institutions could benefit from our findings since the promotion of higher cardiorespiratory fitness levels might reduce the risk of depression with potential benefits on adolescents' academic performance. WHAT IS KNOWN: • Cardiorespiratory fitness is positively associated with academic performance in adolescents. Nevertheless, the psychological mechanisms underlying this association are poorly understood. WHAT IS NEW: • Risk of depression mediates the association between cardiorespiratory fitness and academic performance in adolescents, independently of sex. • Our findings may improve the efficacy of mental health and educational programs by promoting the enhancement of cardiorespiratory fitness levels, which may reduce risk of depression with potential benefits on academic performance.

CRISPR/Cas technology as a promising weapon to combat viral infections.

The versatile clustered regularly interspaced short palindromic repeats (CRISPR)/Cas system has emerged as a promising technology for therapy and molecular diagnosis. It is especially suited for overcoming viral infections outbreaks, since their effective control relies on an efficient treatment, but also on a fast diagnosis to prevent disease dissemination. The CRISPR toolbox offers DNA- and RNA-targeting nucleases that constitute dual weapons against viruses. They allow both the manipulation of viral and host genomes for therapeutic purposes and the detection of viral nucleic acids in "Point of Care" sensor devices. Here, we thoroughly review recent advances in the use of the CRISPR/Cas system for the treatment and diagnosis of viral deleterious infections such as HIV or SARS-CoV-2, examining their strengths and limitations. We describe the main points to consider when designing CRISPR antiviral strategies and the scientific efforts to develop more sensitive CRISPR-based viral detectors. Finally, we discuss future prospects to improve both applications. Also see the video abstract here: https://www.youtube.com/watch?v=C0z1dLpJWl4.

Observational longitudinal association between waking movement behaviours and psychological distress among adolescents using isotemporal analysis: DADOS study.

This study aimed to examine the impact of reallocating time spent in waking movement behaviours at baseline on indicators of psychological distress at 24-month follow-up using isotemporal substitution regression models among a sample of Spanish adolescents. The DADOS (Deporte, ADOlescencia y Salud) study is a 3-year longitudinal observational research project carried out between years 2015-2017. The analyses included 197 adolescents (91 girls) aged 13.9 ± 0.3 years at baseline. Waking movement behaviours were assessed by a wrist-worn GENEActiv triaxial accelerometer and expressed as minutes/day of light physical activity (LPA), moderate-vigorous physical activity (MVPA) and time spent in sedentary behaviour (SB). The Behaviour Assessment System for Children and Adolescents (level 3 for adolescents) was used to assess psychological distress indicators (i.e., anxiety, social stress, and risk of depression). Results showed significant associations only for girls. The substitution of 10 min/day of SB or LPA at baseline with 10 min/day of MVPA was associated with lower levels of anxiety (both p ≤ 0.01) and social stress (both p < 0.05) at follow-up. The substitution of 10 min/day of SB with 10 min/day of LPA was associated with higher levels of anxiety at follow-up (p = 0.01). These findings highlight the need of specific physical activity recommendations for mental health paying special attention to sex-differences.

Diet and feeding behaviour of albacore Thunnus alalunga in the western Mediterranean Sea during the spawning period.

Mature albacore tuna (Thunnus alalunga) are expected to have high energy requirements at the time of breeding. However, there are no descriptions of the diet of albacore in the Mediterranean Sea that can help us to understand if such requirements can be obtained from feeding during reproduction. In this study, we analysed the stomach contents of reproductively active albacore captured from 2010 to 2015 in the oligotrophic waters of the western Mediterranean Sea, one of their main spawning grounds. Estimates of stomach fullness revealed intense feeding activity, and prey composition indicated important consumption of mesopelagic fish, including barracudinas, myctophids and small pelagic crustaceans. Plastic debris occurred in 25%-53% of the stomachs sampled across all years. Prey composition was not different between males and females. However, females fed at higher rates and had higher hepatosomatic index values than males, suggesting that increased feeding could contribute to meet their higher energy demand associated with offspring production. We observed a diet shift from small crustaceans to fish prey along fish size. During the spawning period, albacore showed a specialist feeding behaviour by preying on aggregations of vertically migrating myctophids and small crustaceans, probably when they were near the surface. This study provides information and biological data to support ecosystem modelling and to increase the understanding of albacore ecology.

The mediating role of adiposity in the longitudinal association between cardiorespiratory fitness and blood pressure in adolescents: LabMed cohort study.

BACKGROUND: The aim of this prospective cohort study was to examine whether the association between the cardiorespiratory fitness (CRF) at baseline and blood pressure (BP) at follow-up is mediated by adiposity in adolescents. MATERIALS AND METHODS: The sample comprised 734 adolescents (349 girls) aged 12-18 years from the LabMed Physical Activity Cohort Study. The variables of interest were measured in 2011 (baseline) and in 2013 (2-year follow-up). CRF was assessed by the 20-m shuttle run test. Body mass index, waist circumference, body fat percentage, pubertal status and resting BP were assessed according to standard procedures. Boot-strapped mediation procedures were performed, and indirect effects (IE) with confidence intervals (CI) not including zero were considered statistically significant. RESULTS: After adjusting for potential confounders, body mass index acted as a mediator of the relationship between CRF and systolic BP (IE = -0. 023; CI = -0.039; -0.009), pulse pressure (IE = -0.023; CI = -0.034; -0.012) and rate product pressure (IE = -2.839; CI = -5.329; -0.340). Similar results were obtained for waist circumference as mediator for systolic BP (IE = -0.019; CI = -0.033; -0.005), pulse pressure (IE = -0.017; CI = -0.028; -0.007) and rate product pressure (IE = -3.793; CI = -6.097; -1.689). Likewise, body fat percentage mediated the association for: systolic BP (IE = -0.029; CI = -0.048; -0.010), pulse pressure (IE = -0.027; CI = -0.041; -0.013) and rate product pressure (IE = -4.280; CI = -7.488; -1.264). CONCLUSIONS: Adiposity mediated the association between CRF and BP in adolescents. Therefore, both optimal CRF and adiposity levels are important to maintain normal BP ranges throughout adolescence.

Health-related quality of life in adolescents: individual and combined impact of health-related behaviors (DADOS study).

PURPOSE: To investigate the individual and combined effect of physical activity, adherence to the Mediterranean diet, sleep quality, sleep duration, and screen time on health-related quality of life (HRQoL) in adolescents. METHODS: This is a cross-sectional analysis with 262 adolescents (13.9 ± 0.3 years) from DADOS (Deporte, ADOlescencia y Salud) study. Physical activity was assessed with a wrist-worn GENEActiv triaxial accelerometer. Adherence to the Mediterranean diet was evaluated by the KIDMED questionnaire. Sleep patterns were self-reported through the Spanish version of Pittsburgh Sleep Quality Index questionnaire. Screen time was assessed through the HELENA sedentary behavior questionnaire. HRQoL was measured using the KIDSCREEN-10 questionnaire. Scores were categorized into low and high using a normative cut-off used to identify factors associated with being in a high HRQoL group. A healthy lifestyle index was created including positive scores for each individual behavior, and five categories of achievement were established (0, 1, 2, 3, ≥ 4). RESULTS: Sleep patterns and screen time revealed a significant individual relationship with HRQoL (p < 0.05). Adolescents achieving ≥ 3 positive health-related behaviors showed higher HRQoL levels compared to those fulfilling none (p < 0.05). Logistic regression analysis revealed an increased likelihood of high HRQoL according to the number of positive health-related behaviors achieved (p < 0.05). CONCLUSIONS: Our results reveal higher levels of HRQoL in those adolescents achieving ≥ 3 health-related behaviors compared to their peers achieving none. Moreover, our findings show a cumulative effect of health-related behaviors on HRQoL. These findings underline the key role of promoting a healthy lifestyle in order to improve adolescents' health and well-being.

Late HIV diagnosis among immigrants in Spain vs. native-born Spaniards, 2010-15.

BACKGROUND: In 2012, the central government of Spain enacted Royal Decree-Law (RDL) 16/2012 and Royal Decree (RD) 1192/2012, which abolished universal healthcare coverage, thus limiting access to care for undocumented immigrants. Free health care was also no longer granted to anyone who has never been employed. In this context, this study investigated the prevalence of late HIV diagnoses (LHDs) among immigrants living in Spain vs. native-born Spaniards. METHODS: Data (n = 5943) from the 2010 to 2015 Cohort of the Spanish AIDs Research Network were used, including HIV-positive and antiretroviral therapy (ART)-naïve patients throughout Spain. Multivariate logistic models were fitted to compare the prevalence of LHD among the groups, adjusting for covariates. RESULTS: The prevalence of LHD in the total sample was 39.5%. Compared with native-born Spaniards (n = 4445), immigrants (n = 1488) were more likely to have LHD (37.4% vs. 45.7%, respectively; P < 0.001). Multivariate analysis showed that the prevalence ratio of LHD among immigrants vs. native-born Spaniards was 1.15 [95% confidence interval (CI), 1.02-1.28], after adjusting for covariates. This disparity widened from 2010 to 2011 (APR = 1.14, 95% CI, 1.02-1.29) to 2012-15 (APR = 1.28, 95% CI, 1.17-1.39), although the change was not statistically significant. CONCLUSIONS: Immigrants in Spain had a higher risk of LHD compared with native-born counterparts. LHD is an important healthcare marker due to the positive benefits of early HIV diagnosis, including prevention, improvements in health outcomes and decreases in overall cost of treatment. More research is needed on the causes of the disparity and potential social and policy interventions to reduce the prevalence of LHD among immigrants.

Independent and combined influence of physical fitness components on self-esteem in adolescents: DADOS study.

BACKGROUND: Self-esteem is a common indicator of psychological well-being, but its relationship with physical fitness components during adolescence is not fully understood. AIMS: The aims of this study were to analyse the association of physical fitness components (low vs. high) with self-esteem in adolescents, and to examine the combined influence of physical fitness on self-esteem. SUBJECTS AND METHODS: A total of 225 participants (44% girls), aged 13.9 ± 0.3 years, from the DADOS (Deporte, ADOlescencia y Salud) study were included in the analyses. ALPHA-Fitness Test Battery was used to evaluate physical fitness components. The Spanish version of the Behaviour Assessment System for Children-3 questionnaire was used to assess self-esteem. RESULTS: Our results showed differences on self-esteem between groups of cardiorespiratory fitness (low = 49.51 ± 12.03 vs. high = 55.01 ± 4.46; p < 0.05) and upper limb muscular strength (low = 53.87 ± 7.38 vs. high = 54.29 ± 5.99; p < 0.05). Lower limb muscular strength and speed-agility groups did not show statistical differences. Significant differences on self-esteem were found when comparing adolescents with a physical fitness index of ≤1 vs. 4 (52.66 vs. 55.28; p < 0.05). CONCLUSION: These findings suggest that cardiorespiratory fitness and upper limb muscular strength are positively related with self-esteem. Moreover, our results revealed a combined influence of physical fitness on the self-esteem of adolescents.

Prevalence of severe/morbid obesity and other weight status and anthropometric reference standards in Spanish preschool children: The PREFIT project.

BACKGROUND: Childhood obesity has become a major health problem in children under the age of 5 years. Providing reference standards would help paediatricians to detect and/or prevent health problems related to both low and high levels of body mass and to central adiposity later in life. Therefore, the aim of this study was to examine the prevalence of different weight status categories and to provide sex- and age-specific anthropometry reference standards for Spanish preschool children. METHODS: A total of 3178 preschool children (4.59±0.87 years old) participated in this study. Prevalence of different degrees of obesity (mild, severe, and morbid) and other weight status categories were determined. RESULTS: Reference standards were obtained. Prevalence of overweight and obese preschool children in the Spanish population ranged from 21.4 to 34.8%. Specifically, the obesity prevalence was 3.5, 1.2, and 1.3% of these subjects were categorized as mild, severe, and morbid obese. Sex- and age-specific reference standards for anthropometric parameters are provided for every 0.25 years (i.e. every trimester of life). CONCLUSION: Our results show a high prevalence of overweight/obese preschoolers. The provided sex- and age-specific anthropometric reference standards could help paediatricians to track and monitor anthropometric changes at this early stage in order to prevent overweight/obesity.

Interlimb Asymmetries in Youth Tennis Players: Relationships With Performance.

Madruga-Parera, M, Bishop, C, Fort-Vanmeerhaeghe, A, Beltran-Valls, MR, Gonzalo-Skok, O, and Romero-Rodríguez, D. Interlimb asymmetries in youth tennis players: relationships with performance. J Strength Cond Res 34(10): 2815-2823, 2020-Change of direction speed (CODS) has been highlighted as a critical component of tennis. Interlimb asymmetries have been commonly studied in jump tests, but less attention given to the topic during CODS. The aim of this study was to quantify interlimb asymmetries in jumping and CODS (during traditional and isoinertial tests) and establish their relationship with measures of physical performance. Twenty-two elite youth tennis players (16.3 ± 1.4 years) performed single-leg countermovement jump (SLCMJ), single-leg broad jump, and single-leg lateral jump, a double 180° turn CODS test, and shuffle lateral step and crossover step with an isoinertial resistance device. Paired-samples t-tests revealed significant differences between limbs for all tests (p < 0.05). Interlimb asymmetry scores ranged from 1.83 to 15.03%, and a 1-way repeated-measures analysis of variance showed significant differences between interlimb asymmetry scores across multiple tests (p < 0.05). Spearman's rank order r correlations showed significant negative relationships between CODS asymmetry and SLCMJ performance on both limbs (r = -0.50; p = 0.02 and r = -0.53; p = 0.01) and CODS performance on both limbs (r = 0.50; p = 0.02 and r = 0.63; p = 0.002). These results show the test-specific nature of asymmetries in youth tennis athletes, with the SLCMJ presenting the greatest magnitude of asymmetry. Furthermore, interlimb differences during CODS were associated with reduced performance during jumping and CODS tests, suggesting the monitoring of asymmetries within this population may therefore be warranted.

Intellectual disability and independent living: Professionals' views via a Delphi study.

BACKGROUND: The Convention on the Rights of Persons with Disabilities (2006) states that people have the right to decide where to live and with whom. Professionals play a key role in supporting processes for independent living (IL). This research aimed to identify which ideas generated more or less consensus among professionals regarding the role of different agents involved in the processes of IL in Spain. METHOD: The Delphi method was applied to an expert panel of 25 professionals. RESULTS: A high consensus was reached regarding the role that people with intellectual disabilities, their families and their natural support networks play in supporting IL processes, but there was less consensus on the role played by organizations and professionals. CONCLUSIONS: The study highlights the need to promote practices that favour the decision-making capacity of individuals to move towards models of support based on community and the human rights model.

Independent and combined influence of healthy lifestyle factors on academic performance in adolescents: DADOS Study.

BACKGROUND: Few studies have analyzed the combined effect of lifestyle factors on academic performance (AP) in adolescents. The aim of this study was to analyze the independent and combined effects of weight status, screen time, sleep quality, daily meal frequency, cardiorespiratory fitness, and physical activity (PA) on AP in adolescents. METHODS: A total of 262 adolescents (13.9 ± 0.3 years) from the DADOS study were included in the analysis. Weight status was assessed through body mass index (kg/m2). Participants completed questionnaires to evaluate screen time, sleep quality, and daily meal frequency. Cardiorespiratory fitness was assessed by the 20-m shuttle run test. PA was evaluated by a wrist-worn GENEActiv accelerometer. AP was assessed through the final academic grades and a validated questionnaire. RESULTS: Non-overweight status, low screen time, good sleep quality, and proper meal frequency showed independent, positive influence on AP. Moreover, adolescents achieving at least three healthy lifestyles were more likely to be in the high-performance group for academic grades than those achieving ≤1 (math OR: 3.02-9.51, language OR: 3.51-6.76, and grade point average OR: 4.22-9.36). CONCLUSIONS: Although individual healthy lifestyles are independently and positively associated with AP, the cumulative effect of multiple healthy lifestyles have a stronger impact.

Associations between objectively measured and self-reported sleep with academic and cognitive performance in adolescents: DADOS study.

Adequate sleep has been positively related with health and school achievement outcomes during adolescence. The aim of this study was to investigate the associations of objectively measured and self-reported sleep duration and quality with academic and cognitive performance in adolescents. This study was conducted with 257 adolescents (13.9 ±â€…0.3 years) from the DADOS study (Deporte, ADOlescencia y Salud). Objectively measured and self-reported sleep duration and quality were obtained by a wrist-worn GENEActiv accelerometer and the Spanish version of Pittsburgh Sleep Quality Index questionnaire, respectively. Academic performance was analysed through school records using four indicators: math, language, science and grade point average score. Cognitive performance was measured using the Spanish version of the "SRA Test of Educational Ability". After Benjamini-Hochberg correction for the false discovery rate, objectively measured sleep duration was negatively associated with verbal ability (ß = -0.179, p = .004), whilst self-reported sleep quality was positively associated with academic performance (ß ranging from 0.209 to 0.273; all p < .001). These associations remained significant after further controlling for physical fitness and physical activity. Conversely, there were no associations between self-reported sleep duration and objective sleep quality with academic and cognitive performance. Our findings fit in line with previous research showing that sleep quality may play an important role on adolescents' academic performance. Further interventional research is needed to clarify the mechanisms by which sleep is related to academic performance in youth.

Acute liver failure due to visceral leishmaniasis in Barcelona: a case report.

BACKGROUND: Leishmaniasis is an emerging infectious disease. Due to human migration and tourism, visceral leishmaniasis may become more common in non-endemic areas. In the Mediterranean basin, visceral leishmaniasis typically occurs in rural regions. CASE PRESENTATION: We present an unusual urban case of acute liver failure due to visceral leishmaniasis, following a prolonged fever of unknown origin. After obtaining negative results from the bone marrow aspirate, we performed a liver biopsy that elucidated the diagnosis. The liver involvement in visceral leishmaniasis may appear as chronic granulomatous hepatitis. However diffuse hepatitis process, a necro-inflammatory pattern, without forming granulomas were observed in the liver biopsy specimens in this case. Intracytoplasmic Leishmania amastigotes were observed in the liver biopsy specimens and a polymerase chain reaction confirmed the diagnosis. Only five pathological confirmed cases of acute hepatitis due to visceral leishmaniasis have been described so far, just two in adults and both from Barcelona. A revision of the literature is performed. CONCLUSIONS: Acute hepatitis is an uncommon debut of visceral leishmaniasis in immunocompetent patients. Furthermore there are only few cases in the literature that describe the histopathological changes that we found in this patient. In conclusion, in case of acute hepatitis leading to liver failure, leishmaniasis should be considered a differential diagnosis (even in non-endemic countries and without clear epidemiological exposure) and liver biopsy can elucidate the diagnosis.

The influence of adherence to the Mediterranean diet on academic performance is mediated by sleep quality in adolescents.

AIM: This study examined the association of adherence to the Mediterranean diet with academic performance and tested whether this association was mediated by sleep in Spanish adolescents. METHODS: We recruited 269 adolescents (52% boys) aged 13.9 ± 0.3 years from the Deporte, ADOlescencia y Salud study of 38 secondary schools and sport clubs in Castellon, Spain, between February and May 2015. Adherence to the Mediterranean diet was assessed by the KIDMED questionnaire, sleep quality was evaluated with the Pittsburgh Sleep Quality Index test and sleep duration was objectively computed using a wrist-worn accelerometer. Academic performance was assessed through final school grades and a validated test. RESULTS: Greater adherence to the Mediterranean diet was associated with higher scores in language, core subjects, grade point average and verbal ability (p < 0.05). Sleep quality acted as a significant mediator of the association between adherence to the Mediterranean diet and final grades in maths, language, core subjects and the grade point average. CONCLUSION: Our data show that the influence of adherence to the Mediterranean diet on academic performance was mediated by sleep quality in adolescents. Education and public health professionals should work together to achieve both improved health status and academic performance in adolescents.

Cardiorespiratory fitness and academic performance association is mediated by weight status in adolescents: DADOS study.

The aim of our study was to examine the mediation effect of weight status on the association between cardiorespiratory fitness (CRF) and academic performance (AP). Two hundred sixty-nine adolescents (140 boys) aged 13.9 ± 0.3 years old from the DADOS study were included in this cross-sectional analysis. CRF was assessed by the 20-m shuttle run test and estimated maximum oxygen uptake was used in the analysis. AP was assessed through the final academic grades and the Science Research Associates Test of Educational Abilities for assessing reasoning, verbal, and numeric abilities. Weight status was assessed by body mass index (kg/m2). Boot-strapped mediation procedures were performed and indirect effects (IE) with confidence intervals (CI) not including zero were considered statistically significant. Mediation analysis revealed that weight status acted as a mediator of the relationship of CRF with reasoning ability (IE = 0.039; CI = 0.001; 0.091) and the final grades in Math (IE = 0.011; CI = 0.002; 0.025), Language (IE = 0.013; CI = 0.004; 0.027), and GPA (IE = 0.011; CI = 0.003; 0.023). CONCLUSIONS: Our data show that the influence of CRF on academic performance is mediated by weight status in adolescents. We suggest that our data could be considered by educators, families, and policy makers, so that active lifestyles might be promoted when designing programs aimed to improve AP among adolescents. What is Known: • Academic performance is associated with both, cardiorespiratory fitness and weight status. • The role of weight status in the association between cardiorespiratory fitness and academic performance is poorly understood. What is New: • We support the scarce research investigating the mediating role of weight status as mechanism in the association between fitness and academic performance in youth. • Previous knowledge is expanded by suggesting that cardiorespiratory fitness is related to weight status which in turn may positively influence academic performance in adolescents.