Effects of Low-Volume, High-Intensity Interval Training Compared with Continuous Training on Regional and Global Body Composition in Adults with Metabolic Syndrome: A post hoc Analysis of a Randomized Clinical Trial.

OBJECTIVE: The aim of this study was to compare the effects of low-volume, high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT) on body composition in adults with metabolic syndrome (MS). METHODS: This is a post hoc analysis of the randomized clinical trial Intraining-MET. Sixty adults (40-60 years old) were randomized to an MICT (n = 31) or HIIT (n = 29) supervised programme 3 days/week for 12 weeks. MICT sessions were conducted for 36 min at 60% of peak oxygen consumption (VO2peak). HIIT sessions included 6 intervals at 90% VO2peak for 1 min, followed by 2 min at 50% VO2peak. Body composition was assessed with dual energy X-ray absorptiometry. RESULTS: Body weight did not change from pre- to post-training in either MICT (78.9 ± 15.6 kg; 77.7 ± 16.5 kg, p = 0.280) or HIIT groups (76.3 ± 13.4 kg; 76.3 ± 13.7 kg, p = 0.964). Body fat percentage and fat mass (FM) decreased post-training in the MICT (-0.9%; 95% confidence interval [CI]: -0.27 to -1.47 and -0.7 kg; 95% CI: -0.12 to -1.30) and HIIT groups (-1.0%; 95% CI: -0.32 to -1.68 and -0.8 kg; 95% CI: -0.17 to -1.47). Compared to the HIIT programme, MICT significantly reduced android FM (-0.14 kg; 95% CI: -0.02 to -0.26). Lean mass (LM) increased post-training in MICT (+0.7 kg; 95% CI: 0.01-1.41) and HIIT groups (+0.9 kg; 95% CI: 0.12-1.64), but only HIIT increased the trunk LM (+0.6 kg; 95% CI: 0.06-1.20). CONCLUSIONS: Both MICT and HIIT reduced FM without changing body weight in adults with MS. MICT had additional benefits by reducing the android FM, whereas HIIT seemed to increase LM. Given the characteristics of the post hoc analysis, further research is required to confirm these results.

Reliability and validity of a sedentary behavior questionnaire for South American pediatric population: SAYCARE study.

BACKGROUND: Multicenter studies from Europe and the United States have developed specifically standardized questionnaires for assessing and comparing sedentary behavior, but they cannot be directly applied for South American countries. The aim of this study was to assess the reliability and validity of the South American Youth Cardiovascular and Environmental (SAYCARE) sedentary behavior questionnaire. METHODS: Children and adolescents from seven South American cities were involved in the test-retest reliability (children: n = 55; adolescents: n = 106) and concurrent validity (children: n = 93; adolescents: n = 94) studies. The SAYCARE sedentary behavior questionnaire was administered twice with two-week interval and the behaviors were parent-reported for children and self-reported for adolescents. Questions included time spent watching television, using a computer, playing console games, passive playing (only in children) and studying (only in adolescents) over the past week. Accelerometer was used for at least 3 days, including at least one weekend day. We compared values of sedentary time, using accelerometers, by quartiles of reported sedentary behavior time and their sum. RESULTS: The reliability of sedentary behavior time was moderate for children (rho ≥0.45 and k ≥ 0.40) and adolescents (rho ≥0.30). Comparisons between the questionnaire and accelerometer showed a low overall agreement, with the questionnaire systematically underreporting sedentary time in children (at least, - 332.6 ± 138.5 min/day) and adolescents (at least, - 399.7 ± 105.0 min/day). CONCLUSION: The SAYCARE sedentary behavior questionnaire has acceptable reliability in children and adolescents. However, the findings of current study indicate that SAYCARE questionnaire is not surrogate of total sedentary time.

Correlation of body mass index and waist to height ratio with cardiovascular risk factors in Colombian preschool and school children.

Objective: To analyze the agreement between body mass index (BMI) and waist-to-height Ratio (WHtR) to identify preschool and school children with cardiovascular risk factors (CRFs). Methods: Three-hundred-twenty-one kids were divided into preschool (3-5 years) and school children (6-10 years). BMI was used to classify children as overweight or obese. Abdominal obesity was defined with a WHtR ≥0.50. Fasting blood lipids, glucose and insulin were measured, and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. The presence of CRFs and multiple non-waist circumference (non-WC) metabolic syndrome factors (MetS-Factors) [high HOMA-IR, high triglycerides and low high-density lipoprotein cholesterol (HDL-C)] were analyzed. Results: One-hundred-twelve preschool and 209 school children were evaluated. WHtR ≥0.50 classified abdominal obesity in more than half of the preschool children, exceeding those classified with overweight+obesity by BMI (59.5% vs. 9.8%; p<0.001). There was no agreement between WHtR and BMI to identify preschool kids with CRFs and multiple non-WC MetS-Factors (kappa: 0.0 to 0.23, p>0.05). There were similar proportions of school children classified with abdominal obesity by the WHtR and overweight+obesity by the BMI (18.7% vs. 24.9%; p>0.05). There was substantial agreement between WHtR and BMI to identify school children with high total cholesterol values, low-density lipoprotein cholesterol (LDL-C), triglycerides, non-HDL-C, insulin, HOMA-IR, low HDL-C values, and the presence of multiple non-WC MetS-Factors (kappa: 0.616 to 0.857, p<0.001). Conclusion: In preschool children WHtR ≥0.5 disagree with BMI results, but in school kids, it has good agreement with the BMI to classify the children´s nutritional status and to identify those with CRFs.

Objetivo: Analizar el grado de acuerdo entre el índice de masa corporal (IMC) y la relación/cintura estatura (rCE) para identificar niños con factores de riesgo cardiovascular (FRC). Métodos: Estudio transversal analítico con 112 niños preescolares (3-5 años) y 209 escolares (6-10 años). El sobrepeso y la obesidad se clasificaron con el IMC y la obesidad abdominal con la rCE ≥0.50. Se tomaron muestras sanguíneas en ayuno para análisis de glucosa, insulina, lípidos y cálculo del índice HOMA-IR. Se analizó la presencia de FRC y de múltiples factores del síndrome metabólico (Factores-SinMet) diferentes a la cintura [HOMA-IR elevado, triglicéridos elevados y colesterol de alta densidad (HDL-C) bajo]. Resultados: rCE ≥0.50 clasificó con obesidad abdominal a más de la mitad de los niños preescolares, excediendo el número de niños clasificados con sobrepeso+obesidad por IMC (59.5% vs 9.8%; p<0.001). No hubo acuerdo entre el IMC y la rCE para identificar niños preescolares con FRC o múltiples Factores-SinMet diferentes a la cintura (kappa: 0.0 a 0.23, p>0.05). Fueron similares las proporciones de niños escolares clasificados con obesidad abdominal por la rCE o con sobrepeso+obesidad por el IMC (18.7% vs. 24.9%; p>0.05). Hubo acuerdo sustancial entre la rCE y el IMC para identificar niños escolares con valores elevados de colesterol total, colesterol de baja densidad, triglicéridos, colesterol no-HDL, insulina, HOMA-IR, valores bajos de HDL-C y la presencia de múltiples Factores-SinMet diferentes a la cintura (kappa: 0.616 a 0.857, p<0.001). Conclusión: En niños preescolares la aplicación de rCE ≥0.5 no presenta acuerdo con el IMC, pero en escolares presenta un acuerdo sustancial con el IMC en la clasificación del estado nutricional y en la identificación de niños con FRC.

Reliability and Validity Estimate of the Pro-Inflammatory/Anti-Inflammatory Food Intake Score in South American Pediatric Population: SAYCARE Study.

Chronic low-grade inflammation may be associated with the development of chronic non-communicable diseases in young populations, often lasting to adulthood. Studies show that the diet is related to chronic inflammation. The Pro-inflammatory/Anti-inflammatory Food Intake Score (PAIFIS) is an indicator that measures the inflammatory potential of the diet, with the help of validated tools that assess food consumption. The validation of tools that assess inflammatory dietary patterns in young populations to produce valid and reliable results is essential to guide disease prevention strategies for adulthood. METHODS: This study aimed to estimate the Pro-inflammatory/Anti-inflammatory Food Intake Score (PAIFIS) in children and adolescents in South America and to test its reliability and validity using a food frequency questionnaire (FFQ) and an inflammatory biomarker. This work consists of a validation study in a sample of children and adolescents conducted in South America (SAYCARE Study). The habitual consumption of food contributing to calculating the PAIFIS was obtained through an FFQ and 24 h Dietary Recall (24HDR). Reliability was tested using the FFQ (FFQ1 × FFQ2), using Spearman's correlation coefficient to estimate the agreement between measurements. The validity of the PAIFIS was tested using 24HDR and the inflammatory biomarker C-reactive protein (CRP) using Spearman's correlation and multilevel linear regression. RESULTS: For children and adolescents, pro- and anti-inflammatory food groups showed Spearman's correlation coefficients ranging from 0.31 to 0.66, convergent validity ranging from 0.09 to 0.40, and criterion validity for a reliability range from -0.03 to 0.18. The PAIFIS showed Spearman's correlation coefficients for reliability ranging from 0.61 to 0.69, convergent validity from 0.16 to 0.23, and criterion validity from -0.03 to 0.24. CONCLUSION: The PAIFIS showed acceptable reliability, weak convergent validity, and weak criterion validity in children and adolescents.

Prevalence of Anti-SARS-CoV-2 Antibodies and Associated Factors Among Health Care Workers in Santiago De Cali, Colombia.

Purpose: This study aims to determine the seroprevalence of coronavirus disease (COVID-19) among health care workers and describe the associated sociodemographic and labor features. Patients and Methods: An observational study with an analytical component was conducted at a clinic in Cali, Colombia. The sample size was 708 health workers and they were selected by stratified random sampling. A Bayesian analysis was developed to determine the raw and adjusted prevalence. A Poisson regression model was used to estimate the prevalence ratios. Results: Overall seroprevalence of COVID-19 among healthcare workers was 29%. Miscellaneous services workers, healthcare, and administrative workers, was 38%, 33%, and 32%, respectively. Factors related to seropositivity were having a contact with a COVID-19 patient for >120 minutes and being diagnosed with COVID-19 by laboratory tests. Conclusion: The present study shows a adjusted seroprevalence of 29% in health workers, indicating a high level of disease transmission and an increased risk of infection in this population group.

Plateau iris syndrome: Epidemiology, diagnosis, and treatment: A narrative review.

Plateau iris syndrome (PIS) was first coined in 1958 to describe the iris configuration of a patient, 2 years later; the concept of plateau iris was published. In 1992, the anatomic aspects of plateau iris were studied using ultrasound biomicroscopy (UBM) determining it as a form of primary angle-closure glaucoma caused by a large or anteriorly positioned ciliary body that leads to mechanical obstruction of the trabecular meshwork, this condition is most often found in young patients. We aim to review the current literature and knowledge on the diagnosis and treatment options of PIS; the search was conducted in PubMed, LILACS, and BIREME internet search sites using keywords and snowball search strategy of articles published until 2022, focusing on PIS history, epidemiology, clinical diagnosis, UBM feature, and treatment.

Height-based equations as screening tools for elevated blood pressure in the SAYCARE study.

This study evaluated the accuracy of four height-based equations: blood pressure to height ratio (BPHR), modified BPHR (MBPHR), new modified BPHR (NMBPHR), and height-based equations (HBE) for screening elevated BP in children and adolescents in the SAYCARE study. We measured height and BP of 829 children and adolescents from seven South American cities. Receiving operating curves were used to assess formula performance to diagnose elevated BP in comparison to the 2017 clinical guideline. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated for the four screening formulas. The diagnostic agreement was evaluated with the kappa coefficient. The HBE equation showed the maximum sensitivity (100%) in children, both for boys and girls, and showed the best performance results, with a very high NPV (>99%) and high PPV (>60%) except for female children (53.8%). In adolescents, the highest sensitivity (100%) was achieved with the NMBPHR for both sexes. Kappa coefficients indicated that HBE had the highest agreement with the gold standard diagnostic method (between 0.70 and 0.75), except for female children (0.57). Simplified methods are friendlier than the percentile gold standard tables. The HBE equation showed better performance than the other formulas in this Latin American pediatric population.

Intra-observer reliability of the anthropometric measurements in South American children and adolescents: the SAYCARE Study.

INTRODUCTION: Introduction: the South American Youth/Child Cardiovascular and Environmental (SAYCARE) feasibility study aims to develop valid and reliable indicators to investigate health-related behavior and nutritional status in children and adolescents. Anthropometric measurements are one of the evaluated indicators in the study. The accuracy of the anthropometric data is very important and relies in the quality of the measurements. Objective: to describe the intra-observer reliability of ten anthropometric measurements: weight, height, circumferences (neck, arm, waist, hip) and skinfolds (triceps, subscapular, biceps and suprailiac) of children and adolescents from six South American cities: Lima, Medellin, Montevideo, Santiago, San Pablo and Teresina. Methods: prior to the study, fieldworkers from the seven centers participated in central training to ensure the application of standardized procedures in the anthropometric measurements. Intra-observer precision, technical error of measurement (TEM) and coefficient of reliability (R) were estimated for each measurement. Results: reliability of weight and height was above 99% in almost all cities. TEM for skinfold thickness was below 1.4 mm in children and 2.13 mm in adolescents, while reliability was above 95% in most of the skinfold measurements. TEM for circumferences was below 1.8 cm in children and 0.64 cm in adolescents, while reliability was above 99% in almost all circumferences. Conclusions: reliability of the anthropometric measurements in this study was high. In comparison with similar European or American studies, the reliability of the measurements taken in our study was, in most cases, similar or even higher.

INTRODUCCIÓN: Introducción: el estudio piloto South American Youth/Child cARdiovascular and Environmental (SAYCARE) tiene como objetivo desarrollar indicadores válidos y confiables para investigar el estado nutricional y las conductas vinculadas a la salud en niños y adolescentes. Uno de estos indicadores son las mediciones antropométricas. La precisión de los datos antropométricos es muy importante y se basa en la calidad con que se toman las mediciones. Objetivos: describir la confiabilidad intraobservador de diez mediciones antropométricas: peso, talla, circunferencias (cuello, brazo, cintura, cadera) y pliegues (trÍceps, subscapular, bÍceps y suprailIaco) de niños y adolescentes de seis ciudades de Sudamérica: Lima, Medellín, Montevideo, Santiago, San Pablo and Teresina. Métodos: previo al estudio, los trabajadores de campo de los seis centros participaron de un entrenamiento centralizado, para asegurar la aplicación de procedimientos estandarizados en la toma de las mediciones antropométricas. Para determinar la precisión intraobservador, se estimó el error técnico de medición (TEM) y el coeficiente de confiabilidad (R) para cada medición. Resultados: la confiabilidad de las medidas de peso y la talla estuvo por encima del 99% en casi todas las ciudades. El TEM para el grosor de los pliegues estuvo debajo de 1,4 mm en los niños y de 2,13 mm en los adolescentes, mientras que la confiabilidad fue superior al 95% en la mayoría de las mediciones de los pliegues. El TEM para las circunferencias estuvo por debajo de 1,8 cm en los niños y de 0,64 cm en los adolescentes, mientras que la confiabilidad fue superior al 99% en casi todas las circunferencias. Conclusiones: la confiabilidad de las mediciones antropométricas en este estudio fue alta. Comparada con estudios similares realizados en Europa y Estados Unidos, la confiabilidad de las medidas tomadas en nuestro estudio es, en la mayoría de los casos, similar o aún más elevada.

[Validation by hydrodensitometry of skinfold thickness equations used for female body composition assessment]. / Validación por hidrodensitometría de ecuaciones de pliegues cutáneos utilizadas para estimar la composición corporal en mujeres.

Introduction. Skinfold thickness equations are widely used for body composition assessment. However the equations have not been validated in Colombia with a reference method. Objective. The skinfold thickness equations of Durning/Womersley, Jackson/Pollock and Ramírez/Torun were validated by hydrodensitometry in female from 18 to 40 years old. Materials and methods. The percentage of body fat was compared among 52 women, using underwater weighing (Chatillon scale) with simultaneous measured of residual lung volume (VMAX 22 Sensormedics spirometer) and skinfold thickness (Harpenden caliper) equations of Durning/Womersley, Jackson/Pollock and Ramírez/Torun. The statistic analysis included paired t test, Pearson and intraclass correlation coefficients, and the Bland-Altman method. Results. The mean percentage of body fat by hydrodensitometry (29.6+/-5.8%) was different (p Conclusion. The skinfold thickness equations showed poor validity for body fat assessment. The equations had significant differences and lower correlation coefficients with hydrodensitometry. In addition, the equations indicated agreement with hydrodensitometry over very wide limits. The outcomes suggested that the results obtained by hydrodensitometry were neither comparable nor interchangeable with those from Durning/Womersley, Jackson/Pollock y Ramírez/Torun skinfold thickness equations.

Correlation of body mass index and waist to height ratio with cardiovascular risk factors in Colombian preschool and school children

Objective: To analyze the agreement between body mass index (BMI) and waist-to-height Ratio (WHtR) to identify preschool and school children with cardiovascular risk factors (CRFs). Methods: Three-hundred-twenty-one kids were divided into preschool (3-5 years) and school children (6-10 years). BMI was used to classify children as overweight or obese. Abdominal obesity was defined with a WHtR ≥0.50. Fasting blood lipids, glucose and insulin were measured, and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. The presence of CRFs and multiple non-waist circumference (non-WC) metabolic syndrome factors (MetS-Factors) [high HOMA-IR, high triglycerides and low high-density lipoprotein cholesterol (HDL-C)] were analyzed. Results: One-hundred-twelve preschool and 209 school children were evaluated. WHtR ≥0.50 classified abdominal obesity in more than half of the preschool children, exceeding those classified with overweight+obesity by BMI (59.5% vs. 9.8%; p0.05). There were similar proportions of school children classified with abdominal obesity by the WHtR and overweight+obesity by the BMI (18.7% vs. 24.9%; p>0.05). There was substantial agreement between WHtR and BMI to identify school children with high total cholesterol values, low-density lipoprotein cholesterol (LDL-C), triglycerides, non-HDL-C, insulin, HOMA-IR, low HDL-C values, and the presence of multiple non-WC MetS-Factors (kappa: 0.616 to 0.857, p<0.001). Conclusion: In preschool children WHtR ≥0.5 disagree with BMI results, but in school kids, it has good agreement with the BMI to classify the children´s nutritional status and to identify those with CRFs.

Objetivo: Analizar el grado de acuerdo entre el índice de masa corporal (IMC) y la relación/cintura estatura (rCE) para identificar niños con factores de riesgo cardiovascular (FRC). Métodos: Estudio transversal analítico con 112 niños preescolares (3-5 años) y 209 escolares (6-10 años). El sobrepeso y la obesidad se clasificaron con el IMC y la obesidad abdominal con la rCE ≥0.50. Se tomaron muestras sanguíneas en ayuno para análisis de glucosa, insulina, lípidos y cálculo del índice HOMA-IR. Se analizó la presencia de FRC y de múltiples factores del síndrome metabólico (Factores-SinMet) diferentes a la cintura [HOMA-IR elevado, triglicéridos elevados y colesterol de alta densidad (HDL-C) bajo]. Resultados: rCE ≥0.50 clasificó con obesidad abdominal a más de la mitad de los niños preescolares, excediendo el número de niños clasificados con sobrepeso+obesidad por IMC (59.5% vs 9.8%; p0.05). Fueron similares las proporciones de niños escolares clasificados con obesidad abdominal por la rCE o con sobrepeso+obesidad por el IMC (18.7% vs. 24.9%; p>0.05). Hubo acuerdo sustancial entre la rCE y el IMC para identificar niños escolares con valores elevados de colesterol total, colesterol de baja densidad, triglicéridos, colesterol no-HDL, insulina, HOMA-IR, valores bajos de HDL-C y la presencia de múltiples Factores-SinMet diferentes a la cintura (kappa: 0.616 a 0.857, p<0.001). Conclusión: En niños preescolares la aplicación de rCE ≥0.5 no presenta acuerdo con el IMC, pero en escolares presenta un acuerdo sustancial con el IMC en la clasificación del estado nutricional y en la identificación de niños con FRC.

Efficacy of high-intensity, low-volume interval training compared to continuous aerobic training on insulin resistance, skeletal muscle structure and function in adults with metabolic syndrome: study protocol for a randomized controlled clinical trial (Intraining-MET).

BACKGROUND: Evidence of the efficacy of high-intensity, low-volume interval training (HIIT-low volume) in treating insulin resistance (IR) in patients with metabolic disorders is contradictory. In addition, it is unknown whether this effect is mediated through muscle endocrine function, which in turn depends on muscle mass and fiber type composition. Our aims were to assess the efficacy of HIIT-low volume compared to continuous aerobic exercise (CAE) in treating IR in adults with metabolic syndrome (MS) and to establish whether musclin, apelin, muscle mass and muscle composition are mediators of the effect. METHODS: This is a controlled, randomized, clinical trial using the minimization method, with blinding of those who will evaluate the outcomes and two parallel groups for the purpose of showing superiority. Sixty patients with MS and IR with ages between 40 and 60 years will be included. A clinical evaluation will be carried out, along with laboratory tests to evaluate IR (homeostatic model assessment (HOMA)), muscle endocrine function (serum levels of musclin and apelin), thigh muscle mass (by dual energy x-ray absorptiometry (DXA) and thigh muscle composition (by carnosine measurement with proton magnetic resonance spectroscopy (1H-MRS)), before and after 12 weeks of a treadmill exercise program three times a week. Participants assigned to the intervention (n = 30) will receive HIIT-low volume in 22-min sessions that will include six intervals at a load of 90% of maximum oxygen consumption (VO2 max) for 1 min followed by 2 min at 50% of VO2 max. The control group (n = 30) will receive CAE at an intensity of 60% of VO2 max for 36 min. A theoretical model based on structural equations will be proposed to estimate the total, direct and indirect effects of training on IR and the proportion explained by the mediators. DISCUSSION: Compared with CAE, HIIT-low volume can be effective and efficient at improving physical capacity and decreasing cardiovascular risk factors, such as IR, in patients with metabolic disorders. Studies that evaluate mediating variables of the effect of HIIT-low volume on IR, such as endocrine function and skeletal muscle structure, are necessary to understand the role of skeletal muscle in the pathophysiology of MS and their regulation by exercise. TRIAL REGISTRATION: NCT03087721 . High-intensity Interval, Low Volume Training in Metabolic Syndrome (Intraining-MET). Registered on 22 March 2017, retrospectively registered.

Reliability and Validity of a Questionnaire for Physical Activity Assessment in South American Children and Adolescents: The SAYCARE Study.

OBJECTIVE: The objective of this article is to test the reliability and validity of the new and innovative physical activity (PA) questionnaire. METHODS: Subsamples from the South American Youth/Child Cardiovascular and Environment Study (SAYCARE) study were included to examine its reliability (children: n = 161; adolescents: n = 177) and validity (children: n = 82; adolescents: n = 60). The questionnaire consists of three dimensions of PA (leisure, active commuting, and school) performed during the last week. To assess its validity, the subjects wore accelerometers for at least 3 days and 8 h/d (at least one weekend day). The reliability was analyzed by correlation coefficients. In addition, Bland-Altman analysis and a multilevel regression were applied to estimate the measurement bias, limits of agreement, and influence of contextual variables. RESULTS: In children, the questionnaire showed consistent reliability (ρ = 0.56) and moderate validity (ρ = 0.46), and the contextual variable variance explained 43.0% with -22.9 min/d bias. In adolescents, the reliability was higher (ρ = 0.76) and the validity was almost excellent (ρ = 0.88), with 66.7% of the variance explained by city level with 16.0 min/d PA bias. CONCLUSIONS: The SAYCARE PA questionnaire shows acceptable (in children) to strong (in adolescents) reliability and strong validity in the measurement of PA in the pediatric population from low- to middle-income countries.

[Body composition assessment by anthropometry and bioelectrical impedance]. / Evaluación de la composición corporal de adultos sanos por antropometría e impedancia bioeléctrica.

INTRODUCTION: Anthropometry and electric impedance methods are widely used for body composition assessment. However the evidence is unclear whether the results obtained from the two methods can be compared. OBJECTIVE: Two methods are compared for assessment of body composition; anthropometry and electric impedance. MATERIALS AND METHODS: Body composition was measured in 70 women; aged 22 to 56 and 53 men; aged 24 to 54, using anthropometry (Durning/Womersley and Jackson/Pollock skinfolds equations) and electric impedance (foot to foot electric impedance) to obtain percentage body fat. RESULTS: The mean percentage body fat was significant higher with Durning/Womersley (25.2%) than Jackson/Pollock (20.1%) and electric impedance (19.3%) for men (p<0.001). The mean percentage body fat was significant higher with Durning/Womersley (36.9%) than Jackson/Pollock (31.0%) and electric impedance (27.6%) for women (p<0.001). Correlation coefficient was high when two methods were compared (r>0.77) however, the concordance between methods to classify obesity subjects was low (K<0.5). CONCLUSIONS: The percentages obtained from the anthropometry method were higher than the bioelectrical impedance method. A significant difference was found between methods applied in men and women, and therefore these methods are not comparable.

Relationship between optic disc hemorrhage and glaucoma among patients diagnosed with systemic hypertension and Diabetes Mellitus: the Colombian Glaucoma Study / Relación entre Hemorragia de Disco Óptico y Glaucoma en pacientes con diagnóstico de Hipertensión Sistémica y Diabetes Mellitus: Estudio Colombiano de Glaucoma

Introduction: Glaucoma is a leading cause of irreversible blindness worldwide; several risk factors have been identified as major underlying causes for developing this condition. Optic disc hemorrhage has been identified as a risk factor for the development and progression of primary open-angle glaucoma, as well it has been related to playing an important role in normal-tension glaucoma. Material and methods: A cross-sectional study was conducted in Colombia among hypertensive and diabetic patients. This study included 2,067 subjects older than 50 years who were attended by a group of ophthalmologists in six cities in Colombia who conducted a complete medical and ophthalmological examination and applied standardized questionnaires and interviews aiming to evaluate participant’s health conditions and lifestyles. Results: We found a prevalence of Optic disc hemorrhage (ODH) of 0.4%. ODH presented an OR: 8.82 (95% CI 1.60 - 48.52) for the presence of Glaucoma. Patients diagnosed with systemic hypertension had an OR: 0.02 (95% CI 0.00 - 0.96); Patients with Retinal Nerve Fiber Layer Defect (RNFL) presented an OR: 509.40 (95% CI 8.60 - 30152.97) for the presence of ODH and 50% of patients with ODH did not have a diagnosis of glaucoma. Conclusions: Despite the low prevalence of ODH in our study (0.4%), its presence is a High-risk factor for the presence of Glaucoma. RNFL defect is also highly related to ODH and the presence of Glaucoma. (AU)

Introducción: El glaucoma es una de las principales causas de ceguera irreversible a nivel mundial; varios factores de riesgo han sido identificados como las principales causas subyacentes para el desarrollo de esta condición. La hemorragia del disco óptico se ha identificado como un factor de riesgo para el desarrollo y progresión del glaucoma primario de ángulo abierto, así como también se ha relacionado con desempeñar un papel importante en el glaucoma de tensión normal. Material y métodos: Se realizó un estudio transversal en Colombia entre pacientes hipertensos y diabéticos. Este estudio incluyó a 2.067 sujetos mayores de 50 años que fueron atendidos por un grupo de oftalmólogos en seis ciudades de Colombia, quienes realizaron un examen médico y oftalmológico completo y aplicaron cuestionarios y entrevistas estandarizados con el fin de evaluar las condiciones de salud y estilos de vida de los participantes. Resultados: Encontramos una prevalencia de hemorragia del disco óptico (HDO) del 0,4%. ODH presentó un OR: 8,82 (IC 95% 1,60 - 48,52) para la presencia de Glaucoma. Los pacientes diagnosticados de hipertensión sistémica tuvieron OR: 0,02 (IC 95% 0,00 - 0,96); Los pacientes con Defecto de la Capa de Fibras Nerviosas de la Retina (RNFL) presentaron un OR: 509,40 (IC 95% 8,60 - 30152,97) para la presencia de ODH y el 50% de los pacientes con ODH no tenían diagnóstico de glaucoma. Conclusiones: A pesar de la baja prevalencia de HDO en nuestro estudio (0,4%), su presencia es un factor de alto riesgo para la presencia de Glaucoma. El defecto de la RNFL también está muy relacionado con la ODH y la presencia de glaucoma. (AU)

[Health services access survey for Colombian households]. / Encuesta de acceso a servicios de salud para hogares colombianos.

OBJECTIVE: The aim of this study was to design and validate a health services access survey for households in Colombia to provide a methodological tool that allows the country to accumulate evidence of real-life access conditions experienced by the Colombian population. METHODS: A validation study with experts and a pilot study were performed. It was conducted in the municipality of Jamundi, located in the department of Valle del Cauca, Colombia. Probabilistic, multistage and stratified cluster sampling was carried out. The final sample was 215 households. RESULTS: The survey was composed of 63 questions divided into five modules: socio-demographic profile of the head of the household or adult informant, household socioeconomic profile, access to preventive services, access to curative and rehabilitative services and household out of pocket expenditure. In descriptive terms, the promotion of preventive services only reached 44%; the use of these services was always highest among children younger than one year old and up to the age of ten. The perceived need for emergency medical care and hospitalisation was between 82% and 85%, but 36% perceived the quality of care to be low or very low. Delays were experienced in medical visits with GPs and specialists. DISCUSSION: The designed survey is valid, relevant and representative of access to health services in Colombia. Empirically, the pilot showed institutional weaknesses in a municipality of the country, indicating that health coverage does not in practice mean real and effective access to health services.

Intra-observer reliability of the anthropometric measurements in South American children and adolescents: the SAYCARE Study / Confiabilidad intraobservador de mediciones antropométricas en niños y adolescentes sudamericanos: Estudio SAYCARE

Introduction: the South American Youth/Child Cardiovascular and Environmental (SAYCARE) feasibility study aims to develop valid and reliable indicators to investigate health-related behavior and nutritional status in children and adolescents. Anthropometric measurements are one of the evaluated indicators in the study. The accuracy of the anthropometric data is very important and relies in the quality of the measurements. Objective: to describe the intra-observer reliability of ten anthropometric measurements: weight, height, circumferences (neck, arm, waist, hip) and skinfolds (triceps, subscapular, biceps and suprailiac) of children and adolescents from six South American cities: Lima, Medellin, Montevideo, Santiago, San Pablo and Teresina. Methods: prior to the study, fieldworkers from the seven centers participated in central training to ensure the application of standardized procedures in the anthropometric measurements. Intra-observer precision, technical error of measurement (TEM) and coefficient of reliability (R) were estimated for each measurement. Results: reliability of weight and height was above 99% in almost all cities. TEM for skinfold thickness was below 1.4 mm in children and 2.13 mm in adolescents, while reliability was above 95% in most of the skinfold measurements. TEM for circumferences was below 1.8 cm in children and 0.64 cm in adolescents, while reliability was above 99% in almost all circumferences. Conclusions: reliability of the anthropometric measurements in this study was high. In comparison with similar European or American studies, the reliability of the measurements taken in our study was, in most cases, similar or even higher

Introducción: el estudio piloto South American Youth/Child cARdiovascular and Environmental (SAYCARE) tiene como objetivo desarrollar indicadores válidos y confiables para investigar el estado nutricional y las conductas vinculadas a la salud en niños y adolescentes. Uno de estos indicadores son las mediciones antropométricas. La precisión de los datos antropométricos es muy importante y se basa en la calidad con que se toman las mediciones. Objetivos: describir la confiabilidad intraobservador de diez mediciones antropométricas: peso, talla, circunferencias (cuello, brazo, cintura, cadera) y pliegues (trÍceps, subscapular, bÍceps y suprailIaco) de niños y adolescentes de seis ciudades de Sudamérica: Lima, Medellín, Montevideo, Santiago, San Pablo and Teresina. Métodos: previo al estudio, los trabajadores de campo de los seis centros participaron de un entrenamiento centralizado, para asegurar la aplicación de procedimientos estandarizados en la toma de las mediciones antropométricas. Para determinar la precisión intraobservador, se estimó el error técnico de medición (TEM) y el coeficiente de confiabilidad (R) para cada medición. Resultados: la confiabilidad de las medidas de peso y la talla estuvo por encima del 99% en casi todas las ciudades. El TEM para el grosor de los pliegues estuvo debajo de 1,4 mm en los niños y de 2,13 mm en los adolescentes, mientras que la confiabilidad fue superior al 95% en la mayoría de las mediciones de los pliegues. El TEM para las circunferencias estuvo por debajo de 1,8 cm en los niños y de 0,64 cm en los adolescentes, mientras que la confiabilidad fue superior al 99% en casi todas las circunferencias. Conclusiones: la confiabilidad de las mediciones antropométricas en este estudio fue alta. Comparada con estudios similares realizados en Europa y Estados Unidos, la confiabilidad de las medidas tomadas en nuestro estudio es, en la mayoría de los casos, similar o aún más elevada

Comparación de la composición corporal de mujeres jóvenes obtenida por hidrodensitometría y tres técnicas de bioimpedancia / Comparison of three bioimpedance techniques with hydrodensitometry for assessment of body composition in young adult women / Comparação da composição corporal de mulheres jovens obtida por hidrodensitometria e três técnicas de bioimpedância

RESUMEN Antecedentes: existe controversia sobre la exactitud de las técnicas de bioimpedancia para calcular el porcentaje de grasa corporal (%GC). Objetivo: comparar el %GC obtenido por tres técnicas de bioimpedancia con la hidrodensitometría como método de referencia. Metodología: en 31 mujeres se midió el %GC por hidrodensitometría con medición simultánea del volumen residual pulmonar, y por las técnicas de bioimpedancia manos-pies (8-electrodos), mano-pie (4-electrodos) y pie-pie (4-electrodos). Resultados: el promedio de edad fue 22,4 ± 2,8 años y el del índice de masa corporal 23,6 ± 3,3 kg/m2 . No hubo diferencias (p > 0,05) en el %GC obtenido por hidrodensitometría y por la técnica manos-pies (31,4 ± 6,6 % y 31,9 ± 5,9 %, respectivamente). Las técnicas mano-pie y pie-pie presentaron diferencias (p < 0,05) en el %GC con la hidrodensitometría de +1,4 % y -4,9 %, respectivamente. El grado de acuerdo con el método de referencia fue aceptable para las técnicas manos-pies (Bland-Altman: IC95 %: -6,6; 5,6) y mano-pie (Bland-Altman: IC95 %: -8,0; 5,2), pero inadecuado para la técnica pie-pie (Bland-Altman: IC95 %: -4,7; 14,4). Conclusiones: en mujeres jóvenes con peso corporal promedio adecuado, la técnica de bioimpedancia manos-pies determina valores del %GC más cercanos a los de la hidrodensitometría que las técnicas mano-pie y pie-pie. Asimismo, la técnica manos-pies presenta una concordancia ligeramente mayor con el método de referencia que las técnicas mano-pie y pie-pie.

SUMMARY Background: Bioimpedance measurement allows quick and safe estimation of the body composition. However, it remains controversial which bioimpedance measurement technique is more exact for calculating the fat mass percentage (%FM). Objective: To compare the %FM obtained with three bioimpedance techniques with hydrodensitometry, as a reference method. Materials and methods: In 31 women, the %FM was assessed by hydrodensitometry with simultaneous lung residual volume measurement and three bioimpedance techniques: hands-to-feet (8-electrodes), hand-to-foot (4-electrodes) and footto-foot (4-electrodes). Results: Average age and body mass index were 22.4 ± 2.8 years and 23.6 ± 3.3 kg/m2 , respectively. There were no significant differences (p > 0.05) between the %FM obtained by hydrodensitometry (31.4 ± 6.6) and hands-to-feet technique (31.9 ± 5.9). However, hand-to-foot and foot-to-foot techniques showed differences (p < 0.05) with the reference method of +1.4 % and -4.9%, respectively. There was a fair agreement between hydrodensitometry and the results obtained with hands-to-feet (Bland-Altman: IC95 %: -6.6; 5.6) and hand-to-foot (Bland-Altman: IC95 %: -8.0; 5.2) techniques. The foot-to-foot measurement showed poor agreement with the reference method (Bland-Altman: IC95 %: -4.7; 14.4). Conclusions: In this group of young women with healthy body weight, the hands-to-feet bioimpedance technique generates body composition values closer to the hydrodensitometry results as compared with the hand-to-foot and foot-to-foot techniques. Additionally, the hands-to-feet technique shows a slightly better agreement with hydrodensitometry than the hand-to-foot and foot-to-foot techniques.

RESUMO Antecedentes: existe controvérsia sobre a exatidão das técnicas de bioimpedância para calcular a porcentagem de gordura corporal (%GC). Objetivo: comparar a %GC obtida por três técnicas de bioimpedância com a hidrodensitometria ou pesagem hidrostática como método de referência. Metodologia: em 31 mulheres se mediu a %GC por hidrodensitometria com medição simultânea do volume residual pulmonar, e pelas técnicas de bioimpedância mãos-pés (8-eletrodos), mão-pé (4-eletrodos) e pé-pé (4-eletrodos). Resultados: A média de idade foi 22,4 ± 2,8 anos e o do índice de massa corporal. 23,6 ± 3,3 kg/m2 . Não houve diferenças (p > 0,05) na %GC obtido por hidrodensitometria e pela técnica mãos-pés (31,4 ± 6,6 % e 31,9 ± 5,9 %, respectivamente). As técnicas mão-pé e pé-pé apresentaram diferenças (p < 0,05) na %GC com a hidrodensitometria de +1,4 % e -4,9 %, respectivamente. O grau de acordo com o método de referência foi aceitável para as técnicas mãos-pés (Bland-Altman: IC95 %: -6,6; 5,6) e mão-pé (BlandAltman: IC95 %: -8,0; 5,2), mas inadequado para a técnica pé-pé (Bland-Altman: IC95 %: -4,7;14,4). Conclusões: em mulheres jovens com peso corporal médio adequado, a técnica de bioimpedância mãospés determina valores da %GC mais próximos aos da hidrodensitometria que as técnicas mão-pé e pé- pé. Além disso, a técnica mãos-pés apresenta uma concordância ligeiramente maior com o método de referência que as técnicas mão-pé e pé-pé.

Encuesta de acceso a servicios de salud para hogares colombianos / Health services access survey for Colombian households

Objetivo: Diseñar y validar una encuesta de acceso a servicios de salud dirigida a hogares en Colombia para aportar una herramienta metodológica de país que permita ir acumulando evidencia sobre las condiciones de acceso real que tiene la población colombiana. Método: Se realizó un estudio de validación con personas expertas y prueba piloto aplicada en el municipio de Jamundí, en el departamento del Valle del Cauca, Colombia. Se realizó un muestreo probabilístico, polietápico, estratificado y por conglomerados. La muestra final fue de 215 hogares. Resultados: La encuesta quedó conformada por 63 preguntas distribuidas en cinco módulos: perfil sociodemográfico del jefe/a del hogar o adulto/a informante, perfil socioeconómico del hogar, acceso a servicios preventivos, acceso a servicios curativos y de rehabilitación, y gasto de bolsillo en acceso. En términos descriptivos, la promoción de servicios preventivos solo alcanzó valores del 44%; el uso de estos servicios siempre fue mayor, en especial en los grupos del primer año de vida y hasta los 10 años. Para los servicios de urgencias y hospitalización, la percepción de atención de la necesidad estuvo entre el 82% y el 85%. No obstante, hubo percepción de mala y muy mala calidad de la atención hasta en un 36%. Por su parte, la oportunidad de la atención de consulta médica general y con especialista presentó demoras. Discusión: La encuesta diseñada es válida, relevante y representativa del constructo acceso a servicios de salud en Colombia. En términos empíricos, la prueba piloto mostró debilidades institucionales en un municipio del país, indicando además que la cobertura en salud no significa acceso real y efectivo a los servicios (AU)

Objective: The aim of this study was to design and validate a health services access survey for households in Colombia to provide a methodological tool that allows the country to accumulate evidence of real-life access conditions experienced by the Colombian population. Methods: A validation study with experts and a pilot study were performed. It was conducted in the municipality of Jamundi, located in the department of Valle del Cauca, Colombia. Probabilistic, multistage and stratified cluster sampling was carried out. The final sample was 215 households. Results: The survey was composed of 63 questions divided into five modules: socio-demographic profile of the head of the household or adult informant, household socioeconomic profile, access to preventive services, access to curative and rehabilitative services and household out of pocket expenditure. In descriptive terms, the promotion of preventive services only reached 44%; the use of these services was always highest among children younger than one year old and up to the age of ten. The perceived need for emergency medical care and hospitalisation was between 82% and 85%, but 36% perceived the quality of care to be low or very low. Delays were experienced in medical visits with GPs and specialists. Discussion: The designed survey is valid, relevant and representative of access to health services in Colombia. Empirically, the pilot showed institutional weaknesses in a municipality of the country, indicating that health coverage does not in practice mean real and effective access to health services (AU)

Factores fisiológicos y psicológicos que influyen en la rehabilitación de las personas con trauma raquimedular / Physiological and psychological factors in rehabilitation of persons with traumatic of spinal cord

Resumen La rehabilitación integral de las personas con trauma raquimedular requiere integrar lo físico, emocional y social, es necesario indagar como estos factores se interrelacionan y afectan su calidad de vida. El objetivo fue determinar la interrelación de los factores fisiológicos y psicológicos en la rehabilitación integral de las personas con trauma raquimedular a partir de la Teoría de los Síntomas Desagradables de Elizabeth Lenz. Estudio descriptivo transversal, con 51 personas. Las variables independientes fueron clasificación ASIA, nivel de la lesión y sexo; las variables dependientes los factores fisiológicos y psicológicos. Se aplico análisis univariado y la prueba t para identificar las diferencias estadísticamente significativas. La disrreflexia autonómica, las disfunciones vesicales e intestinales generan estados de depresión y expresión de ira especialmente en los hombres, es muy importante brindar soporte para el cuidado de estos factores durante la rehabilitación integral.

Abstract The comprehensive rehabilitation of people with spinal cord trauma takes into account the person as a whole being in the physical, emotional and social sense; therefore, it is necessary to investigate how these factors interact and affect their quality of life. The objective was determining the interrelation between the physiological and psychological factors on rehabilitation of people with spinal cord trauma from the theory of unpleasant symptoms Elizabeth Lenz. A transversal descriptive study, with 51 people. The independent variables were ASIA classification, the level of injury, and gender; the dependent variables were the physiological and psychological factors. A univariate analysis, the t- test was applied to identify statistically significant differences. The autonomic dysreflexia and both bladder as well as bowel dysfunction, are symptoms that generate states of depression and expression of anger, and are more evident in men. The support is required in the care of these factors during la integral rehabilitation.

Validación de las escalas de riesgo TIMI y GRACE para el síndrome coronario agudo en una cohorte contemporánea de pacientes / Validation of GRACE and TIMI risk scales for acute coronary syndrome in a contemporary cohort of patients

Introducción: la estratificación de riesgo es uno de los principales objetivos en el manejo integral de los síndromes coronarios agudos (SCA). En la actualidad las guías de práctica clínica recomiendan la estratificación por medio de los puntajes de riesgo TIMI y GRACE. Teniendo en cuenta la alta prevalencia de esta enfermedad, consideramos de gran importancia conocer en nuestro medio la utilidad de estas escalas para el tratamiento integral de nuestros pacientes con SCA y determinar cuál escala tiene mejor capacidad de predicción para morbimortalidad. Objetivo: evaluar la validez de las escalas TIMI y GRACE para predecir el riesgo de muerte e infarto en los pacientes que se presentan con diagnóstico de síndrome coronario agudo en la unidad de dolor torácico del Hospital San Vicente de Paúl Fundación, y establecer cuál de estas dos escalas tiene mejor capacidad de predicción en nuestro medio en SCA sin elevación del segmento ST. Métodos: estudio de validez de una escala de pronóstico, observacional, analítico, con análisis retrospectivo de la calibración del modelo y la discriminación del riesgo, en una cohorte de pacientes en hospital de cuarto nivel en Medellín, Colombia. Resultados: 164 sujetos con SCA fueron identificados. 141 pacientes con seguimiento completo hasta los seis meses. El TIMI promedio fue de 3.5 puntos y el GRACE promedio de 124. La estratificación del TIMI para SCA sin elevación del segmento ST mostró: 19.1% de pacientes en riesgo bajo, 59.6% en riesgo intermedio y 21.3% en riesgo alto; según la escala de riesgo GRACE encontramos para muerte hospitalaria: 38.3% de pacientes en riesgo bajo, 32.6% en riesgo intermedio y 29.1% en riesgo alto. Para estratificación de muerte a seis meses se encontró 39.7% en riesgo bajo, 36.2% en riesgo intermedio y 24.1% en riesgo alto. La evaluación del componente de calibración mostró que ambas escalas se ajustan a nuestra muestra para SCA sin elevación ST (Prueba de Hosmer-Lemeshow p > 0.05). La evaluación del componente de discriminación mostró que ambas escalas pueden distinguir la población de mayor riesgo a seis meses (estadístico C mayor a 0.7). La escala TIMI discriminó mejor el riesgo de muerte intrahospitalaria comparada con el GRACE (estadístico C= 0.9 versus 0.8). La escala GRACE por el contrario, presentó mejor poder de discriminación de muerte a seis meses (0.86 versus 0.65). Conclusión: ambas escalas se ajustaron a la población estudiada, son útiles y pueden recomendarse para determinar el riesgo de mortalidad de nuestros pacientes con SCA. Para el SCA sin ST, la escala de riesgo TIMI discriminó mejor el riesgo a nivel hospitalario, mientras que la escala GRACE fue mejor para predecir el riesgo a los seis meses después del SCA sin elevación del segmento ST.

Background: risk stratification is one of the main objectives in the comprehensive management of acute coronary syndromes (ACS). Currently, clinical practice guidelines recommend stratification by the TIMI and GRACE risk scores. Given the high prevalence of this disease, we attach great importance to know in our environment the usefulness of these scales for the comprehensive treatment of our patients with ACS and determine which scale has better predictive power for morbidity and mortality. Objective: to assess the validity of the TIMI and GRACE risk scores to predict death and infarction in patients presenting with diagnosis of acute coronary syndrome in the chest pain unit of the Hospital San Vicente de Paul Fundación, and establish which of these two scales has better predictive power in ACS without ST segment elevation in our environment. Methods: validation study of a prognostic scale, observational, analytical, with retrospective analysis of model calibration and risk discrimination in a cohort of patients at a fourth level hospital in Medellin, Colombia. Results: 164 subjects with ACS were identified. 141 patients with complete follow-up to 6 months. The average TIMI was 3.5 points and the GRACE average 124. TIMI stratification for ACS without ST-segment elevation showed 19.1% of patients at low risk, 59.6% at intermediate risk and 21.3% at high risk; according to the GRACE risk score for hospital death, were found: 38.3% of patients at low risk, at intermediate risk 32.6% and 29.1% at high risk. For stratification of death at six months, was found: 39.7% at low-risk, 36.2% at intermediate risk and 24.1% at high risk. The evaluation of the component of calibration showed that both scales fit our sample for ACS without ST elevation (Hosmer-Lemeshow test p> 0.05). The evaluation of the component of discrimination showed that both scales can distinguish the population of higher-risk to 6 months (C statistic greater than 0.7 C). The TIMI scale better discriminated risk of hospital death compared with GRACE (C statistic = 0.9 versus 0.8). On the contrary, the GRACE scale showeda better discrimination power of death at 6 months. (0.86 versus 0.65). Conclusion: both scales were adjusted to the population studied, are useful and can be recommended to determine the risk of mortality in our patients with ACS. For ACS without ST elevation, the TIMI risk score discriminated better the hospital risk, while GRACE scale was better at predicting risk at 6 months after ACS without ST segment elevation.