Longitudinal body mass index and cancer risk: a cohort study of 2.6 million Catalan adults.

Single body mass index (BMI) measurements have been associated with increased risk of 13 cancers. Whether life course adiposity-related exposures are more relevant cancer risk factors than baseline BMI (ie, at start of follow-up for disease outcome) remains unclear. We conducted a cohort study from 2009 until 2018 with population-based electronic health records in Catalonia, Spain. We included 2,645,885 individuals aged ≥40 years and free of cancer in 2009. After 9 years of follow-up, 225,396 participants were diagnosed with cancer. This study shows that longer duration, greater degree, and younger age of onset of overweight and obesity during early adulthood are positively associated with risk of 18 cancers, including leukemia, non-Hodgkin lymphoma, and among never-smokers, head and neck, and bladder cancers which are not yet considered as obesity-related cancers in the literature. Our findings support public health strategies for cancer prevention focussing on preventing and reducing early overweight and obesity.

Spiritual care provided by the nursing team to the person in palliation in intensive care.

OBJECTIVE: To understand how the spiritual care provided by the nursing team to the person undergoing palliation in the Intensive Care Unit occurs. METHOD: Study with a qualitative approach, conducted in an Intensive Care Unit in Salvador, Bahia. Data collection took place through semi-structured interviews between January and May 2019. 14 nurses and 21 nursing technicians participated in the study. The data were submitted to Bardin Content Analysis and analyzed in the light of the Peaceful End of Life Theory. RESULTS: Two categories emerged: 1. Spiritual care provided through words of optimism, encouragement of faith and prayer; 2. Care provided through attention to spiritual needs and assurance of comfort. FINAL CONSIDERATIONS: Although empirically and not aware of the spiritual care provided, the nursing team offers support with words of optimism, faith, moments of prayer and contributes to the spiritual comfort of the person in palliation.

A longitudinal evaluation of alcohol intake throughout adulthood and colorectal cancer risk.

BACKGROUND: Alcohol intake is an established risk factor for colorectal cancer (CRC); however, there is limited knowledge on whether changing alcohol drinking habits during adulthood modifies CRC risk. OBJECTIVE: Leveraging longitudinal exposure assessments on alcohol intake at different ages, we examined the relationship between change in alcohol intake and subsequent CRC risk. METHODS: Within the European Prospective Investigation into Cancer and Nutrition, changes in alcohol intake comparing follow-up with baseline assessments were investigated in relation to CRC risk. The analysis included 191,180, participants and 1530 incident CRC cases, with exclusion of the first three years of follow-up to minimize reverse causation. Trajectory profiles of alcohol intake, assessed at ages 20, 30, 40, 50 years, at baseline and during follow-up, were estimated using latent class mixed models and related to CRC risk, including 407,605 participants and 5,008 incident CRC cases. RESULTS: Mean age at baseline was 50.2 years and the follow-up assessment occurred on average 7.1 years later. Compared to stable intake, a 12 g/day increase in alcohol intake during follow-up was positively associated with CRC risk (HR = 1.15, 95%CI 1.04, 1.25), while a 12 g/day reduction was inversely associated with CRC risk (HR = 0.86, 95%CI 0.78, 0.95). Trajectory analysis showed that compared to low alcohol intake, men who increased their alcohol intake from early- to mid- and late-adulthood by up to 30 g/day on average had significantly increased CRC risk (HR = 1.24; 95%CI 1.08, 1.42), while no associations were observed in women. Results were consistent by anatomical subsite. CONCLUSIONS: Increasing alcohol intake during mid-to-late adulthood raised CRC risk, while reduction lowered risk.

La enfermera en los cuidados paliativos en unidades de cuidados intensivos una Teoría del Final de Vida Pacífico / The Nurse in Palliative Care in Intensive Care Units, a Peaceful End of Life Theory

Introducción: La elevada tasa de mortalidad en las Unidades de Cuidados Intensivos por enfermedades sin posibilidades terapéuticas introdujo los cuidados paliativos en este escenario. En este contexto, la labor de la enfermera se hace primordial para posibilitar a los pacientes y familiares una atención biopsicosocial y espiritual, con la promoción de una asistencia integral que debe basarse en teorías como la Teoría del Final de la Vida Pacífico. Objetivo: Conocer la actuación de la enfermera en los cuidados paliativos en la Unidad de Cuidados Intensivos a la luz del Teoría del Final de la Vida Pacífico. Métodos: Estudio con enfoque cualitativo realizado con 14 enfermeras de la Unidad de Cuidados Intensivos Inmunológica de un hospital privado de la ciudad de Salvador, Bahía, Brasil. El período de recogida de datos se realizó entre noviembre de 2018 y mayo de 2019, mediante entrevista con guion semiestructurado; se analizaron a través de la técnica de Análisis de Contenido de Bardin y se discutieron a la luz de la Teoría del Final de Vida Pacífico. Resultados: Surgieron cuatro categorías: Comprensión de las enfermeras sobre los cuidados paliativos en la unidad de cuidados intensivos. Percepción y actuación de las enfermeras en la comodidad del paciente en Cuidados Paliativos. La enfermera permite la proximidad a la familia. La enfermera permite que el paciente esté en paz. Conclusión: La actuación de la enfermera en cuidados paliativos se dirige a los cuidados terminales e implica en promover el confort, acciones de aproximación familiar y actitudes que dignifiquen el proceso de morir(AU)

Introduction: The high mortality rate in intensive care units due to diseases without therapeutic possibilities introduced palliative care in this setting. In this context, the nurse's work becomes paramount to enable patients and families a biopsychosocial and spiritual care, with the promotion of a comprehensive care that should be based on theories such as the peaceful end of life theory. Objective: To know the nurse's performance in palliative care in the intensive care unit under the peaceful end of life theory. Methods: A study with a qualitative approach was carried out with fourteen nurses from the immunological intensive care unit of a private hospital Salvador City, Bahia, Brazil. Data collection covered the period between November 2018 and May 2019, using the semistructured interview. They were analyzed through Bardin's content analysis technique and discussed under the peaceful end of life theory. Results: Four categories emerged: nurses' understanding of palliative care in the intensive care unit, nurses' perception and performance concerning patient comfort in palliative care, the nurse allows proximity to the family, and the nurse allows the patient to be at peace. Conclusion: The nurse's performance in palliative care is directed to terminal care and involves promoting comfort, family approach actions and attitudes that dignify the dying process(AU)

Impact of cumulative body mass index and cardiometabolic diseases on survival among patients with colorectal and breast cancer: a multi-centre cohort study.

BACKGROUND: Body mass index (BMI) and cardiometabolic comorbidities such as cardiovascular disease and type 2 diabetes have been studied as negative prognostic factors in cancer survival, but possible dependencies in the mechanisms underlying these associations remain largely unexplored. We analysed these associations in colorectal and breast cancer patients. METHODS: Based on repeated BMI assessments of cancer-free participants from four European countries in the European Prospective Investigation into Cancer and nutrition (EPIC) study, individual BMI-trajectories reflecting predicted mean BMI between ages 20 to 50 years were estimated using a growth curve model. Participants with incident colorectal or breast cancer after the age of 50 years were included in the survival analysis to study the prognostic effect of mean BMI and cardiometabolic diseases (CMD) prior to cancer. CMD were defined as one or more chronic conditions among stroke, myocardial infarction, and type 2 diabetes. Hazard ratios (HRs) and confidence intervals (CIs) of mean BMI and CMD were derived using multivariable-adjusted Cox proportional hazard regression for mean BMI and CMD separately and both exposures combined, in subgroups of localised and advanced disease. RESULTS: In the total cohort of 159,045 participants, there were 1,045 and 1,620 eligible patients of colorectal and breast cancer. In colorectal cancer patients, a higher BMI (by 1 kg/m2) was associated with a 6% increase in risk of death (95% CI of HR: 1.02-1.10). The HR for CMD was 1.25 (95% CI: 0.97-1.61). The associations for both exposures were stronger in patients with localised colorectal cancer. In breast cancer patients, a higher BMI was associated with a 4% increase in risk of death (95% CI: 1.00-1.08). CMDs were associated with a 46% increase in risk of death (95% CI: 1.01-2.09). The estimates and CIs for BMI remained similar after adjustment for CMD and vice versa. CONCLUSIONS: Our results suggest that cumulative exposure to higher BMI during early to mid-adulthood was associated with poorer survival in patients with breast and colorectal cancer, independent of CMD prior to cancer diagnosis. The association between a CMD diagnosis prior to cancer and survival in patients with breast and colorectal cancer was independent of BMI.

Spiritual care provided by the nursing team to the person in palliation in intensive care / Cuidado espiritual proporcionado por el equipo de enfermería a la persona en paliación en cuidados intensivos / Cuidado espiritual prestado pela equipe de enfermagem à pessoa em paliação na terapia intensiva

ABSTRACT Objective: To understand how the spiritual care provided by the nursing team to the person undergoing palliation in the Intensive Care Unit occurs. Method: Study with a qualitative approach, conducted in an Intensive Care Unit in Salvador, Bahia. Data collection took place through semi-structured interviews between January and May 2019. 14 nurses and 21 nursing technicians participated in the study. The data were submitted to Bardin Content Analysis and analyzed in the light of the Peaceful End of Life Theory. Results: Two categories emerged: 1. Spiritual care provided through words of optimism, encouragement of faith and prayer; 2. Care provided through attention to spiritual needs and assurance of comfort. Final considerations: Although empirically and not aware of the spiritual care provided, the nursing team offers support with words of optimism, faith, moments of prayer and contributes to the spiritual comfort of the person in palliation.

RESUMEN Objetivo: Comprender cómo ocurre el cuidado espiritual prestado por el equipo de enfermería a la persona en paliación en la Unidad de Cuidados Intensivos. Método: Estudio con enfoque cualitativo, realizado en una Unidad de Cuidados Intensivos en Salvador, Bahía. La recolección de datos ocurrió a través de entrevistas semiestructuradas entre enero y mayo de 2019. Participaron del estudio 14 enfermeros y 21 técnicos de enfermería. Los datos se sometieron al Análisis de Contenido de Bardin y se analizaron a la luz de la Teoría del Final Pacífico de la Vida. Resultados: surgieron dos categorías: 1. Atención espiritual a través de palabras de optimismo, estímulo de la fe y oración; 2. Atención a través de la atención a las necesidades espirituales y garantía de comodidad. Consideraciones finales: Aunque empíricamente y desconociendo el cuidado espiritual prestado, el equipo de enfermería ofrece apoyo con palabras de optimismo, fe, momentos de oración y contribuye al confort espiritual de la persona en paliativo.

RESUMO Objetivo: Apreender como ocorre o cuidado espiritual prestado pela equipe de enfermagem à pessoa em paliação na Unidade de Terapia Intensiva. Método: Estudo de abordagem qualitativa, realizado em uma Unidade de Terapia Intensiva em Salvador, Bahia. A coleta de dados ocorreu por entrevistas semiestruturadas entre janeiro e maio de 2019. Participaram do estudo 14 enfermeiras e 21 técnicas de enfermagem. Os dados foram submetidos à Análise de Conteúdo de Bardin e analisados à luz da Teoria Final de Vida Pacífico. Resultados: Emergiram duas categorias: 1. Cuidado espiritual prestado através de palavras de otimismo, estímulo a fé e oração; 2. Cuidado prestado através da atenção às necessidades espirituais e da garantia de conforto. Considerações finais: Embora de forma empírica e não consciente do cuidado espiritual prestado, a equipe de enfermagem oferta apoio com palavras de otimismo, fé, momentos de orações e contribui para o conforto espiritual da pessoa em paliação.

Transitional care of nurses to older adults with artificial pacemaker / Atención transitoria de enfermeras a ancianos con marcapasos artificial / Cuidado transicional de enfermeiras ao idoso com marcapasso artificial

ABSTRACT Objective: to understand how the transitional care of nurses to olde adults with artificial pacemaker occurs. Method: a qualitative research, carried out in a philanthropic hospital in the city of Salvador, Bahia, Brazil. Fourteen nurses working in surgical and cardiac inpatient units participated. Data were collected between August and November 2020, through semi-structured interviews, and analyzed using the methodological framework Discourse of the Collective Subject and discussed in the light of Afaf Meleis' theory of transitions. Results: nurses' incipient knowledge about transitional care was identified. It was observed that the nursing discharge report is a facilitating instrument for transitional care. Final considerations: the study pointed out that the transitional care of nurses to older adults with artificial pacemakers does not have a theoretical foundation, reporting as a priority the care with the pacemaker identification card and with the surgical wound.

RESUMEN Objetivo: comprender cómo se produce el cuidado transitorio del enfermero al anciano con marcapasos artificial. Método: investigación cualitativa, realizada en un hospital filantrópico de la ciudad de Salvador, Bahía, Brasil. Participaron 14 enfermeros que laboran en las unidades de internación quirúrgica y cardíaca. Los datos fueron recolectados entre agosto y noviembre de 2020, a través de entrevistas semiestructuradas, y analizados utilizando el marco metodológico Discurso del Sujeto Colectivo y discutidos a la luz de la teoría de las transiciones de Afaf Meleis. Resultados: se identificó el conocimiento incipiente de las enfermeras sobre los cuidados transicionales. Se observó que el informe de alta de enfermería es un instrumento facilitador para la transición asistencial. Consideraciones finales: el estudio señaló que el cuidado transicional de enfermeras al anciano con marcapasos artificiales no tiene un fundamento teórico, reportando como prioridad el cuidado con la tarjeta de identificación del marcapasos y con la herida quirúrgica.

RESUMO Objetivo: apreender como ocorre o cuidado transicional da enfermeira ao idoso com marcapasso artificial. Método: pesquisa qualitativa, realizada em um hospital filantrópico, na cidade de Salvador, Bahia, Brasil. Participaram 14 enfermeiras atuantes nas unidades de internação cirúrgica e cardiológica. Os dados foram coletados entre agosto e novembro de 2020, por meio de entrevista semiestruturada, e analisados pelo referencial metodológico Discurso do Sujeito Coletivo e discutidos à luz da teoria das transições de Afaf Meleis. Resultados: foi identificado conhecimento insipiente das enfermeiras acerca do cuidado transicional. Observou-se que o relatório de alta de enfermagem constitui um instrumento facilitador para a transição do cuidado. Considerações finais: o estudo apontou que o cuidado transicional de enfermeiras ao idoso com marcapasso artificial não possui fundamentação teórica, relatando como prioridade o cuidado com a carteira de identificação do marcapasso e com a ferida operatória.

Transitional care of nurses to older adults with artificial pacemaker.

OBJECTIVE: to understand how the transitional care of nurses to olde adults with artificial pacemaker occurs. METHOD: a qualitative research, carried out in a philanthropic hospital in the city of Salvador, Bahia, Brazil. Fourteen nurses working in surgical and cardiac inpatient units participated. Data were collected between August and November 2020, through semi-structured interviews, and analyzed using the methodological framework Discourse of the Collective Subject and discussed in the light of Afaf Meleis' theory of transitions. RESULTS: nurses' incipient knowledge about transitional care was identified. It was observed that the nursing discharge report is a facilitating instrument for transitional care. FINAL CONSIDERATIONS: the study pointed out that the transitional care of nurses to older adults with artificial pacemakers does not have a theoretical foundation, reporting as a priority the care with the pacemaker identification card and with the surgical wound.

Body mass index and waist circumference in relation to the risk of 26 types of cancer: a prospective cohort study of 3.5 million adults in Spain.

BACKGROUND: A high body mass index (BMI) has been associated with increased risk of several cancers; however, whether BMI is related to a larger number of cancers than currently recognized is unclear. Moreover, whether waist circumference (WC) is more strongly associated with specific cancers than BMI is not well established. We aimed to investigate the associations between BMI and 26 cancers accounting for non-linearity and residual confounding by smoking status as well as to compare cancer risk estimates between BMI and WC. METHODS: Prospective cohort study with population-based electronic health records from Catalonia, Spain. We included 3,658,417 adults aged ≥ 18 years and free of cancer at baseline between 2006 and 2017. Our main outcome measures were cause-specific hazard ratios (HRs) with 99% confidence intervals (CIs) for incident cancer at 26 anatomical sites. RESULTS: After a median follow-up time of 8.3 years, 202,837 participants were diagnosed with cancer. A higher BMI was positively associated with risk of nine cancers (corpus uteri, kidney, gallbladder, thyroid, colorectal, breast post-menopausal, multiple myeloma, leukemia, non-Hodgkin lymphoma) and was positively associated with three additional cancers among never smokers (head and neck, brain and central nervous system, Hodgkin lymphoma). The respective HRs (per 5 kg/m2 increment) ranged from 1.04 (99%CI 1.01 to 1.08) for non-Hodgkin lymphoma to 1.49 (1.45 to 1.53) for corpus uteri cancer. While BMI was negatively associated to five cancer types in the linear analyses of the overall population, accounting for non-linearity revealed that BMI was associated to prostate cancer in a U-shaped manner and to head and neck, esophagus, larynx, and trachea, bronchus and lung cancers in an L-shaped fashion, suggesting that low BMIs are an approximation of heavy smoking. Of the 291,305 participants with a WC measurement, 27,837 were diagnosed with cancer. The 99%CIs of the BMI and WC point estimates (per 1 standard deviation increment) overlapped for all cancers. CONCLUSIONS: In this large Southern European study, a higher BMI was associated with increased risk of twelve cancers, including four hematological and head and neck (only among never smokers) cancers. Furthermore, BMI and WC showed comparable estimates of cancer risk associated with adiposity.

Relationship of problematic cannabis use among youth in Spain with perceived risk, environmental factors and sociodemographic factors. / Relación del consumo problemático de cannabis en la población joven de España con el riesgo percibido, los factores ambientales y los factores sociodemográficos.

The relationship of problematic cannabis consumption with perceived risk, socioenvironmental and sociodemographic factors among youth in Spain is not well known. The aims of this study are: 1) to describe the patterns of cannabis consumption (problematic and non-problematic) in Spanish youth, and 2) to explore whether problematic cannabis consumption is related to perceived risk, environmental factors and individual sociodemographic characteristics. A cross-sectional design based on data from the 2015/16 Spanish Household Survey on Alcohol and Drugs (EDADES) was performed. Individuals between 15 and 35 years old having used cannabis during the last year with a complete Cannabis Abuse Screening Test (CAST) were included (N = 1,674). Problematic consumption (CAST >= 7) was considered as dependent variable. Perceived risk, environmental factors (availability of the substance and exposure to consumption situations) and sociodemographic factors were taken as independent variables. Descriptive analyses of consumption patterns were performed and univariable and multivariable Poisson regression models were done. All analyses were stratified by gender. Problematic cannabis consumption was more frequent among men (38.9 %) than among women (23.2 %). While among men, problematic use was related to environmental factors and educational level, among women it was associated with perceived risk and unemployment. Problematic cannabis consumption among Spanish youth is associated with different types of gender-related factors. Due to its representativeness at the population level and the validity of the measures, these results might have important implications on the development of prevention strategies targeted at problematic cannabis consumption.

La relación entre el consumo problemático de cannabis, el riesgo percibido y los factores socioambientales y sociodemográficos no es clara actualmente. Los objetivos del estudio son: describir los patrones de consumo de cannabis (problemático y no problemático) en la población joven de España y explorar como el consumo problemático se relaciona con el riesgo percibido, y los factores ambientales y sociodemográficos. Se llevó a cabo un diseño transversal basado en datos de la edición de 2015/2016 de la Encuesta Domiciliaria sobre Alcohol y Drogas (EDADES). La encuesta incluyó participantes de entre 15 y 35 años que habían consumido cannabis en al menos una ocasión durante el último año y que completaron el Cannabis Abuse Screening Test (CAST) (N = 1674). Se consideró el consumo problemático (CAST >= 7) como variable dependiente. Como variables independientes se consideraron el riesgo percibido, los factores ambientales (disponibilidad de la sustancia y exposición a situaciones de consumo) y los factores sociodemográficos. Se llevaron a cabo análisis descriptivos de los patrones de consumo y se realizaron modelos univariables y multivariables de Poisson. Todos los análisis se estratificaron por género. El consumo problemático fue más frecuente en hombres (38,9 %) que en mujeres (23,2 %). Mientras en hombres el consumo problemático se relacionó con factores ambientales y nivel educativo, en mujeres se asoció con riesgo percibido y desempleo. Dada la representatividad de los datos y la validez de las medidas, estos resultados podrían tener importantes implicaciones para el desarrollo de medidas preventivas contra el consumo problemático de cannabis.

Relación del consumo problemático de cannabis en la población joven de España con el riesgo percibido, los factores ambientales y los factores sociodemográficos / Relationship of problematic cannabis use among youth in Spain with perceived risk, environmental factors and sociodemographic factors

La relación entre el consumo problemático de cannabis, el riesgo percibido y los factores socioambientales y sociodemográficos no es clara actualmente. Los objetivos del estudio son: describir los patrones de consumo de cannabis (problemático y no problemático) en la población joven de España y explorar como el consumo problemático se relaciona con el riesgo percibido, y los factores ambientales y sociodemográficos. Se llevó a cabo un diseño transversal basado en datos de la edición de 2015/2016 de la Encuesta Domiciliaria sobre Alcohol y Drogas (EDADES). La encuesta incluyó participantes de entre 15 y 35 años que habían consumido cannabis en al menos una ocasión durante el último año y que completaron el Cannabis Abuse Screening Test (CAST) (N = 1674). Se consideró el consumo problemático (CAST >= 7) como variable dependiente. Como variables independientes se consideraron el riesgo percibido, los factores ambientales (disponibilidad de la sustancia y exposición a situaciones de consumo) y los factores sociodemográficos. Se llevaron a cabo análisis descriptivos de los patrones de consumo y se realizaron modelos univariables y multivariables de Poisson. Todos los análisis se estratificaron por género. El consumo problemático fue más frecuente en hombres (38,9 %) que en mujeres (23,2 %). Mientras en hombres el consumo problemático se relacionó con factores ambientales y nivel educativo, en mujeres se asoció con riesgo percibido y desempleo. Dada la representatividad de los datos y la validez de las medidas, estos resultados podrían tener importantes implicaciones para el desarrollo de medidas preventivas contra el consumo problemático de cannabis

The relationship of problematic cannabis consumption with perceived risk, socioenvironmental and sociodemographic factors among youth in Spain is not well known. The aims of this study are: 1) to describe the patterns of cannabis consumption (problematic and non-problematic) in Spanish youth, and 2) to explore whether problematic cannabis consumption is related to perceived risk, environmental factors and individual sociodemographic characteristics. A cross-sectional design based on data from the 2015/16 Spanish Household Survey on Alcohol and Drugs (EDADES) was performed. Individuals between 15 and 35 years old having used cannabis during the last year with a complete Cannabis Abuse Screening Test (CAST) were included (N = 1,674). Problematic consumption (CAST >= 7) was considered as dependent variable. Perceived risk, environmental factors (availability of the substance and exposure to consumption situations) and sociodemographic factors were taken as independent variables. Descriptive analyses of consumption patterns were performed and univariable and multivariable Poisson regression models were done. All analyses were stratified by gender. Problematic cannabis consumption was more frequent among men (38.9 %) than among women (23.2 %). While among men, problematic use was related to environmental factors and educational level, among women it was associated with perceived risk and unemployment. Problematic cannabis consumption among Spanish youth is associated with different types of gender-related factors. Due to its representativeness at the population level and the validity of the measures, these results might have important implications on the development of prevention strategies targeted at problematic cannabis consumption

Spatial dynamics of COVID-19 cases in a state in the southeast region of Brazil

This study analyzed the progression of COVID-19 in the State of Espírito Santo, identifying the areas where the disease spread furthest. Temporal and spatial analysis were performed based on confirmed cases of the disease reported in the eSUS/VS System - State Health Department, from March 2020 to February 2021. The highest incidence was noted in July (ranging from 146.1 to 2,099.5 cases per 100,000 inhabitants in the municipalities of Espírito Santo State), with the majority being females, people aged 20 to 39 years and residents in cities in the metropolitan region. A positive and complete high association (p < 0.05) was identified in all months, with clusters containing a greater number of municipalities in April, May and June 2020 in the Central region of the state. The results of the present study indicated a continuous spread of COVID-19 since its introduction, especially in the cities in the Central region of the State of Espírito Santo. These findings present an important aid for decision making regarding the most effective strategies to control the disease. Furthermore, individual and collective protection measures against the transmission of the SARS-CoV-2 must be encouraged.

The Relation of CUN-BAE Index with Body Mass Index and Waist Circumference in Adults Aged 50 to 85 Years: The MCC-Spain Study.

Backgound: Traditional anthropometrics such as body mass index (BMI) or waist circumference (WC) do not fully capture the complex biology of body fat (BF) in the elderly. The Clinica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) index, based on BMI, is proposed as a better indicator of BF. However, its relation with BMI is not clear. The aim was to compare the agreement between CUN-BAE, BMI, and WC in those aged ≥50 years. Methods: A cross-sectional sample of 3153 Caucasian healthy adults was taken from the MCC-Spain study. The Pearson's correlation and its 95% confidence interval (CI), adiposity distribution, and Kappa Index (95%CI) were calculated. Results: The correlation of CUN-BAE with WC is 0.18 (95%CI 0.14-0.21) and that with BMI is moderate (r 0.58; 95%CI 0.55-0.60), but both increased strongly by sex. Agreement (normal weight/overweight/obesity) of CUN-BAE with BMI is 7% and with WC is 18%. Conclusions: The correlation and the degree of agreement of CUN-BAE with BMI and WC are low in individuals aged over 50, but it is higher by sex. Thus, this different criterion of obesity may have clinical applications. More studies with a gold standard are needed to evaluate the CUN-BAE in elderly adults.

A comparative study on feature selection for a risk prediction model for colorectal cancer.

BACKGROUND AND OBJECTIVE: Risk prediction models aim at identifying people at higher risk of developing a target disease. Feature selection is particularly important to improve the prediction model performance avoiding overfitting and to identify the leading cancer risk (and protective) factors. Assessing the stability of feature selection/ranking algorithms becomes an important issue when the aim is to analyze the features with more prediction power. METHODS: This work is focused on colorectal cancer, assessing several feature ranking algorithms in terms of performance for a set of risk prediction models (Neural Networks, Support Vector Machines (SVM), Logistic Regression, k-Nearest Neighbors and Boosted Trees). Additionally, their robustness is evaluated following a conventional approach with scalar stability metrics and a visual approach proposed in this work to study both similarity among feature ranking techniques as well as their individual stability. A comparative analysis is carried out between the most relevant features found out in this study and features provided by the experts according to the state-of-the-art knowledge. RESULTS: The two best performance results in terms of Area Under the ROC Curve (AUC) are achieved with a SVM classifier using the top-41 features selected by the SVM wrapper approach (AUC=0.693) and Logistic Regression with the top-40 features selected by the Pearson (AUC=0.689). Experiments showed that performing feature selection contributes to classification performance with a 3.9% and 1.9% improvement in AUC for the SVM and Logistic Regression classifier, respectively, with respect to the results using the full feature set. The visual approach proposed in this work allows to see that the Neural Network-based wrapper ranking is the most unstable while the Random Forest is the most stable. CONCLUSIONS: This study demonstrates that stability and model performance should be studied jointly as Random Forest turned out to be the most stable algorithm but outperformed by others in terms of model performance while SVM wrapper and the Pearson correlation coefficient are moderately stable while achieving good model performance.

Agreement among Mediterranean Diet Pattern Adherence Indexes: MCC-Spain Study.

There are many different methods used to measure the degree of adherence to a Mediterranean diet (MD), limiting comparison and interpretation of their results. The concordance between different methodologies has been questioned and their evaluation recommended. The aim of this study was to evaluate the agreement among five indexes that measure adherence to a Mediterranean dietary pattern. The study population included healthy adults selected in the Multi-Case Control Spain (MCC-Spain) study recruited in 12 provinces. A total of 3640 controls were matched to cases by age and sex. To reach the aim, the following scores of adherence to a Mediterranean dietary pattern were calculated: Mediterranean diet score (MDS), alternative Mediterranean diet (aMED), relative Mediterranean diet (rMED), dietary score (DS) and literature-based adherence score (LBAS). The relative frequency of subjects with a high level of adherence to a MD varied from 22% (aMED index) to 37.2% (DS index). Similarly, a high variability was observed for the prevalence of a low level of MD: from 24% (rMED) to 38.4% (aMED). The correlation among MDS, aMED and rMED indexes was moderate, except for MDS and aMED with a high coefficient of correlation 0.75 (95% CI 0.74⁻0.77). The Cohen's Kappa coefficient among indexes showed a moderate⁻fair concordance, except for MDS and aMED with a 0.56 (95% CI 0.55⁻0.59) and 0.67 (95% CI 0.66⁻0.68) using linear and quadratic weighting, respectively. The existing MD adherence indexes measured the same, although they were based on different constructing algorithms and varied in the food groups included, leading to a different classification of subjects. Therefore, concordance between these indexes was moderate or low.

Low adherence to the western and high adherence to the mediterranean dietary patterns could prevent colorectal cancer.

PURPOSE: To assess if the associations found between three previously identified dietary patterns with breast, prostate and gastric cancer are also observed for colorectal cancer (CRC). METHODS: MCC-Spain is a multicase-control study that collected information of 1629 incident cases of CRC and 3509 population-based controls from 11 Spanish provinces. Western, Prudent and Mediterranean data-driven dietary patterns-derived in another Spanish case-control study-were reconstructed in MCC-Spain. Their association with CRC was assessed using mixed multivariable logistic regression models considering a possible interaction with sex. Risk by tumor site (proximal colon, distal colon, and rectum) was evaluated using multinomial regression models. RESULTS: While no effect of the Prudent pattern on CRC risk was observed, a high adherence to the Western dietary pattern was associated with increased CRC risk for both males [ORfourth(Q4) vs. first(Q1)quartile (95% CI): 1.45 (1.11;1.91)] and females [ORQ4 vs. Q1 (95% CI): 1.50 (1.07;2.09)] but seem to be confined to distal colon [ORfourth(Q4) vs. first(Q1)quartile (95% CI): 2.02 (1.44;2.84)] and rectal [ORQ4 vs. Q1 (95% CI): 1.46 (1.05;2.01)] tumors. The protective effect of the Mediterranean dietary pattern against CRC was observed for both sexes [males: ORQ4 vs. Q1 (95% CI): 0.71 (0.55;0.92); females: ORQ4 vs. Q1 (95% CI): 0.56 (0.40;0.77)] and for all cancer sites: proximal colon [ORQ4 vs. Q1 (95% CI): 0.70 (0.51;0.97)], distal colon [ORQ4 vs. Q1 (95% CI): 0.65 (0.48;0.89)], and rectum (ORQ4 vs. Q1 (95% CI): 0.60 (0.45;0.81)]. CONCLUSION: Our results are consistent with most of the associations previously found between these patterns and breast, prostate and gastric cancer risk and indicate that consuming whole fruits, vegetables, legumes, olive oil, nuts, and fish and avoiding red and processed meat, refined grains, sweets, caloric drinks, juices, convenience food, and sauces might reduce CRC risk.

Net contribution and predictive ability of the CUN-BAE body fatness index in relation to cardiometabolic conditions.

BACKGROUND: The CUN-BAE (Clínica Universidad de Navarra-Body adiposity estimator) index is an anthropometric index based on age, sex and body mass index (BMI) for a refined prediction of body fatness in adults. CUN-BAE may help detect metabolically unhealthy individuals with otherwise normal weight according to BMI or waist circumference (WC). The aim of this study was to evaluate whether CUN-BAE, independent of its components (BMI, age and sex), was associated with cardiometabolic conditions including arterial hypertension, diabetes mellitus and metabolic syndrome (MetS). METHODS: The ENRICA study was based on a cross-sectional sample of non-institutionalized men and women representative of the adult Spanish population. Body weight, height, and WC were measured in all participants. The residual of CUN-BAE (rCUN-BAE), i.e. the part of the index not explained by its components, was calculated. The associations of CUN-BAE, rCUN-BAE, BMI and WC with hypertension, diabetes and MetS were analysed by multivariate logistic regression, and the Akaike information criterion (AIC) was calculated. RESULTS: The sample included 12,122 individuals. rCUN-BAE was associated with hypertension (OR 1.14, 95% CI 1.07-1.21) and MetS (OR 1.48, 1.37-1.60), but not with diabetes (OR 1.05, 0.94-1.16). In subjects with a BMI < 25 kg/m2, CUN-BAE was significantly associated with all three outcome variables. CUN-BAE was more strongly associated with the cardiometabolic conditions than BMI and WC and fit similar AICs. CONCLUSIONS: The CUN-BAE index for body fatness was positively associated with hypertension, diabetes and MetS in adults independent of BMI or WC. CUN-BAE may help to identify individuals with cardiometabolic conditions beyond BMI, but this needs to be confirmed in prospective settings.

Cuidado de enfermagem ao idoso com delirium em unidade intensiva / Nursing care for elderly patients with delirium in intensive care units

Objetivo: analisar as evidências da literatura científica acerca do cuidado de enfermagem na prevenção, detecção e manejo do delirium em idosos na Unidade de Terapia Intensiva. Método: trata-se de uma revisão integrativa em artigos publicados entre 2013 e 2018 nas bases MEDLINE, LILACS, BDENF e CINAHL. Analisaram-se os dados pela técnica de Análise de Conteúdo. Apresentaram-se os resultados em figuras. Resultados: encontraram-se seis artigos que atenderam ao objetivo do estudo, dos quais emergiram 2 categorias: 1. Prevenção, identificação e manejo do delirium realizado pela equipe de enfermagem à pessoa idosa na Unidade de Terapia Intensiva; 2. Importância da realização de intervenções educativas com a equipe de enfermagem na Unidade de Terapia Intensiva. Conclusão: constatou-se que os estudos analisados são incipientes. Aponta-se que as medidas não farmacológicas contribuem no combate da síndrome. Faz-se necessária a realização de educação permanente com a equipe de enfermagem a fim de prepará-la para prevenção, reconhecimento e manejo do delirium em idosos na unidade de terapia intensiva.(AU)

Objective: to analyze the evidence from the scientific literature about nursing care for prevention, detection and management of delirium in elderly patients in Intensive Care Units. Method: this is an integrative review of articles published between 2013 and 2018 available in the following databases: MEDLINE, LILACS, BDENF, and CINAHL. The data were analyzed through the Content Analysis technique. The results were presented in figures. Results: six articles met the objective of the study, from which two categories emerged: 1. Prevention, identification and management of delirium by the nursing team in elderly patients admitted to Intensive Care Units; 2. Importance of educational interventions with nursing teams in Intensive Care Units. Conclusion: it was observed that the studies analyzed are incipient. It is noteworthy that non-pharmacological measures contribute to the syndrome. It is necessary to carry out continuing education with nursing teams in order to prepare them for the prevention, recognition and management of delirium in elderly patients in intensive care units.(AU)

Objetivo: analizar las evidencias de la literatura científica acerca del cuidado de enfermería en la prevención, detección y manejo del delirium en adultos mayores en la Unidad de Terapia Intensiva. Método: se trata de una revisión integradora en artículos publicados entre 2013 y 2018 realizada en las bases MEDLINE, LILACS, BDENF y CINAHL. Se analizaron datos por medio de la técnica de Análisis de Contenido. Se presentaron los resultados en figuras. Resultados: se encontraron seis artículos que atendieron al objetivo del estudio, de los cuales surgieron 2 categorías: 1. Prevención, identificación y manejo del delirium realizado por el equipo de enfermería a la persona mayor en la Unidad de Terapia Intensiva; 2. Importancia de la realización de intervenciones educativas com el equipo de enfermeira en la Unidad de Terapia Intensiva. Conclusión: se constató que los estudios analizados son incipientes. Se apunta que las medidas no farmacológicas contribuyen en el combate del síndrome. Es necesaria la realización de educación permanente con el equipo de enfermería para perpararlo para prevención, reconocimiento y manejo del delirium en adultos mayores en la unidad de terapia intensiva.(AU)