[Evolution of the diet and physical activity of university students after the COVID-19 pandemic]. / Evolución de la dieta y la actividad física de los estudiantes universitarios tras la pandemia de COVID-19.

Introduction: Objective: to assess the evolution of adherence to Mediterranean diet and level of physical activity of university students of Health Sciences in Castilla-La Mancha during the COVID-19 lockdown and one year afterwards. Methods: a cross-sectional observational study using questionnaires on adherence to the Mediterranean diet and level of physical activity. A total of 893 students enrolled in Health Sciences degrees at the University of Castilla la Mancha participated, 575 in the first survey (during the lockdown) and 318 in the second (one year later). By sex, 672 women and 221 men (in the first survey 77.7 % were women and 22.3 % men while in the second survey these were 70.8 % and 29.2 %, respectively). Adherence to the Mediterranean diet was assessed with the Mediterranean Diet Adherence Screener (MEDAS) questionnaire and the modified Prevention with Mediterranean Diet (PREDIMED) questionnaire. The level of physical activity was assessed with the Rapid Assessment of Physical Activity Scale (RAPA). Results: one year after the COVID-19 confinement, consumption of olive oil has almost tripled. Daily fruit consumption has also doubled. Similarly, the consumption of wine and alcoholic beverages has doubled. Conversely, there was a reduction in the consumption of butter and margarine, as well as of carbonated drinks and sweetened beverages. Likewise, the percentage of university students with high adherence to the Mediterranean diet increased significantly (from 26 % to 34.3 %). Regarding physical activity level, there was a significant increase in the percentage of university students who engaged in light, moderate and even intense physical activity on an irregular basis. This increase was not found in the case of muscular strength and flexibility training activities. Conclusion: the results of the study indicate that, although the levels of adherence to the Mediterranean diet and physical activity have improved after the COVID-19 confinement, adherence to Mediterranean diet and physical activity level among the university population analyzed is still low. It is necessary to implement strategies for the achievement or maintenance of a healthy lifestyle in this population.

Introducción: Objetivo: valorar la evolución de la adherencia a la dieta mediterránea y el nivel de actividad física de los estudiantes universitarios de Ciencias de la Salud de Castilla-La Mancha durante la pandemia de COVID-19 y un año después de la misma. Método: estudio observacional transversal mediante cuestionarios sobre la adherencia a la dieta mediterránea y el nivel de actividad física. Participaron 893 alumnos matriculados en grados de Ciencias de la Salud de la Universidad de Castilla-La Mancha, 575 en la primera encuesta (durante la pandemia) y 318 en la segunda (un año después). Por sexos, 672 mujeres y 221 hombres (en la primera encuesta, el 77,7 % eran mujeres y el 22,3 % hombres, mientras que en la segunda lo eran el 70,8 % y 29,2 %, respectivamente). La adherencia a la dieta mediterránea se valoró con el cuestionario Mediterranean Diet Adherence Screener (MEDAS) y el cuestionario de Prevención con Dieta Mediterránea (PREDIMED), modificado. El nivel de actividad física se valoró con el cuestionario Rapid Assessment of Physical Activity Scale (RAPA). Resultados: tras un año desde el confinamiento por la COVID-19, el consumo de aceite de oliva casi se ha triplicado. Se ha duplicado también el consumo de frutas diario. De igual modo, se ha duplicado el consumo de vino y bebidas alcohólicas. Por el contrario, se encontró una reducción del consumo de mantequilla y margarina, al igual que de bebidas carbonatadas y azucaradas. Asimismo, aumentó significativamente el porcentaje de estudiantes universitarios con adherencia alta a la dieta mediterránea (del 26 % al 34,3 %). En cuanto al nivel de actividad física, ha aumentado significativamente el porcentaje de estudiantes universitarios que realizan actividad fisica ligera, moderada e incluso intensa de forma irregular. Este aumento no se ha encontrado en el caso de las actividades de fuerza muscular y flexibilidad. Conclusión: los resultados del estudio nos indican que, aunque los niveles de adherencia a la dieta mediterránea y de actividad física han mejorado tras el confinamiento por la COVID-19, la adherencia a la dieta mediterránea y el nivel de actividad física de la población universitaria analizada siguen siendo bajos. Es necesario aplicar estrategias para la consecución o mantenimiento de un estilo de vida saludable en dicha población.

Las actuales guías en el manejo de las dislipidemias europeas y estadounidenses no están de acuerdo en sus objetivos y recomendaciones / Current guidelines on the management of European and American dyslipidemias do not agree on their objectives and recommendations

La prevención de la enfermedad cardiovascular (ECV) constituye una prioridad fundamental en la práctica clínica diaria, tanto en Enfermería como en Medicina. Para conseguirla, el control de la dislipidemia es fundamental y la elaboración de guías por expertos, basadas en la evidencia disponible, el modo más racional de su abordaje. Pero en ocasiones, la producción científica llega a ser tan abundante que seleccionar la calidad de los estudios puede generar controversias. Este es el caso que se presenta en este estudio, donde las guías estadounidenses, basadas en ensayos clínicos aleatorizados y controlados, han establecido un nuevo paradigma frente a las guías europeas que además han considerado los diseños de estudios observacionales. Se exponen los puntos fundamentales de ambos casos, la controversia generada y el posterior acercamiento entre ambas guías, valorando la importancia que aporta la evidencia científica.(AU)

Prevention of cardiovascular disease (CVD) constitutes a critical priority of daily clinical practice, for both nurses and doctors. In order to achieve this, it’s essential to control dyslipidemia by using guides created by experts, based on available research. Occasionally, however, the amount of scientific research can be so abundant that choosing which studies to include can generate controversy. This study analyzes cases in which guides created in the United States, using evidence from randomized controlled clinical trials, have established a new paradigm compared to European guides, which have considered the designs of the American guides to be observational studies. The fundamental arguments of both sides will be discussed, as well as the resulting controversy and the subsequent reconciliation between both guides, which now place more value on scientific evidence.(AU)

En personas mayores no se encontró asociación entre niveles bajos de ansiedad y enfermedades cardiovasculares / There is no association related with low anxiety level and cardiovascular diseases in older people

OBJETIVO: El envejecimiento implica padecer enfermedades crónicas y ansiedad. Los objetivos han sido relacionar la ansiedad con las enfermedades cardiovasculares (ECV) y sus factores de riesgo (FRCV). También con la actividad física (AF) y el consumo de alcohol y tabaco. MÉTODO: Estudio observacional y analítico, transversal. Participaron 27 voluntarios (16 mujeres) mayores de 65 años. La ansiedad se valoró con la escala de Hamilton. El resto de variables mediante encuesta estructurada. Se utilizó estadística descriptiva y análisis bivariante. RESULTADOS: Edad media 75,3 años. Ansiedad media 10,4. Los bebedores presentaron una ansiedad de 6,7 frente a 15,9 en los no bebedores (p = 0,004). La media de ansiedad somática fue 3,1 en los que hacían otro tipo de AF frente a 4,3 en los que no (p = 0,025). CONCLUSIONES: No se ha encontrado relación entre la ansiedad y las ECV y sus FRCV. Tampoco con el consumo de tabaco. Sí con el consumo de alcohol y la AF

OBJECTIVE: Aging implies suffering from chronic diseases and anxiety. The objectives are to relate anxiety with cardiovascular diseases (CVD) and their risk factors (CVRF). Also with physical activity (PA) and the consumption of alcohol and tobacco. METHODS: Observational and analytical, cross-sectional study. An amount of 27 volunteers have participated (16 women) older than 65 years. Anxiety was assessed with the Hamilton scale. The rest of variables through structured survey. Descriptive statistics and bivariate analysis were used. RESULTS: Average age 75.3 years. Average anxiety 10.4. The alcoholic drinkers presented an anxiety of 6.7 versus 15.9 in non-alcoholic drinkers (p = 0.004). The mean somatic anxiety was 3.1 in those who did another type of PA compared to 4.3 in those who did not (p = 0.025). CONCLUSIONS: No relationship was found between anxiety and CVD and their CVRF. Neither with tobacco consumption. There is with alcohol consumption and PA

Clusters of Cardiovascular Risk Factors and Their Impact on the 20-Year Cardiovascular Risk in a General Population.

BACKGROUND: Clustering of cardiovascular risk factors (CVRFs) is extraordinarily common and is associated with an increased risk of cardiovascular disease (CVD). However, the particular impact of the sum of CVRFs on cardiovascular morbidity and mortality has not been sufficiently explored in Europe. OBJECTIVE: The aim of this study was to analyze the differences in survival-free probability of CVD in relation to the number of CVRFs in a Spanish population. METHODS: A prospective cohort study was conducted from 1992 to 2016 in a Spanish population that included 1144 subjects with no history of CVD (mean age, 46.7 years) drawn from the general population. We calculated the number of CVRFs for each subject (male sex, smoking, diabetes, hypertension, dyslipidemia, obesity, and left ventricular hypertrophy). Cardiovascular morbidity and mortality records were collected, and survival analysis was applied (competing risk models). RESULTS: There were 196 cardiovascular events (17.1%). The differences in total survival-free probability of cardiovascular morbidity and mortality of the different values of the sum of CVRFs were significant, increasing the risk of CVD (hazard ratio, 1.30; 95% confidence interval, 1.13-1.50) per each additional risk factor. CONCLUSION: Differences in survival-free probability of CVD in relation to the number of CVRFs present were statistically significant. Further studies are needed to corroborate our results.

Comparison Between Non-High-Density Lipoprotein Cholesterol and Low-Density Lipoprotein Cholesterol to Estimate Cardiovascular Risk Using a Multivariate Model.

BACKGROUND: Although studies exist comparing low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (HDL-C) in the development of cardiovascular disease (CVD), most have limitations in the mathematical models used to evaluate their prognostic power adjusted for the other risk factors (cardiovascular risk). OBJECTIVE: The aim of this study was to compare LDL-C and non-HDL-C in patients with CVD to determine whether both parameters predict CVD similarly. METHODS: A cohort of 1322 subjects drawn from the general population of a Spanish region was followed between 1992 and 2006. The outcome was time to CVD. Secondary variables were gender, age, hypertension, diabetes, personal history of CVD, current smoker, body mass index, LDL-C, and non-HDL-C. Two CVD prediction models were constructed with the secondary variables, with only the lipid parameter varying (non-HDL-C or LDL-C). In the construction of the models, the following were considered: multiple imputation, events per variable of 10 or more, and continuous predictors as powers. The validation was conducted by bootstrapping obtaining the distribution of the C statistic (discrimination) and the probabilities observed by smooth curves. These results were compared in both models using graphical and analytical testing. RESULTS: There were a total of 137 CVD events. The models showed no differences in the distributions of the C statistic (discrimination, P = .536) or in the calibration plot. CONCLUSIONS: In our population, LDL-C and non-HDL-C were equivalent at predicting CVD. More studies using this methodology are needed to confirm these results.

Valoración del tratamiento anticoagulante en pacientes diagnosticados de fibrilación auricular no valvular en una zona básica de salud / Assessment of anticoagulation treatments in non-valvular atrial fibrillation patients diagnosed in a basic health area

Introducción: La fibrilación auricular (FA) es la arritmia cardiaca más frecuente. En su manejo, es clave valorar la necesidad de anticoagulación. Nuestro objetivo fue valorar en pacientes diagnosticados de FA no valvular si la indicación de anticoagulación es adecuada en función de la escala CHA2DS2-VASc y la adecuación del rango del International Normalizad Ratio (INR) en los pacientes en tratamiento con antivitamina K. Métodos: Estudio observacional, analítico transversal. Se seleccionaron 232 pacientes con diagnóstico de FA no valvular. Se han analizado variables demográficas, variables de la escala CHA2DS2-VASc, tratamiento prescrito y valores de INR durante 6 meses consecutivos. La comparación de variables se realizó con ji cuadrado y la tendencia lineal entre grupos por Mantel Haenzel, siendo calculadas las odds ratios. Resultados: La prevalencia total de FA no valvular en el área fue 1,05%. El 88,4% presentó un CHA2DS2-VASc ≥ 2. Un 71,1% de pacientes con fibrilación auricular estaban anticoagulados, de los que el 58,2% tomaban fármacos antivitamina K. El 46,7% de los pacientes en tratamiento con acenocumarol presentó un INR con un tiempo en rango terapéutico directo insuficiente. La prescripción de antivitamina K en los pacientes con FA permanente fue superior que en pacientes con FA paroxística (62,8 vs. 37,2%, p<0,001). El consumo de fármacos que aumentan el sangrado se asoció a un peor control de INR (tras ajuste por las principales variables de relevancia clínica (odds ratio 2,17 [1,02-4,59], p=0,043). Conclusiones: El control de la anticoagulación oral con antivitamina K fue subóptimo pese a la adecuada adherencia de los pacientes. Los pacientes con FA paroxística recibieron menos antivitamina-K que los de FA persistente/permanente (AU)

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia. To assess the need for anticoagulation is essential for its management. Our objective was to investigate whether the indication of anticoagulation was adequate in patients diagnosed with non-valvular AF, given the CHA2-DS2-VASc scale, measuring the International Normalizad Ratio range (INR) in patients treated with anti-vitamin K drugs. Methods: This is an observational and cross sectional study. 232 patients with atrial fibrillation were included. We analyzed demographic, the CHA2-DS2-VASc and HAS-BLED variables, the treatment and INR values for 6 consequentive months. The confrontation of variables was performed using chi-square and Mantel-Haenzel test. Results: The prevalence of AF was 1.05%. The 88.4% had CHA2-DS2-VASc ≥ 2. The 71.1% were taking anticoagulants, of which 58.2% were under antivitamin k. The 46.7% of patients taking antivitamin K, presented inadequate range of INR. There was a greater prescription of antivitamin k in patients with persistent or permanent AF compared to the paroxysmal form (62.8 vs. 37.2% p<.001). The use of drugs that increase bleeding was associated with a worse control of INR after adjustment for the main variables of clinical relevance (odds ratio 2.17 [1.02-4.59], p=.043). Conclusions: The level of anticoagulation with antivitamin K was inadequate in our sample, despite a proper follow up and adherence to treatment. Patients with paroxysmal AF received less antivitamin K than those with persistent/permanent AF (AU)

Assessment of anticoagulation treatments in non-valvular atrial fibrillation patients diagnosed in a basic health area. / Valoración del tratamiento anticoagulante en pacientes diagnosticados de fibrilación auricular no valvular en una zona básica de salud.

INTRODUCTION: Atrial fibrillation (AF) is the most common cardiac arrhythmia. To assess the need for anticoagulation is essential for its management. Our objective was to investigate whether the indication of anticoagulation was adequate in patients diagnosed with non-valvular AF, given the CHA2-DS2-VASc scale, measuring the International Normalizad Ratio range (INR) in patients treated with anti-vitamin K drugs. METHODS: This is an observational and cross sectional study. 232 patients with atrial fibrillation were included. We analyzed demographic, the CHA2-DS2-VASc and HAS-BLED variables, the treatment and INR values for 6 consequentive months. The confrontation of variables was performed using chi-square and Mantel-Haenzel test. RESULTS: The prevalence of AF was 1.05%. The 88.4% had CHA2-DS2-VASc ≥ 2. The 71.1% were taking anticoagulants, of which 58.2% were under antivitamin k. The 46.7% of patients taking antivitamin K, presented inadequate range of INR. There was a greater prescription of antivitamin k in patients with persistent or permanent AF compared to the paroxysmal form (62.8 vs. 37.2% p<.001). The use of drugs that increase bleeding was associated with a worse control of INR after adjustment for the main variables of clinical relevance (odds ratio 2.17 [1.02-4.59], p=.043). CONCLUSIONS: The level of anticoagulation with antivitamin K was inadequate in our sample, despite a proper follow up and adherence to treatment. Patients with paroxysmal AF received less antivitamin K than those with persistent/permanent AF.

A method to construct a points system to predict cardiovascular disease considering repeated measures of risk factors.

Current predictive models for cardiovascular disease based on points systems use the baseline situation of the risk factors as independent variables. These models do not take into account the variability of the risk factors over time. Predictive models for other types of disease also exist that do consider the temporal variability of a single biological marker in addition to the baseline variables. However, due to their complexity these other models are not used in daily clinical practice. Bearing in mind the clinical relevance of these issues and that cardiovascular diseases are the leading cause of death worldwide we show the properties and viability of a new methodological alternative for constructing cardiovascular risk scores to make predictions of cardiovascular disease with repeated measures of the risk factors and retaining the simplicity of the points systems so often used in clinical practice (construction, statistical validation by simulation and explanation of potential utilization). We have also applied the system clinically upon a set of simulated data solely to help readers understand the procedure constructed.

Construction and Validation of a 14-Year Cardiovascular Risk Score for Use in the General Population: The Puras-GEVA Chart.

UNLABELLED: The current cardiovascular risk tables are based on a 10-year period and therefore, do not allow for predictions in the short or medium term. Thus, we are unable to take more aggressive therapeutic decisions when this risk is very high.To develop and validate a predictive model of cardiovascular disease (CVD), to enable calculation of risk in the short, medium and long term in the general population.Cohort study with 14 years of follow-up (1992-2006) was obtained through random sampling of 342,667 inhabitants in a Spanish region. MAIN OUTCOME: time-to-CVD. The sample was randomly divided into 2 parts [823 (80%), construction; 227 (20%), validation]. A stepwise Cox model was constructed to determine which variables at baseline (age, sex, blood pressure, etc) were associated with CVD. The model was adapted to a points system and risk groups based on epidemiological criteria (sensitivity and specificity) were established. The risk associated with each score was calculated every 2 years up to a maximum of 14. The estimated model was validated by calculating the C-statistic and comparison between observed and expected events.In the construction sample, 76 patients experienced a CVD during the follow-up (82 cases per 10,000 person-years). Factors in the model included sex, diabetes, left ventricular hypertrophy, occupational physical activity, age, systolic blood pressure × heart rate, number of cigarettes, and total cholesterol. Validation yielded a C-statistic of 0.886 and the comparison between expected and observed events was not significant (P: 0.49-0.75).We constructed and validated a scoring system able to determine, with a very high discriminating power, which patients will develop a CVD in the short, medium, and long term (maximum 14 years). Validation studies are needed for the model constructed.

Prognostic value of obesity on both overall mortality and cardiovascular disease in the general population.

BACKGROUND: Obesity represents an important health problem and its association with cardiovascular risk factors is well-known. The aim of this work was to assess the correlation between obesity and mortality (both, all-cause mortality and the combined variable of all-cause mortality plus the appearance of a non-fatal first cardiovascular event) in a general population sample from the south-east of Spain. MATERIALS AND METHODS: This prospective cohort study used stratified and randomized two-stage sampling. Obesity [body mass index (BMI) ≥ 30 kg/m(2)] as a predictive variable of mortality and cardiovascular events was assessed after controlling for age, sex, cardiovascular disease history, high blood pressure, diabetes mellitus, hypercholesterolemia, high-density lipoprotein/triglycerides ratio, total cholesterol and smoking with the Cox regression model. RESULTS: The mean follow-up time of the 1,248 participants was 10.6 years. The incidence of all-cause mortality during this period was 97 deaths for every 10,000 person/years (95% CI: 80-113) and the incidence of all-cause mortality+cardiovascular morbidity was 143 cases for every 10,000 person/years (95% CI: 124-163). A BMI ≥ 35 kg/m(2) yielded a hazard ratio for all-cause mortality of 1.94 (95% CI: 1.11-3.42) in comparison to non-obese subjects (BMI <30 kg/m(2)). For the combination of cardiovascular morbidity plus all-cause mortality, a BMI ≥ 35 kg/m(2) had a hazard ratio of 1.84 (95% CI: 1.15-2.93) compared to non-obese subjects. CONCLUSIONS: A BMI ≥ 35 kg/m(2) is an important predictor of both overall mortality and of the combination of cardiovascular morbidity plus all-cause mortality.

Crisis Hipertensivas / Hypertensive crises

Las crisis hipertensivas constituyen un motivo frecuente de consulta en los servicios de urgencias.Aproximadamente un 1-2% de los pacientes hipertensos desarrollarán una crisis hipertensiva en algúnmomento de su vida. El presente trabajo pretende revisar las guías clínicas de referencia más actualesen el manejo de esta patología, con el fi n de poder plantear unas recomendaciones clínicas. El temade estudio suele estar incluido en los documentos de consenso que sobre el manejo de la hipertensiónarterial se han publicado, los cuales son muy similares en cuanto a contenidos y recomendaciones.Las guías clínicas evaluadas son muy similares en cuanto a contenidos y recomendaciones, incluyendocasi todas un apartado de introducción, clasifi cación, defi niciones, y manejo general, diferenciandoentre urgencias y emergencias hipertensivas dependiendo de la ausencia o presencia de lesión aguda de órganos diana de la hipertensión arterial.Son escasos los ensayos clínicos aleatorizados publicados que han comparado diferentes fármacoso estrategias de manejo de las crisis hipertensivas.Se han encontrado guías sobre el manejo de la HTA que sustentan sus recomendaciones en niveles de evidencia, pero no se han encontrado guías similares para las crisis hipertensivas, con excepción del manejo de la pre-eclampsia/eclampsia

Hypertensive crises are a frequent motive for consultation in the emergency services. Approximately1-2% of hypertensive patients develop a hypertensive crisis at some time of their lives. The presentwork aims to review the most recent clinical manuals for management of this condition, in order topropose some clinical recommendations. The subject of this study is usually treated in the consensusdocuments published on the management of arterial hypertension.The clinical manuals evaluated have very similar contents and recommendations, almost all of themincluding an introduction section, classifi cation, defi nitions and general management. Differencesappear, however, in hypertensive urgencies and emergencies depending on the absence or presenceof acute lesion of target organs of the arterial hypertension.There are few published randomised clinical trials that have compared different drugs or managementstrategies for hypertensive crises.Manuals have been found on the management of AHT that base their recommendations on evidence,but similar manuals for hypertensive crises do not exist, except for the management of preeclampsia/eclampsia

dolor torácico en un piloto de combate español / Chest pain in a Spanish fighter pilot

El dolor torácico es una causa frecuente de consulta médica. Pero cuando es debido a maniobras que originan aceleraciones en los aviones de combate y que los pilotos padecen, esta causa no es contemplada en los libros de medicina clásicos. Es conveniente conocer esta situación, ya que un piloto de combate puede consultar a cualquier médico por este motivo. Describimos a continuación un caso que sucedió en la Base Aérea de Albacete (Ala 14) (AU)

The chest pain is consultation frequent cause. When it is due to maneuvers that generate accelerations and that the fighter pilot suffer, this cause is not contemplated in the classic medicine books. That, it is useful to know this situation because a fighter pilot can consult to any physician for this reason. We describe a case that happened in Albacete Air Base (Wing 14) (AU)