Characterizing beach changes using high-frequency Sentinel-2 derived shorelines on the Valencian coast (Spanish Mediterranean).

Shoreline position can be efficiently extracted with subpixel accuracy from mid-resolution satellite imagery using tools as SHOREX. However, it is necessary to develop procedures for deriving descriptors of the beach morphology and its changes in order to become truly useful data for characterizing the coastal dynamism. A new approach is proposed based on a spatiotemporal model of the beach widths. Divided into 80m analysis segments, it offers a robust and detailed characterization of the beach state along large micro-tidal regions, with continuous information through time and space. Geographical and temporal differences can be recognized and measured, making it possible to study the beach response both to general factors (as wave conditions) and to punctual anthropic actions (as small sand nourishments). Widths were defined throughout two and a half years from 60 shorelines (3.04m RMSE) covering 50km of the Gulf of Valencia. Important width contrasts appeared along the study site associated with sediment imbalances motivated by sediment traps and other anthropic actions. Segments too narrow for maintaining the recreational function were located and mapped (16% narrower than 30m). Short-term width changes appeared linked to storm events, with fast retreatments and slow recoveries. Punctually, even small-magnitude nourishments created perceptible changes in width (12,830m3 were associated with a 4m increase). This novel description of the beach state and its changes from Satellite-Derived Shorelines is useful for coastal management, especially considering the global coverage of these free satellite images. It may improve the comprehension of coastal processes as well as monitor human interventions on the coast, helping in the decision-making.

VIM-Klebsiella oxytoca outbreak in a Neonatal Intensive Care Unit. This time it wasn't the drain.

OBJECTIVE: We describe an outbreak of VIM-carbapenemase Klebsiella oxytoca (VIM-Kox) in a NICU. MATERIALS AND METHODS: Prospective Epidemiological Surveillance:Systematically (weekly screening cultures) or on admission, if the patient had a history of previous colonization by VIM-Kox.Clinical cultures, done if infection was suspected.Other possible microorganism sources were investigated: their mothers (rectal microbiota), milk packages and preparation apparata in the lactodietary section, echocardiagram transductors, cribs, the sinks (faucets and drains), washing bowls, etc.Molecular typing was performed using the DiversiLab (bioMérieux) system on all VIM-Kox isolated from environment or patients (one by neonate). RESULTS: We identified 20 VIM-Kox cases, the most only presented colonization, but 4 showed infection. Three of the ten sinks (drains) in our NICU, were positive for VIM-Kox. Another four drains harbored P.aeruginosa, S. maltophilia and/or Enterobacter sp. Nevertheless the VIM-Kox bacteria in the sinks (drains) were not the same as those in the patients, who showed three different strains. CONCLUSIONS: A VIM-Kox colonization or infection outbreak in a NICU is described. Rather than environment, not even drains, the source of the outbreak was other patients. The outbreak was relatively brief, as a result of the rapidness with which appropriate measures were taken and followed.

Microbe associated molecular patterns from rhizosphere bacteria trigger germination and Papaver somniferum metabolism under greenhouse conditions.

Ten PGPR from different backgrounds were assayed on Papaver somniferum var. Madrigal to evaluate their potential as biotic elicitors to increase alkaloid content under the rationale that some microbe associated molecular patterns (MAMPs) are able to trigger plant metabolism. First, the 10 strains and their culture media at two different concentrations were tested for their ability to trigger seed germination. Then, the best three strains were tested for their ability to increase seedling growth and alkaloid levels under greenhouse conditions. Only three strains and their culture media enhanced germination. Then, germination enhancing capacity of these best three strains, N5.18 Stenotrophomonas maltophilia, Aur9 Chryseobacterium balustinum and N21.4 Pseudomonas fluorescens was evaluated in soil. Finally, the three strains were applied on seedlings at two time points, by soil drench or by foliar spray. Photosynthesis was measured, plant height was recorded, capsules were weighted and alkaloids analyzed by HPLC. Only N5.18 delivered by foliar spray significantly increased plant height coupled to an increase in total alkaloids and a significant increase in opium poppy straw dry weight; these increases were supported by a better photosynthetic efficiency. The relative contents of morphine, thebaine, codeine and oripavine were affected by this treatment causing a significant increase in morphine coupled to a decrease in thebaine, demonstrating the effectivity of MAMPs from N5.18 in this plant species. Considering the increase in capsule biomass and alkaloids together with the acceleration of germination, strain N5.18 appears as a good candidate to elicit plant metabolism and consequently, to increase productivity of Papaver somniferum.

Interpretación computarizada del electrocardiograma para el diagnóstico de hipertrofia del ventrículo izquierdo. Proyecto ELECTROPRES / Computerized interpretation of the electrocardiogram in the diagnosis of left ventricular hypertrophy. The ELECTROPRES project

Antecedentes y objetivos. En la práctica clínica, el electrocardiograma (ECG) es la herramienta más utilizada para detectar la hipertrofia ventricular izquierda (HI) a pesar de su baja sensibilidad. Hemos evaluado el impacto de la interpretación computerizada del ECG en el diagnóstico de HVI en condiciones de práctica clínica. Métodos. ELECTROPRES es una plataforma informática de libre acceso que permite la interpretación completa del ECG on-line. Incluye 19 criterios de HVI previamente validados mediante ecocardiografía. Se analizan los datos de los primeros 669 pacientes con hipertensión arterial (HTA) esencial incluidos en la plataforma ELECTROPRES procedentes de 21 centros de Atención Primaria de 9 de las 17 comunidades autónomas. Resultados. Hasta abril de 2010 se han analizado 669 pacientes con HTA esencial (51,7% mujeres) con una edad media (+DE) de 66±12 años. La evolución media de la enfermedad fue de 8 años y recibían un promedio de 2,4 fármacos antihipertensivos. La presión arterial sistólica fue de 139±17mmHg y la diastólica de 76±11mmHg. La frecuencia de HVI conocida por el ECG fue del 3%. Con la plataforma ELECTROPRES la prevalencia de HVI aumentó hasta el 33,3% (p<0,001). Al analizar los criterios de HVI por separado, el índice de Lewis ([R-I+S-III]-[R-II+S-II]) y el producto de Cornell (R-aVL+S-V3 [+6 en mujeres]) fueron los que más diagnósticos de HVI ofrecieron (24,8 y 13,3% respectivamente). El producto de Cornell obtuvo un mejor rendimiento global para la detección de HVI, independientemente del estadio de HTA y de la presencia de complicaciones cardiovasculares. Conclusiones. En una población de hipertensos esenciales, la lectura computarizada del ECG (plataforma ELECTROPRES) aumenta sustancialmente la detección de HVI, en comparación con la detección convencional por ECG en condiciones de práctica clínica habitual(AU)

Introduction. Despite its low sensitivity, the electrocardiogram (ECG) is the tool used the most in the daily practice for detection of left ventricular hypertrophy (LVH). This study has aimed to assess the impact of the computerized interpretation of the ECG on the diagnosis of LVH in the practical clinical setting. Methods. ELECTROPRES is a project based on a free access computer platform that permits an online interpretation of the electrocardiogram. It includes 19 different left LVH criteria previously validated by echocardiography in a substudy. We analyzed the data from the first 669 patients with essential arterial hypertension (ATH) included in the ELECTROPRES platform from 21 primary care centers in 9 of the 17 Spanish autonomous communities. Results. Up to April 2010, a cohort of 669 hypertensive patients (51.7% women), with a mean age of 66.3±11.89 years, was analyzed. The mean evolution of the disease was 8 years, and the patients had been receiving an average of 2.4 antihypertensive agents. Systolic blood pressure was 139±17mmHg and diastolic blood pressure 76±11. The ECG-known frequency of LVH was 3%. The prevalence of LVH increased up to 33.3% (P<0.001) with the ELECTROPRES platform. When all the criteria were independently examined, the Lewis index (R-I+S-III) and the Cornell product [(R-aVL+S-V3 (+6 for women)] were those in which the most cases of left ventricular hypertrophy were detected (24.8% and 13.3%, respectively). The Lewis index and the Cornell product were the criteria that detected more cases of left ventricular hypertrophy, regardless of the AHT stage and of the presence of cardiovascular complications. Conclusions. The ECG computerized reading (ELECTROPRES platform) significantly increases detection of left ventricular hypertrophy in a population of essential hypertense subjects compared to conventional detection with the ECG by the physician in the usual clinical practice setting(AU)

[Computerized interpretation of the electrocardiogram in the diagnosis of left ventricular hypertrophy. The ELECTROPRES project]. / Interpretación computarizada del electrocardiograma para el diagnóstico de hipertrofia del ventrículo izquierdo. Proyecto ELECTROPRES.

INTRODUCTION: Despite its low sensitivity, the electrocardiogram (ECG) is the tool used the most in the daily practice for detection of left ventricular hypertrophy (LVH). This study has aimed to assess the impact of the computerized interpretation of the ECG on the diagnosis of LVH in the practical clinical setting. METHODS: ELECTROPRES is a project based on a free access computer platform that permits an online interpretation of the electrocardiogram. It includes 19 different left LVH criteria previously validated by echocardiography in a substudy. We analyzed the data from the first 669 patients with essential arterial hypertension (ATH) included in the ELECTROPRES platform from 21 primary care centers in 9 of the 17 Spanish autonomous communities. RESULTS: Up to April 2010, a cohort of 669 hypertensive patients (51.7% women), with a mean age of 66.3±11.89 years, was analyzed. The mean evolution of the disease was 8 years, and the patients had been receiving an average of 2.4 antihypertensive agents. Systolic blood pressure was 139±17 mmHg and diastolic blood pressure 76±11. The ECG-known frequency of LVH was 3%. The prevalence of LVH increased up to 33.3% (P<0.001) with the ELECTROPRES platform. When all the criteria were independently examined, the Lewis index (R-I+S-III) and the Cornell product [(R-aVL+S-V3 (+6 for women)] were those in which the most cases of left ventricular hypertrophy were detected (24.8% and 13.3%, respectively). The Lewis index and the Cornell product were the criteria that detected more cases of left ventricular hypertrophy, regardless of the AHT stage and of the presence of cardiovascular complications. CONCLUSIONS: The ECG computerized reading (ELECTROPRES platform) significantly increases detection of left ventricular hypertrophy in a population of essential hypertense subjects compared to conventional detection with the ECG by the physician in the usual clinical practice setting.

Adding questions about cardiovascular risk factors improve the ability of the ADA questionnaire to identify unknown diabetic patients in Spain

Introduction: Currently, there are not specific questionnaires for Spanish population to identify people at risk of undiagnosed diabetes. When American Diabetes Association (ADA) test is validated in the Spanish population, the sensitivity and specificity values obtained are lower than those found in the USA. Objectives: To develop a screening tool based on the ADA questionnaire, to prospectively identify undiagnosed type 2 diabetes in Spanish ambulatory patients. Methods: Epidemiological, transversal, multicentre study, including 2,662 ambulatory patients of Primary Care centres, mean age (SD) 61.7 (10.2) years (53% women), needing a blood test and attending follow-up protocols for chronic pathologies or periodic screening programs. Classification tree construction was achieved through classical and Artificial Intelligence (AI) methods. The sensitivity, specificity, and the positive and negative predictive values were described and compared with the ADA questionnaire. Results: The final selected classification tree included the following variables: previous impaired fasting glucose or glucose intolerance; recent weight gain; parents, siblings or children with diabetes; smoking habit and pharmacologic treatment for lipid disorders (sensitivity: 80.7%; specificity: 70.9%; positive predictive value: 45.3%; negative predictive value: 92.5%). This tree showed a better Receiver Operating Characteristic curve than that of the ADA test (sensitivity: 84.3%; specificity: 20.9%). Conclusions: The inclusion of questions regarding lipid disorders, smoking habit and weight gain increase the specificity of the ADA test to identify undiagnosed type 2 diabetes in Spanish patients older than 45 years (AU)

Artroplastias de cadera y rodilla en el Sistema Nacional de Salud martes / Hip and knee replacement in the Spanish National Health System

Objetivo: Analizar las artroplastias de cadera y de rodilla y sus características en el Sistema Nacional de Salud. Material y método: Estudio transversal llevado a cabo de forma global y por comunidades autónomas de las altas por artroplastia total primaria de cadera (ATC) y por artroplastias totales primarias de rodilla (ATR), así como las de revisión a partir de datos clínico-administrativos de 2005. Se calcularon las tasas estandarizadas de ATC y de ATR por edad y sexo por 10.000 habitantes analizando su variabilidad a partir del componente sistemático de variación (CSV). De cada alta se analizó: sexo, edad, motivo de intervención, índice de comorbilidad de Charlson, estancia, mortalidad intrahospitalaria y tromboembolismo pulmonar (TEP). Se analizó la carga de la cirugía de revisión a partir del porcentaje que representó sobre el total de artroplastias. Resultados: Las tasas fueron de 4,3 en ATC y de 7,3 en ATR variando de 2,3 a 10,0 en ATC (CSV del 24,4%) y de 4,0 a 12,8 en ATR (CSV del 20,6%). La mayoría de los pacientes fueron mayores de 65 años. La artrosis fue el principal motivo de intervención con escasa variabilidad. El ICC fue en general 0. La estancia mediana fue de 9 días en ATC y de 8 días en ATR. La mortalidad varió entre el 0 y el 0,9% y el TEP varió entre el 0 y el 0,6%. La carga de revisión en cadera fue del 9,2% y del 7% en rodilla. Conclusiones: La variabilidad de las tasas y las características de los pacientes puede estar indicando diferencias en los criterios de indicación. Será necesario establecer criterios de indicación homogéneos y desarrollar instrumentos para la evaluación de los resultados (AU)

Purpose:To analyze hip and knee arthroplasties and their characteristics in the Spanish National Health System.Materials and Methods: A cross-sectional at the global and Spanish autonomous comunity level of discharges of patients subjected to primary and revision total hip (THR) and knee (TKR) arthroplasties on the basis of clinical-administrative data gathered in 2005. Standardized THR and TKR rates were calculated by age and gender per 10,000 inhabitants analyzing their variability as compared with sistematic component of variation (SCV) values. Of each discharge we analyzed gender, age, reason for the procedure, the Charlson comorbidity index (CCI), length of stay, in-hospital mortality and pulmonary thromboembolism (PTE). We also analyzed the burden represented by revision surgery on the basis of the number of revision procedures as a percentage of the total number of arthroplasties. Results: The rates obtained were 4.3 for THR and 7.3 for TKR, ranging from 2.3 to 10.0 in THR (SCV: 24.4%) and from 4.0 to 12.8 (SCV: 20.6%) in TKR. The majority of patients were older than 65 years. Osteoarthritis was the main reason for surgery with little variability. Generally speaking, the CCI was 0. Median length of stay was 9 days in THR and 8 in TKR. Mortality varied between 0% and 0.9% and PTE between 0% and 0.6%. The percentage of hip revisions was 9.2% and that of knee revisions was 7%. Conclusions: Variability in terms of the different rates and patient characteristics could be pointing to differences in the indication criteria. Homogeneous indication criteria should be established and instruments should be developed for assessing the results (AU)

Hospital indicators by Regional Communities, 1980-2004 (Longitudinal analysis of morbidity indicators and hospital staffing in mental health).

INTRODUCTION: Comparative analysis by Spanish Regional Communities (RC) of indicators related to morbidity and staffing in psychiatric care hospital over a period of time (1980-2004) marked by the initiation and development of deinstitutionalization policies and handover of powers to RC. METHODOLOGY: Longitudinal study. Descriptive analysis of variables, broken down by RC, related to psychiatric morbidity (ICD-9, codes 290-319) and indicators of hospital staffing over a 25-year period. DATABASE SOURCE: Hospital Morbidity Survey, 1980-2004 and Statistics for care facilities providing in-patient care regime, 1980-2004. RESULTS: Differences between Regional Communities are substantial in all the analyzed variables: discharges, total and average stay, total and initial consultations, rate of psychiatrists in hospital care, number of beds and psychiatric hospitals. For all the Regional Communities as a whole, an increase is observed in hospital discharges, decrease of total and mean stays, notable increase of consultations, little increase in psychiatric staff in hospital care and stagnation in the decline of psychiatric hospitals and beds in operation in psychiatric hospital during the last period of time series and low increase in beds for the hospitals that are not classified as a psychiatric hospital. CONCLUSIONS: We found evidence of qualitatively different care models between Regional Communities and substantial changes in major indicators over time series.

Anthropometric body fat composition reference values in Spanish adolescents. The AVENA Study.

OBJECTIVE: To determine reference values for body mass index (BMI), sum of six skinfolds (sigma6 skinfolds) and body fat percentage (BF%) in Spanish adolescents aged 13-18 years, included in the AVENA Study (Alimentación y Valoración del Estado Nutricional en Adolescentes: Food and Assessment of the Nutritional Status of Adolescents). DESIGN: Multicentre cross-sectional study. SETTING: Representative sample of Spanish adolescents. SUBJECTS: The population was selected by means of a multiplestep, simple random sampling. The final number of subjects included in the AVENA Study was 2859 adolescents; 2160 adolescents had a complete set of anthropometric measurements and were then included in this study (1109 males and 1051 females). INTERVENTIONS: Weight, height and six skinfold thicknesses were measured. As indices of total adiposity, we calculated BMI, summation sigma6 skinfolds and BF% with the formulas described by Slaughter et al. RESULTS: Sigma6 skinfolds and BF% in each age group were significantly higher in females than in males. In males, age showed a significant effect for BMI, sigma6 skinfolds and BF%; however, in females, the effect was only significant for BF%. The percentile distribution was more disperse towards higher sigma6 skinfolds and BF% values in males when compared with females. CONCLUSIONS: The presented percentile values will help us to classify adolescents in comparison with a well-established reference population, and to estimate the proportion of adolescents with high or low adiposity amounts. SPONSORSHIP: The AVENA-Study was supported by the Spanish Ministry of Health (FIS 00/0015), and grants from Panrico SA, Madaus SA and Procter and Gamble SA. This study was also supported by Instituto de Salud Carlos III (Spain), RCESP (C03/09) and Spanish Ministry of Education (AP2003-2128).

Secular trends in waist circumference in Spanish adolescents, 1995 to 2000-02.

Two studies, in 1995 and 2000-02, were compared to assess changes in waist circumference in adolescents. Between the two time periods, waist circumference increased significantly in males at 13 years and in females at 14 years. Significant changes in waist circumference were observed during the study period; the rates of change were 0.53 and 0.86 cm/y in boys and 0.67 and 0.87 cm/y in girls. Future morbidity in adolescents may be affected due to accumulation of excess central fat.

Body fat measurement in adolescents: comparison of skinfold thickness equations with dual-energy X-ray absorptiometry.

OBJECTIVE: To compare the most commonly used equations to predict body fatness from skinfold thickness, in male and female adolescents, with dual-energy X-ray absorptiometry (DXA) as a reference method of fatness measurement. DESIGN: Cross-sectional nutrition survey. SETTING: General adolescent population from Zaragoza (Spain). SUBJECTS AND METHODS: A total of 238 Caucasian adolescents (167 females and 113 males), aged 13.0-17.9 y, were recruited from 15 school groups in 11 public and private schools. The percentage fat mass (%FM) was calculated by using skinfold-thickness equations. Predicted %FM was compared with the reference %FM values, measured by DXA. The lack of agreement between methods was assessed by calculating the bias and its 95% limits of agreement. RESULTS: Most equations did not demonstrate good agreement compared with DXA. However, in male adolescents, Slaughter et al equations showed relative biases that were not dependent on body fatness and the limits of agreement were narrower than those obtained from the rest of equations. In females, Brook's equation showed nonsignificant differences against DXA and the narrowest 95% limits of agreement. Only biases from Brook and Slaughter et al equations were not dependent on body fatness in female adolescents. CONCLUSIONS: Accuracy of most of the skinfold-thickness equations for assessment of %FM in adolescents was poor at the individual level. Nevertheless, to predict %FM when a relative index of fatness is required in field or clinical studies, Slaughter et al equations may be used in adolescents from both sexes and the Brook equation in female adolescents.

Body composition in adolescents: measurements and metabolic aspects.

INTRODUCTION: Adolescence is a decisive period in human life in which important body composition changes occur. Increase of total body mass and its relative distribution are mainly related to gender and pubertal development. OBJECTIVE: This review explores the specific measurements that may be used in this age group to assess excess body fat and to define obesity and overweight. RESULTS: Identification of subjects at risk for adiposity requires simple anthropometric cutoffs for the screening of overweight and obesity. In this context, BMI criterion is the most frequently used but, in spite of its high sensitivity and specificity, an important number of adolescents classified as overweight or obese do not have really high adiposity (32.1% of females and 42% of males). Excess total body fat and intra-abdominal visceral fat are related to metabolic abnormalities that increase the risk of cardiovascular diseases. Waist circumference seems to be the best simple anthropometric predictor for the screening of the metabolic syndrome in children and adolescents. CONCLUSIONS: Early identification of adolescents at risk for adiposity and its related metabolic complications requires reliable, simple and specific measures of excess body fat for this age group.

The nutrition transition in Spain: a European Mediterranean country.

BACKGROUND: Mediterranean diets are felt to be healthful diets linked with reduced mortality from diet-related noncommunicable diseases. OBJECTIVE: To examine trends in diet, activity, obesity and diet-related noncommunicable diseases for Spain and compare these with other European countries, particularly those from the Mediterranean area. DESIGN: A combination of large-scale primary and secondary nationally representative data analysis are used. DATA: Nationally representative data on household food consumption, physical activity, adult obesity, and cause of death are combined with regionally representative adolescent obesity data, obtained in the last four decades. Comparative diet and obesity data come from nationally representative comparable data, obtained during the same period. RESULTS: The Spanish diet has shifted toward a very high level of fat intake, high fruit and dairy intake and moderate vegetable intake. Dairy and fruit intakes were the highest in Europe, as was the proportion of energy from fat, when we compared with the available data. Adult overweight and obesity trends show a marked increase in the past decade to levels as high as Italy and far above France. Overweight for children aged 6-7 is above that of even the USA, while adolescent overweight levels are among the highest in the world. Cardiovascular disease mortality is low, as with Italy and France, and the cancer mortality rate is lower than Italy and France. CONCLUSIONS: We have observed that, in Spain, relatively high obesity prevalences and dairy intake levels are related to much lower levels of cardiovascular disease and cancer mortality than are found in other European countries. This unique Spanish dietary and obesity pattern should be further explored in order to clarify the causal links. SUPPORT: The National Institutes of Health (NIH; R01-HD30880 and R01-HD38700).

Determinants of resting energy expenditure in obese and non-obese children and adolescents.

Resting energy expenditure (REE) is the largest component of total daily energy expenditure. Objectives of this study were to examine whether differences in REE exist after obesity develops in a group of children and adolescents, and to determine the effects of body composition, gender, age, pubertal development and parental obesity on REE. In 116 Caucasian children and adolescents (57 obese and 59 non-obese), aged 7.8 to 16.6 years, REE was assessed by open-circuit indirect calorimetry and different anthropometric variables and bioelectrical impedance were obtained (weight, height, skinfold thicknesses, waist and hip circumferences). Anthropometric indices and body compartments were calculated: the body mass index, surface area (SA), fat-free mass (FFM), fat-mass (FM) and percentage of FM. Differences between obese and non-obese subjects were tested and stepwise multiple regression analysis was performed with REE as dependent variable. Results show that REE was significantly higher in obese than in non-obese children and adolescents but REE/FFM ratio was not significantly different between these groups. In the non-obese group, FFM explained 73.1% of the variability in REE and gender, age and SA added 3.8%, 2.6%, and 2.6% to it, respectively. In the obese group, FFM was also the most powerful predictor of REE with 72.3%, followed by waist circumference and age with 2.5% and 2.1%, respectively. These results show that REE differences between obese and lean children do not seem to justify the maintenance of obesity. The main determinant of REE is FFM in both groups. No significant contribution of FM, pubertal development or parental obesity in REE was found in children and adolescents.

Leptin and metabolic syndrome in obese and non-obese children.

Metabolic syndrome is characterized by a clustering of metabolic abnormalities: insulin resistance - hyperinsulinemia, dyslipidemia (high triglycerides and low HDL - cholesterol serum concentrations), impaired glucose tolerance and/or type 2 diabetes, and hypertension. The aim of this study was to analyse the role of different variables of metabolic syndrome, including leptin, in 74 non-obese children and 68 children with non-syndromal obesity. As metabolic syndrome variables, we have included body mass index, waist circumference, trunk-to-total skinfolds (%), systolic blood pressure, diastolic blood pressure, glucose, uric acid, fasting insulin, triglycerides and high-density lipoprotein-cholesterol (HDL-C). Factor analysis showed 4 factors in each group. In non-obese children, waist circumference, BMI, fasting insulin, triglycerides, trunk-to-total skinfolds (%), leptin and uric acid loaded positively on factor 1, and HDL-C loaded negatively on this factor; systolic and diastolic blood pressure had high positive loadings in factor 2; HDL-C and leptin showed positive loadings and triglycerides and uric acid, negative loadings in factor 3; and, finally, glucose and insulin showed positive loadings in factor 4. These four factors explained 72.16 % of the total variance in the non-obese group. In obese children, BMI, waist circumference, leptin, diastolic blood pressure and systolic blood pressure loaded positively on factor 1; diastolic blood pressure, trunk-to-total skinfolds (%), uric acid and systolic blood pressure showed high positive loadings in factor 2; fasting insulin, glucose and triglycerides showed positive loadings in factor 3; and, finally, triglycerides showed positive loadings and HDL-C negative loadings in factor 4. These four factors explained 74.18 % of the total variance in the obese group. Our results point to a different homeostatic control of metabolic syndrome characteristics in obese and non-obese children. Leptin seems to play a key underlying role in metabolic syndrome, especially in the obese group.

Resting energy expenditure in children and adolescents: agreement between calorimetry and prediction equations.

BACKGROUND AND AIMS: To assess the degree of agreement between indirect calorimetry and five equations commonly used to predict resting energy expenditure (REE) in obese and non-obese children and adolescents. METHODS: In 116 children and adolescents (57 obese and 59 non-obese) aged between 7.8 and 16.6 years, REE was measured (MREE) by open-circuit indirect calorimetry under standardized conditions. REE was predicted (PREE) in all subjects with equations from the Food and Agriculture/World Health Organization/United Nations University (FAO/WHO/UNU), Maffeis et al., Harris and Benedict, and two from Schofield: one using weight (W) and one using height and weight (H-W). Agreement between indirect calorimetry and equations was assessed following the Bland-Altman method. RESULTS: In the entire cohort group, only data from FAO/WHO/UNU, Schofield-W and Schofield-HW equations showed non-statistic differences against calorimetry results. When agreement between equations and calorimetry was tested, Schofield-HW equation showed the lowest mean MREE-PREE difference: 3.7 kcal/d (limits of agreement -293 and 300 kcal/d; 95% confidence interval for the bias -24.0 to 31.5 kcal/d) and the best agreement. Group by group, equations which obtained the best agreement were: FAO/WHO/UNU in girls, Schofield-HW in boys, Schofield-HW in obese, and Schofield-W in non-obese. CONCLUSIONS: Until more accurate prediction equations are developed, we recommend Schofield-HW equations for REE studies with a mixed population of obese and non-obese children and adolescents; however, FAO/WHO/UNU equation may also be useful in girls and Schofield-W equation in non-obese children.

Evaluación de las tecnologías sanitarias y ordenación de las prestaciones en los sistemas sociales avanzados / Evaluation of health technologies and benefits entitlement in advanced social systems

El presente trabajo parte de la consideración de la salud como un bien asegurable cuya protección se ha convertido en un derecho fundamental. En la misma línea, la asistencia sanitaria ha adquirido un carácter contractual, cuya "naturaleza" ha evolucionado de individual a colectiva, y que se expresa en términos de "seguro sanitario", sea público o privado. En tal contexto se hace necesaria la cuantificación de resultados para poder definir las variables del Sistema y, subsiguientemente, las condiciones de contratación Los resultados económicos son imprescindibles para conocer los costes y, en consecuencia, las necesidades financieras del Sistema; mientras que los resultados clínicos lo son para que el asegurado tenga unas expectativas realistas de los beneficios que puede esperar de la asistencia que se le ofrece. A su vez, el ritmo vertiginoso de innovación tecnológica que caracteriza la medicina moderna obliga a la continua revisión del estado del arte, encuadrado en un sector sanitario cuyo perfil multifactorial le confiere creciente complejidad. En conclusión, la evaluación de las tecnologías sanitarias se hace imprescindible para expresar la efectividad de la asistencia, posibilitar su gestión eficiente, definir responsabilidades y brindar garantías a los usuarios; todo lo cual ya forma parte de un cuerpo ético que, cada día con mayor nitidez, se va configurando en el Derecho y que, a su vez, es garantía de pervivencia del Sistema Asistencial (AU)

Waist circumference for the screening of the metabolic syndrome in children.

AIM: To identify the best anthropometric predictor of the metabolic syndrome in children. METHODS: Screening performance was evaluated in a clinical setting. The study included 140 children: 72 non-obese and 68 with non-syndromal obesity. Body mass index (BMI), waist circumference and triceps/subscapular skinfolds ratio were used as predictor variables, and systolic blood pressure, diastolic blood pressure, glucose, uric acid, fasting insulin, triglycerides and HDL-C as metabolic syndrome variables. RESULTS: The areas under the receiver operating characteristic (ROC) curves were 0.849 (95% CI: 0.780, 0.919) for BMI, 0.868 (95% CI: 0.801,0.934) for waist circumference and 0.834 (95% CI: 0.757,0.910) for the triceps/subscapular skinfolds ratio. No statistically significant differences were found for the three areas under the ROC curves. The point on the ROC curve closest to 1 corresponded to the 65th percentile for BMI, to the 70th percentile for waist, and to the 40th percentile for the triceps/subscapular skinfolds ratio. CONCLUSION: Waist circumference seems to be the best predictor of children with the metabolic syndrome in paediatric clinical settings.

[Evaluation of health technologies and benefits entitlement in advanced social systems]. / Evaluación de las tecnologías sanitarias y ordenación de las prestaciones en los sistemas sociales avanzados.

In the present study, health is considered a subject of insurance whose protection has become a Fundamental Right. In the same line, health care has acquired a contractual character whose "nature" has evolved from individual to collective, expressed in terms of "health care insurance", public or private. In such context, outcome measurement becomes necessary to be able to define the variables of the System and, subsequently, the contracting conditions. Having an understanding of the economic impact is required to analyze the costs and, in consequence, the financial necessities of the System; as well as the clinical results in order for the insured to have some realistic expectations of the benefits that can be expected from the health care that is offered. In turn, the vertiginous rhythm of technological innovation that characterizes the modern medicine forces to the continuous revision of the state of the art framed in a health sector whose multifactorial profile confers it growing complexity. In conclusion, health technology assessment becomes indispensable to identify health care effectiveness, to facilitate its efficient management, to define responsibilities and to offer guarantees to the users; all which is already part of an ethical body that, day by day with more clarity, is being configured by the legislation and that, in turn, guarantees the survival of the Health Care System.

Secular changes in body fat patterning in children and adolescents of Zaragoza (Spain), 1980-1995.

OBJECTIVE: To examine whether children and adolescents of Zaragoza (Spain) are becoming centrally obese to a greater extent than would be predicted by their relative body weights. DESIGN: Two cross-sectional surveys conducted in 1980 and 1995. SUBJECTS: The samples selected for the 1980 and 1995 surveys comprised 1553 and 701 male children, and 1311 and 659 female children, respectively, with ages ranging from 6.0 to 14.9 y. MEASUREMENTS: We measured four skinfold thicknesses (biceps, triceps, subscapular, suprailiac) and calculated some indices of fat patterning: triceps/subscapular skinfolds (T/SS), biceps+triceps/subscapular+suprailiac skinfolds (B+T/SS+SI), and (subscapular+suprailiac/biceps+triceps+subscapular+suprailiac skinfolds)x100 (trunk-to-total skinfolds %). RESULTS: In males, B+T/SS+SI, and trunk-to-total skinfolds % showed a significant trend to a central pattern of fat distribution from 1980 to 1995, at the ages of 6.5-11.5 y. In females, B+T/SS+SI and trunk-to-total skinfolds % showed a significant trend to a central pattern of fat distribution from 1980 to 1995, at the ages of 6.5 and 7.5 y. Similar results were obtained when we adjusted for BMI values. CONCLUSION: We have observed a trend to a central pattern of adipose tissue distribution, especially in males and at the youngest ages studied (6-11 y in males, and 6-7 y in females). These observations were independent of trends in BMI.