[Evaluation of a motivational intervention of physical activity program in the treatment of obesity and overweight]. / Evaluación de un programa de intervención motivacional de actividad física en el tratamiento de la obesidad y el sobrepeso.

OBJECTIVE: To analyse the outcomes of a motivational physical activity program for the treatment of obesity. METHOD: A randomised, controlled, double blind clinical trial with 2 arms, 12 months of follow-up and a 1:1 allocation ratio. The data was collected between July 2017 and July 2018. The patients, of both genders, had to be referred by their occupational medicine doctors with the diagnosis of overweight or obesity and be aged between 20 and 65 years. An analysis was made of the anthropometric measurements, lipid parameters, as well as on the follow-up of the program. RESULTS: A total of 123 obese or overweight patients participated. Two groups were formed; 61 in intervention group [G1] and 62 in as usual care control group [G2]). As regards the 107 that finished the study (60 in G1 and 47 in G2), the mean age was 45.55±12.83 SD, with 57.2% women and 42.8% men. The number of patients followed-up was much higher in the Physical Activity Program than in the control group, and the number of dropouts (only one) was insignificant. It can be seen how both the weight and the body mass index as the main lipid parameters are reduced in the study group significantly with respect to the control group. The physical activity of the group in the motivated physical activity program is three times higher than in the group without intervention. There was a significant relationship between the increase in activity and weight reduction (P<.001), also between the reduction in weight and the reduction in cholesterol and triglycerides. CONCLUSIONS: In our study, a motivational physical activity program leads to more follow-up and therefore improves the anthropometric and lipid parameters.

[Cardiovascular risk and cardiovascular events in the general population of the sanitary area of Toledo. RICARTO Study]. / Justificación, objetivos y diseño metodológico del estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo).

INTRODUCTION: The main aim of this study is to ascertain the prevalence of cardiovascular risk factors (CVRF), target organ damage (TOD), cardiovascular disease (CVD), as well as life habits (physical exercise, alcohol consumption, and Mediterranean diet) in the population of a Health Area in Toledo, Spain, to assess cardiovascular risk (CVR). MATERIAL AND METHODS: Epidemiological and observational study that will analyse a sample from the general population aged 18 years or older, randomly selected from a database of health cards, and stratified by age and gender. Clinical history, physical examination, and complementary tests will be performed. Aliquots of whole blood and serum samples will be stored at a temperature of-85°C to evaluate future genetic studies. CVR will be estimated by using SCORE project scales calibrated for Spanish population and the Framingham Heart Study scale. When the estimated sample size has been achieved and after a minimum follow-up of 5 years, a final visit will performed in which CVRF, TOD, CVD, CVRF control, and fatal and non-fatal outcomes will be evaluated. DISCUSSION: The RICARTO study is aimed to assess the prevalence of the main CVRF, TOD and CVD in order to determine the CVR in the general population of a health area of Toledo. An analysis will be repeated on the final sample after at least 5 years of follow-up to ascertain the incidence of CV outcomes and the temporal trends of life style, as well as the prevalence of CVRF, TOD, and CVD.

[Characteristics and cardiovascular events in a general population included in the RICARTO (RIesgo CARdiovascular TOledo) study: Data from the first 1,500 individuals included in the study]. / Características de la población general incluida en el estudio RICARTO (RIesgo CARdiovascular y eventos cardiovasculares en la población general del área sanitaria de TOledo): resultados con los primeros 1.500 individuos incluidos en el estudio.

INTRODUCTION: The aim of this study was to assess cardiovascular risk (CVR) by investigating the prevalence of CVR factors (CVRF), target organ damage (TOD), and cardiovascular disease (CVD) in general population of the health area of Toledo, Spain. MATERIAL AND METHODS: Epidemiological and observational study that analysed a sample from the general population aged 18years or older, randomly selected from a database of health cards stratified by age and gender. Clinical history, physical examination, and complementary tests were performed. Total blood and serum samples were frozen at -85°C to evaluate genetic studies in the future. Standard statistical analysis was performed. CVR was assessed by the SCORE scale calibrated for the Spanish population, and the Framingham Heart Study scale. RESULTS: A total of 1,500 individuals (mean age 49.1±15.8years, 55.6% women) were included. Prevalences: dyslipidaemia 56.9% (95% confidence interval [95% CI]: 54.3-59.4), hypertension 33.0% (95%CI: 30.6-35.4), diabetes mellitus 8.6% (95%CI: 7.17-10.1), smoking 24.2% (95%CI; 122.0-26.4), obesity 25.3% (95%CI; 23.1-27.5), and sedentary life-style 39.4% (95%CI; 36.9-41.8). No CVRF was reported in 21.1% of cases, and 18.6% had 3-5 CVRF. TOD: electrocardiographic left ventricular hypertrophy, 4.3%, peripheral artery disease, 10.1% (Doppler ultrasound), and 15.3% (oscillometric device), microalbuminuria, 4.3%, sub-clinical renal disease, 3.2%, and nephropathy in 3.8% (CKD-EPI). At least one CVD was reported in 9.2% of cases. A low CVR (SCORE) was present in 44.6% of individuals. CONCLUSIONS: Dyslipidaemia was found in 60% of individuals, 40% had a sedentary life-style, 30% with hypertension, 20% smoked, 20% obesity, and almost 10% with diabetes. More than a half of individuals have a moderate-high-very high risk. The prevalence of TOD and CVD are significant.

[Analysis of clinical relevance applied to 3methods of reducing weight in overweight or obesity followed-up for one year]. / Análisis de relevancia clínica aplicado a 3métodos de reducción de peso en pacientes con sobrepeso u obesidad seguidos durante un año.

OBJECTIVE: To analyse the effect of the use/implementation of 3methods to reduce weight in overweight or obese patients during one year of follow up. MATERIAL AND METHODS: The design corresponds to a double-blind, randomised, controlled clinical trial with 3arms, and 12 months of follow-up. Patients were randomised into 3intervention groups: obesity motivational intervention, with a nurse previously trained in motivational intervention by expert psychologists (G1; n=60); lower intensity consultation, non-motivational group, with digital platform support (G2; N=61), and a third group that received recommendations for weight loss and follow-up in Primary Care Clinic (G3; n=59). Anthropometric variables (weight, height, and abdominal-waist circumference) were measured, and the percentage of patients who managed to reduce their weight ≥5% was considered as the main measurement of treatment effectiveness. RESULTS: All groups significantly decreased body weight at the end of the study, with a reduction in G1 (-5.6kg) followed by G2 (-4.3kg), and G3 (-1.7kg), with an overall mean: -3.9kg. The indicators of clinical relevance were in G1/G3: relative risk (RR): 4.99 (95% CI: from 2.71 to 9.18); relative risk reduction (RRR): 399.1% (171.3 to 818.0); Absolute risk reduction (RAR): 65.3% (from 51.5 to 79.1) and NNT: 2 (from 2 to 2). In the G2/G3 groups: RR: 3.01 (from 1.57 to 5.76); RRR: 200.5% (from 57.0 to 475.5); RAR: 32.8% (from 16.9 to 48.7) and NNT: 4 (from 3 to 6). In the G1/G2 groups: RR: 1.66 (from 1.25 to 2.20); RRR: 66.1% (from 25.3 to 120.1); RAR: 32.5% (from 16.6 to 48.4) and NNT: 4 (from 3 to 7). CONCLUSIONS: All 3groups were able to reduce weight. Although the group with motivational intervention achieved the greatest decrease, as well as the most favourable clinical relevance indicators.

Alteraciones radiológicas y movilidad de la columna vertebral observadas en pilotos de combate españoles / Radiological alterations and spine mobility in Spanish fighter pilots

Antecedentes y Objetivos: El dolor de espalda es padecido por la mayoría de pilotos de combate. Los objetivos del presente estudio hansido valorar en esta población si aparecen lesiones precoces de la columna vertebral y la movilidad de ésta. Material y Métodos: Participaron 30 pilotos de combate y 16 militares como grupo de comparación (GC), no pilotos, destinados en la Base Aérea de Albacete, España. A todos se les practicó 6 radiografías (dos en la columna cervical, dos en la columna dorsal y dos en la región lumbosacra). Se calculó larazón de prevalencias (RP) de las lesiones valoradas entre los dos grupos, considerando significativo un valor de P≤0,05. Resultados: Tanto la edad media de los pilotos (31,9 años [DE=5,9]) como la del GC (32,3 años [DE=3,4]), así como su índice de masa corporal (24,4 kg/m2 en los pilotos frente a 24,4 [DE=1,9] del GC) fueron similares. Encontramos diferencias significativas entre los dos grupos en las siguientes variables: uncoartrosis (RP=2,4; P=0,02), artrosis interapofisarias (RP=2,82; P=0,02), osteofitos (RP=4,26; P=0,007), pérdida de alturadel cuerpo vertebral (RP=11,29; P=0,008) en la región cervical, e irregularidades subcondrales (RP=2,82; P=0,02) en la región dorsal. La movilidad de la espalda (valorada por flexiones en las distintas regiones, extensiones, rotaciones y lateralizaciones) fue menor en el piloto de combate. Conclusiones: Los pilotos de combate de nuestro estudio presentan una mayor rigidez en la columna vertebral, asi como alteraciones radiológicas precoces, principalmente en la región cervical, comparados con un GC similar (AU)

Background and Objectives: Back pain is suffered by most fighter pilots. The objectives of this study were evaluated in this population ifthere are early lesions of the spine and their mobility. Material and Methods: The participants were 30 fighter pilots and 16 soldiers as acomparison group (CG), no fighter pilots, stationed in the Air Base in Albacete, Spain. All 6 underwent X-rays (two in the cervical spine,two in the thoracic spine and two in the lumbosacral region). We calculated the prevalence ratio (PR) of the lesions assessed between thetwo groups was considered significant a P value ≤ 0.05. Results: Both the average age of fighter pilots (31.9 years [SD = 5.9]) as the CG (32.3 years [SD = 3.4]) and body mass index (24 , 4 kg/m2 in fighter pilots compared to 24.4 [SD = 1.9] of the CG) were similar. We foundsignificant differences between the two groups in the following variables: uncoartrosis (PR = 2.4, P = 0.02), apophyseal osteoarthritis (PR = 2.82, P = 0.02), osteophytes (PR = 4.26 P = 0.007), loss of vertebral body height (PR = 11.29, P = 0.008) in the cervical region, subchondral irregularity (PR = 2.82, P = 0.02) in the dorsal region. The mobility of the back (as measured by bending in different areas, extensions, rotations and lateralized) was lower in the fighter pilot. Conclusions: The fighter pilots of our study have a higher stiffness in the spine, aswell as early radiological changes, mainly in the cervical region, compared with a similar CG (AU)

[Evaluation of the p53 Arg72Pro polymorphism as a prognostic factor in severe head injury and the inclusion of this indicator in a predictive model]. / Evaluación del polimorfismo Arg72Pro de p53 como factor pronóstico del traumatismo craneoencefálico grave y su participación en la construcción de un modelo predictivo.

BACKGROUND AND OBJECTIVE: Physiologic variables have traditionally been studied as prognostic factors in severe head injury. Until recently it was not thought that genetic factors might play a role. The main objective of this study was to construct a logistic regression model including physiologic variables and the p53 Arg72Pro polymorphism, which can promote neuron death through apoptosis. MATERIAL AND METHODS: We included 90 patients admitted to the postoperative recovery unit with severe head injury. Patients with previous neurologic deficits were excluded. Clinical variables were recorded. The p53 Arg72Pro polymorphism was analyzed using polymerase chain reaction of DNA in blood. Neurologic outcome was assessed on the Glasgow Outcome Scale. A predictive logistic regression model was then constructed based on relevant candidate variables (sex, age, poor Glasgow score, the Acute Physiology and Chronic Health Evaluation II score, pupil size, pupil reactivity, subarachnoid hemorrhage, number of days in the recovery unit, number of days on mechanical ventilation, and the early development of hypotension) in addition to the p53 Arg72Pro polymorphism. RESULTS: The Arg/Arg polymorphism was an independent predictor of poor outcome (odds ratio, 3.55; 95% confidence interval [CI], 1.11-1132; P = .032). The selected model (including the variables age, gene polymorphism, pupil reactivity, and Glasgow score) had adequate discriminatory power (sensitivity 823%, 95% CI 72.8%-91.8%; specificity 78.6%, 95% CI 63.4%-93.8%), classifying 81.1% of the patients correctly. The p53 Arg72Pro polymorphism, along with pupil reactivity, age and Glasgow score, is useful in a predictive model of good or poor outcome on discharge after head injury.

[Influence of diet and lifestyle in colorectal cancer]. / Influencia de la dieta y los estilos de vida en el cáncer colorrectal.

OBJECTIVE: to assess the relationship between different colorectal cancer risk factors in Albacete province. MATERIAL AND METHOD: the incidence and prevalence of CC (colorectal cancer) in Albacete province during the years from 1992 to 1999 were calculated using data from the Surgery and Anatomical Pathology Departments of hospitals located in the province, both public ("Complejo Hospitalario Universitario de Albacete" and "Hospital Comarcal de Hellín") and private ("Recoletas", "Sanatorios del Rosario" and "Santa Cristina"), and the provincial archives of the National Cancer Registry. Subsequently, the same calculation was made for each of the 33 Health Areas into which the province is organized. The three Health Areas with the highest incidence, and the three with the lowest incidence, of CC were selected for the study. By means of a systematic randomization of persons over 50 years, 445 persons were selected for the study using the census of the 25 villages and towns located in the high and low CC incidence areas. Subsequently we carried out the survey in these two zones: high and low incidence areas. Data were collected in Dbase IV, and the statistical analysis was carried out with the statistical package SPSS 10.1 for Windows. RESULTS: during the period studied 531 new cases of CC were registered, of which 291 (54.99%) were men. Mean rate was 15.9 per 100,000 persons/year. Highest incidence areas included Elche de la Sierra (30.2 per 100,000 persons/year), followed by Alcadozo (28.3), and Ontur (26.9). Lowest incidence areas were Ossa de Montiel (5.9), Munera (5.1), and Balazote (6.5). Out of 450 participants 414 (92%) filled out the questionnaire correctly. Variables including some kind of alcohol use (beer, wine, and coffee with brandy) are significantly associated with CC and multiply by more than one the risk for this disease. Some qualitative variables with statistically significant association increase, while some decrease, the risk of CC. For example, associated pathologies multiplies the risk of CC by 0.6, physical exercise by 0.3, moderate intake of alcohol by 0.5, olive oil intake by 0.7, and water intake by 0.3. Furthermore, a high intake of alcohol multiplies the risk of CC by 1.8, eggs and omelette by 2.95, pasta and rice by 2.15, blue fish by 1.8, meat and cold meats by 1.6, and having a first- or second-degree relative with cancer by 3. CONCLUSIONS: there is a significant relationship between colorectal cancer and familial cancer, physical activity, and the ingestion of alcohol, water, pasta, rice, and eggs.

Arteriosclerosis y riesgo vascular en la obesidad / Arteriosclerosis and vascular risk in the obesity

La obesidad constituye un auténtico problema de salud pública, originando un enorme gasto sanitario, estrechamente relacionada con la arteriosclerosis y asociada a una mayor morbimortalidad. Los objetivos del presente estudio son valorar el nexo de la obesidad con la arteriosclerosis en los diferentes territorios vasculares, su relación con otros factores de riesgo vascular y si una vez corregido el defecto metabólico disminuye la morbimortalidad asociada. Para ello se analiza especialmente y a la luz de los datos actuales la relación de la obesidad con la hipertensión arterial, con el metabolismo hidrocarbonado, las dislipemias, el síndrome plurimetabólico y la mortalidad. Cuando el tratamiento de la obesidad es efectivo, la reducción de peso disminuye con la morbimortalidad, mejora la insulinorresistencia, disminuye la presión arterial; el estado protrombótico, el nivel de glucemia y favorece el perfil lipídico. Como conclusión final, la reducción de peso, aunque necesaria, no es fácil, por lo que para lograr este objetivo se insiste en que debe existir una gran motivación por parte del profesional sanitario y del paciente, ya que requiere unos cambios permanentes en los hábitos de vida, de difícil implantación. Por ello, el mejor tratamiento en la actualidad lo constituye la intervención de los sistemas de salud, padres y educadores en una adecuada divulgación de la nutrición correcta en las primeras etapas de la vida, con el fin de que quede consolidada en todas las etapas posteriores (AU)

La oficina de farmacia puede mejorar el grado de conocimiento de la hipertensión arterial / Pharmacies can improve the detection of arterial hypertension

Objetivo. Valorar la posible utilidad de medidas repetidas de presión arterial (PA) en la farmacia (OF) para mejorar del grado de conocimiento de la hipertensión arterial (HTA).Diseño. Estudio de intervención sin asignación aleatoria, antes-después. Métodos. De forma voluntaria participaron OF en las que, sin criterios específicos de selección, se realizaron tres medidas de PA, en condiciones estandarizadas y con un aparato electrónico automático validado (OMRON 705 CP), a 5-10 sujetos mayores de 18 años no hipertensos conocidos que acudían por cualquier motivo a la farmacia. Si los valores medios de la segunda-tercera toma eran 140/90 mmHg se les citaba otros dos días diferentes en los cuales se volvían a realizar otras tres medidas. Si los valores medios de las 6 medidas (segunda-tercera medidas de los 3 días) eran 140/90 mmHg se les consideraba como hipertensos y se remitían a sus centros de salud volviéndoles a citar al cabo de 4 semanas para ver si se había confirmado en el centro de salud el diagnóstico. Resultados. Han participado 36 OF en las que se ha medido la PA a 326 sujetos, considerando, con las medidas del primer día, a 90 de ellos como posibles hipertensos. Completaron las medidas de los 3 días 55 posibles hipertensos de los que 45 confirmaron el diagnóstico de HTA en la OF y de ellos 24 lo confirmaron en su centro de salud. Conclusiones. La OF, con medidas estandarizadas y aparatos electrónicos validados, pueden ser un lugar ideal para mejorar el grado de conocimiento de la HTA. Es preciso hacer medidas repetidas de PA para confirmar el diagnóstico de HTA. (AU)