Reply: New alternatives in body composition assessment techniques.

Undoubtedly, ultrasound measurement of fat thickness and A/G ratio could provide a practical solution in places where DXA is unavailable. Still, it possesses several challenges due to diverse corporal compositions, especially in the measure of fat thickness in overweight or obese patients. In addition, those patients tend to have a sizeable abdominal diameter, so visualizing the aorta could be challenging; despite this technical factor, ultrasound often results be accurate and reliable, as should be expected from a suitable measurement technique for abdominal subcutaneous fat. It would be interesting to compare other body composition assessment techniques, such as MRI, which has excellent agreement with DXA without the ionizing radiation or compare it to computed tomography that can accurately determine fat in skeletal muscle tissue and the liver.

Nursing Students' Satisfaction: A Comparison between Medium- and High-Fidelity Simulation Training.

Training based on clinical simulation is an effective method of teaching in nursing. Nevertheless, there is no clear evidence about if it is better to use high- or medium-fidelity simulation. The aim is to analyse if students are more satisfied when their clinical simulation practices are based on high-fidelity simulation (HFS) or medium-fidelity simulation (MFS). Students´ satisfaction was assessed using the Satisfaction Scale Questionnaire with High-Fidelity Clinical Simulation. The sample is composed of 393 students from two Spanish Universities. Satisfaction with simulation in nursing students is significantly greater in MFS than HFS. Simulation is beneficial for learning in all its forms, but for the acquisition of basic skills, and at a lower cost, MFS proves to be effective. However, high-fidelity is not always better than medium-fidelity as this depends on the student's level of knowledge and clinical experience.

Estudio descriptivo de la satisfacción de los estudiantes del Grado en Enfermería en las prácticas de simulación clínica de alta fidelidad / Descriptive study of the satisfaction of nursing degree students in high-fidelity clinical simulation practices

OBJETIVO: Describir el nivel de satisfacción de los estudiantes de Enfermería con la simulación clínica en su formación de Grado. MÉTODO: Se realizó un estudio observacional descriptivo de corte transversal retrospectivo en estudiantes del Grado en Enfermería durante los cursos académicos 2016-2017 y 2017-2018. El instrumento utilizado fue la escala de satisfacción en SC de alta fidelidad en estudiantes (ESSAF), un cuestionario validado, anónimo y autoadministrado (alfa de Cronbach 0,857) para medir el grado de satisfacción tras las prácticas en simulación clínica de alta fidelidad. RESULTADOS: Participaron un total de 269 estudiantes, de los cuales el 63,3% fueron mujeres y la edad media ± desviación estándar de la muestra fue de 21,68 ± 13,46 años. El análisis de frecuencias muestra resultados del nivel de satisfacción superiores al 89%, especialmente en la toma de decisiones, la capacidad de priorizar y el aprendizaje de procedimientos. El 87% de las respuestas superaban una media de 4 sobre 5. Las preguntas del cuestionario con respuestas superiores al 4,6 fueron el realismo de los casos (4,71), el profesor hace retroalimentación constructiva después de cada sesión (4,65), la simulación relaciona la teoría con la practica (4,72), el análisis (debriefing) al final de la sesión ayuda a la reflexión de los casos (4,65) y utilidad práctica (4,69). CONCLUSIONES: Los estudiantes del Grado en Enfermería de la Universidad de Cantabria (España) refieren una elevada satisfacción con la simulación clínica de alta fidelidad, confirmando su utilidad en el proceso de aprendizaje

OBJECTIVE: To describe the level of satisfaction of nursing students with clinical simulation in their undergraduate training. METHOD: a descriptive observational study of a retrospective cross section was conducted in undergraduate students in Nursing during the academic years 2016-17 and 2017-18. The instrument used was the High Fidelity Clinical Simulation satisfaction scale in students (ESSAF), a validated, anonymous and self-administered questionnaire (alpha .857) to measure the level of satisfaction after high-fidelity clinical simulation practices. RESULTS: Data were collected from a total of 269 students, of which 63.3% were women and the average age of the sample was 21.68±13.46 years. The analysis of frequencies shows results of the grade of satisfaction over 89%, especially in decision-making, the ability to prioritize and learning procedures. Of the answers, 87% exceeded an average of 4 out of 5. The questions in the questionnaire with answers higher than 4.6 were the realism of the cases (4.71), the teacher provides constructive feedback after each session (4.65), the simulation relates theory to practice (4.72), the analysis (debriefing) at the end of the session helps reflection on the cases (4.65) and practical utility (4.69). CONCLUSIONS: Nursing students from the University of Cantabria (Spain) report high satisfaction in high fidelity clinical simulation, confirming its usefulness in the learning process

Self-Reported Prevalence of Chronic Non-Communicable Diseases in Relation to Socioeconomic and Educational Factors in Colombia: A Community-Based Study in 11 Departments.

Background: Chronic non-communicable diseases are prevalent conditions in developing countries, such as Colombia. Several socioeconomic and educational factors have been associated with these pathologies. However, there is little country-specific information regarding the self-reported prevalence of chronic diseases and their association with the aforementioned factors in Colombia. Objectives: To evaluate the current situation of chronic non-transmissible diseases in Colombia by self-report and to analyze its potential relationship with sociodemographic, economic and educational factors. Methods: This is a cross-sectional baseline sub-analysis from the prospective, standardized collaborative PURE study in Colombia. Participants were recruited between 2005 to 2009, in 11 departments of the country, and included 7,485 subjects of 35 to 70 years old. Questionnaires of self-reported chronic non-communicable diseases, and demographic, socioeconomic and educational variables were applied. Results: Hypertension was the most prevalent chronic condition reported with a prevalence of 22.2% (21.2%-23.1%, 95% CI), followed by diabetes with a prevalence of 5.7% (5.1%-6.2%, 95% CI), asthma 2.7% (2.2%-3.0%, 95% CI), coronary heart disease 2.4% (2.0%-2.7%, 95% CI), stroke and heart failure 1.5% (1.2%-1.8%, 95% CI) each, chronic obstructive pulmonary disease 1.2% (0.6%-1.5%, 95% CI), and cancer 1.2% (1.0%-1.5%, 95% CI). Among the study sample, 23.3% (22.4%-24.3%, 95% CI) reported having one chronic NCDs, and 6.4% (5.9%-7.0%, 95% CI) reported having multiple chronic NCDs. The prevalence of multiple NCDs increased significantly with age, was more common in those from households with higher income, whereas it was significantly lower in persons with high education.The central and central-east regions of the country are those with the higher prevalence of self-reported NCDs. Conclusion: The results of the current study indicate the presence of socioeconomic and educational inequalities in the distribution of chronic NCDs in the Colombian population.

The Spanish version of the stressors in nursing students scale.

WHAT IS KNOWN ON THE SUBJECT?: The mental health of health professionals is affected by their own work. Nurses and nursing students face high levels of stress, which results in anxiety, burnout, and depression. There are scales that allow the measurement of specific stress levels of nursing students, especially when they first attend their clinical practices in real settings such as hospitals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our study consists of validating an existing scale (the Stressors in Nursing Students Scale, SINS) that measures these stress levels in Spanish. Stress is an issue for nursing students and is related to the specific stressors they encounter in the process of their professional work and study. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The validation and adaptation of this scale to Spain will allow us to adequately assess the stress levels of our students to give them adequate tools for the emotional control of their anxiety and stress. Once we have a reliable and appropriate tool for measuring the factors of greater impact in the generation of stress, we can implement preventive measures which may be very useful for the control of anxiety. ABSTRACT: Introduction Nursing professionals and students suffer a greater number of stressors with negative health consequences. Aim To translate and test a Spanish version of the Stressors in Nursing Students Scale (SINS-S), with a cohort of nursing students in Spain. Also, we sought to examine the factor structure of this test and explore the psychometric structure of stress among this population. Method The SINS scale was translated into Spanish and administered to a cohort (n = 398) of male and female Spanish nursing students in the final three years of their nursing program. Data were analyzed using exploratory factor analysis. Results Exploratory factor analysis revealed four factors: "Clinical," "Financial," "Confidence," and "Education." Discussion There were similarities between the perception of stressors by nursing students in Spain compared with the original version of the SINS from the United Kingdom. Stress is an issue for nursing students and is related to the specific stressors they encounter in the process of their professional work and study.

Descriptive study of the satisfaction of nursing degree students in high-fidelity clinical simulation practices. / Estudio descriptivo de la satisfacción de los estudiantes del Grado en Enfermería en las prácticas de simulación clínica de alta fidelidad.

OBJECTIVE: To describe the level of satisfaction of nursing students with clinical simulation in their undergraduate training. METHOD: a descriptive observational study of a retrospective cross section was conducted in undergraduate students in Nursing during the academic years 2016-17 and 2017-18. The instrument used was the High Fidelity Clinical Simulation satisfaction scale in students (ESSAF), a validated, anonymous and self-administered questionnaire (alpha .857) to measure the level of satisfaction after high-fidelity clinical simulation practices. RESULTS: Data were collected from a total of 269 students, of which 63.3% were women and the average age of the sample was 21.68±13.46 years. The analysis of frequencies shows results of the grade of satisfaction over 89%, especially in decision-making, the ability to prioritize and learning procedures. Of the answers, 87% exceeded an average of 4 out of 5. The questions in the questionnaire with answers higher than 4.6 were the realism of the cases (4.71), the teacher provides constructive feedback after each session (4.65), the simulation relates theory to practice (4.72), the analysis (debriefing) at the end of the session helps reflection on the cases (4.65) and practical utility (4.69). CONCLUSIONS: Nursing students from the University of Cantabria (Spain) report high satisfaction in high fidelity clinical simulation, confirming its usefulness in the learning process.

The spectrum of the dyslipidemia in Colombia: The PURE study.

BACKGROUND: Dyslipidemia is a major risk factor for cardiovascular diseases (CVD). Worldwide, a third of ischemic heart disease is due to abnormal cholesterol levels and it is the most common cause of cardiovascular deaths in Colombia. In Colombia, no representative, large-scale study has assessed the prevalence of dyslipidemia. The aim of the present analysis was to identify the magnitude of the problem in Colombia, a middle-income-country with large regional, geographic, and socio-economical differences. MATERIAL AND METHODS: The sample comprised 6628 individuals aged 35 to 70 years (mean age 50.7 years, 64.1% women) residing in the four Colombian regions. RESULTS: The overall prevalence of dyslipidemia was 87.7% and was substantially higher among participants older than 50 years, male, rural residents, and those with a lower level of education (66.8%), and with a lower income (66.4%). High non HDL-c was the most common abnormality (75.3%). The values of total cholesterol and non-HDL-cholesterol were higher in areas with the lowest health needs index than in the areas with intermediate and highest health need index, the isolated HDL-c value was much lower. CONCLUSION: Colombia has a high prevalence of abnormalities of the lipid profile. The causes of the high rates of dyslipidemia were not well define in this study, but were more common in rural and poorer regions and among those with lower socio-economical status. Strategies to tackle the adverse lipid profile to reduce CVD are needed in Colombia, particularly in rural areas and among the areas with the higher health need index.

Fixed-dose combination therapy to improve hypertension treatment and control in Latin America / Terapia de combinación a dosis fija para mejorar el tratamiento y el control de la hipertensión en América Latina

Abstract Hypertension is a major risk factor for cardiovascular disease. Its prevalence is increasing worldwide, and is more common in low and middle-income countries. The effectiveness of hypertension treatment is determined by health cost, awareness, and patients' compliance with the treatment. People worldwide with an adequate control of hypertension correspond to a very small percentage in low and medium income countries as the Latin America ones. Between the causes to explain these are the low availability, affordability and adherence to treatment with multiple pills. It has been proposed that fixed dose combination therapy could improve the availability, affordability, adherence and control of hypertension. This article aims to review the evidence, showing that fixed dose combination can improve adherence, decrease health cost and improve control of hypertension. Improvement in hypertension control with fixed dose combination could make an important contribution to efforts to fight against the global cardiovascular morbidity and mortality. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Resumen La hipertensión es un factor de riesgo importante para el desarrollo de enfermedades cardiovasculares. Su prevalencia está aumentando en todo el mundo, y es más común en los países de medianos a bajos ingresos. La eficacia del tratamiento de la hipertensión está determinada por el costo, el conocimiento y la adherencia de los pacientes con el tratamiento. El control adecuado de la hipertensión corresponde a un porcentaje muy pequeño en países de medianos a bajos ingresos como los países de América Latina. Entre las causas para explicar esto se encuentran la baja disponibilidad, asequibilidad y adherencia al tratamiento con múltiples medicamentos antihipertensivos. Se ha propuesto que la terapia combinada a dosis fija podría mejorar la disponibilidad, asequibilidad, adherencia y control de la hipertensión. Este artículo tiene como objetivo revisar la evidencia que demuestra que la combinación de dosis fija puede mejorar la adherencia, disminuir los costos de salud y mejorar el control de la hipertensión. La mejoría en el control de la hipertensión con terapia de combinación a dosis fija podría aportar una importante contribución a los esfuerzos para combatir la morbilidad y la mortalidad cardiovascular a nivel mundial. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Polypill: an affordable strategy for cardiovascular disease prevention in low-medium-income countries.

The simplification of fixed dose medications by using a single 'polypill' is an attractive strategy to improve adherence to medications which has shown benefit to cardiovascular risk factor control and cardiovascular disease prevention or delay in the progression of these diseases. We review the evidence obtained from a series of clinical trials demonstrating an improvement in adherence to the polypill compared to the use of each compound separately, and found similar or better control of the classical cardiovascular risk factors and a similar safety profile. These results suggest that the use of the polypill could have a beneficial impact in cardiovascular morbidity and mortality. Furthermore, the polypill has the potential to improve cost effectiveness and is simple to use. However, before recommending the implementation of the polypill in programs aimed at primary and secondary cardiovascular prevention, we are awaiting the results of several current clinical trials aimed at measuring the impact on the frequency of major cardiovascular outcomes, particularly in low-medium-income countries.

Fixed-dose combination therapy to improve hypertension treatment and control in Latin America.

Hypertension is a major risk factor for cardiovascular disease. Its prevalence is increasing worldwide, and is more common in low and middle-income countries. The effectiveness of hypertension treatment is determined by health cost, awareness, and patients' compliance with the treatment. People worldwide with an adequate control of hypertension correspond to a very small percentage in low and medium income countries as the Latin America ones. Between the causes to explain these are the low availability, affordability and adherence to treatment with multiple pills. It has been proposed that fixed dose combination therapy could improve the availability, affordability, adherence and control of hypertension. This article aims to review the evidence, showing that fixed dose combination can improve adherence, decrease health cost and improve control of hypertension. Improvement in hypertension control with fixed dose combination could make an important contribution to efforts to fight against the global cardiovascular morbidity and mortality.