Efectividad de la intervención motora temprana en el desarrollo motor de los niños con parálisis cerebral entre 3 y 5 años de edad. Revisión sistemática / Effectiveness of early motor interventions in children with cerebral palsy between 3 to 5 years of age: Systematic review

La intervención motora temprana es esencial en niños con parálisis cerebral; sin embargo, se desconoce su efectividad entre los 3 y los 5años. El objetivo fue determinar la efectividad de la intervención motora temprana en el desarrollo motor de dicha población. Se realizó una revisión sistemática de literatura acerca de intervenciones motoras tempranas realizada en diferentes bases de datos como Pubmed/Medline, PEDro, OTSeeker, Embase y LILACS. Finalmente se seleccionaron 18 artículos, de los cuales 4 presentaron cambios a favor del grupo experimental en los desenlaces desarrollo motor global y función motora manual, con la terapia de integración sensorial y la terapia de movimiento inducido por restricción, respectivamente; no obstante, los resultados no fueron estadísticamente significativos y el nivel de evidencia fue bajo. La intervención motora temprana podría incluirse con precaución para la mejoría del desarrollo motor global y la función manual. Es necesario realizar estudios de mayor calidad metodológica. (AU)

Early motor intervention is essential in children with cerebral palsy; however, it is unknown its effectiveness between 3 to 5years. The objective was to determinate the effectiveness of early motor intervention in the motor development of this population. A systematic literature search was performed in Pubmed/Medline, PEDro, OTSeeker, Embase, and LILACS. Finally, 18 articles were selected, of which 4 showed favorable changes in the experimental group in the outcomes of overall motor development and manual motor function, with sensory integration therapy and movement-induced restriction therapy, respectively; however, the results were not statistically significant, and the level of evidence was low. Early motor intervention could be cautiously considered for improving overall motor development and manual function. Higher-quality methodological studies are necessary. (AU)

Prevalence of irritable bowel syndrome and other functional gastrointestinal disorders in Uruguay.

INTRODUCTION AND AIMS: Irritable bowel syndrome (IBS) is one of the most frequent functional gastrointestinal disorders. Prevalence worldwide is estimated at 11%. There is little information on the prevalence of the other functional bowel disorders (FBDs). Our aim was to establish the prevalence of IBS and other FBDs according to the Rome IV criteria, in Uruguay. MATERIALS AND METHODS: An observational, population-based prevalence study was conducted. Data were collected through an online questionnaire, utilizing the Rome IV criteria. RESULTS: Of the 1,052 participants (79% women, mean patient age 44 years), 47.2% met the Rome IV diagnostic criteria for at least one of the FBDs analyzed. Functional constipation (FC) was the most frequent, at 18.7% (16.4-21.1), followed by IBS at 17.1% (14.9-19.4) and functional diarrhea (FD) at 15.4% (13.3-17.6). IBS with constipation (IBS-C) was the most frequent IBS subtype (35%) and the IBS with diarrhea (IBS-D) subtype predominated in men. All FBDs were more prevalent in women and youths. Of the survey participants with a FBD, 59% stated that they perceived no worsening of their symptoms related to the COVID-19 pandemic. CONCLUSIONS: Ours is the first prevalence study on FBDs conducted on the Uruguayan general population. Half of the participants surveyed presented with a FBD analyzed in the study. FC was the most frequent, followed by IBS and FD. The prevalence rate of IBS was the highest, based on the Rome IV diagnostic criteria, and constipation was the most frequent subtype.

Motor and process skills of people with parkinson's disease compared to healthy older adults. A cross-sectional study. / Habilidades motoras y de procesamiento en personas con enfermedad de Parkinson en comparación con adultos mayores sanos. Un estudio transversal.

INTRODUCTION: Both Parkinson's disease (PD) and the process of ageing are associated with functional limitations. The aim of this study was to determine the differences in motor and process skills between individuals with PD and healthy older adults, as well as to observe how disease progression affects motor and process skills performance in PD patients. SUBJECTS AND METHODS: A cross-sectional study was conducted. The Assessment of Motor and Process Skills (AMPS) measure was employed in order to analyze the differences in the motor and process skills of daily tasks in people with PD and healthy older adults age- and sex-matched. Part III of the Unified Parkinson Disease Rating Scale (UPDRS), the Hoehn and Yahr (HY) scale and the Schwab & England scale was administered to determine the severity of the disease. RESULTS: Seventy participants (49 patients with PD and 21 healthy older adults) were recruited for this study. Our results showed that even at moderate stages of the disease, both motor and process skills were found deteriorated in PD patients more than older healthy older adults (p < 0.001). As PD progresses, motor and process skills present significantly deterioration. CONCLUSION: PD leads to a greater deterioration in motor and process skills compared to healthy older adults. As disease stages advance according to the HY scale, performance in motor and process skills deteriorates significantly between moderate and advanced PD stages. According to the AMPS scale, PD patients show no impairment of processing skills up to HY IV, but motor impairment at HY stages II, III and IV.

TITLE: Habilidades motoras y de procesamiento en personas con enfermedad de Parkinson en comparación con adultos mayores sanos. Un estudio transversal.Introducción. Tanto la enfermedad de Parkinson (EP) como el proceso de envejecimiento están asociados con limitaciones funcionales. El objetivo de este estudio fue determinar las diferencias en habilidades motoras y de procesamiento entre individuos con EP y adultos mayores sanos, así como observar cómo la progresión de la enfermedad afecta al desempeño de las habilidades motoras y de procesamiento en pacientes con EP. Sujetos y métodos. Se realizó un estudio transversal. Se empleó la medida de la Assessment of Motor and Process Skills (AMPS) para analizar las diferencias en las habilidades motoras y de procesamiento de tareas cotidianas entre personas con EP y adultos mayores sanos, emparejados en edad y sexo. Se administró la sección III de la Unified Parkinson Disease Rating Scale, la escala de Hoehn y Yahr (HY) y la escala de Schwab & England para determinar la gravedad de la enfermedad. Resultados. Se reclutó a 70 participantes (49 pacientes con EP y 21 adultos mayores sanos). Nuestros resultados mostraron que incluso en estadios moderados de la enfermedad, tanto las habilidades motoras como las de procesamiento se encontraron deterioradas en los pacientes con EP en comparación con los adultos mayores sanos (p < 0,001). A medida que avanza la enfermedad, las habilidades motoras y de procesamiento presentan un deterioro significativo en las personas con EP. Conclusiones. La EP conduce a un mayor deterioro de las habilidades motoras y de procesamiento en comparación con adultos mayores sanos. A medida que avanzan los estadios de la enfermedad según la escala HY, el rendimiento en las habilidades motoras y de procesamiento se deteriora significativamente entre los estadios moderados y avanzados de la EP. Según la escala AMPS, los pacientes con EP no muestran un deterioro en las habilidades de procesamiento hasta el estadio HY IV, pero muestran deterioro motor en los estadios HY II, III y IV.

[Effectiveness of early motor interventions in children with cerebral palsy between 3 to 5years of age: Systematic review]. / Efectividad de la intervención motora temprana en el desarrollo motor de los niños con parálisis cerebral entre 3 y 5años de edad. Revisión sistemática.

Early motor intervention is essential in children with cerebral palsy; however, it is unknown its effectiveness between 3 to 5years. The objective was to determinate the effectiveness of early motor intervention in the motor development of this population. A systematic literature search was performed in Pubmed/Medline, PEDro, OTSeeker, Embase, and LILACS. Finally, 18 articles were selected, of which 4 showed favorable changes in the experimental group in the outcomes of overall motor development and manual motor function, with sensory integration therapy and movement-induced restriction therapy, respectively; however, the results were not statistically significant, and the level of evidence was low. Early motor intervention could be cautiously considered for improving overall motor development and manual function. Higher-quality methodological studies are necessary.

Habilidades de desempeño ocupacional en la enfermedad de Parkinson: relación con la calidad de vida relacionada con la salud y la carga del cuidador / Occupational performance skills in Parkinson’s disease: relationship with health-related quality of life and caregiver burden

Introducción: La progresión de la enfermedad de Parkinson (EP) da lugar a una pérdida de la capacidad para realizar actividades de la vida diaria y de la calidad de vida relacionada con la salud. Los objetivos de este estudio fueron establecer las relaciones entre las habilidades de desempeño ocupacional y la calidad de vida relacionada con la salud, y el grado de carga del cuidador en pacientes con EP. Pacientes y métodos: Participaron en el estudio 49 sujetos en diferentes estadios de EP según la escala de Hoehn y Yahr. Los pacientes fueron evaluados usando el cuestionario de la enfermedad de Parkinson (PDQ-39), el EuroQoL (EQ-5D), la evaluación de las habilidades motoras y de procesamiento (AMPS), y la entrevista de Zarit sobre la carga del cuidador (ZCBI). Resultados: Se encontraron fuertes correlaciones entre la sección de habilidades motoras de la AMPS y el PDQ-39 (r = –0,76; p = 0,001), y los cuestionarios EQ-5D (r = 0,72; p = 0,001), mientras que se encontraron correlaciones moderadas con las habilidades de procesamiento. Las habilidades de procesamiento de la AMPS se correlacionaron moderadamente con la movilidad y las actividades de la vida diaria. La ZCBI sólo se correlacionó débilmente con las habilidades motoras de la AMPS (r = –0,34; p = 0,02). Conclusión: Las puntuaciones decrecientes en la AMPS están estrechamente relacionadas con la pérdida de calidad de vida relacionada con la salud en pacientes con EP y, en menor medida, con el grado de carga del cuidador.(AU)

Introduction: The progression of Parkinson’s disease (PD) results in a loss of ability to performance activities of daily living and health-related quality of life. The objectives of this study were to establish the relations between occupational performance skills and health-related quality of life, and the degree of caregiver burden in PD patients. Patients and methods: Forty-nine patients at different stages of PD according to the Hoehn and Yahr scale participated in the study. Patients were assessed using the Parkinson’s Disease Questionnaire (PDQ-39), the EuroQoL (EQ-5D), the Assessment of Motor and Process Skills (AMPS), and the Zarit Caregiver Burden Interview (ZCBI). Results: Strong correlations were found between the motor skills section of the AMPS scale and the PDQ-39 (r = –0.76; p = 0.001), and the EQ-5D questionnaires (r = 0.72; p = 0.001), while moderate correlations were found with the process skills. AMPS process skills were moderately correlated with mobility and activities of daily living. The ZCBI was only weakly correlated with the AMPS motor skills (r = –0.34; p = 0.02). Conclusion: Declining scores on the AMPS scale are closely related to the loss of health-related quality of life in PD patients, and, to a lesser extent, with the degree of caregiver burden.(AU)

Fuerza muscular y parámetros espaciotemporales de la marcha en personas con enfermedad de Parkinson. Un estudio piloto / Muscle strength and spatiotemporal gait parameters in people with Parkinson´s disease. A pilot study

Introducción: La debilidad muscular en personas con enfermedad de Parkinson (EP) ha sido frecuentemente reconocida como un síntoma inespecífico. En otras patologías neurológicas, la debilidad de las extremidades inferiores, específicamente la debilidad de los cuádriceps, es el factor que causa mayor incapacidad para caminar. Pocas investigaciones han evaluado la relación entre la fuerza muscular de los miembros inferiores, utilizando herramientas objetivas en personas con EP y el desempeño de la marcha. El objetivo de este estudio fue analizar la correlación entre la fuerza muscular de los miembros inferiores, utilizando un dinamómetro isocinético, y los parámetros espaciotemporales de la marcha en la EP, en comparación con controles sanos emparejados por edad y sexo. Sujetos y métodos: El estudio se llevó a cabo con siete personas con EP –Hoehn y Yahr (HY) entre II y III– y siete controles sanos. Se realizaron pruebas isocinéticas de rodilla y tobillo a 60 y 120°/s y la prueba de marcha de 10 metros, a velocidad de marcha cómoda y rápida, en todos los sujetos reclutados. Resultados: Se observaron diferencias significativas en las medidas relacionadas con la fuerza de las extremidades inferiores y en los parámetros de la marcha entre las personas con EP y los controles. Los parámetros de la marcha mostraron excelentes correlaciones (rho = 0,7) para ambas extremidades inferiores: trabajo de flexión plantar de tobillo/desgaste corporal a 180°/s con número de pasos (indirecto) y zancada (directa) a ambas velocidades, y entre pico de torsión de flexión plantar de tobillo/desgaste corporal a 180°/s con número de pasos (indirecto) y zancada (directa) a velocidad máxima; y entre trabajo de extensión de rodilla/desgaste corporal a 60°/s con zancada (directa) a velocidad autoseleccionada. Conclusiones: La fuerza muscular de las extremidades inferiores de las personas con EP (estadios de HY II-III) se...(AU)

Introduction: Muscle weakness in persons with Parkinson disease (PD) has been frequently recognized as a nonspecific symptom. In other neurological conditions, lower limb weakness, specifically quadriceps weakness, is the factor that causes greater gait disability. Little research has evaluated the relationship between lower limb muscle strength, using objective tools, in PD persons and gait performance. The aim of this study was to analyze the correlation between lower limb muscle strength, using an isokinetic dynamometer, and the spatiotemporal gait parameters in PD, compared with age- and sex- matched healthy controls. Subjects and methods: The study was conducted with 7 persons with PD –Hoehn and Yahr (HY) between II-III– and 7 healthy controls. Isokinetic knee and ankle tests at 60 and 120°/s and the 10-meter walking test at comfortable and fast walking speed, were performed on all recruited subjects. Results: Significant differences in lower limb strength-related measures and gait parameters were observed between persons with PD and controls. Gait parameters showed excellent correlations (rho ≥ 0.7) for both lower limb: ankle plantar flexion work/body wearing at 180°/s with number of steps (indirect) and stride (direct) at both speeds, and between the ankle plantar flexion peak torque/ body wearing at 180°/s with number of steps (indirect) and stride (direct) at maximum speed; and between knee extension work/body wearing at 60°/s) with stride (direct) at self-selected speed. Conclusions: Persons with PD (HY II-III stages) lower limb muscle strength correlates excellently with gait pattern, showing lower isokinetic strength than healthy subjects of the same age and sex. This protocol showed safety to be performed in a larger sample.(AU)

Muscle strength and spatiotemporal gait parameters in people with Parkinson´s disease. A pilot study. / Fuerza muscular y parámetros espaciotemporales de la marcha en personas con enfermedad de Parkinson. Un estudio piloto.

INTRODUCTION: Muscle weakness in persons with Parkinson disease (PD) has been frequently recognized as a nonspecific symptom. In other neurological conditions, lower limb weakness, specifically quadriceps weakness, is the factor that causes greater gait disability. Little research has evaluated the relationship between lower limb muscle strength, using objective tools, in PD persons and gait performance. The aim of this study was to analyze the correlation between lower limb muscle strength, using an isokinetic dynamometer, and the spatiotemporal gait parameters in PD, compared with age- and sex- matched healthy controls. SUBJECTS AND METHODS: The study was conducted with 7 persons with PD -Hoehn and Yahr (HY) between II-III- and 7 healthy controls. Isokinetic knee and ankle tests at 60 and 120°/s and the 10-meter walking test at comfortable and fast walking speed, were performed on all recruited subjects. RESULTS: Significant differences in lower limb strength-related measures and gait parameters were observed between persons with PD and controls. Gait parameters showed excellent correlations (rho = 0.7) for both lower limb: ankle plantar flexion work/body wearing at 180°/s with number of steps (indirect) and stride (direct) at both speeds, and between the ankle plantar flexion peak torque/ body wearing at 180°/s with number of steps (indirect) and stride (direct) at maximum speed; and between knee extension work/body wearing at 60°/s) with stride (direct) at self-selected speed. CONCLUSIONS: Persons with PD (HY II-III stages) lower limb muscle strength correlates excellently with gait pattern, showing lower isokinetic strength than healthy subjects of the same age and sex. This protocol showed safety to be performed in a larger sample.

TITLE: Fuerza muscular y parámetros espaciotemporales de la marcha en personas con enfermedad de Parkinson. Un estudio piloto.Introducción. La debilidad muscular en personas con enfermedad de Parkinson (EP) ha sido frecuentemente reconocida como un síntoma inespecífico. En otras patologías neurológicas, la debilidad de las extremidades inferiores, específicamente la debilidad de los cuádriceps, es el factor que causa mayor incapacidad para caminar. Pocas investigaciones han evaluado la relación entre la fuerza muscular de los miembros inferiores, utilizando herramientas objetivas en personas con EP y el desempeño de la marcha. El objetivo de este estudio fue analizar la correlación entre la fuerza muscular de los miembros inferiores, utilizando un dinamómetro isocinético, y los parámetros espaciotemporales de la marcha en la EP, en comparación con controles sanos emparejados por edad y sexo. Sujetos y métodos. El estudio se llevó a cabo con siete personas con EP ­Hoehn y Yahr (HY) entre II y III­ y siete controles sanos. Se realizaron pruebas isocinéticas de rodilla y tobillo a 60 y 120°/s y la prueba de marcha de 10 metros, a velocidad de marcha cómoda y rápida, en todos los sujetos reclutados. Resultados. Se observaron diferencias significativas en las medidas relacionadas con la fuerza de las extremidades inferiores y en los parámetros de la marcha entre las personas con EP y los controles. Los parámetros de la marcha mostraron excelentes correlaciones (rho = 0,7) para ambas extremidades inferiores: trabajo de flexión plantar de tobillo/desgaste corporal a 180°/s con número de pasos (indirecto) y zancada (directa) a ambas velocidades, y entre pico de torsión de flexión plantar de tobillo/desgaste corporal a 180°/s con número de pasos (indirecto) y zancada (directa) a velocidad máxima; y entre trabajo de extensión de rodilla/desgaste corporal a 60°/s con zancada (directa) a velocidad autoseleccionada. Conclusiones. La fuerza muscular de las extremidades inferiores de las personas con EP (estadios de HY II-III) se correlaciona excelentemente con el patrón de la marcha, mostrando una fuerza isocinética inferior a la de sujetos sanos de la misma edad y sexo. Este protocolo mostró seguridad para ser realizado en una muestra mayor.

Clinical, molecular, and immune correlates of the Immunotherapy Response Score in patients with advanced urothelial carcinoma under atezolizumab monotherapy: analysis of the phase II IMvigor210 trial.

BACKGROUND: In the advanced urothelial carcinoma (aUC) scenario there are no consistent immune checkpoint blockade predictive biomarkers. Recently a novel pan-tumor molecular tissue-based biomarker, the Immunotherapy Response Score (IRS), has been proposed. We conducted a retrospective study to validate the prognostic/predictive utility of the IRS in patients with aUC under atezolizumab monotherapy and to characterize its underlying molecular/immune features in the context of the IMvigor210 phase II trial. PATIENTS AND METHODS: This is a post hoc pooled analysis of 261 patients with available clinical, molecular, and immune tumor data treated with atezolizumab monotherapy in the IMvigor210 phase II clinical trial. Efficacy endpoints were overall survival (OS), disease control rate (DCR), and overall response rate (ORR). Survival estimates were calculated by the Kaplan-Meier method, and groups were compared with the log-rank test. The Cox proportional hazards regression model was used to evaluate factors independently associated with OS. Factors associated with disease control (DC) and response were tested with logistic regression in univariable and multivariable analyses. Comparisons between patient and disease characteristics were carried out using chi-square or Fisher's exact tests. All P values were two-sided, and those <0.05 were considered statistically significant. RESULTS: High IRS was significantly associated with a better OS in univariable [hazard ratio (HR) = 0.49, P < 0.001] and multivariable (HR = 0.60, P = 0.018) analyses. DCR and ORR were significantly higher among high IRS patients (DCR for high IRS versus low IRS patients: 57% versus 32%, P < 0.001; ORR: 42% versus 10%, P < 0.001). High IRS patients presented a higher probability of DC and response in univariable [DC: odds ratio (OR) = 2.72, P < 0.001; response: OR = 3.92, P < 0.001] and multivariable (DC: OR = 2.72, P < 0.001; response: OR = 3.92, P < 0.001) analyses. CONCLUSIONS: This study validates IRS as a strong independent prognostic and predictive biomarker for OS and DC/response in patients with aUC treated with atezolizumab monotherapy in the IMvigor210 phase II clinical trial.

Sexual education for university students and the community in a european project: study protocol.

BACKGROUND: The World Health Organisation (WHO) calls on stakeholders to give Higher Education a key educational importance for the future of Europe. Within the content of the training programmes at university, sexuality emerges as a relevant topic in the nursing degree, to promote integral health from a holistic perspective. However, research on the presence of sexuality at the curricular level in Higher Education suggests that it is incomplete and underdeveloped. METHODS: This is a protocol for a long-term, multi-centre, exploratory, descriptive, and cross-sectional study with a quantitative and qualitative approach lasting two years. The research will be carried out in the educational community, including, on the one hand, students, and professors and health professionals of nursing programmes from five universities in different parts of the world (Portugal, Spain, Italy, and the United States), and on the other hand, women, young people, and immigrants from these communities. The study will have several target populations. Firstly, the target is nursing students, with whom the aim is to define their perspective on the sexuality content taught at the university, and their level of knowledge. Secondly university professors and health professionals, with whom we will check their perspective on sexuality in the classroom, as well as their level of knowledge in this field. And finally, we will work with the community (women, young people, and immigrants) to whom we will try to bring sexuality from a useful and enjoyable perspective. In order to measure these variables in the protocol, instruments such as questionnaires and semi-structured interviews will be used. During data collection, ethical principles will be guaranteed and informed consent will be requested from the participants. DISCUSSION: The results of the research will have a high curricular impact on the educational community, and will last over time, since the tools generated in the project will be included as part of nursing training programmes. In addition, participation in the project will improve health education for health professionals and at the community level on sexuality in both urban and rural populations.

Impact of acute psychosocial stress on attentional control in humans. A study of evoked potentials and pupillary response.

Psychosocial stress has increased considerably in our modern lifestyle, affecting global mental health. Deficits in attentional control are cardinal features of stress disorders and pathological anxiety. Studies suggest that changes in the locus coeruleus-norepinephrine system could underlie the effects of stress on top-down attentional control. However, the impact of psychosocial stress on attentional processes and its underlying neural mechanisms are poorly understood. This study aims to investigate the effect of psychosocial stress on attentional processing and brain signatures. Evoked potentials and pupillary activity related to the oddball auditory paradigm were recorded before and after applying the Montreal Imaging Stress Task (MIST). Electrocardiogram (ECG), salivary cortisol, and subjective anxiety/stress levels were measured at different experimental periods. The control group experienced the same physical and cognitive effort but without the psychosocial stress component. The results showed that stressed subjects exhibited decreased P3a and P3b amplitude, pupil phasic response, and correct responses. On the other hand, they displayed an increase in Mismatch Negativity (MMN). N1 amplitude after MIST only decreased in the control group. We found that differences in P3b amplitude between the first and second oddball were significantly correlated with pupillary dilation and salivary cortisol levels. Our results suggest that under social-evaluative threat, basal activity of the coeruleus-norepinephrine system increases, enhancing alertness and decreasing voluntary attentional resources for the cognitive task. These findings contribute to understanding the neurobiological basis of attentional changes in pathologies associated with chronic psychosocial stress.

Occupational performance skills in Parkinson's disease: relationship with health-related quality of life and caregiver burden. / Habilidades de desempeño ocupacional en la enfermedad de Parkinson: relación con la calidad de vida relacionada con la salud y la carga del cuidador.

INTRODUCTION: The progression of Parkinson's disease (PD) results in a loss of ability to performance activities of daily living and health-related quality of life. The objectives of this study were to establish the relations between occupational performance skills and health-related quality of life, and the degree of caregiver burden in PD patients. PATIENTS AND METHODS: Forty-nine patients at different stages of PD according to the Hoehn and Yahr scale participated in the study. Patients were assessed using the Parkinson's Disease Questionnaire (PDQ-39), the EuroQoL (EQ-5D), the Assessment of Motor and Process Skills (AMPS), and the Zarit Caregiver Burden Interview (ZCBI). RESULTS: Strong correlations were found between the motor skills section of the AMPS scale and the PDQ-39 (r = -0.76; p = 0.001), and the EQ-5D questionnaires (r = 0.72; p = 0.001), while moderate correlations were found with the process skills. AMPS process skills were moderately correlated with mobility and activities of daily living. The ZCBI was only weakly correlated with the AMPS motor skills (r = -0.34; p = 0.02). CONCLUSION: Declining scores on the AMPS scale are closely related to the loss of health-related quality of life in PD patients, and, to a lesser extent, with the degree of caregiver burden.

TITLE: Habilidades de desempeño ocupacional en la enfermedad de Parkinson: relación con la calidad de vida relacionada con la salud y la carga del cuidador.Introducción. La progresión de la enfermedad de Parkinson (EP) da lugar a una pérdida de la capacidad para realizar actividades de la vida diaria y de la calidad de vida relacionada con la salud. Los objetivos de este estudio fueron establecer las relaciones entre las habilidades de desempeño ocupacional y la calidad de vida relacionada con la salud, y el grado de carga del cuidador en pacientes con EP. Pacientes y métodos. Participaron en el estudio 49 sujetos en diferentes estadios de EP según la escala de Hoehn y Yahr. Los pacientes fueron evaluados usando el cuestionario de la enfermedad de Parkinson (PDQ-39), el EuroQoL (EQ-5D), la evaluación de las habilidades motoras y de procesamiento (AMPS), y la entrevista de Zarit sobre la carga del cuidador (ZCBI). Resultados. Se encontraron fuertes correlaciones entre la sección de habilidades motoras de la AMPS y el PDQ-39 (r = ­0,76; p = 0,001), y los cuestionarios EQ-5D (r = 0,72; p = 0,001), mientras que se encontraron correlaciones moderadas con las habilidades de procesamiento. Las habilidades de procesamiento de la AMPS se correlacionaron moderadamente con la movilidad y las actividades de la vida diaria. La ZCBI sólo se correlacionó débilmente con las habilidades motoras de la AMPS (r = ­0,34; p = 0,02). Conclusión. Las puntuaciones decrecientes en la AMPS están estrechamente relacionadas con la pérdida de calidad de vida relacionada con la salud en pacientes con EP y, en menor medida, con el grado de carga del cuidador.

Impacto del Programa de Rehabilitación Interdisciplinario de Dolor Crónico en pacientes sin y con trastornos del sueño / Impact of the Interdisciplinary Chronic Pain Rehabilitation Programme in patients with and without sleep disorders

Introducción: Los trastornos del sueño y el dolor crónico están relacionados bidireccionalmente. Ambos están relacionados con trastornos afectivos, fatiga, depresión, ansiedad y abuso de fármacos, y afectan significativamente a la calidad de vida. El objetivo del Programa Interdisciplinario de Dolor (PRID) es aliviar el dolor del paciente y mejorar su funcionalidad a través de la incorporación de hábitos posturales, del sueño y nutricionales saludables, técnicas de relajación, ejercicio físico y mecanismos cognitivoconductuales. Pacientes y métodos: Se realizó un estudio retrospectivo, observacional y transversal. Se examinó a 323 pacientes con dolor crónico que completaron el PRID. Se les evaluó al principio y al final del programa con escalas de dolor, depresión, calidad de vida e insomnio, y se les comparó entre grupos con y sin insomnio –índice de gravedad del insomnio (ISI) menor de 15 frente a mayor o igual a 15–. Se estudió a 58 pacientes con polisomnografía. Resultados: Se observó una mejoría significativa (p < 0,0001) del dolor, la depresión y la calidad de vida evaluados mediante la escala analógica visual (EVA), el inventario de Beck y el cuestionario Short Form-36 (SF-36), tanto en pacientes con dolor crónico con ISI menor de 15 como ISI mayor o igual a 15. Los resultados fueron superiores en el grupo de pacientes con insomnio. La presencia de un índice de apneas e hipopneas elevado y movimientos periódicos de los miembros inferiores en los pacientes no se relacionó con la mejoría de las escalas de Beck, SF-36, ISI y EVA. Conclusiones: En conclusión, el PRID beneficia a los pacientes con dolor crónico no oncológico en varias esferas afectadas, además del dolor, mediante un tratamiento integral. La polisomnografía puede ayudar a diagnosticar patologías específicas e individualizar el tratamiento farmacológico.(AU)

Introduction: Sleep disorders and chronic pain are linked to each other bidirectionally. Both are related to affective disorders, fatigue, depression, anxiety and drug abuse, and have a significant effect on quality of life. The Interdisciplinary Pain Programme (IDP) aims to relieve the patients’ pain and improve their functionality by incorporating healthy postural, sleep and nutritional habits, relaxation techniques, physical exercise and cognitive-behavioural mechanisms. Patients and methods: A retrospective, observational, cross-sectional study was conducted. A total of 323 patients with chronic pain who completed the IDP were examined. They were assessed at the beginning and at the end of the programme with pain, depression, quality of life and insomnia scales, and were then compared between groups with and without insomnia, that is, with an insomnia severity index (ISI) less than 15 versus greater than or equal to 15. Fifty-eight patients were studied by means of polysomnography. Results: A significant improvement (p < 0.0001) in pain, depression and quality of life, as assessed by the visual analogue scale (VAS), the Beck inventory and the Short Form-36 (SF-36) questionnaire was observed in chronic pain patients with an ISI below 15 and in those with an ISI greater than or equal to 15. The results were superior in the group of patients with insomnia. The presence of a high apnoea and hypopnoea index and periodic lower limb movements in patients was not related to improvements on the Beck, SF-36, ISI and VAS scales. Conclusions: In conclusion, IDP benefits patients with chronic non-cancer-induced pain in several affected areas, in addition to pain, due to a comprehensive treatment. Polysomnography can help diagnose specific pathologies and individualise pharmacological treatment.(AU)

[Impact of the Interdisciplinary Chronic Pain Rehabilitation Programme in patients with and without sleep disorders]. / Impacto del Programa de Rehabilitación Interdisciplinario de Dolor Crónico en pacientes sin y con trastornos del sueño.

INTRODUCTION: Sleep disorders and chronic pain are linked to each other bidirectionally. Both are related to affective disorders, fatigue, depression, anxiety and drug abuse, and have a significant effect on quality of life. The Interdisciplinary Pain Programme (IDP) aims to relieve the patients' pain and improve their functionality by incorporating healthy postural, sleep and nutritional habits, relaxation techniques, physical exercise and cognitive-behavioural mechanisms. PATIENTS AND METHODS: A retrospective, observational, cross-sectional study was conducted. A total of 323 patients with chronic pain who completed the IDP were examined. They were assessed at the beginning and at the end of the programme with pain, depression, quality of life and insomnia scales, and were then compared between groups with and without insomnia, that is, with an insomnia severity index (ISI) less than 15 versus greater than or equal to 15. Fifty-eight patients were studied by means of polysomnography. RESULTS: A significant improvement (p < 0.0001) in pain, depression and quality of life, as assessed by the visual analogue scale (VAS), the Beck inventory and the Short Form-36 (SF-36) questionnaire was observed in chronic pain patients with an ISI below 15 and in those with an ISI greater than or equal to 15. The results were superior in the group of patients with insomnia. The presence of a high apnoea and hypopnoea index and periodic lower limb movements in patients was not related to improvements on the Beck, SF-36, ISI and VAS scales. CONCLUSIONS: In conclusion, IDP benefits patients with chronic non-cancer-induced pain in several affected areas, in addition to pain, due to a comprehensive treatment. Polysomnography can help diagnose specific pathologies and individualise pharmacological treatment.

TITLE: Impacto del Programa de Rehabilitación Interdisciplinario de Dolor Crónico en pacientes sin y con trastornos del sueño.Introducción. Los trastornos del sueño y el dolor crónico están relacionados bidireccionalmente. Ambos están relacionados con trastornos afectivos, fatiga, depresión, ansiedad y abuso de fármacos, y afectan significativamente a la calidad de vida. El objetivo del Programa Interdisciplinario de Dolor (PRID) es aliviar el dolor del paciente y mejorar su funcionalidad a través de la incorporación de hábitos posturales, del sueño y nutricionales saludables, técnicas de relajación, ejercicio físico y mecanismos cognitivoconductuales. Pacientes y métodos. Se realizó un estudio retrospectivo, observacional y transversal. Se examinó a 323 pacientes con dolor crónico que completaron el PRID. Se les evaluó al principio y al final del programa con escalas de dolor, depresión, calidad de vida e insomnio, y se les comparó entre grupos con y sin insomnio ­índice de gravedad del insomnio (ISI) menor de 15 frente a mayor o igual a 15­. Se estudió a 58 pacientes con polisomnografía. Resultados. Se observó una mejoría significativa (p < 0,0001) del dolor, la depresión y la calidad de vida evaluados mediante la escala analógica visual (EVA), el inventario de Beck y el cuestionario Short Form-36 (SF-36), tanto en pacientes con dolor crónico con ISI menor de 15 como ISI mayor o igual a 15. Los resultados fueron superiores en el grupo de pacientes con insomnio. La presencia de un índice de apneas e hipopneas elevado y movimientos periódicos de los miembros inferiores en los pacientes no se relacionó con la mejoría de las escalas de Beck, SF-36, ISI y EVA. Conclusiones. En conclusión, el PRID beneficia a los pacientes con dolor crónico no oncológico en varias esferas afectadas, además del dolor, mediante un tratamiento integral. La polisomnografía puede ayudar a diagnosticar patologías específicas e individualizar el tratamiento farmacológico.

The impact of Parkinson's disease severity on performance of activities of daily living: an observational study. / El impacto de la gravedad de la enfermedad de Parkinson en el desempeño de las actividades de la vida diaria: un estudio observacional.

INTRODUCTION: Parkinson's disease (PD) affects the ability to perform activities of daily living (ADL), increasing with disease progression. The study of the association between PD severity and occupational performance skills may improve the understanding of the functional impairment associated with this pathology. OBJECTIVE: To study the relationship between PD severity and the loss of functional performance. PATIENTS AND METHODS: 49 non-demented PD patients were assessed with The Assessment of Motor and Process Skills (AMPS) scale, the Hoehn and Yahr scale (HY), the section III of the Unified Parkinson Disease Rating Scale (UPDRS), and the Schwab and England scale. RESULTS: PD severity was related to the AMPS scale (p < 0.001). There was a strong correlation between the AMPS motor skills and the HY scale (p < 0.001) and UPDRS III (p < 0.001), as well as between process skills and the Schwab and England E scale (p < 0.001). A moderate correlation was found between Schwab and England scale and AMPS motor skills, while a strong correlation was found with the process skills. Finally, a weak correlation was found between the AMPS scale and disease duration, yet only in the motor section. CONCLUSIONS: The severity of PD is closely related to the impairment of functional skills measured with the AMPS scale in non-demented PD patients. A strong correlation was found with the motor skills. A strong correlation was found between the AMPS process skills scale and Schwab and England ADL scale. A weak correlation was found between the AMPS motor scale and disease duration. The AMPS scale might be a useful tool to monitoring the PD progression through the observation of ADL performance.

TITLE: El impacto de la gravedad de la enfermedad de Parkinson en el desempeño de las actividades de la vida diaria: un estudio observacional.Introducción. La enfermedad de Parkinson (EP) afecta a la capacidad para realizar actividades de la vida diaria (AVD), lo que se incrementa con la progresión de la enfermedad. El estudio de la asociación entre la gravedad de la EP y las habilidades de desempeño ocupacional puede mejorar la comprensión del deterioro funcional asociado a esta patología. Objetivo. Estudiar la relación entre la gravedad de la EP y la pérdida de rendimiento funcional. Pacientes y métodos. Se evaluó a 49 pacientes con EP con la escala Assessment of Motor and Process Skills (AMPS), la escala Hoehn and Yahr (HY), la sección III de la Unified Parkinson Disease Rating Scale (UPDRS) y la escala Schwab and England. Resultados. La gravedad de la EP se observó correlacionada con la escala AMPS (p < 0,001). Hubo una fuerte correlación entre las destrezas motoras de la AMPS y las escalas HY (p < 0,001) y UPDRS III (p < 0,001), así como entre las destrezas de procesamiento y la escala Schwab and England (p < 0,001). Se encontró una correlación moderada entre la escala Schwab and England y las habilidades motoras de la AMPS, mientras que se encontró una correlación fuerte con las habilidades de procesamiento. Por último, se encontró una correlación débil entre la escala AMPS y los años de evolución de la EP, aunque sólo en el apartado motor. Conclusiones. La gravedad de la EP está estrechamente relacionada con el deterioro de las habilidades funcionales medidas con la escala AMPS en pacientes con EP no dementes. Se encontró una fuerte correlación con las habilidades motoras. Se encontró una fuerte correlación entre la escala AMPS de habilidades de procesamiento y la escala Schwab and England. Se encontró una correlación débil entre la escala motora AMPS y la duración de la enfermedad. La escala AMPS podría ser una herramienta útil para monitorizar la progresión de la EP a través de la observación del desempeño de las AVD.

El impacto de la gravedad de la enfermedad de Parkinson en el desempeño de las actividades de la vida diaria: un estudio observacional / The impact of Parkinson’s disease severity on performance of activities of daily living: an observational study

Introducción: La enfermedad de Parkinson (EP) afecta a la capacidad para realizar actividades de la vida diaria (AVD), lo que se incrementa con la progresión de la enfermedad. El estudio de la asociación entre la gravedad de la EP y las habilidades de desempeño ocupacional puede mejorar la comprensión del deterioro funcional asociado a esta patología. Objetivo: Estudiar la relación entre la gravedad de la EP y la pérdida de rendimiento funcional. Pacientes y métodos: Se evaluó a 49 pacientes con EP con la escala Assessment of Motor and Process Skills (AMPS), la escala Hoehn & Yahr (HY), la sección III de la Unified Parkinson Disease Rating Scale (UPDRS) y la escala Schwab & England. Resultados: La gravedad de la EP se observó correlacionada con la escala AMPS (p < 0,001). Hubo una fuerte correlación entre las destrezas motoras de la AMPS y las escalas HY (p < 0,001) y UPDRS III (p < 0,001), así como entre las destrezas de procesamiento y la escala Schwab & England (p < 0,001). Se encontró una correlación moderada entre la escala Schwab & England y las habilidades motoras de la AMPS, mientras que se encontró una correlación fuerte con las habilidades de procesamiento. Por último, se encontró una correlación débil entre la escala AMPS y los años de evolución de la EP, aunque sólo en el apartado motor. Conclusiones: La gravedad de la EP está estrechamente relacionada con el deterioro de las habilidades funcionales medidas con la escala AMPS en pacientes con EP no dementes. Se encontró una fuerte correlación con las habilidades motoras. Se encontró una fuerte correlación entre la escala AMPS de habilidades de procesamiento y la escala Schwab & England. Se encontró una correlación débil entre la escala motora AMPS y la duración de la enfermedad. La escala AMPS podría ser una herramienta útil para monitorizar la progresión de la EP a través de la observación del desempeño de las AVD.(AU)

Introduction: Parkinson’s disease (PD) affects the ability to perform activities of daily living (ADL), increasing with disease progression. The study of the association between PD severity and occupational performance skills may improve the understanding of the functional impairment associated with this pathology. Objective: To study the relationship between PD severity and the loss of functional performance. Patients and methods: 49 non-demented PD patients were assessed with The Assessment of Motor and Process Skills (AMPS) scale, the Hoehn & Yahr scale (HY), the section III of the Unified Parkinson Disease Rating Scale (UPDRS), and the Schwab & England scale. Results: PD severity was related to the AMPS scale (p < 0.001). There was a strong correlation between the AMPS motor skills and the HY scale (p < 0.001) and UPDRS III (p < 0.001), as well as between process skills and the Schwab & England E scale (p < 0.001). A moderate correlation was found between Schwab & England scale and AMPS motor skills, while a strong correlation was found with the process skills. Finally, a weak correlation was found between the AMPS scale and disease duration, yet only in the motor section. Conclusions: The severity of PD is closely related to the impairment of functional skills measured with the AMPS scale in non-demented PD patients. A strong correlation was found with the motor skills. A strong correlation was found between the AMPS process skills scale and Schwab & England ADL scale. A weak correlation was found between the AMPS motor scale and disease duration. The AMPS scale might be a useful tool to monitoring the PD progression through the observation of ADL performance.(AU)

Expresión de los factores de transcripción sensibles a la hipoxia, de la respuesta inflamatoria y del estrés oxidativo a nivel muscular en tres modelos clínicos de hipoxemia / Expression of transcription factors sensitive to hypoxia, of the inflammatory response and oxidative stress to muscle level in three clinical models of hypoxemia

OBJETIVO: Comparar la expresión de marcadores de respuesta a hipoxia, inflamatorios y de estrés oxidativo en biopsia muscular de grupos de pacientes con hipoxia crónica continua, crónica intermitente y ambas combinadas. Evaluar el estado de la musculatura periférica y compararla entre grupos. METODOLOGÍA: Incluimos varones mayores de 18 años, diagnosticados de EPOC, Apnea Obstructiva del Sueño (AOS) o AOS-EPOC, a los que se realizó biopsia muscular del cuádriceps. Los biomarcadores seleccionados para su estudio en músculo fueron factores de transcripción asociados a la hipoxia, como el factor inducible por hipoxia HIF-1, HIF-2 y el factor nuclear. También biomarcadores inflamatorios como factor de necrosis tumoral-α, interkeukina 6 y 8, factor de crecimiento endotelial vascular y proteína de adhesión celular vascular 1 (VCAM-1), así como biomarcadores de estrés oxidativo, como superóxidodismutasa (SOD) y actividad catalasa. Además se realizó evaluación de la función muscular en los tres grupos. RESULTADOS: Reclutamos 29 sujetos: 4 con EPOC, 12 con AOS y 13 EPOC-AOS. En el músculo, encontramos diferencias entre los grupos de estudio en VCAM-1 (casos de EPOC que expresan 2,1 veces más que AOS y 1,16 veces más que EPOC-AOS) y SOD (EPOC-AOS que expresan 3,48 veces más que EPOC, y AOS 3,02 veces más que EPOC). CONCLUSIONES: La expresión de biomarcadores estudiados es de intensidad similar en los tres grupos de pacientes referidos, con pocas excepciones.La fuerza muscular periférica y el porcentaje de masa libre de grasa es significativamente menor en los pacientes con EPOC que en los pacientes con AOS. (AU)

OBJECTIVE: Compare the expression of markers of response to hypoxia, inflammation and oxidative stress in biopsy muscle of groups of patients with continuous chronic hypoxia, intermittent chronic and both combined. Evaluate the state of the peripheral musculature and compare it between groups. METHODOLOGY: We included males older than 18 years, diagnosed of COPD, Obstructive Sleep Apnea (OSA) or OSA-COPD, to quadriceps muscle biopsy was performed. biomarkers selected for study in muscle were factors of transcription associated with hypoxia, such as the factor inducible by hypoxia HIF-1, HIF-2 and nuclear factor. Also biomarkers Inflammatory agents such as tumor necrosis factor-α, interkeukin 6, and 8, vascular endothelial growth factor and adhesion protein vascular cell 1 (VCAM-1), as well as stress biomarkers oxidative, such as superoxide dismutase (SOD) and catalase activity. In addition, evaluation of muscle function was performed in the three groups. RESULTS: We recruited 29 subjects: 4 with COPD, 12 with OSA and 13 COPD-OSA. In muscle, we found differences between the study groups in VCAM-1 (COPD cases expressing 2.1-fold more than OSA and 1.16 times more than COPD-OSA) and SOD (COPD-OSA than express 3.48 times more than COPD, and OSA 3.02 times more than COPD). CONCLUSIONS: The expression of studied biomarkers is of similar intensity in the three groups of referred patients, with few exceptions. Peripheral muscle strength and percentage of fat-free mass is significantly lower in patients with COPD than in patients with OSA. (AU)

Estudio proteomico diferencial entre liquidos pleurales secundarios a cáncer de pulmón versus mesotelioma / Differential proteomic study between pleural fluid secondary to lung cancer versus mesothelioma

Objetivo: Encontrar perfiles proteicos en líquido pleural que diferencien derrames pleurales secundarios a cáncer de pulmón (CP) versus mesotelioma pleural maligno (MPM).Metodología: Recogimos líquidos pleurales de 60 pacientes de tres grupos diferentes: MPM (N = 20), CP (N = 20) y derrames pleurales benignos (N = 20). Realizamos un análisis con proteómica diferencial con ITRAQ 4 plex (Applied Biosystem). Realizamos la identificación y cuantificación relativa de las proteínas con el programa Proteome Discoverer 1.4 (Termofisher Scientific). Construimos diagramas de Venn con las proteínas sobre/infra-expresadas en cada grupo. Realizamos una validación interna/externa mediante ELISA (Myobiosorce) añadiendo 25 muestras de CP y 14 de MPM.Resultados: Encontramos sobreexpresión de Pi3K en los derrames pleurales neoplásicos (16,86 +/- 25,83 ng/ml en CP; 20,66 +/- 17,26 ng/ml en MPM vs 5,92 +/- 0,99 ng/ml en controles). Hubo sobreexpresión de SPRM en MPM (30.702 +/- 30.310,53 ng/ml en el grupo MPM vs 10.404 +/- 10.157,72 ng/ml en el grupo CP vs 8.498 + /- 3.437,18 ng/ml en controles). Existió sobreexpresión de RhoB en CP (4,46 +/- 1,65 mg/ml en CP vs 1,65 +/- 2,65 mg/ml en MPM vs 0,92 +/- 1,6 mg/ml en controles). También encontramos sobreexpresión de PDGFR-alfa en derrames pleurales benignos (74,12 +/- 22,57 ng/ml en controles vs 43,05 +/- 23,96 ng/ml en CP vs 36,12 +/- 21,51 ng/ml en MPM).Conclusión: Existe un perfil diferencial proteico entre los derrames secundarios a CP (sobreexpresión de RhoB) y a MPM (sobrexpresión de SPRM). La sobrexpresión de Pi3K indica asociación a derrames pleurales malignos y la de PDGFR-alfa a derrames benignos. (AU)

Objetivo: Find protein profiles in pleural fluid that differentiate pleural effusions secondary to lung cancer (LC) versus malignant pleural mesothelioma (MPM).Metodología: We collected pleural fluids from 60 patients from three different groups: MPM (N = 20), CP (N = 20), and benign pleural effusions (N = 20). We performed differential proteomics analysis with ITRAQ 4 plex (Applied Biosystem). We performed the identification and relative quantification of the proteins with the Proteome Discoverer 1.4 program (Termofisher Scientific). We built Venn diagrams with the over/under-expressed proteins in each group. We performed an internal/external validation using ELISA (Myobiosorce) adding 25 CP and 14 MPM samples.Resultados: We found Pi3K overexpression in neoplastic pleural effusions (16.86 +/- 25.83 ng/ml in PC; 20.66 +/- 17.26 ng/ml in MPM vs 5.92 +/- 0.99 ng/ml in controls). There was overexpression of SPRM in MPM (30,702 +/- 30,310.53 ng/ml in the MPM group vs 10,404 +/- 10,157.72 ng/ml in the CP group vs 8,498 +/- 3,437.18 ng/ml in controls). There was overexpression of RhoB in CP (4.46 +/- 1.65 mg/ml in CP vs 1.65 +/- 2.65 mg/ml in MPM vs 0.92 +/- 1.6 mg/ml in controls). We also found overexpression of PDGFR-alpha in benign pleural effusions (74.12 +/- 22.57 ng/ml in controls vs 43.05 +/- 23.96 ng/ml in PC vs 36.12 +/- 21.51 ng/ml in MPM ).Conclusión: There is a differential protein profile between effusions secondary to CP (RhoB overexpression) and MPM (SPRM overexpression). Pi3K overexpression indicates association with malignant pleural effusions and PDGFR-alpha overexpression with benign effusions. (AU)

Cellular mechanisms involved in the pathogenesis of airway remodeling in chronic lung disease.

Background: Airway epithelial cells and lung fibroblasts play an important role in the development of chronic lung disease, but the exact mechanisms responsible have not been clarified. Our objective was to investigate the involvement of these cells in the inflammatory response associated to chronic lung disease. Methods: Human lung fibroblasts and airway epithelial cells were challenged with Interleukin-1ß and hypoxia, and with inhibitory (simvastatin) stimuli of the inflammatory response. Expression of markers of local inflammation ((IL-8, monocyte chemoattractant protein-1 (MCP-1), factor-κB1 (NF-κB1)), systemic inflammation ((C-reactive protein (CRP) and serum amyloid A (SAA)) and proteases matrix metalloproteinase (MMP) 9 and 12 were assessed by PCR and ELISA. Apoptosis/necrosis was analyzed by flow cytometry. Results: Our results showed that the lung fibroblasts had a higher expression of local and systemic inflammation and protease activity markers when they were treated with IL-1ß compared to airway epithelial cells. Under hypoxic conditions, we observed a decrease in systemic inflammation in lung fibroblasts, which was further attenuated by simvastatin. Conclusion: The lung fibroblasts seem to be the main initially stimulated cells that could potentially trigger the inflammatory response, and be responsible for the eventual onset of chronic lung disease. The involvement of IL-1ß stimulation in systemic inflammatory and proteinase imbalance biomarkers is higher in lung fibroblasts. Apoptosis is not a predominant mechanism in these cells.

Impact of environmental pollution on the obesogenic environment.

Obesity figures in the world continue to increase, representing a multifactorial and multidimensional problem. Efforts to contribute to reduction in obesity have led to the study of this condition from different approaches, including the obesogenic environment (OE), which is harmful to health due to the multiple factors that compose the OE. Some of the most important factors are stress, lifestyle, and urban design, framed in a food system that provides caloric foods and contributes to intake of hypercaloric diets. The OE exacerbates the obesogenic process and chronic low-grade inflammation. However, these factors are not the only ones responsible for obesity. Environmental pollutants also contribute, because they interfere with metabolic processes that regulate lipid accumulation and increase body adiposity. In this review, we analyze the relationship between pollution and obesogenic processes. We postulate the inclusion of environmental pollution within the factors and definition of the OE.