Effectiveness of exercise interventions, alone or in combination with dietary modifications, on working memory in overweight and obese individuals: A systematic review.

This systematic review aimed to establish the effectiveness of exercise interventions, alone or in combination with dietary modifications, on working memory (WM) in individuals living with overweight and obesity. A comprehensive literature search was conducted using the Scopus, PubMed, Springer-Link, RefSeek, and Cochrane Library databases to identify relevant publications up to January 18, 2024. Data on participants' characteristics, intervention settings, and key outcomes related to WM were extracted. The quality of the studies was assessed using the PEDro scale. A total of 15 articles met pre-established inclusion criteria, involving participants across nine countries with a range of 12-125 individuals and ages spanning from 6 to 80 years old. Among the studies analyzed, 10 exclusively investigated exercise interventions, whereas five explored the combined effects. Notably, 70% of the exercise interventions (7 out of 10) exhibited positive improvements in WM. Likewise, 60% of the combined interventions (3 out of 5) demonstrated favorable enhancements in WM. No differences were found between the two protocols. Common features between the protocols were identified and described. Both protocols showed favorable and promising effects on WM in this clinical population. Nonetheless, the limited evidence addressing the combination of exercise and diet in the same research approach reduces the generalizability of the findings. This review offers valuable insights for future clinical and research applications in people with overweight and obesity.

Is the frequency of breakfast consumption associated with life satisfaction in children and adolescents? A cross-sectional study with 154,151 participants from 42 countries.

BACKGROUND: The promotion of daily breakfast consumption and the importance of making appropriate breakfast choices have been underscored as significant public health messages. The aim of this study was to examine the relationship between breakfast frequency and life satisfaction in large and representative samples of school-going children and adolescents aged 10-17 years from 42 different countries. METHODS: This study used information from the 2017/2018 Health Behavior in School-aged Children study, comprising nationally representative samples of children and adolescents aged 10-17 years who were attending school. The total number of participants from the 42 countries included in the study was 155,451 (51.3% girls). The evaluation of breakfast consumption in this study involved a specific question: "How often do you typically have breakfast (more than a glass of milk or fruit juice)?". To measure life satisfaction, a subjective assessment scale was used in the form of a ladder, visually spanning from 0 to 10. On this scale, the topmost point (10) denotes the highest conceivable quality of life, whereas the bottom point (0) represents the worst imaginable quality of life. RESULTS: After adjusting for several covariates, the lowest estimated marginal mean of life satisfaction was identified in those participants who skipped breakfast (mean [M] = 5.6, 95% confidence interval [CI] 5.5 to 5.8). Conversely, the highest estimated marginal mean of life satisfaction was observed in those who had breakfast every day (M = 6.5, 95% CI 6.3 to 6.6). Overall, a nearly linear relationship between higher frequency of breakfast and greater life satisfaction in children and adolescents was identified (p-for-trend < 0.001). In addition, the highest estimated marginal mean of life satisfaction score was identified in those participants from Portugal who had breakfast every day (M = 7.7; 95% CI 6.9 to 8.5 points). Conversely, the lowest estimated marginal mean of life satisfaction was observed in those participants from Romania who no breakfast (M = 3.5; 95% CI 2.6 to 4.4 points). CONCLUSIONS: There is a nearly linear relationship between higher frequency of breakfast and greater life satisfaction in children and adolescents. Considering the potential health advantages associated with breakfast during this critical age phase, these findings imply the necessity for additional global efforts to promote increased breakfast consumption among children and adolescents.

Substantial parallel mediation contribution by cognitive domains in the relationship between adolescents' physical fitness and academic achievements: the Cogni-Action Project.

Objective: To determine how cognitive domains mediate the link between fitness components, their global score (GFS), and adolescents' academic achievement (ACA) across various school subjects. Methods: In this study, 1,296 adolescents aged 10-14 participated. GFS was computed by three fitness components (strength, muscular, and cardiorespiratory fitness) through the ALPHA-fitness test battery. ACA was determined by five school subjects (Language, English, Mathematics, Science, and History) and two academic scores (a) "Academic Average" (five subjects) and (b) "Academic-PISA" (Language, Mathematics, and Science). A principal component analysis was performed to establish four factors (working memory [WM], cognitive flexibility [CF], inhibitory control [IC], and fluid reasoning [FR]). A parallel mediation approach was implemented with 5,000 bootstrapped samples controlled for sex, maturity, central obesity, having breakfast before cognitive tasks, schools, and school vulnerability. Total, direct, indirect effects, and mediation percentages were estimated. Results: Overall, the finding showed a full parallel mediation effect for Language (92.5%) and English (53.9%), while a partial mediation for Mathematics (43.0%), Science (43.8%), History (45.9%), "Academic Average" (50.6%), and "Academic-PISA" (51.5%). In particular, WM, IC, and FR mediated all school subjects except mathematics, where IC was not significant. CF has not mediated any relationship between GF and academic performance. Conclusion: This study underscores the pivotal role of cognitive domains, specifically WM, IC, and FR, in mediating the link between physical fitness and academic performance in adolescents. These insights have relevant implications for educational and public health policies.

Exploring the mediating role of promoting school physical activity on the relationship between low socioeconomic status and academic achievement and school climate: evidence from 4,990 Chilean schools.

There is evidence that promoting school physical activity (PSPA) benefits children and adolescents, but little is understood about how this promotion may relate to academic achievement and school climate across varying levels of socioeconomic status (SES). Hence, the study aimed to address this knowledge gap by examining two main objectives: (1) determining the association between PSPA and academic achievement and school climate according to schools' SES and (2) exploring the potential mediating role of PSPA in the relationship between schools' SES and academic achievement and school climate. This cross-sectional study at the school level focused on 4,990 schools (including public, subsidized, and private schools) that participated in the National Educational Study 2018 (Chile), which was applied to primary schoolchildren (4th grade, aged 8-10 years). Schools were divided into non-PSPA (n = 4,280) and PSPA (n = 710) during the year 2018. Changes in academic achievement from 2017 to 2018 and school climate were considered. PSPA was associated with improvements in maths (low-SES OR: 1.80, p < 0.001) and reading (middle-SES OR: 1.45, p = 0.029; low-SES OR: 1.47, p < 0.001). The indirect effect (IE) showed that PSPA partially mediated the relationship between SES and academic achievement in reading (IE = 1.017; SE = 0.12; 95%CI, -1.27, -0.77), maths (IE = -1.019; SE = 0.12; 95%CI, -1.25, -0.78), and school climate (IE = -0.46; SE = 0.52; 95%CI, -0.56, -0.35). In conclusion, PSPA was linked to positive changes in academic achievement, especially among low SES, and PSPA presented a potential mediating role in the relationship between SES of schools and academic achievement and school climate.

Lifestyle behavior of physiotherapy students from Ecuador upon admission to higher education: a cross-sectional study.

Introduction: Admission to university has been identified as a period involving the adoption of unhealthy lifestyle behaviors. However, few studies have addressed the extent of this experience among Latin American university students. The aim of this study was twofold: first, to describe anthropometric variables, body composition, physical activity, sedentary behavior, sleep duration and quality, diet, and alcohol consumption in first-year students entering physiotherapy school at the Universidad de las Americas in Quito, Ecuador; second, to test differences in these variables between sexes. Methods: A total of 116 students were recruited. Sociodemographic variables, anthropometric indices, body composition, physical activity, sedentary behavior, sleep quality and duration, adherence to 24-hour movement guidelines, physical fitness (i.e., handgrip strength), diet, alcohol consumption, and smoking habits were evaluated. Results: A total of 50 male (43.1%) and 66 female (56.9%) students were assessed. Overall, the adherence to the 24-hour movement guidelines of the students upon admission to university was 8.6%. Conversely, 86 students (74.1%) did not meet any of the recommendations. Upon admission to university, only 8.6% of the students (female 2.6%; male 6%) met the overall 24-hour movement guidelines. Additionally, 82 students (70.7%) needed changes in diet quality, 81 students (69.8%) had significant sleep disturbances, and 22 students (18.9%) had harmful alcohol consumption. A greater proportion of males met all three 24-h movement recommendations (p = 0.025) than females did. In addition, females reported a greater percentage of occasional smokers (p = 0.025) and a greater prevalence of obesity (p < 0.001), a lower level of physical activity (p < 0.001), and a greater percentage of sleep disturbance (p < 0.001). Conversely, males reported greater waist circumference (p = 0.005), weight (p < 0.001), handgrip strength (p < 0.001), and a greater percentage of harmful alcohol consumption (p < 0.001). Discussion: Our study showed that upon admission to university, overall adherence to the 24-hour movement guidelines is low among university students. Additionally, a high percentage of students reported unhealthy lifestyle behaviors, with differences according to sex. Our findings could lead to the use of specific sex-specific strategies for the prevention and promotion of movement and lifestyle behaviors during this critical period.

Study protocol and rationale of "the UP project": evaluating the effectiveness of active breaks on health indicators in desk-based workers.

Background: Excessive sedentary time has been negatively associated with several health outcomes, and physical activity alone does not seem to fully counteract these consequences. This panorama emphasizes the essential of sedentary time interruption programs. "The Up Project" seeks to assess the effectiveness of two interventions, one incorporating active breaks led by a professional and the other utilizing a computer application (self-led), of both equivalent duration and intensity. These interventions will be compared with a control group to evaluate their impact on physical activity levels, sedentary time, stress perception, occupational pain, and cardiometabolic risk factors among office workers. Methods: This quasi-experimental study includes 60 desk-based workers from universities and educational institutes in Valparaiso, Chile, assigned to three groups: (a) booster breaks led by professionals, (b) computer prompts that are unled, and (c) a control group. The intervention protocol for both experimental groups will last 12 weeks (only weekdays). The following measurements will be performed at baseline and post-intervention: cardiometabolic risk based on body composition (fat mass, fat-free mass, and bone mass evaluated by DXA), waist circumference, blood pressure, resting heart rate, and handgrip strength. Physical activity and sedentary time will be self-reported and device-based assessed using accelerometry. Questionnaires will be used to determine the perception of stress and occupational pain. Discussion: Governments worldwide are addressing health issues associated with sedentary behavior, particularly concerning individuals highly exposed to it, such as desk-based workers. Despite implementing certain strategies, there remains a noticeable gap in comprehensive research comparing diverse protocols. For instance, studies that contrast the outcomes of interventions led by professionals with those prompted by computers are scarce. This ongoing project is expected to contribute to evidence-based interventions targeting reduced perceived stress levels and enhancing desk-based employees' mental and physical well-being. The implications of these findings could have the capacity to lay the groundwork for future public health initiatives and government-funded programs.

Adolescents with a Favorable Mediterranean-Style-Based Pattern Show Higher Cognitive and Academic Achievement: A Cluster Analysis-The Cogni-Action Project.

A Mediterranean diet (MedDiet) has emerged as a crucial dietary choice, not only in attenuating various adolescents' metabolic health issues but it has also been associated with improved cognitive and academic achievement. However, few studies have established patterns of food consumption linked to both cognitive and academic achievement in adolescents living in a developing country with non-Mediterranean-based food. Methods: This cross-sectional study included 1296 Chilean adolescents (50% girls) aged 10-14 years. The MedDiet Quality Index was used to assess adherence to the MedDiet in children and adolescents. Through cluster analysis, four distinct dietary patterns were identified: Western diet (WD = 4.3%); low fruit and vegetables, high-sugar diet (LFV-HSD = 28.2%); low fruit and vegetables, low-sugar diet (LFV-LSD = 42.2%); and the MedDiet (25.3%). A mixed-model analysis was conducted to compare these clusters and their relationships with cognitive and academic achievements. Principal component analysis was performed to identify four primary cognitive domains: working memory, cognitive flexibility, inhibitory control, and fluid reasoning. Academic achievement was determined with five school subjects (Language, English, Mathematics, Science, and History) and included the Academic-PISA score derived from the mean scores in Language, Mathematics, and Science. Results: A marked difference was observed between the four clusters, which was mainly related to the consumption of sugar, ultra-processed foods, fruits, and vegetables. According to cognitive performance, the MedDiet group showed higher performance across all domains than the LFV-HSD, LFV-LSD, and WD groups. Regarding academic achievement, the WD underperformed in all analyses compared to the other groups, while the MedDiet was the unique profile that achieved a positive difference in all academic subjects compared to the WD and LFV-HSD groups (p < 0.05). Conclusions: These findings suggest that higher adherence to Mediterranean-style-based patterns and better food quality choices are associated with improved cognitive and academic achievements.

Lifestyle risk factors and all-cause and cause-specific mortality in the Mexico City prospective study: Assessing the influence of reverse causation.

BACKGROUND: We examined the association between individual lifestyle risk factors with all-cause and cause-specific mortality. METHODS: Prospective cohort study including 155,002 participants from the Mexico City Prospective Study. Cox regression models were used to estimate the association between individual lifestyle risk factors and all-cause and cause-specific mortality. Participants with prevalent diseases at baseline and participants who died during the first 2, 5, 10, and 15 years of follow-up were excluded to account for reverse causation. RESULTS: 27,469 people died during 18.3 years of follow-up years. Overweight and moderate alcohol consumption were inversely associated with all-cause mortality, while low physical activity and smoking were positively associated when all participants were included, regardless of prevalent disease or duration of follow-up. The direction of the association of overweight with all-cause mortality changed from inverse to positive after excluding the first 10 years of follow-up. Compared with normal weight, the hazard ratio (95 % confidence interval) was 1.17 (1.13,1.22) for obesity after excluding those who died in the first 5 years of follow-up and 1.71 (1.59,1.84) after excluding the first 15 years of follow-up. The magnitude of the association of alcohol intake, low physical activity, and smoking with mortality attenuated, whereas for fruits and vegetables increased, after excluding longer periods of follow-up. LIMITATIONS: The data were collected exclusively in Mexico City; lifestyle risk factors were self-reported and thus prone to misclassification bias. CONCLUSIONS: Reverse causation may influence both the magnitude and the direction of the associations between lifestyle risk factors and mortality.

Multimodal neuroimaging correlates of physical-cognitive covariation in Chilean adolescents. The Cogni-Action Project.

Health-related behaviours have been related to brain structural features. In developing settings, such as Latin America, high social inequality has been inversely associated with several health-related behaviours affecting brain development. Understanding the relationship between health behaviours and brain structure in such settings is particularly important during adolescence when critical habits are acquired and ingrained. In this cross-sectional study, we carry out a multimodal analysis identifying a brain region associated with health-related behaviours (i.e., adiposity, fitness, sleep problems and others) and cognitive/academic performance, independent of socioeconomic status in a large sample of Chilean adolescents. Our findings suggest that the relationship between health behaviours and cognitive/academic performance involves a particular brain phenotype that could play a mediator role. These findings fill a significant gap in the literature, which has largely focused on developed countries and raise the possibility of promoting healthy behaviours in adolescence as a means to influence brain structure and thereby cognitive/academic achievement, independently of socioeconomic factors. By highlighting the potential impact on brain structure and cognitive/academic achievement, policymakers could design interventions that are more effective in reducing health disparities in developing countries.

Lifestyle and cardiometabolic risk factors in the ethnic and non-ethnic population > 15 years of age: results from the National Chilean Health Survey 2016-2017 / Estilo de vida y factores de riesgo cardiometabólico en la población étnica y no étnica > 15 años: resultados de la Encuesta Nacional de Salud de Chile 2016-2017

Background: lifestyle and cardiometabolic risk factors information is scarce regarding youth and adults of Latin-American ethnics. Objective: the primary aim was to describe the lifestyle and cardiometabolic risk factors for arterial hypertension (HTN) and diabetes in ethnic Latin-American groups (Mapuche and Aymara) and other non-ethnics > 15 years of age in the Chilean population. A secondary aim was to determine the association between physical activity ‘intensity’ with HTN and diabetes markers. Material and methods: a representative sample from the National Chilean Health Survey 2016-2017, included Mapuche (EG-Map; women n = 166, men n = 300; total n = 466), Aymara (EG-Aym; women n = 96, men n = 55; total n = 151), and a non-ethnic population group (No-EG; women n = 2057, men n = 3445; total n = 5502). The main outcomes were; systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (GL), and secondary outcomes were other anthropometric, lipid profile, and lifestyle parameters. Results: GL was significantly associated with nutrition (0.9 %, p < 0.0001), tobacco and alcohol habits (0.6 %, p < 0.0001). SBP was significantly associated with nutrition (whole-grains 0.04, p = 0.001; water consumption 0.07, p < 0.0001), sleep hygiene (week 0.04, p = 0.030; on weekends -0.04, p = 0.026), and alcohol consumption (-0.06, p < 0.0001). Conclusion: in conclusion, lifestyle differences among Mapuche and Aymara ethnic groups in comparison with non-ethnic Chilean peers > 15 years are significantly associated with blood pressure and glycemia. (AU)

Antecedentes: la información sobre estilos de vida y factores de riesgo cardiometabólico es escasa en jóvenes y adultos de etnia latinoamericana. Objetivo: el objetivo principal fue describir el estilo de vida y los factores de riesgo cardiometabólico para la hipertensión arterial (HTA) y la diabetes en grupos étnicos latinoamericanos (Mapuche y Aymara) y otros no étnicos > 15 años de la población chilena. Un objetivo secundario fue determinar la asociación de la “intensidad” de la actividad física con la HTA y los marcadores de diabetes. Material y métodos: muestra representativa de la Encuesta Nacional de Salud de Chile 2016-2017, compuesta por mapuches (EG-Map; mujeres n = 166, hombres n = 300; total n = 466), aymaras (EG-Aym; mujeres n = 96, hombres n = 55; total n = 151) y un grupo poblacional no étnico (No-GE; mujeres n = 2057, hombres n = 3445; total n = 5502). Las principales evaluaciones fueron la presión arterial sistólica (PAS), la presión arterial diastólica (PAD) y la glucosa plasmática en ayunas (GL), y los resultados secundarios fueron otros parámetros antropométricos, del perfil lipídico y del estilo de vida. Resultados: la GL se asoció significativamente a los hábitos nutricionales (0,9 %, p < 0,0001) y los hábitos de tabaco y alcohol (0,6 %, p < 0,0001). La PAS se asoció significativamente con la nutrición (cereales integrales 0,04, p = 0,001; consumo de agua 0,07, p < 0,0001), higiene del sueño (semana 0,04, p = 0,030; fines de semana -0,04, p = 0,026) y consumo de alcohol (- 0,06, p < 0,0001). Conclusión: en conclusión, las diferencias de estilo de vida entre las etnias mapuche y aymara en comparación con sus pares chilenos no étnicos mayores de 15 años se asocian significativamente con la presión arterial y la glucemia. (AU)

Chronic effects of school physical activity on cognitive performance in youngs: a systematic review protocol / Efeitos crônicos da atividade física escolar no desempenho cognitivo de jovens: um protocolo de revisão sistemática

Recent systematic reviews point out the positive acute effects of physical activity on executive func-tions in children and adolescents, but the chronic effects in this age group are still uncertain. This study aims to describe a systematic review with meta-analysis protocol to elucidate the chronic effects of physical activity at school on the executive functions and attention of children and ad-olescents, considering the effect-moderators and examining different interventions in the school environment. A systematic search will be carried out for studies published in the PUBMED, Em-base, Scopus and Cochrane Library databases. Studies that meet the following predefined criteria (PICOS criteria) will be included: 1) studies conducted with healthy children and adolescents (6-18 years-old), 2) studies with physical activity interventions in school, 3) studies conducted with a control group, and 4) studies with cognitive flexibility, working memory, inhibitory control and attention outcomes. Target outcomes will be extracted as pre-and post-test values. Intervention time, frequencies, intensity, volume, session time, and intervention type will be extracted for meta-regres-sion analysis. For methodological quality will be using the tool for the assessment of study quality and reporting in exercise training studies. Pooled effect estimates will be calculated from the scores of changes between baseline and end of interventions. The effect size will be expressed as Cohens' and presented as standardized mean differences and calculations will be performed using random-effects models. Statistical heterogeneity will be evaluated by Cochran's Q statistic and the I² inconsistency test. The meta-analyses will be performed using OpenMeta[Analyst]

Revisões sistemáticas recentes apontam os efeitos agudos positivos da atividade física nas funções executivas em crianças e adolescentes, mas os efeitos crônicos nessa faixa etária ainda são incertos. Este artigo tem como objetivo descrever o protocolo de revisão sistemática e meta-análise que busca elucidar os efeitos crônicos da atividade física no ambiente escolar sobre as funções executivas e atenção de crianças e adolescentes, conside-rando os efeitos-moderadores e examinando diferentes tipos de intervenções no ambiente escolar. Será reali-zada uma busca sistemática de estudos publicados nas bases de dados PUBMED, Embase, Scopus e Cochrane Library. Serão incluídos estudos que atendam aos seguintes critérios pré-definidos (critérios PICOS): 1) estudos realizados com crianças e adolescentes saudáveis (6-18 anos), 2) estudos com intervenções de ativi-dade física na escola, 3) estudos de intervenção, randomizados ou não, realizados com grupo controle e 4) estudos com flexibilidade, memória de trabalho, controle inibitório e resultados de atenção. Os resultados alvo serão extraídos como valores pré e pós-teste. Tempo de intervenção, frequências, intensidade, volume, tempo de sessão e tipo de intervenção serão extraídos para análise de meta-regressão. Para a qualidade metodológica será utilizado o instrumento para avaliação da qualidade do estudo e relato em estudos de treinamento físico. As estimativas de efeito agrupadas serão calculadas a partir das pontuações das mudanças entre a linha de base e o final das intervenções. O tamanho do efeito será expresso em Cohens e apresentado como diferenças médias padronizadas e os cálculos serão realizados utilizando modelos de efeitos aleatórios. A heterogeneida-de estatística será avaliada pela estatística Q de Cochran e pelo teste de inconsistência I². As meta-análises serão realizadas usando OpenMeta[Analyst]

Prevalence of responders of a school intervention at physical fitness and mental health of children: a quasi-experimental study

Abstract Aim: to verify the effect of a physical education program at school on physical fitness and mental health in children and to determine the individual prevalence of responders. Methods: This is a quasi-experimental study, developed with 67 children aged between 6 and 11 years old. (8.09 ± 1.81). A 21-week intervention was performed, that intervention condition (IC) consisted of sports and circuit training, and nutritional education. For the control condition (CC) classes followed to the Common Curricular National Base. The following variables were evaluated at baseline and post-intervention: physical fitness and mental health through the strength and difficulties questionnaire. Mixed analysis of variance and the prevalence of responders were used for statistical analysis. Results: The main results indicate that there were improvements in the IC in the components of physical fitness (cardiorespiratory fitness, speed, and agility) and mental health indicators (total difficulties, emotional symptoms, problems with peers, and prosocial behavior) after a school physical education program in comparison with the CC. Concerning the prevalence of responders between groups, it was found differences in cardiorespiratory fitness (CC: 33.33%; IC: 65.38%), agility (CC: 36.66%; IC: 73.07%), speed (CC: 43.33%; IC: 79.16%), emotional symptoms (CC: 28.57%; IC: 50.00%), and prosocial behavior (CC: 17.14%; IC: 46.87%). Conclusion: It is reinforced that well-planned physical education classes and simple intervention programs can be adopted at the school level and are capable of promoting children's physical and mental health.

Volumen plaquetario medio como predictor de la mortalidad en pacientes con sepsis: revisión sistemática y metanálisis / Mean platelet volume as a predictor of mortality in patients with sepsis: systematic review and meta-analysis

Introducción: El volumen medio plaquetario (VMP) es un biomarcador utilizado en el abordaje integral de la sepsis. Objetivo: Evaluar la asociación entre VMP con la mortalidad en pacientes con sepsis. Métodos: Se realizó una revisión sistemática de estudios observacionales en cinco bases de datos. Se analizó la mortalidad asociada con la sepsis; las intervenciones consideradas fueron VMP, APACHE y lactato sérico. Resultados: Respecto a la mortalidad asociada a sepsis, se encontró un valor significativo en la VMP a las 72 horas (200 fallecidos versus 654 no fallecidos; MD 0.83 IC95% 0.53-1.13, p=< 0.0001, I2 =72.9%); así como el valor de APACHE II (220 muertos frente a 604 no fallecidos; MD 0.81 IC95% 0.62-1.0, p= 0.0001, I2 =32%). No se encontró significancia estadística para las demás variables clínicas. Conclusiones: El aumento de la VMP se asocia con mayor riesgo de mortalidad en pacientes con sepsis, especialmente después de 72 horas de evolución de las características clínicas.

Introduction: Platelet mean volume (MVP) is a biomarker used in the integral approach to sepsis. Objective: To assess the association between MVP and mortality in patients with sepsis. Methods: A systematic review of observational studies in five databases was performed. Mortality associated with sepsis was analysed; interventions considered were MPV, APACHE and serum lactate. Results: Regarding mortality associated with sepsis, a significant value was found in the MVP at 72 hours (200 deceased versus 654 not deceased; MD 0.83 IC95% 0.53-1.13, p=<0.0001, I2 =72.9%); as well as the value of APACHE II (220 dead versus 604 not deceased; MD 0.81 IC95% 0.62-1.0, p= 0.0001, I2 =32%). No statistical significance was found for the other clinical variables. Conclusions: Increased MVP is associated with increased risk of mortality in patients with sepsis, especially after 72 hours of evolution of clinical features.

Referencias históricas en la evolución del tratamiento de las quemaduras / Historical references in the evolution of burn treatment

No disponible

Caracterización de los estilos de vida en dueñas de casa chilenas: análisis de la Encuesta Nacional de Salud 2009-2010 / Lifestyles of Chilean housewives: analysis of the 2009-2010 Chilean Health Survey

Background: Housewives represent a important proportion of the Chilean population. However, there is limited evidence about their lifestyles. Aim: To characterize lifestyles and determine the level of compliance with healthy lifestyles guidelines of housewives in Chile. Material and Methods: Housewives from the 2009-2010 National Health Survey were included. The variables studied included levels of physical activity (PA), sedentary behavior, diet, hours of sleep and smoking. Compliance with healthy lifestyle behaviors was evaluated through logistic regression, granting a value of 1 for compliance and 0 for non-compliance. A healthy lifestyle was defined as meeting at least four healthy behaviors. Results: Housewives aged > 55 years had a higher BMI and waist circumference compared to those aged < 40 years. Housewives were also more likely to report moderate alcohol consumption and were more likely to meet a healthier lifestyle score (Odds ratio = 1.52 [95% confidence intervals: 1.09 to 2.11], p = 0.013). No significant age trends were observed for other lifestyle behaviors. Conclusions: Housewives had high levels of central obesity, excess body weight and high levels of salt intake but low alcohol intake. Their healthy lifestyles behaviors increased along with increasing age.

Impacto de las condiciones sociodemográficas sobre el control prenatal en Latinoamérica / Impact of sociodemographic conditions on prenatal care in Latin America

Resumen Introducción. El control prenatal corresponde a una estrategia encaminada a prevenir las posibles complicaciones del embarazo, el parto y el puerperio. Diversos estudios aislados se han realizado para identificar factores que pueden afectar de forma negativa el control prenatal. Objetivo. Realizar una síntesis cualitativa de la literatura respecto al impacto de las condiciones sociodemográficas sobre el control prenatal en Latinoamérica. Materiales y métodos. Se realizó una búsqueda de la literatura a junio de 2018 en las bases de datos EBSCO, Embase, ScienceDirect, LILACS, SciELO, Cochrane Library, MEDLINE-PubMed y Google Scholar, con los términos "prenatal care" AND "Health services accessibility" AND "Pregnancy, Health services accessibility" AND "Pregnancy, prenatal care" AND "Health services accessibility" y sin límite de tiempo. Resultados. Se encontraron 13 artículos con información relevante para el desarrollo de la presente revisión. Conclusiones. La literatura disponible sugiere que condiciones sociodemográficas desfavorables podrían incidir de manera negativa sobre el control prenatal. El cuidado del hogar, la atención de otros hijos, la afiliación al sistema de seguridad social, la obligación laboral y el desempleo parecen ser los principales factores que afectan la calidad del mismo.

Abstract Introduction: Prenatal care is a strategy aimed at preventing the possible complications of pregnancy, childbirth and the postpartum period. Several isolated studies have been conducted to identify factors that may negatively affect prenatal care. Objective: To make a qualitative synthesis of the literature regarding the impact of sociodemographic conditions on prenatal care in Latin America. Materials and methods: A literature search was conducted in June 2018 on the EBSCO, Embase, ScienceDirect, LILACS, SciELO, Cochrane Library, MEDLINE-PubMed and Google Scholar databases using the following terms: "prenatal care" AND "Health services accessibility" AND "Pregnancy, Health services accessibility" AND "Pregnancy, prenatal care" AND "Health services accessibility". No time limits were considered in the search. Results: Thirteen articles with information relevant to the development of the present review were found. Conclusions: The available literature suggests that unfavourable socio-demographic conditions may have a negative impact on prenatal care. Household care, care of other children, affiliation to the social security system, obligation to work and unemployment seem to be the main factors affecting the quality of prenatal care.

Relación entre niveles de actividad física y sedentarismo con síndrome metabólico. ENS Chile 2009-2010 / Relationship between levels of physical activity and sedentarism with metabolic syndrome. ENS Chile 2009-2010

Resumen: Objetivo: Asociar una nueva e integradora clasificación de actividad física (AF) y sedentarismo con riesgo de síndrome metabólico (SM) en una muestra representativa de adultos chilenos. Material y métodos: Se incluyeron 5040 participantes de la Encuesta Nacional de Salud de Chile 2009-2010. Fueron creadas cuatro categorías mediante una combinación entre niveles de AF y sedentarismo (SED) usando el cuestionario GPAQ. El SM fue definido según las normas del NCEP ATP-III. Resultados: Se observa una menor probabilidad de presentar SM sólo en las categorías que cumplen con las recomendaciones internacionales de AF (p<0.05), "activo y bajo-SED" (RM=0.72 [0.57 a 0.91]) y "activo y alto-SED" (RM=0.63 [0.49 a 0.81]). El nivel de sedentarismo (alto/bajo) no se asoció con una reducción significativa de SM en ninguno de los grupos. Conclusiones: Este tipo de clasificación demuestra que la principal estrategia para reducir el riesgo de SM debiera estar asociada con cumplir las recomendaciones de AF.

Abstract: Objective: To use a new methodology to classify the level of physical activity (PA) by combining the levels of PA and sedentary time (SED) in order to establish its association with metabolic syndrome (MS). Materials and methods: A representative sample of Chilean adults (≥18 years old) who participated in the National Health Survey (ENS 2009-2010) was included in this study (n=5 040). Four categories were created using a combination of PA and SED levels through the GPAQ questionnaire. MS was defined according to the norms established by NCEP ATP-III. Results: A lower probability of MS was observed only in the categories that comply with the international recommendations of PA, "active and low-SED" (OR=0.72 [0.57 to 0.91]) and "active and high-SED" (OR=0.63 [0.49 to 0.81]). While the level of SED (high/low) was not associated with a significant reduction of MS in any of the groups. Conclusions: This type of classification demonstrates that the main strategy to reduce the risk of MS should be associated with compliance with the recommendations of PA.

Influencia de la edad sobre el cumplimiento de las recomendaciones de actividad física: Resultados de la Encuesta Nacional de Salud en Chile 2009-2010 / Adherence to physical activity recommendations across age categories: Findings from the 2009-2010 Chilean National Health Survey

RESUMEN A pesar de que la actividad física (AF) es un factor protector contra las enfermedades crónicas no transmisibles, un gran porcentaje de la población no cumple los niveles mínimos recomendados. El objetivo fue investigar como varían los niveles de práctica de AF entre los diferentes grupos etarios en la población chilena. Se incluyeron 5.133 participantes de la Encuesta Nacional de Salud 2009-2010. La AF fue determinada utilizando el cuestionario GPAQ. La inactividad física fue definida como <600 MET/min/semana de AF moderada a vigorosa. La asociación entre AF y edad fue investigada por sexo mediante regresión logística. Las mujeres presentaron una mayor probabilidad de ser físicamente inactivas en comparación a los hombres (p<0,0001). Al analizar la prevalencia de inactividad física por sexo y grupo etario, esta cambió ligeramente entre los 20 a 59 años, pero a partir de los 60 se observó un incremento importante en la prevalencia llegando a 63% y 56% para mujeres y hombres >80 años, respectivamente. Los resultados obtenidos confirman la necesidad de seguir fomentando la práctica regular de AF física a través de todo el ciclo vital, pero en especial sobre los 60 años, ya que este grupo presenta una mayor probabilidad de ser físicamente inactivo.

ABSTRACT Although physical activity (PA) is a protective factor against non-communicable diseases, there is an important proportion of the population who do not meet PA guidelines. Our aim was to investigate how adherence to PA guidelines varies across different age groups in the Chilean population. 5,133 participants from the 2009-2010 Chilean Health Survey were included in this study. PA was measured using the Global Physical Activity Questionnaire (GPAQ). Physical inactivity was defined as <600 MET/min/week of moderate to vigorous intensity PA. Logistic regression was used to investigate the association of PA with age. The main finding of this shows that women were more likely to be inactive than men (p<0.0001). Physical inactivity prevalence varied slightly between 20 and 59 years. However, among those individuals aged >60 years the prevalence increased markedly, reaching 63% and 56% for women and men aged >80 years, respectively. These findings confirm the necessity of promoting PA across the lifespan, but more importantly, these results suggest that more promotion and opportunities for engaging in PA should be created especially for older adults, who are more likely to be physically inactive.

Revisión Bibliográfica: Glicocálix Endotelial como Blanco de Agresión del Fenómeno Isquemia Reperfusión / Bibliographic Review: Endothelial Glycocalyx as Target of Aggression of the Ischemia-Reperfusion Injury

El glicocálix endotelial es una estructura rica en glucosaminoglicanos, proteoglicanos y glucoproteínas que recubre el endotelio vascular; además de ser una estructura de protección, al estar en contacto directo con la sangre se convierte en el blanco de agresión de diversos mecanismos fisiopatológicos. El fenómeno isquemia-reperfusión se presenta comúnmente en varias entidades del paciente crítico, incluyendo: eventos cerebro vasculares isquémicos, síndrome coronario agudo, sepsis y choque en sus distintos tipos, traumatismos mayores, cirugía y trasplante. Las complicaciones derivadas de este fenómeno son múltiples y dependientes del sitio de presentación; el común denominador es la disfunción microvascular que potencialmente podría desencadenar un fallo multisistémico. El objetivo de esta revisión bibliográfica fue realizar una actualización de los conocimientos en relación a la injuria del glicocálix endotelial durante el fenómeno isquemia-reperfusión.(au)

The endothelial glycocalyx is a structure rich in glycosaminoglycans, proteoglycans and glycoproteins that cover vascular endothelium; in addition of being a protective structure, the direct contact with blood turns it the target of aggression of multiple physiopathological mechanisms. The ischemia-reperfusion injury commonly presents in several critical care entities, including: ischemic stroke, acute coronary syndrome, sepsis and shock, major trauma, surgery and transplantation. Complications are multiple and dependent of the site of presentation; the common denominator is microvascular dysfunction that could potentially trigger multiple organ dysfunction syndrome. The aim of this bibliographic review was to update the knowledge regarding endothelial glycocalyx damage and ischemia-reperfusion injury.(au)

Efficacy and safety of growing rods in the treatment of scoliosis in children under 10 / Eficácia e segurança de hastes de crescimento no tratamento da escoliose em crianças menores de 10 / Eficacia y seguridad de las barras de alargamiento en el tratamiento de escoliosis en niños menores de 10 años

ABSTRACT Objective: To determine the efficacy and safety of growing rods in the treatment of scoliosis in children aged under 10 years. Methods: A retrospective review of medical records of patients under 10 with scoliosis, treated with growing rods from the period between 1997 and 2012. Results: We identified 35 patients treated with growing rods who met the selection criteria. The average age at the start of treatment was 5.9 ± 2.3 years. Most of the patients (51.4%) showed idiopathic etiology scoliosis. Pre-surgery and post-surgery radiographic change showed a 47.7% reduction in Cobb angle (p>0.001). We identified 8 patients with some complication, the most prevalent being instrumentation failure (22.9%). The only predicting factor for post-operative complications was the total number of lengthenings performed (OR=7.03; CI 95% [1.1-45.4]; p=0.040). Conclusions: Treatment of scoliosis with growing rods in patients aged under 10 achieved a significant reduction in the magnitude of the deformity before final bone fusion. However, the rate of complications is rather high, therefore we recommend reducing the frequency of lengthenings to the minimum needed to maintain correction and longitudinal growth of the spine. Level of Evidence IV; Case series.

RESUMO Objetivo: Determinar a eficácia e segurança de hastes de crescimento no tratamento de escoliose em crianças menores de 10 anos. Métodos: Revisão retrospectiva de prontuários de pacientes menores de 10 anos com escoliose, tratados com hastes de crescimento entre 1997 e 2012. Resultados: Identificamos 35 pacientes, que foram tratados com hastes de crescimento, que satisfizeram os critérios de seleção. A idade média no início do tratamento foi de 5,9 ± 2,3 anos. A maioria dos pacientes (51,4%) apresentou escoliose de etiologia idiopática. A alteração radiográfica pré e pós-operatória mostra uma redução de 47,7% do ângulo de Cobb (p> 0,001). Foram identificados 8 pacientes com alguma complicação, sendo falha de instrumentação a mais prevalente (229%). O único fator preditivo para complicações pós-operatórias foi o número total de alongamentos realizados (OR = 7,03; IC95% [1,1-45,4]; p = 0,040). Conclusão: O tratamento para escoliose em pacientes com menos de 10 anos com hastes de crescimento alcançou uma redução significativa na magnitude da deformidade antes da fusão óssea final. No entanto, a frequência de complicações é bastante alta e, para isso, recomendamos reduzir ao mínimo a frequência de alongamentos, a fim de manter a correção e o crescimento longitudinal da coluna. Nível de Evidência IV; Série de casos.

RESUMEN Objetivo: Determinar la eficacia y seguridad de las barras de alargamiento en el tratamiento de la escoliosis en niños menores de 10 años. Métodos: Revisión retrospectiva de registros médicos de pacientes menores de 10 años con escoliosis, tratados mediante barras de alargamiento entre 1997 y 2012. Resultados: Se identificaron 35 pacientes tratados con barras de alargamiento que satisfacían los criterios de selección. El promedio de edad al inicio del tratamiento fue de 5,9 ± 2,3 años. La mayoría de los pacientes (51,4%) tenían escoliosis de etiología idiopática. El cambio radiográfico prequirúrgico y postquirúrgico mostró reducción del 47,7% en el ángulo de Cobb (p > 0,001). Se identificaron 8 pacientes con alguna complicación, siendo el fallo del instrumental más prevalente (22,9%). El único factor predictor de complicaciones postoperatorias fue el número total de alargamientos realizados (OR = 7,03; IC 95% [1,1-45,4]; p = 0,040). Conclusiones: El tratamiento de la escoliosis con barras de alargamiento en pacientes menores de 10 años logró una reducción significativa de la magnitud de la deformidad antes de la fusión ósea definitiva. Sin embargo, la tasa de complicaciones es bastante alta, por lo cual se recomienda disminuir la frecuencia de alargamientos al mínimo necesario para mantener la corrección y el crecimiento longitudinal de la columna vertebral. Nivel de Evidencia IV; Serie de Casos.