Limits of stability and falls during a multicomponent exercise program in faller older adults: A retrospective cohort study.

BACKGROUND/OBJETIVES: Multicomponent exercise programs have been demonstrated to prevent falls in older adults. However, the underlying responsible mechanisms are not clear. We aimed to analyze the association between changes in the limits of stability (LOS) as a relevant balance component, and falls occurrence during a multicomponent physical exercise program. METHODS: Retrospective study, including ninety-one participants who had experienced a fall in the previous year, and were attended in a falls unit. All of them were included in a twice-a-week multicomponent exercise program during 16 weeks. Pre- and post-program measurements were collected for leg press, gait speed, the short physical performance battery (SPPB), and LOS (point of excursion [POE] and maximal excursion [MEX]) with posturography. Falls occurrence was assessed between the beginning and the completion of the exercise program (16 week). RESULTS: The mean age was 77.2 years, and 72 were female. Thirty-two participants fell at least once during the exercise period. The global baseline POE was 47.6 %, and the MEX was 64.7 %, and there were no differences between fallers and nonfallers. Nonfallers presented greater improvements in POE (6.3 % versus 1.3 %; p < .05) and MEX (9.2 % versus 3.0 %; p < .01) than fallers. The POE and MEX were independently associated with a reduced probability of having had a fall, OR: 0.95 (95 % CI: 0.91 to 0.99) and 0.94 (95 % CI: 0.90 to 0.99), respectively. Changes in SPPB results or leg press strength were not associated with decreased falls. Adjusted probability of fall occurrence decreased by 5 % and 6 % per 1 % improvement in absolute values in POE and MEX, respectively. CONCLUSIONS: Improvements in LOS after a multicomponent physical exercise program in older adults with previous falls may be associated with a decreased occurrence of falls.

Frailty, depression risk and 10-year hospitalization in older adults. The FRADEA study.

OBJECTIVES: To determine whether the interaction between frailty status and depression risk is associated with hospitalization density in older adults. METHODS: Ongoing cohort study in 794 subjects aged over 70 years from Albacete (Spain). Data were collected on depression risk, frailty, hospitalizations, and covariates. Participants were categorized into six groups. RESULTS: Adjusted hospitalization risk was higher for groups of prefrail/-non depression risk (HR 1.48; 95% confidence interval (CI) 1.16-1.89), prefrail/depression risk (HR 1.73; 95% CI 1.29-2.30), frail/non depression risk (HR 1.79; 95% CI 1.22-2.62), and frail/depression risk (HR 2.12; 95% CI 1.49-3.02), compared with robust/non depression risk group (p<0.01). Frail and prefrail groups presented increased hospitalization density in the first four follow-up years. CONCLUSIONS: Depression risk changes the yearly probabilities of hospitalization in prefrail and frail groups, increasing them in the first years. Depression risk should be monitored in prefrail and frail older adults as an independent risk factor for hospitalization.

Nursing Student Satisfaction with the Teaching Methodology Followed during the COVID-19 Pandemic.

Background: Halfway through the 2019−2020 academic year, the entire university system was affected by an exceptional situation caused by the COVID-19 pandemic. Online learning was globally implemented for all degrees to finish the course and to meet academic objectives. This unforeseen change in teaching and subsequent evaluations meant teachers and students had to invest significant effort. Student satisfaction is used to measure the evaluation of teaching/learning processes in higher education. Our objective was to know and compare the satisfaction of nursing students taught at a Spanish public university after making changes to the teaching methodology. Methods: A descriptive observational study that measures student satisfaction. Study population: 240 students registered in academic years 2019−2020 and 2020−2021 answered the survey. The survey contained 30 items answered on a Likert-type scale. The main variables: the learning methodology (online or blended) was the independent variable; student satisfaction was the dependent variable. Descriptive and bivariate analyses were performed. Results: A response rate between 37.4% and 41.2%. Overall satisfaction was 2.75 points (SD 0.56) and 2.94 points (SD 0.49) with online learning and bimodal learning, respectively (maximum score 4 points) (p < 0.004). Conclusions: Student satisfaction was moderate−high for both learning methodologies. Students found that the b-learning methodology was the most valued.

Predictive Model of Quality of Life in Patients with Parkinson's Disease.

Parkinson's disease is a chronic, progressive, and disabling neurodegenerative disease which evolves until the end of life and triggers different mood and organic alterations that influence health-related quality of life. The objective of our study was to identify the factors that negatively impact the quality of life of patients with Parkinson's disease and construct a predictive model of health-related quality of life in these patients. METHODS: An analytical, prospective observational study was carried out, including Parkinson's patients at different stages in the Albacete Health Area. The sample consisted of 155 patients (T0) who were followed up at one (T1) and two years (T2). The instruments used were a purpose-designed data collection questionnaire and the "Parkinson's Disease Questionnaire" (PDQ-39), with a global index where a higher score indicates a worse quality of life. A multivariate analysis was performed by multiple linear regression at T0. Next, the model's predictive capacity was evaluated at T1 and T2 using the area under the ROC curve (AUROC). RESULTS: Predictive factors were: sex, living in a residence, using a cane, using a wheelchair, having a Parkinson's stage of HY > 2, having Alzheimer's disease or a major neurocognitive disorder, having more than five non-motor symptoms, polypharmacy, and disability greater than 66%. This model showed good predictive capacity at one year and two years of follow-up, with an AUROC of 0.89 (95% CI: 0.83-0.94) and 0.83 (95% CI: 0.76-0.89), respectively. CONCLUSIONS: A predictive model constructed with nine variables showed a good discriminative capacity to predict the quality of life of patients with Parkinson's disease at one and two years of follow-up.

Type 1 diabetes incidence trends in children and adolescents aged 0-14 years in Europe: a systematic review and meta-analysis protocol.

INTRODUCTION: Monitoring type 1 diabetes (T1D) trends across most European countries using objectively measured data and how this incidence has evolved over the past three decades should be considered a public health priority. This study protocol provides a standardised and transparent methodology to assess TD1 trends among 0-14-year-old children and adolescents across Europe from 1994 to 2021. METHODS AND ANALYSIS: This protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the Cochrane Collaboration Handbook. The literature search will be conducted using MEDLINE, Embase, CINAHL and Web of Science databases from 1994 to 2021. Observational cohort studies providing incidence rates for European children and adolescents diagnosed with T1D aged ≤14.9 years and studies written in English, Spanish or Portuguese will be included. The risk of bias of the included studies will be assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies from the National Heart, Lung, and Blood Institute. Subgroup analyses will be performed based on gender, age, study year, country or European region. Metaregression analysis will be conducted using economic and geographic variables, such as gross national income of the country or geographic latitude. ETHICS AND DISSEMINATION: The systematic review based on this protocol will provide a comprehensive description of T1D incidence trends in children and adolescents across Europe from 1994 to 2021. The results will be disseminated in a peer-reviewed journal and in mass media. This study will exclusively use data from published research, so institutional ethical approval is not required. PROSPERO REGISTRATION NUMBER: CRD42021239480.

Comparative effect of eHealth interventions on hypertension management-related outcomes: A network meta-analysis.

BACKGROUND: Increasingly, health professionals and patients have begun to be involved in eHealth interventions to assist in the self-management of hypertension. Therefore, this study was aimed at comparing the effect of different types of eHealth interventions (phone calls, blood pressure telemonitoring, emails, web-site, smartphone-app, short message service (SMS) and more than two eHealth interventions) on reducing systolic and diastolic blood pressure, increasing adherence to medication treatment, improving physical activity compliance, controlling blood pressure, and improving quality of life (QoL). METHODS: A systematic search in MEDLINE (via PubMed), EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases was conducted to identify experimental studies addressing the effect of eHealth interventions on the self-management of hypertension. Comparative evaluation of the eHealth interventions effect were performed by conducting a standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between eHealth interventions and control/non-intervention. RESULTS: Fifty-one studies were included in the analysis showing a moderate effect size for more than two types of eHealth interventions (-0.46; 95%CI: -0.64, -0.27, p < 0.001 and -0.29; 95%CI: -0.46, -0.13, p < 0.001), phone calls (-0.37; 95%CI: -0.57, -0.17, p < 0.001 and -0.29; 95%CI: -0.52, -0.07, p = 0.011) and smartphone-app (-0.26; 95%CI: -0.50, -0.01, p = 0.040 and -0.40; 95%CI: -0.70, -0.10, p = 0.010) on reducing both systolic and diastolic blood pressure, respectively. Additionally, i) smartphone-app improved medication adherence by 45%; ii) more than two types of eHealth interventions and emails improved physical activity compliance by 18% and 57% respectively; ii) more than two types of eHealth interventions, phone calls, blood pressure telemonitoring, website and SMS improved blood pressure control between 16% and 30%; and iv) blood pressure telemonitoring showed a week effect on QoL CONCLUSIONS: Our study reported eHealth to be a suitable intervention for the self-management of hypertension. Considering our results and the population's accessibility to eHealth devices, eHealth could be a useful and largely scalable tool for the self-management of hypertension. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020187468.

The Role of Physical Fitness in the Relationship between Nut Consumption and Body Composition in Young Adults.

The main objective of this study was to estimate the association between nut consumption and body composition-related measures and to examine whether this relationship is mediated by cardiorespiratory fitness (CRF) and the muscle strength index (MSI) in young adults. A cross-sectional study involving college students (n = 354) aged 18-30 years from a Spanish public university was conducted. Body composition and fitness components were assessed using standard methods. Nut consumption was evaluated using a Food-Frequency Questionnaire. ANCOVA models were used to assess the mean differences in physical fitness and body composition by nut consumption categories. Hayes's PROCESS macro was applied for mediation and interaction analyses adjusted for the main confounders. Young adults with high nut consumption (≥5 portions of 30 g/week) showed significantly higher values of physical fitness components and fat-free mass and lower values of adiposity-related measures than their peers in the lowest categories of nut consumption (˂1 portion/week) (p < 0.05). No significant interaction between CRF and nut consumption on body composition was found. In the mediation analysis, CRF and MSI acted as full mediators of the relationship of nut consumption with fat-free mass and waist circumference/height index. Otherwise, CRF and MSI partially mediated the relationship between nut consumption and body mass index and percent of fat mass. Finally, nut consumption, per se, does not appear to have a significant impact on body composition indicators because these associations have been shown to be partially (for BMI and %BF) or entirely (for ratio WC/height and fat-free mass) explained by CRF and MSI.

The Acute Effect of Exercise on Arterial Stiffness in Healthy Subjects: A Meta-Analysis.

Arterial stiffness has been shown to be a subclinical marker associated with cardiovascular disease. Meanwhile, long-term exercise has been demonstrated to reduce arterial stiffness, providing a decrease in cardiovascular risk. However, the acute effect of exercise on arterial stiffness is unclear. This systematic review and meta-analysis aimed to assess the acute effect of exercise interventions on arterial stiffness in healthy adults. We searched the Cochrane Central Register of Controlled Trials, MEDLINE (via Pubmed), Scopus, and Web of Science databases, from their inception to 30 June 2020. A meta-analysis was performed to evaluate the acute effect of exercise on arterial stiffness using random-effects models to calculate pooled effect size estimates and their corresponding 95% CI. Pulse wave velocity was measured as an arterial stiffness index. The 30 studies included in the meta-analysis showed that pulse wave velocity was not modified immediately after exercise (0 min post) (ES: 0.02; 95% CI: -0.22, 0.26), but subsequently decreased 30 min after exercise (ES: -0.27; 95% CI: -0.43, -0.12). Thereafter, pulse wave velocity increased to its initial value 24 h after exercise (ES: -0.07; 95% CI: -0.21, 0.07). Our results show that, although there is a significant reduction in pulse wave velocity 30 min after exercise, the levels of arterial stiffness return to their basal levels after 24 h. These findings could imply that, in order to achieve improvements in pulse wave velocity, exercise should be performed on a daily basis.

Frailty, depression risk, and 10-year mortality in older adults: the FRADEA study.

OBJECTIVES: To investigate if depression risk modifies the association between frailty and mortality in older adults. DESIGN: Ongoing cohort study. SETTING: Albacete city, Spain. PARTICIPANTS: Eight hundred subjects, 58.8% women, over 70 years of age from the Frailty and Dependence in Albacete (FRADEA) study. MEASUREMENTS: Frailty phenotype, Geriatric Depression Scale (GDS), comorbidity, disability, and drug use were collected at baseline. Six groups were categorized: (G1: non-frail/no depression risk; G2: non-frail/depression risk; G3: prefrail/no depression risk; G4: prefrail/depression risk; G5: frail/no depression risk; and G6: frail/depression risk). Mean follow-up was 2542 days (SD 1006). GDS was also analyzed as a continuous variable. The association between frailty and depression risk with 10-year mortality was analyzed. RESULTS: Mean age was 78.5 years. Non-frail was 24.5%, prefrail 56.3%, frail 19.3%, and 33.5% at depression risk. Mean GDS score was 3.7 (SD 3.2), increasing with the number of frailty criteria (p < 0.001). Ten-year mortality rate was 44.9%. Mortality was 21.4% for the non-frail, 45.6% for the prefrail, and 72.7% for the frail participants, 56% for those with depression risk, and 39.3% for those without depression risk. Mean survival times for groups G1 to G6 were, respectively, 3390, 3437, 2897, 2554, 1887, and 1931 days. Adjusted mortality risk was higher for groups G3 (HR 2.1; 95% confidence interval (CI) 1.4-3.1), G4 (HR 2.5; 95% CI 1.7-3.8), G5 (HR 3.8; 95% CI 2.4-6.1), and G6 (HR 4.0; 95% CI 2.6-6.2), compared with G1 (p < 0.001). Interaction was found between frailty and depression risk, although they were independently associated with mortality. CONCLUSIONS: Depression risk increases mortality risk in prefrail older adults but not in non-frail and frail ones. Depression should be monitored in these older adults to optimize health outcomes. Factors modulating the relationship between frailty and depression should be explored in future studies.

Gait plasticity impairment as an early frailty biomarker.

BACKGROUND/OBJECTIVES: To assess whether gait plasticity and gait reserve, valid measures of gait adaptation to environmental stressors, are associated with frailty. DESIGN: Cross-sectional sub-analysis of the FISTAC study (Identification of the Physical Attributes of the Fear of Falling Syndrome). SETTING: Community-dwelling women from the Falls Unit of a Geriatrics Department. PARTICIPANTS: One hundred and twenty-nine women with an age ≥ 70 years old and presence of at least one previous fall in the last year. MEASURES: Age, comorbidity, nutritional status, cognitive status, depression, medications, disability, fear of falling, physical function, hand grip strength, 1RM leg-press strength, maximum and mean leg-press power were determined. Frailty was assessed using the frailty phenotype criteria. Gait plasticity parameters were measured by walking at normal pace, fast pace, and slow pace, and mean (left and right) stride velocity and stride variability (SD) for the three walks were determined independently and for the sum of the three walks. Gait reserve was calculated as the difference in stride velocity from normal to fast pace. ROC curves were constructed to determine the best association between gait plasticity parameters and frailty. RESULTS: The mean age of the participants was 79 years (SD 8.0). The median of normal, fast, slow and three-walks pace stride velocity were 68.9 cm/s (interquartile range [IQR 33.8]), 96.1 cm/s (IQR 38.3), 51.6 cm/s (IQR 19.8), and 72.7 cm/s (IQR 20.7) respectively. The median of normal, fast, slow and three-walks pace stride variability were 4.5 cm/s (IQR 3.3), 5.4 cm/s (IQR 3.8), 3.6 cm/s (IQR 2.3) and 15.9 cm/s (IQR 16.5) respectively. The median of gait reserve was 23 cm/s (IQR 46). Gait reserve and fast pace stride velocity were associated not only with frailty, but also with a lower age, disability, depression, physical function, muscle strength and power, and fear of falling, more than gait velocity. Areas under the curve (95% CI) for gait parameters with stronger association with frailty were fast pace stride velocity 0.801 (0.723-0.880), three-walk mean stride velocity 0.761 (0.678-0.845), three-walks stride variability 0.724 (0.635-0.81) and gait reserve 0.727 (0.635-0.818). CONCLUSIONS: Lower gait reserve and lower gait plasticity have a stronger association with frailty than gait speed in older women. Our results may support the use of these gait parameters to early identify frailty in community-dwelling older women.