Allostatic load and executive functions in overweight adults.

BACKGROUND/OBJECTIVE: Overweight is linked to inflammatory and neuroendocrine responses potentially prompting deregulations in biological systems harmful to the brain, particularly to the prefrontal cortex. This structure is crucial for executive performance, ultimately supervising behaviour. Thus, in the present work, we aimed to test the relationship between allostatic load increase, a surrogate of chronic physiological stress, and core executive functions, such as cognitive flexibility, inhibitory control, and working memory. METHOD: Forty-seven healthy-weight and 56 overweight volunteers aged from 21 to 40 underwent medical and neuropsychological examination. RESULTS: Overweight subjects exhibited a greater allostatic load index than healthy-weight individuals. Moreover, the allostatic load index was negatively related to inhibitory control. When separated, the link between allostatic load index and cognitive flexibility was more marked in the overweight group. CONCLUSIONS: An overweight status was linked to chronic physiological stress. The inverse relationship between the allostatic load index and cognitive flexibility proved stronger in this group. Set-shifting alterations could sustain rigid-like behaviours and attitudes towards food.

Allostatic load and disordered white matter microstructure in overweight adults.

Overweight and stress are both related to brain structural abnormalities. The allostatic load model states that frequent disruption of homeostasis is inherently linked to oxidative stress and inflammatory responses that in turn can damage the brain. However, the effects of the allostatic load on the central nervous system remain largely unknown. The current study aimed to assess the relationship between the allostatic load and the composition of whole-brain white matter tracts in overweight subjects. Additionally, we have also tested for grey matter changes regarding allostatic load increase. Thirty-one overweight-to-obese adults and 21 lean controls participated in the study. Our results showed that overweight participants presented higher allostatic load indexes. Such increases correlated with lower fractional anisotropy in the inferior fronto-occipital fasciculi and the right anterior corona radiata, as well as with grey matter reductions in the left precentral gyrus, the left lateral occipital gyrus, and the right pars opercularis. These results suggest that an otherwise healthy overweight status is linked to long-term biological changes potentially harmful to the brain.

[Therapeutic inertia in the management of type 2 diabetic patients in Primary Health Care]. / Inercia terapéutica en el manejo de pacientes con diabetes mellitus tipo 2 en el ámbito de la Atención Primaria.

OBJECTIVE: To assess therapeutic inertia (TI) in the management of type 2 diabetic patients (DM2), as regards glycemic and lipid control. MATERIALS AND METHODS: Two groups of patients were studied. Group 1: All the patients were older than 14 years, diagnosed with DM2 up to 28th February 2013, and their last determination of HbA1c was ≥ 8.5%. Group 2: All patients, under 60 years old, diagnosed with DM2 between the 1st January 2011 and the 31st December 2012, with no chronic complications and their last determination of HbA1c was ≥ 6.5%. RESULTS: Group 1: 253 patients were included (13% of DM2 diagnosed). TI was 43% for DM2, 83% for LDL cholesterol, and 80% for triglycerides. TI was lower (P=.037) in patients with HbA1c ≥ 10%. There was no difference in TI as regards the management of lipid profile depending on the HbA1c levels. Group 2: All DM2 patients (n=53) who met inclusion criteria were assessed (2.7% of DM2 diagnosed). Percentage of visits of those patients that had TI: 55% for DM2, 63% for LDL cholesterol and 64% for triglycerides. A more intense therapy was observed in patients with HbA1c>7.5% in 3 of the 5 visits made. CONCLUSIONS: TI in both groups was high and there is a lack of recording the reasons for this. It is important to improve the attitude of the professionals who care for the diabetic population.

Affected connectivity organization of the reward system structure in obesity.

With the prevalence of obesity rapidly increasing worldwide, understanding the processes leading to excessive eating behavior becomes increasingly important. Considering the widely recognized crucial role of reward processes in food intake, we examined the white matter wiring and integrity of the anatomical reward network in obesity. Anatomical wiring of the reward network was reconstructed derived from diffusion weighted imaging in 31 obese participants and 32 normal-weight participants. Network wiring was compared in terms of the white matter volume as well as in terms of white matter microstructure, revealing lower number of streamlines and lower fiber integrity within the reward network in obese subjects. Specifically, the orbitofrontal cortex and striatum nuclei including accumbens, caudate and putamen showed lower strength and network clustering in the obesity group as compared to healthy controls. Our results provide evidence for obesity-related disruptions of global and local anatomical connectivity of the reward circuitry in regions that are key in the reinforcing mechanisms of eating-behavior processes.

Functional connectivity in obesity during reward processing.

Obesity is a health problem that has become a major focus of attention in recent years. There is growing evidence of an association between obesity and differences in reward processing. However, it is not known at present whether these differences are linked exclusively to food, or whether they can be detected in other rewarding stimuli. We compared responses to food, rewarding non-food and neutral pictures in 18 young adults with obesity and 19 normal-weight subjects using independent component analysis. Both groups modulated task-related activity in a plausible way. However, in response to both food and non-food rewarding stimuli, participants with obesity showed weaker connectivity in a network involving activation of frontal and occipital areas and deactivation of the posterior part of the default mode network. In addition, obesity was related with weaker activation of the default mode network and deactivation of frontal and occipital areas while viewing neutral stimuli. Together, our findings suggest that obesity is related to a different allocation of cognitive resources in a fronto-occipital network and in the default mode network.

[Glucose metabolism alterations and follow-up study of a non-diabetic adult population]. / Alteraciones del metabolismo de la glucosa y estudio de seguimiento de una población adulta no diabética.

OBJECTIVE: To determine the appearance of type 2 diabetes mellitus (DM2) and impaired fasting glucose (IFG) at five years of follow-up in a known non-diabetic population. DESIGN: nested case control studies (case s-control into a cohort) developed in two stages: 1) identification and characterization of the cohort and 2) follow-up. STUDY POPULATION: representative sample of a non-diabetic population between 40 and 75 years old attended in a Primary Health Center. IDENTIFICATION: 326 persons, 2.1% of whom were diagnosed of previously unknown DM2 and 7.3% of IFG. Insulin resistance (IR) was higher in patients with IFG and pancreatic function of beta cells (PFBC) was higher in the population without glucose metabolism alteration. FOLLOW-UP: 121 persons, 9.7 % of whom evolved to DM2 (all with IFG). IFG proportion at the end of the follow-up was 23.96%. CONCLUSIONS: At 5 years of follow-up, more than 1/3 of the population studied developed DM2 or IFG. These diagnoses were related with IR and PFBC.

Alteraciones del metabolismo de la glucosa y estudio de seguimiento de una población adulta no diabética / Glucose metabolism alterations and follow-up study of a non-diabetic adult population

Objetivo. Determinar la aparición de diabetes mellitus (DM) y glucemia basal alterada (GBA) a los cinco años de seguimiento de una población no diabética conocida. Material y métodos. Diseño: estudio casos-control anidado (casos-control dentro de una cohorte) desarrollado en dos fases, la de identificación y caracterización de la cohorte a estudio y la de seguimiento. Población a estudio: muestra representativa de población no diabética de 40 a 75 años atendida en un Centro de Atención Primaria. Resultados. Fase de identificación: 326 personas de las que un 2,1% fueron diagnosticadas de DM2 no conocida previamente y un 7,3% de GBA. La resistencia a la insulina (RI) fue superior en los pacientes con GBA y la función de la célula beta pancreática (FBP) fue superior en la población sin alteraciones del metabolismo de la glucosa. Fase de seguimiento: 121 personas. Un 9,7% evolucionaron a DM2 (todos con GBA previa) siendo la proporción de GBA al final del seguimiento de 23,96%. Conclusiones. A los cinco años de seguimiento, más de un tercio de la población estudiada evolucionó a DM o a GBA, estando la aparición de estas alteraciones relacionada con la RI y con la FBP (AU)

Objective. To determine the appearance of type 2 diabetes mellitus (DM2) and impaired fasting glucose (IFG) at five years of follow-up in a known non-diabetic population. Patients and methods. Design: nested case control studies (case s-control into a cohort) developed in two stages: 1) identification and characterization of the cohort and 2) follow-up. Study population: representative sample of a non-diabetic population between 40 and 75 years old attended in a Primary Health Center. Results. Identification: 326 persons, 2.1% of whom were diagnosed of previously unknown DM2 and 7.3% of IFG. Insulin resistance (IR) was higher in patients with IFG and pancreatic function of beta cells (PFBC) was higher in the population without glucose metabolism alteration. Follow-up: 121 persons, 9.7 % of whom evolved to DM2 (all with IFG). IFG proportion at the end of the follow-up was 23.96%. Conclusions. At 5 years of follow-up, more than 1/3 of the population studied developed DM2 or IFG. These diagnoses were related with IR and PFBC (AU)

Hipoestesia mentoniana en paciente fumador / Mentonian hypoesthesis in a patient who smokes

No disponible

[Functional thyroid pathology in the elderly]. / Enfermedad funcional tiroidea en la población de edad avanzada.

OBJECTIVE: To describe the prevalence of functional thyroid pathology (FTP) and pathologies associated with it in an elderly population. DESIGN: Descriptive, cross-sectional study. SETTING: Urban primary care centre. PATIENTS: Representative sample of the entire population attended that was 60 years old or over. MAIN MEASUREMENTS: Demographic variables, clinical history of thyroid pathology and pathology associated with it, Body Mass Index, small tests for diagnosing depression and anxiety, the mini-mental test, electrocardiogram, determination of total cholesterol and LDL cholesterol, and of free thyrotrophin and thyroxin if it is disturbed. RESULTS: 192 people were studied, 56% women, 53% between 60 and 69 and 12% over 79 years old. 10% had a history of previous FTP. Prevalence of active FTP was 13% (10.41% sub-clinical hypothyroidism, 0.52% clinical hypothyroidism, 1.56% sub-clinical hyperthyroidism, and 0.52% clinical hyperthyroidism). Prevalence of new diagnoses of FTP was 4.1% (7 with hypothyroidism and 1 with hyperthyroidism, all sub-clinical). During the study the following pathology was detected in hypothyroidism sufferers: 43% anxiety disorder, 38% depressive syndrome, 28.5% cognitive deterioration, 9.5% dementia, 26% electrocardiographic disturbances, 47.6% obesity, and 28.5% with total cholesterol > or =250 mg/dL. In hyperthyroidism, 50% with depressive syndrome, 25% with cognitive deterioration, 25% with electrocardiographic disturbances, and 50% with obesity were detected. CONCLUSIONS: FTP is more prevalent among the elderly than in the population as a whole, with predominance of hypothyroidism, subclinical pathology and among women. In terms of pathology traditionally linked to thyroid malfunction, few differences were found between the population affected with FTP and those not affected. Primary care doctors are important in reducing under-diagnosis.

[Application of a method for the early detection of diabetic retinopathy in Primary Health Care]. / Aplicación de un método de detección precoz de retinopatía diabética en la Atención Primaria de Salud.

PATIENTS AND METHODS: An ophthalmic examination was performed in 1,495 diabetic patients by means of a photographic method with a non-mydriatic retinal (Ffo-CNM) camera (with inclusion of 81.5% of the total diabetic population in our area attended in three primary care centers in Terrasa, Barcelona. RESULTS: The prevalence of diabetic retinopathy known prior to the study was 15% (n = 218). With the application of the Ffo-CNM method the prevalence increased up to 28% (p = 0.0001). The diagnoses obtained were: normal fundoscopic appearance (bilateral), 61% (n = 908), DR without maculopathy, 22% (n = 334); DR with maculopathy, 5% (n = 75); severe DR or preproliferative DR, 0.1% (n = 1), and proliferative DR, 0.7% (n = 10). The fundus was not visible in 11% (n = 167) of patients, mainly because of darkness refractory miosis (48%) and media opacity (43%). Thirty-nine percent of examined patients were referred to the referral Ophthalmology department either because DR or non-visible eye fundus. CONCLUSIONS: The use of Ffo-CNM enhances the ophthalmoscopic examination in the diabetic population given the simplicity of the technique and its accessibility with the corresponding increase in the number of diagnoses of DR. Likewise, it improves the care quality to the diabetic patient and also the reationalization of patient referral to the ophthalmologic centers.

[Socio-demographic and clinical characteristics of a patient population with diabetes mellitus]. / Características sociodemográficas y clínicas de una población de pacientes con diabetes mellitus.

OBJECTIVES: To describe sociodemographic and clinical characteristics of a diabetic population. To relate sociodemographic and clinical evolutionaries variables. DESIGN: Descriptive transversal study. SETTING: Three urban Primary Health Centers (PHC). Participants. Diabetic patients attended in these PHC.Measurements. VARIABLES: sociodemographic and clinical through an individualized survey and a medical record review. RESULTS: 1495 patients were studied from whom 96% were diabetic type 2. Age: 66 years old (SD 12). Sex: 56% were women. Education level: 62 didn't have finished their primary studies. Family: 71% live together with a partner. Years of evolution: Diabetes (DM) < 10 years: 47% in type 1; 64% in type 2. RISK FACTORS: DM 1: smokers 40%; hypertension (HTA) 7%; DM 2: smokers 12%; HTA 51%; obesity 26%; hypercholesterolemia 28%; hypertriglyceridemia 17%. Chronic complications: DM 1: retinopathy (DR) 26%; nephropathy (Nf) 3.5%; ischemic heart disease (IHD) 3.5%; periferic arteriopathy (PA) 7%; Cerebrovascular accident (CVA) 2%; peripheric neuropathy (PN) 5%. DM 2: DR 14%; Nf 13%; IHD 12%; PA 9%; CVA 5%; PN 4%; autonomic neuropathy 3%. Metabolic control DM 2: 67% HbA1c 7.5. Best metabolic control in DM with less years of evolution (p = 0.001). Treatment DM 2: 32% diet, 51% oral treatment, 13% insulin, 4% mixed. No relation with cultural level and family situation with metabolic control. In chronic complications only DR were more prevalent in patients with less cultural level (p = 0.037). CONCLUSIONS: Less cultural level doesn't influence neither metabolic control nor appearance chronic complications, except DR. The knowledge of diabetic population attended has allowed to detect the need of reinforce the intervention for decrease smoking and increase chronic complications detection.

Características sociodemográficas y clínicas de una población de pacientes con diabetes mellitus / Sociodemographic and clinical characteristics of a patient population with diabetes mellitus

Objetivo. Describir las características sociodemográficas y clínicas de una población diabética. Relacionar variables sociodemográficas y clinicoevolutivas. Diseño. Estudio descriptivo transversal. Emplazamiento. Tres áreas básicas de salud (ABS) urbanas. Pacientes diabéticos atendidos en estas ABS. Mediciones principales. Variables sociodemográficas y clínicas a través de encuesta individualizada y revisión de historias clínicas. Resultados. Se estudiaron 1.495 pacientes, 96 por ciento diabetes (DM) tipo 2. Edad: 66 años (DE ñ 12). Sexo: 56 por ciento mujeres. Estudios: 62 por ciento sin estudios primarios finalizados (15,5 por ciento analfabetismo, 46 por ciento primaria incompleta); 27 por ciento graduado escolar. Núcleo familiar: 71 por ciento convivía en pareja, 11 por ciento con los hijos, 12 por ciento vivían solos. Años evolución: DM < 10 años: 47 por ciento en DM 1; 64 por ciento en DM 2. Factores riesgo: DM 1: tabaquismo 40 por ciento; hipertensión arterial (HTA) 7 por ciento. DM 2: tabaquismo 12 por ciento; HTA 51 por ciento; obesidad 26 por ciento; hipercolesterolemia 28 por ciento; hipertrigliceridemia 17 por ciento. Complicaciones crónicas: DM 1: retinopatía (RD) 26 por ciento; nefropatía (Nf ) 3,5 por ciento; cardiopatía isquémica (CI) 3,5 por ciento; arteriopatía periférica (AP) 7 por ciento; accidente vascular cerebral (AVC) 2 por ciento; neuropatía periférica (NP) 5 por ciento. DM 2: RD 14 por ciento; Nf 13 por ciento; CI 12 por ciento; AP 9 por ciento; AVC 5 por ciento; NP 4 por ciento; neuropatía autonómica 3 por ciento. Control metabólico DM 2: 67 por ciento HbA1c 7,5. Mejor control metabólico en DM de menos años de evolución (p = 0,001). Tratamiento DM 2: 32 por ciento dieta, 51 por ciento tratamiento oral, 13 por ciento insulina, 4 por ciento mixto. No relación ni del nivel cultural ni de la situación familiar de los pacientes con el control metabólico de la DM. De las complicaciones crónicas, solamente la RD era más prevalente en pacientes con nivel cultural más bajo (p = 0,037).Conclusiones. El bajo nivel cultural de los pacientes no influye ni en el control metabólico ni en la aparición de complicaciones crónicas, a excepción de la RD. El conocimiento de la población diabética atendida ha permitido detectar la necesidad de reforzar intervenciones encaminadas a disminuir el tabaquismo y aumentar la detección de complicaciones crónicas (AU)

[Intervention of the family physician in the diagnosis of cancer]. / Intervención del médico de familia en el diagnóstico del cáncer.

OBJECTIVE: To find the intervention of family doctors (FD) in diagnosing tumour pathology. DESIGN: Retrospective descriptive study. SETTING: Urban primary care centre. PATIENTS: Patients over 14 diagnosed with cancer. MEASUREMENTS: Selection of patients from the computerised records between November 1989 and March 1997. Review of clinical histories, analysing: 1. Personal details, 2. Type of cancer, 3. Intervention of the FD in the diagnosis, 4. Symptom of initial consultation, 5. Further tests requested by FD, 6. Interval between consultation and diagnosis, 7. Survival and 8. interval between diagnosis and death. FD intervention in diagnosis was evaluated: 1. Impossible intervention, 2. No intervention, with suspect signs not valued (SSNV) or with suspect signs valued (SSV), 3. Diagnostic intervention, incomplete (Iin) or complete (Ico). RESULTS: 438 tumours were detected: in 256 men (59%) and 171 women (41%). The most common kind in men was lung cancer (46 cases, 17%), and in women breast cancer (59 cases, 34%). In 233 cases (53%) the intervention of the FD was impossible. In 29 cases (6.5%) the FD's intervention was nil (15 cases with SSNV, 14 cases with SSV). Of the 174 cases (39.6%) in which the FD intervened, full diagnosis was made in 40% (69 cases). The mean of the interval between the first consultation and the diagnosis was significantly less when FD intervention existed, at 1.95 months (CI, 0.63-1.06) in Ico and 2.9 months (CI, 0.51-2.19) in Iin, than when there was no intervention, with delays of 5.58 months (CI, 1.46-3.53) with SSNV and 10.5 months (CI, 8.45-12.54) with SSV (p = 0.000). CONCLUSIONS: The family doctor can play an important part in cancer diagnosis. His/her active intervention can reduce the interval between consultation and diagnosis.

[Intervention for alcoholism control among chronic drinkers in primary care]. / Intervención antialcohólica en bebedores crónicos en atención primaria.

OBJECTIVE: To evaluate the evolution of alcohol consumption in chronic drinkers after a primary care alcohol intervention over two years. DESIGN: Prospective intervention study. SETTING: Urban primary care centre. PATIENTS: Males between 20 and 60 years old who consumed 100 or more grams of alcohol per day for at least the previous two years. MEASUREMENTS AND MAIN RESULTS: Detoxification (out-patient or hospital according to the degree of dependency) and habit-breaking, which consisted of psychological support (techniques of brief counselling, brief motivating interview) and/or referral to the care and observance centre (COC) for individual and/or group psychotherapy, took place. A minimum of eight visits were programmed and consumption was assessed in gr/day at the start and at one (1 m), three (3 m), six (6 m), twelve (12 m), eighteen (18 m) and twenty-four months (24 m). 64 out of 129 (49.5%) responded to the appointment. Control visits: nil observance (0 visits) 6 patients (9%), and excellent observance (> or = 9 visits) 21 patients (33%). INTERVENTIONS: Psychotherapy treatment: psychological support 55 patients (86%), referral to the COC 4 (6%), group psychotherapy 2 (3%), and non-treatment 6 (9%). Data on mean consumption: start 131 g/day (SD = 52), 12 m 31 (SD = 41), and 24 m 38 (SD = 42). Mean reduction of consumption at 24 months according to the observance: insufficient -19%, acceptable -71.1%, excellent -83.9% (p = 0.001). CONCLUSIONS: Low response to appointments. Evolution of alcohol consumption was similar to that in other studies. Clear relationship between number of visits and consumption at the end of the study. Given the positive findings, we think a primary care intervention on alcohol is essential.

Intervención antialcohólica en bebedores crónicos en atención primaria / Primary care intervention against alcohol in chronic drinkers

Objetivo. Evaluar la evolución del consumo de alcohol en pacientes bebedores crónicos tras la intervención antialcohólica efectuada en atención primaria durante 2 años. Diseño. Estudio prospectivo longitudinal de intervención. Emplazamiento. Centro de atención primaria urbano. Pacientes. Varones de 20-60 años de edad consumidores de 100 o más gramos de alcohol al día durante, como mínimo, los dos últimos años. Mediciones y resultados principales. Se realizó desintoxicación (ambulatoria u hospitalaria según el grado de dependencia) y deshabituación que consistía en apoyo psicológico (técnicas de consejo breve, entrevista breve motivacional) y/o derivación al centro de atención y seguimiento (CAS) para psicoterapia individual y/o grupal. Se programaron un mínimo de 8 visitas y se valoró el grado de consumo en g/día al inicio y a los 1 (m1), 3 (m3), 6 (m6), 12 (m12), 18 (m18) y 24 meses (m24). Responden a la citación 64/129 (49,5 por ciento). Visitas control: no seguimiento (0 visitas), 6 pacientes (9 por ciento), y seguimiento excelente (>= 9 visitas), 21 pacientes (33 por ciento). Intervención. Tratamiento psicoterápico: apoyo psicológico, 55 pacientes (86 por ciento); derivación al CAS, 4 (6 por ciento); psicoterapia de grupo, 2 (3 por ciento), y no tratamiento, 6 (9 por ciento). Datos de consumo: medias de consumo: inicio, 131 g/día (DE, 52); m12, 31 (DE, 41), y m24, 38 (DE, 42). Porcentaje medio de reducción del consumo a los 24 meses según el seguimiento: insuficiente, -19 por ciento; aceptable, -71,1 por ciento, y excelente, -83,9 por ciento (p = 0,001). Conclusiones. Baja respuesta a la citación. Evolución en el consumo de alcohol similar a la descrita en otros estudios. Clara relación entre el número de visitas y el consumo al final del estudio. Dados los resultados positivos, nos parece fundamental la intervención antialcohólica desde atención primaria (AU)