Physical activity and its association with Mediterranean diet patterns among Spanish university students / Actividad física y su asociación con los patrones de dieta mediterránea en universitarios españoles

Objective: the aim of the present study was to assess the level of physical activity and its association with Mediterranean dietary patterns in university students of health sciences at Universidad de Castilla-La Mancha (Spain). Method: a cross-sectional study was performed through an online survey. The final sample consisted of 555 university students (78.2 % females). Adherence to Mediterranean diet was assessed using the 14-item Mediterranean Diet Adherence Screener (MEDAS). To measure physical activity, the Rapid Assessment of Physical Activity Scale (RAPA) questionnaire was used. Results: according to physical activity, 2.5 % of the participants were considered active and 35.1 % did both strength and flexibility activities. A greater association was seen between intake of fruits (OR = 1.95; 95 % CI, 1.25-3.04), pulses (OR = 1.51; 95 % CI, 1.00-3.20), and nuts (OR = 1.99; 95 % CI, 1.33-2.99) in those considered sufficiently active. Similarly, we found a significant relationship between the intake of fruits (OR = 2.28; 95 % CI, 1.49-3.47), pulses (OR = 1.41; 95 % CI, 1.00-2.08), nuts (OR = 1.96; 95 % CI, 1.34-2.86), and fish/seafood (OR = 1.67; 95 % CI, 1.15-2.43) in those who engaged in both strength and flexibility activities. Conclusion: this study suggests that consumption of certain Mediterranean foods was associated with higher levels of physical activity in a sample of Spanish university students (AU)

Objetivo: el objetivo del presente estudio fue evaluar el nivel de actividad física y su asociación con la dieta mediterránea en estudiantes universitarios de ciencias de la salud de la Universidad de Castilla-La Mancha (España). Método:: se realizó un estudio transversal a través de una encuesta online. La muestra final estuvo formada por 555 estudiantes universitarios (78,2 % mujeres). La adherencia a la dieta mediterránea se evaluó mediante el evaluador de adherencia a la dieta mediterránea de 14 ítems (MEDAS). Para medir la actividad física se utilizó el cuestionario Rapid Assessment of Physical Activity Scale (RAPA). Resultados: de acuerdo con la actividad física, el 2,5 % de los participantes se consideraron activos y el 35,1 % realizaban actividades tanto de fuerza como de flexibilidad. Se observó una mayor asociación entre la ingesta de frutas (OR = 1,95; IC 95 %, 1,25-3,04), legumbres (OR = 1,51; IC 95 %, 1,00-3,20) y frutos secos (OR = 1,99; IC 95 %, 1,33-2,99) en aquellos considerados suficientemente activos. Asimismo, encontramos una relación significativa entre la ingesta de frutas (OR = 2,28; IC 95 %, 1,49-3,47), legumbres (OR = 1,41; IC 95 %, 1,00-2,08), frutos secos (OR = 1,96; IC 95 %, 1,34-2,86) y pescado/marisco (OR = 1,67; IC 95 %, 1,15-2,43), en aquellos que participaron en actividades de fuerza y flexibilidad. Conclusión: este estudio sugiere que el consumo de determinados alimentos mediterráneos se asocia con mayores niveles de actividad física en la muestra de universitarios españoles analizada (AU)

Obesity related risk for chronic kidney disease progression and cardiovascular disease after propensity score matching / Riesgo relacionado con la obesidad para la progresión de insuficiencia renal crónica y enfermedad cardiovascular tras emparejamiento por puntaje de propensión

Introduction: Obesity is a major health problem worldwide. It carries a markedly increased risk for multiple diseases such as type 2 diabetes mellitus, hypertension, cardiovascular disease (CVD) and chronic kidney disease (CKD). To complicate an already difficult topic a new subtype of obesity has been defined lately, the metabolically healthy obese. Our study aimed to clarify the association between obesity, metabolic syndrome and kidney disease progression. Methods: Observational retrospective single centre study including 212 patients with stage 3–4 CKD with no previous history of rapid kidney disease progression. Patients were divided according to BMI status and presence of metabolic syndrome. Anthropometric, clinical and laboratory data were collected to follow-up. Propensity score matching was performed for age, albuminuria and baseline renal function. During follow-up renal and cardiovascular events were recorded. Results: After a mean follow-up of 88.44±36.07 months a total of 18 patients reached the renal outcome in the non-obese group and 21 in the obese group. Differences were not statistically significant (log rank=0.21: p=0.64). Multiple Cox regression analysis showed that obesity was not predictor for worse renal outcomes [HR 1.01, 95% CI 0.45–2.24; p=0.97]. When stratifying the sample according to baseline metabolic syndrome and obesity presence there was no difference in renal survival (log rank=0.852; p=0.35) (AU)

Introducción: La obesidad es un problema mayor de salud a nivel mundial. Comporta un considerable incremento del riesgo de múltiples enfermedades tales como diabetes mellitus tipo 2, hipertensión, enfermedad cardiovascular (ECV) e insuficiencia renal crónica (IRC). Para complicar un tema ya difícil, se ha definido recientemente un nuevo subtipo de obesidad: el obeso metabólicamente sano. El objetivo de nuestro estudio fue aclarar la asociación entre obesidad, síndrome metabólico y progresión de la enfermedad renal. Métodos: Estudio observacional retrospectivo unicéntrico que incluyó a 212 pacientes con IRC estadio 3 a 4, sin antecedentes de progresión rápida de la enfermedad renal. Se dividió a los pacientes conforme a su situación de índice de masa corporal (IMC) y presencia de síndrome metabólico (SM). Durante el seguimiento se recopilaron los datos antropométricos, clínicos y de laboratorio. Se realizó el emparejamiento por puntaje de propensión (Propensity score matching) para edad, albuminuria y función renal nasal. Durante el seguimiento se registraron los episodios renales y cardiovasculares. Resultados: Tras un seguimiento medio de 88,44 ± 36,07 meses, un total de 18 pacientes logró el resultado renal en el grupo de no obesos, y 21 en el grupo de obesos. Las diferencias no fueron estadísticamente significativas (log rank=0,21: p = 0,64). El análisis de regresión múltiple de Cox mostró que la obesidad no era un factor predictivo para peores resultados renales [HR 1,01, IC95% 0,45–2,24; p 0,97]. Al estratificar la muestra con arreglo a síndrome metabólico basal y presencia de obesidad no existió diferencia en cuanto a la supervivencia renal (log rank = 0,852; p = 0,35). (AU)

Obesity related risk for chronic kidney disease progression and cardiovascular disease after propensity score matching.

INTRODUCTION: Obesity is a major health problem worldwide. It carries a markedly increased risk for multiple diseases such as type 2 diabetes mellitus, hypertension, cardiovascular disease (CVD) and chronic kidney disease (CKD). To complicate an already difficult topic a new subtype of obesity has been defined lately, the metabolically healthy obese. Our study aimed to clarify the association between obesity, metabolic syndrome and kidney disease progression. METHODS: Observational retrospective single centre study including 212 patients with stage 3-4 CKD with no previous history of rapid kidney disease progression. Patients were divided according to BMI status and presence of metabolic syndrome. Anthropometric, clinical and laboratory data were collected to follow-up. Propensity score matching was performed for age, albuminuria and baseline renal function. During follow-up renal and cardiovascular events were recorded. RESULTS: After a mean follow-up of 88.44±36.07 months a total of 18 patients reached the renal outcome in the non-obese group and 21 in the obese group. Differences were not statistically significant (log rank=0.21: p=0.64). Multiple Cox regression analysis showed that obesity was not predictor for worse renal outcomes [HR 1.01, 95% CI 0.45-2.24; p=0.97]. When stratifying the sample according to baseline metabolic syndrome and obesity presence there was no difference in renal survival (log rank=0.852; p=0.35) A total of 48 cardiovascular events were registered: seventeen in the non-obese group and thirty-one in the obese group. Differences in event-free time between both groups were statistically significant (log rank=4.44;p=0.035), especially after four years of follow-up. After stratifying for MS and obesity presence at baseline the event-free time differences where again statistically significant (log rank=16.86;p=0.001), specially for the obese patients with metabolic syndrome. CONCLUSIONS: Obesity has little impact on chronic kidney disease progression despite the presence or absence of metabolic syndrome in a cohort matched for age, baseline renal function and albuminuria. Obesity conferred greater cardiovascular risk when combined with metabolic syndrome.

Indicaciones de lo opioides rápidos en dolor posoperatorio / No disponible

No disponible

Prevalencia del dolor posoperatorio agudo y crónico / No disponible

No disponible

[Rapid diagnosis units or immediate health care clinics in internal medicine. Analysis of the first six months of operation in Palencia (Spain)]. / Unidades de diagnóstico rápido o consultas de atención inmediata en medicina interna. Análisis de los primeros 6 meses de funcionamiento en Palencia.

The extraordinary development experienced by Primary Care and medical specialties has not always been matched by better organisation of the health system. Waiting lists, the proportion of inappropriate stays and admissions, or absence of real mechanisms that enable to discriminate the severe cases from the banal in patients on the waiting list are situations that illustrate the above. Thus, the need arises to promote continuity of care between the two levels of care (Primary and Hospital) and improve patient care, most especially for those suspected of serious illness. In this context, Rapid Diagnostic Units were introduced; designed to improve coordination with Primary Care, and reduce delays especially in severe cases. In this paper, we review these units, and present our experience during the first six months of operation.

Dolor en hematología clínica / Pain in clinical hematology

Objetivo: El objetivo de esta revisión es una puesta al día acerca del tratamiento del dolor así como los cuidados paliativos aplicables a pacientes con patología hematológica, oncológica o no. En hematología hay diversas entidades nosológicas y causas que pueden requerir alivio del dolor u otros síntomas molestos para el paciente. Generalmente, se admite que sólo un 5% de los pacientes afectados de enfermedad hematológica maligna presenta cuadros de dolor, mientras que en otros tipos de cáncer (pulmón, próstata y mama que cursan, con frecuencia, con metástasis ósea) el porcentaje llega al 70-80% de los pacientes. El dolor puede venir motivado por la propia enfermedad, por infiltración leucémica o mielomatosa, destrucción ósea (75-80%), por los tratamientos empleados (15-19%), mucositis en neutropénicos, posmetotrexato, talidomida (parestesias), bortezomib (Velcade ®), imatinib (Glivec®), trasplante de médula ósea, neurotoxicidad de citostáticos (vincristina, cisplatino) y radioterapia. El dolor no tiene relación con el cáncer en un 3-5% de casos (debilidad muscular y mialgia, úlceras por decúbito, neuralgia postherpética, procedimientos diagnósticos, etc.). Clásicamente la drepanocitosis, que no es una enfermedad prevalente en España, se encuentra entre las enfermedades hematológicas benignas que producen crisis de dolor. En nuestra experiencia, 10 años después de nuestra primera revisión sobre el tema, el porcentaje de enfermos hematológicos que requieren atención específica al problema del “dolor” (entendido como “dolor total” la afectación de tipo físico, emocional, espiritual, social, laboral, familiar, etc.) se puede incrementar si englobamos no sólo a los pacientes con dolor, sino también a aquellos con síntomas más o menos desagradables durante el curso de su enfermedad...(AU)

Objective: The present review aims to provide an update on the pain management and/or palliative care provided to patients with hematological disease, whether malignant or not. In hematology, several entities may require alleviation of pain or other distressing symptoms. It is generally acknowledged that only 5% of patients with malignant hematological disease experience pain, while this percentage ranges from 70 to 80% in other types of cancer (lung, prostate and breast, which frequently lead to bonemetastases). Pain may be caused by the disease itself, due to leukemic or myelomatoid infiltration, bone destruction (75-80%), the therapies administered (15-19%), mucositis in neutropenic patients, methotrexate, thalidomide (paresthesias), bortezomib (Velcade®), imatinib (Glivec®), bone marrow transplantation, neurotoxicity of cytostatic agents(vincristine, cisplatin) and radiotherapy. Pain is unrelated to malignant disease in 3-5% of patients (muscular weakness and myalgia, decubitus ulcers, postherpetic neuralgia, diagnostic procedures). Classically, sickle cell disease, which is not a prevalent disease in Spain, is included among the benign hematological diseases that produce pain exacerbations. According to our experience, 10 years after our previous review on the topic, the percentage of hematological patients requiring specific management of “pain” (understood as “global pain” = physical, emotional, spiritual, social, occupational, familial...) can increase if, in addition to patients with pain, we also include those with unpleasant symptoms of varying severity throughout the course of their disease. The World health Organization (WHO) estimates that 9 million new cases of cancer occur each year, that there are 6.7 million annual deaths from cancer and that almost 25million persons are still alive 3 years after diagnosis. Pain is moderate to intense in 40-50% of patients and very intense or intolerable in 25-30%...(AU)

Multifactorial approach and adherence to prescribed oral medications in patients with type 2 diabetes.

The aims of this study were to assess adherence to oral hypoglycaemic/cardiovascular drugs and determine non-adherence predictors in type 2 diabetes patients. It was designed as a population-based cross-sectional study in which 90 patients from a primary care setting were studied. Pill count and self-report methods were used to measure adherence. Logistic regression analysis was performed to predict factors related to non-adherence. Adequate adherence to all drugs was found in 29 patients (35.4%; 95% confidence interval (CI) 25.0-45.7). Variables associated with non-adherence were HbA1c odds ratio (OR) 2.32 (95% CI: 1.09-4.95), systolic blood pressure OR 1.68 (95% CI: 1.08-2.62), total cholesterol OR 1.34 (95% CI: 1.08-1.66), number of pills OR 1.80 (95% CI: 1.26-2.55) and duration of disease OR 0.44 (CI 95%: 0.24-0.83). In conclusion, one in three patients had adequate adherence. Factors associated with non-adherence were duration of disease, complexity of drug regimen and inadequate control of cardiovascular risk factors.

[Can or should blood pressure be measured at pharmacy offices?]. / ¿Se puede o debe medir la presión arterial en las oficinas de farmacia?

OBJECTIVE: To evaluate concordance between blood-pressure (BP) measurements at the pharmacy office (PhO) and the nurse office (NO) in the health care centre (HCC). DESIGN: Descriptive study. SETTING: Community. METHODS: 36 PhO have voluntarily participated in the province of Albacete, where they have done 3 BP measures, without previous instructions and with their usual measurements devices, for 3-5 subjects, who were referred to their HCC so that they were taken another 3 BP measures in the NO with their Hg sphymomanometer and in their usual measure conditions (blind measures in relation to those taken at the PhO). These subjects were given a stamped envelope to send the BP measurements (taken at the NO), to the Official Pharmacy College. RESULTS: The 6 BP measurements have been completed to 96 subjects with an average of 57.3 years old (women 63%). The differences between PhO and NO were > 5 mmHg in 58 subjects (60.4%) in the case of SBP and in 45 subjects (46.9%) in the case of DBP, and it was more than 15 mmHg in the 17 subjects (17.7%) with SBP and in 9 subjects (9.4%) with DBP. The difference average was 9.5 mmHg (SD, 8.4 mmHg) and 6.4 mmHg (SD, 5.3 mmHg) respectively. The use rate of digit 0 was 22% at the PhO and 46.5% at the NO. In most of PhO, measurement electronic devices have been used for the BP, but not validated for clinical use. CONCLUSIONS: The PhO can be a good place for the hypertension screening, but the chemist must be trained in the BP correct measurement and use validated electronic devices. Standardization measurement conditions and the use of validated electronic devices must be extended to the NO.

¿Se puede o debe medir la presión arterial en las oficinas de farmacia? / Can blood pressure be measured or not in pharmacy offices?

Objetivo. Evaluar la concordancia entre las medidas de la presión arterial (PA) de la oficina de farmacia (OF) y la consulta de enfermería (CE) del centro de salud (CS).Diseño. Estudio descriptivo. Emplazamiento. Marco comunitario. Métodos. De forma voluntaria han participado 36 OF de la provincia de Albacete en las que han realizado 3 medidas de PA, sin instrucciones previas y con sus aparatos de medida habituales, a 3-5 sujetos que posteriormente acudían a sus CS para que en la CE les llevaran a cabo otras 3 mediciones de PA con sus esfigmomanómetros de mercurio y en sus condiciones habituales de medida (medición ciega respecto de las realizadas en la OF). A los sujetos se les entregaba un sobre franqueado para remitir las medidas de PA de la CE al colegio de farmacéuticos. Resultados. Se han completado las 6 medidas de PA a 96 sujetos con una edad media de 57,3 años (63 por ciento mujeres). Las diferencias entre la OF y la CE fueron > 5 mmHg en 58 sujetos (60,4 por ciento) en el caso de la PAS y en 45 sujetos (46,9 por ciento) en el caso de la PAD, y llegaron a ser de más de 15 mmHg en 17 sujetos (17,7 por ciento) en la PAS y en 9 sujetos (9,4 por ciento) en la PAD. La media de las diferencias fue de 9,5 mmHg (DE, 8,4 mmHg) y de 6,4 mmHg (DE, 5,3 mmHg), respectivamente. La proporción de utilización del dígito 0 fue del 22 por ciento en la OF y del 46,5 por ciento en la CE. En la mayoría de las OF se han utilizado dispositivos electrónicos de medida de la PA, pero no validados para uso clínico. Conclusiones. La OF puede ser un buen lugar para el cribado de la HTA, pero el farmacéutico/a debe estar entrenado en la medida correcta de la PA y utilizar aparatos electrónicos validados. La estandarización en las condiciones de medida y el uso de aparatos electrónicos validados se debe hacer extensible a la CE (AU)

Automedidas domiciliarias de presión arterial y su relación con el diagnóstico de la hipertensión arterial y con la afección orgánica: estudio comparativo con monitorización ambulatoria / Home self-measurements of blood pressure and relationship with diagnosis of hypertension and target organ damage: comparative study with ambulatory monitoring

FUNDAMENTO: El diagnóstico de la hipertensión arterial (HTA) requiere una metodología de la medición exacta y precisa. Las técnicas clásicas sobrestiman con frecuencia su prevalencia y no se relacionan bien con la repercusión orgánica. El objetivo de este trabajo es conocer la asociación entre la automedición domiciliaria de la presión arterial y la afección orgánica de la HTA. PACIENTES Y MÉTODO: Estudio descriptivo en el cual se comparaba la asociación de diferentes técnicas de medida de la presión arterial (PA) con el diagnóstico de HTA y su repercusión orgánica. Mediante muestreo de selección de casos consecutivos, se seleccionaron 64 pacientes con HTA no tratados mayores de 18 años. A todos se les realizaron tres mediciones de PA con esfigmomanómetro de mercurio en la consulta y se les adiestró para hacer 20 automedidas por la mañana en la consulta y 20 automedidas por la tarde en su domicilio con un aparato automático Omron 705CP. El mismo día se realizó una monitorización ambulatoria de la PA (MAPA) de 24 h con un dispositivo Takeda TM-2420; además, se realizó visualización del fondo de ojo, determinación de microalbuminuria y ecocardiografía. RESULTADOS: Los valores medios de las presiones clínicas fueron significativamente superiores a los de las automedidas domiciliarias y a los de la MAPA, que tenían una buena correlación y concordancia entre sí. La correlación de las automedidas domiciliarias con el índice de masa ventricular izquierda (IMVI) fue significativamente superior a la de las presiones arteriales clínicas y similar a la de la MAPA, siendo esta correlación independiente de la edad, el sexo y el índice de masa corporal de los sujetos. La mejor correlación de las automedidas domiciliarias de PA con la MAPA y con el IMVI se obtuvo con los valores medios de la segunda a la sexta automedida. CONCLUSIONES: Un programa mínimo de automedidas domiciliarias de PA con aparatos automáticos obtiene un valor pronóstico y de relación con la afección orgánica de la HTA similar al de la MAPA (AU)

[Home self-measurements of blood pressure and relationship with diagnosis of hypertension and target organ damage: comparative study with ambulatory monitoring]. / Automedidas domiciliarias de presión arterial y su relación con el diagnóstico de la hipertensión arterial y con la afección orgánica: estudio comparativo con monitorización ambulatoria.

BACKGROUND: The diagnosis of arterial of hypertension (AH) requires an accurate and precise measurement methodology. The habitual techniques overstimate the prevalence of AH and have a poor correlation with organ damage. The objective of the study is to know the associations between self-measurements of blood pressure (BP) at home and target organ damage of AH. PATIENTS AND METHOD: Descriptive study which compare the association of different techniques of BP measurement with the diagnosis of AH and its organ damage. Sampling selection of consecutive cases; we select 64 cases of hypertensives not treated hypertensive patients, older than 18 years. We achieved 3 BP measurements with mercury sphygmomanometer in the office and 20 self-measurements in the morning in the office and 20 self-measurements in the afternon at home with a automatic validated device, Omron 705CP; the same day BP was measured with ambulatory blood pressure measurement (ABPM) of 24 h with a Takeda TM-2420 device; we achieved eye fundus study, microalbuminuria analysis and echocardiogram. RESULTS: Mean values of office BP was higher than self-measurements at home and ABPM; these techniques had good correlations and concordance between them. The correlation of selfmeasurements at home with LVMI was higher than office BP and similar to ABPM; this correlation is independent of age, sex and body mass index. The best correlation of self-measurements at home with APBM and LVMI was with the mean values of 2nd-6th self-measurements. CONCLUSIONS: A minimum program of self-measurements of BP at home with automatic devices has a prognostic value and relationship with organ damage of AH similar to ABPM.