Assessment of an intervention for preventing pediatric overweight and obesity through the World Café technique: A qualitative study.

PURPOSE: To evaluate the self-reported perspectives of participants involved in the Previene Cádiz intervention for preventing pediatric overweight and obesity. DESIGN AND METHODS: This qualitative study collected information through the World Café technique. A purposive sample of 40 participants was used, of which 14 were schoolchildren, 12 were teachers, and 14 were parent volunteers. The data were segmented, and concepts were created and grouped into dimensions and categories. RESULTS: The participants confirmed they had learned new information and behaviors about healthy habits. Parental awareness was considered a crucial and necessary element in changing family habits; therefore, increasing the motivation of family members was deemed a critical task in public health interventions conducted in school settings. DISCUSSION: Despite the suitability of qualitative methodology to evaluate the perceptions of the main players in an educational intervention, scientific literature is scarce. Obtaining information from the educational community about an intervention is not always easy, so the perspectives of teachers, students, and families about the Previene Cádiz intervention through the World Café approach is considered a relevant contribution. CONCLUSIONS: The participants considered the intervention positive in terms of learning and fostering increased knowledge, awareness, and healthy behaviors. PRACTICE IMPLICATIONS: Future interventions should encourage the active participation of all social groups involved, integrating dynamic and collaborative training activities that are acceptable to all participants.

Correlaciones entre la ingesta de sal en la dieta y la eliminación de sodio en la orina de 24 h en una muestra de población urbana de Cáceres / Correlations between dietary salt intake and 24-h urine sodium excretion in a sample of the urban population of Cáceres

Objetivo: La ingesta excesiva de sal se asocia a mayores cifras de tensión arterial y prevalencia de enfermedades cardiovasculares. La OMS recomienda consumir menos de 5 g/día de sal (equivalente a 2 g de Na+/día). Identificar alimentos y comportamientos con mayor contribución al exceso de aporte facilitaría el consejo dietético preventivo. Diseño: Estudio observacional. Sitio: Centro de Salud Urbano en Cáceres. Medidas principales: Estimamos el consumo de sal mediante dos cuestionarios de frecuencia de consumo de alimentos (CFA), uno genérico y otro con alimentos con elevado contenido en Na+, y encuesta recordatoria de 24 h. Empleamos el programa Evalfinut para la valoración nutricional de la dieta. Analizamos correlaciones entre ingesta estimada de sal y eliminación de sodio en orina de 24 h (gold standard). Resultados: El 92% de la muestra presenta consumos superiores a las recomendaciones con ingestas equivalentes a 9,5 g/día de sal (3,7 g/día de Na+). Cuando la ingesta de sodio se determina por el cociente Na+/K+, el 79,54% tiene ingestas elevadas. La eliminación de sodio sigue una tendencia ligeramente creciente con el IMC. La percepción de consumo de sal es baja, el 56,3% lo considera «adecuado»; el 32,4% añade sal a los alimentos una vez servidos. Los CFA infraestiman la ingesta de Na+ y encuestas dirigidas aportan valores más elevados. La correlación entre CFA y eliminación urinaria de Na+ es débil. Conclusión: Debemos reducir la ingesta de sal aumentando la percepción del consumo, mejorando el conocimiento sobre el contenido de sal en alimentos e identificando a pacientes diana del consejo sanitario.(AU)

Objective: Excessive salt intake is associated with higher levels of AHT and prevalence of cardiovascular diseases. WHO recommends consuming less than 5 g/day of salt (equivalent to 2 g Na+/day). Identifying foods and behaviours with greater contribution to excess intake would facilitate preventive dietary advice. Design: Observational study. Site: Urban Health Center in Cáceres. Main measurements: We estimated salt consumption using two food consumption frequency (FFQ) questionnaires, one generic and one with high Na+ content, and a 24 h follow-up survey. We use the Evalfinut program for nutritional evaluation of the diet. We analyzed correlations between estimated salt intake and 24-h urine sodium elimination (gold standard). Results: 92% of the population had consumption higher than the recommendations with intakes equivalent to 9.5 g/day of salt (3.7 g/d of Na+). When sodium intake is determined by the Na+/K+ ratio, 79.54% have high intakes. Sodium elimination follows a slightly increasing trend with BMI. The perception of salt consumption is low, 56.3% consider it “adequate”. 32.4% add salt to food once served. FFQ underestimate Na+ intake and targeted surveys provide higher values. The correlation between FFQ and Na+ urinary elimination is weak. Conclusion: We must reduce salt intake by increasing the perception of consumption, improving knowledge about the salt content in food and identifying target patients of the health council.(AU)

[Correlations between dietary salt intake and 24-h urine sodium excretion in a sample of the urban population of Cáceres]. / Correlaciones entre la ingesta de sal en la dieta y la eliminación de sodio en la orina de 24 h en una muestra de población urbana de Cáceres.

OBJECTIVE: Excessive salt intake is associated with higher levels of AHT and prevalence of cardiovascular diseases. WHO recommends consuming less than 5 g/day of salt (equivalent to 2 g Na+/day). Identifying foods and behaviours with greater contribution to excess intake would facilitate preventive dietary advice. DESIGN: Observational study. SITE: Urban Health Center in Cáceres. MAIN MEASUREMENTS: We estimated salt consumption using two food consumption frequency (FFQ) questionnaires, one generic and one with high Na+ content, and a 24 h follow-up survey. We use the Evalfinut program for nutritional evaluation of the diet. We analyzed correlations between estimated salt intake and 24-h urine sodium elimination (gold standard). RESULTS: 92% of the population had consumption higher than the recommendations with intakes equivalent to 9.5 g/day of salt (3.7 g/d of Na+). When sodium intake is determined by the Na+/K+ ratio, 79.54% have high intakes. Sodium elimination follows a slightly increasing trend with BMI. The perception of salt consumption is low, 56.3% consider it "adequate". 32.4% add salt to food once served. FFQ underestimate Na+ intake and targeted surveys provide higher values. The correlation between FFQ and Na+ urinary elimination is weak. CONCLUSION: We must reduce salt intake by increasing the perception of consumption, improving knowledge about the salt content in food and identifying target patients of the health council.

[Social media and cyberbullying in eating disorders]. / Redes sociales y ciberacoso en los trastornos de la conducta alimentaria.

Introduction: Eating disorders (ED) are a multifactorial pathology. In their origin multiple variables are involved to which nowadays a possible enhancing factor is added: the diffusion and promotion of the culture of thinness and the apology of ED through the social media (SM) used by the youngest people. Through the feedback tools of the social networks (likes, comments, visits, retweets, etc.) and the elements of comparison between equals of the most visual SMs, many users come to develop risk behaviours that in turn give feedback to others. In addition, a sense of belonging to a group or tribe is created through communities whose members feel supported and where very restrictive diets are shared in an affective way, as well as ways of hiding these and other behaviours from those who do not belong to the group; both elements make it difficult for professionals and the family to intervene. Due to the extensive use of SMs, the rapid dissemination of all that is published, and the limited control over shared content, it is virtually impossible to control those sites that advocate and promote behaviours that contribute to the development or maintenance of ED. Cyberbullying or intimidation through digital technologies often uses body image criticisms that damage the self-esteem of the most vulnerable. This cyberbullying is a factor increasingly present in young people who have suffered an ED. The key to prevention is considered to be media literacy in the use of SM, as well as parental supervision of the youngest. People at risk or who have already been diagnosed with ED find in these networks the social support they seek but are biased towards risk behaviours, when it is possible for health professionals to use them to the benefit of promoting healthy habits and for recovery from these disorders.

Introducción: Los trastornos de la conducta alimentaria (TCA) son una patología multifactorial. En su inicio están implicadas múltiples variables a las que se les suma hoy en día un posible potenciador: la difusión y promoción de la cultura de la delgadez y la apología de los TCA a través de las redes sociales (RR. SS.) usadas por los más jóvenes. A través de las herramientas de feedback de las redes (likes, comments, visitas, retweets, etc.) y los elementos de comparación entre iguales de las RR. SS. más visuales, muchos usuarios llegan a desarrollar conductas de riesgo que a su vez retroalimentan a otros. Por otra parte, se crea la sensación de pertenencia a un grupo o tribu a través de comunidades cuyos miembros se sienten apoyados y donde se comparten de forma afectiva dietas muy restrictivas, así como formas de ocultarlas y otras conductas a quienes no pertenecen al grupo; ambos elementos dificultan la intervención por parte de los profesionales y la familia. Debido al uso extensivo de las RR. SS., a la rápida difusión de todo aquello que se publica y al escaso control que hay sobre el contenido que se comparte, resulta prácticamente imposible controlar los sitios donde se hace apología y se promueven las conductas que contribuyen al desarrollo o mantenimiento de los TCA. El ciberacoso o intimidación por medio de tecnologías digitales utiliza con frecuencia críticas sobre la imagen corporal que dañan la autoestima de los más vulnerables, y es un factor cada vez más presente en los jóvenes que han padecido un TCA. Se considera que la clave de la prevención reside en la alfabetización mediática del uso de las RR. SS., así como la supervisión parental de los más jóvenes. Las personas en riesgo o ya diagnosticadas de TCA encuentran en estas redes el apoyo social que buscan, pero sesgado hacia las conductas de riesgo, cuando sería posible explotarlas en beneficio de la promoción de hábitos saludables y para la recuperación de estos trastornos.

[Advertising and the media in eating disorders]. / Publicidad y medios de comunicación en los trastornos de la conducta alimentaria.

Introduction: The media, by means of advertising, convey an ideal of unreal beauty associated with positive traits such as popularity, esteem, acceptance, intelligence, etc. This can be one of the factors that compromise emotional and physical health, being responsible for creating unrealistic expectations and body dissatisfaction, and exerting a very important influence on the triggering or maintenance of bad eating habits that can lead to eating disorders. The youngest population has a low capacity to anticipate the harmful effects of certain messages with commercial interests, and this requires implementing preventive programs based on media education, accompanied by modeling in the family nucleus to promote a healthy lifestyle.

Introducción: Los medios de comunicación, a través de la publicidad, transmiten un ideal de belleza no real asociado con rasgos positivos como popularidad, aprecio, aceptación, inteligencia, etc. Esto puede constituir uno de los factores que comprometen la salud emocional y física, siendo responsables de crear expectativas poco realistas e insatisfacción corporal y ejerciendo una influencia muy destacada en el desencadenamiento o mantenimiento de los malos hábitos alimentarios que pueden abocar en trastornos de la conducta alimentaria. La población más joven tiene una baja capacidad para prever los efectos nocivos de ciertos mensajes con intereses comerciales, por lo que se requiere la puesta en marcha de programas preventivos basados en la educación mediática, acompañada de un modelado del núcleo familiar en el que se promueva un estilo de vida saludable.

[Characterization, epidemiology and trends of eating disorders]. / Caracterización, epidemiología y tendencias de los trastornos de la conducta alimentaria.

Introduction: Background: eating disorders are a group of conditions in which negative beliefs about food, body shape, and body weight together with behaviors such as restricted food intake, binge eating, excessive exercise, self-induced vomiting, and use of laxatives. They can become serious, affect quality of life, and lead to multiple physical and even psychiatric complications with a fatal outcome. The purpose of this chapter is to describe the characteristics, epidemiology, and trends of eating disorders with updated information based on the most recent publications. Methods: we conducted a systematic literature search in Medline, EMBASE, Cochrane, and Web of Science. The search terms were "anorexia nervosa", "bulimia nervosa", "binge eating disorders" and "epidemiology" both in titles and in abstracts. Results and conclusions: EDs generally occur in adolescents and young adults. The best characterized TCAs are anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (TA). Prevalence studies indicate wide differences by age group and sex, much higher in young women (NA, 0.1-2 %; BN, 0.37-2.98 %; BED, 0.62-4.45 %). The prevalence of EDs is 2.2 % (0.2-13.1 %) in Europe, 3.5 % (0.6-7.8 %) in Asia, and 4.6 % (2.0-13.5 %) in America. Comorbidity is high with psychiatric problems such as depression, anxiety, attention deficit/hyperactivity disorder, obsessive-compulsive disorder, and personality disorders.

Introducción: Introducción: los trastornos de la conducta alimentaria (TCA) son un grupo de afecciones en las cuales las creencias negativas sobre la comida, la forma del cuerpo y el peso corporal se acompañan de conductas que incluyen restricción de la ingesta, atracones, realización excesiva de ejercicio, provocación del vómito y uso de laxantes. Pueden llegar a ser graves, repercutir sobre la calidad de vida y conducir a múltiples complicaciones físicas y psiquiátricas, incluso con desenlace fatal. El propósito de este artículo es describir las características, la epidemiología y las tendencias de los TCA con información actualizada a partir de las publicaciones más recientes. Métodos: se ha realizado una búsqueda sistemática de la literatura en Medline, EMBASE, Cochrane y Web of Science. Los términos de búsqueda fueron "anorexia nervosa", "bulimia nervosa", "binge eating disorders" and "epidemiology" en título y resumen. Resultados y conclusiones: los TCA se presentan generalmente en adolescentes y adultos jóvenes. Los mejor caracterizados son la anorexia nerviosa (AN), la bulimia nerviosa (BN) y el trastorno por atracón (TA). Los estudios de prevalencia indican amplias diferencias en función del grupo de edad y el sexo, muy superior en las mujeres jóvenes (AN: 0,1-2 %; BN: 0,37-2,98 %; TA: 0,62-4,45 %). La prevalencia de los TCA es del 2,2 % (0,2-13,1 %) en Europa, del 3,5 % (0,6-7,8 %) en Asia y del 4,6 % (2,0-13,5 %) en América. La comorbilidad es elevada con problemas psiquiátricos como la depresión, la ansiedad, el déficit de atención e hiperactividad, el trastorno obsesivo-compulsivo y los trastornos de personalidad.

Independent and Combined Association of Lifestyle Behaviours and Physical Fitness with Body Weight Status in Schoolchildren.

(1) Background: Lifestyle behaviours and physical fitness play a critical role in the development of childhood obesity. It has been demonstrated in this study that self-reported physical fitness is representative of a healthy lifestyle and thus is associated with a lower incidence of overweight/obesity. The objective of this study was to analyse the independent and combined association of lifestyles (physical activity, screen time, diet and hours of sleep) and self-reported physical fitness with body weight in schoolchildren. (2) Methods: This study performed a descriptive and cross-sectional analysis. The study sample consisted of 864 schoolchildren between 8−9 years old from 26 schools of the province of Cádiz. To measure lifestyles and self-reported physical fitness, questionnaires were administered to both schoolchildren and families. To obtain the body weight status, the children were measured by body mass index (BMI). To verify the influence of lifestyles and self-reported physical fitness on the body weight status of schoolchildren, a combined score of lifestyles and self-reported physical fitness was calculated. (3) Results: Schoolchildren who followed healthier lifestyles and presented good physical fitness had a better body weight status (p < 0.001). Schoolchildren who had less healthful lifestyles and bad physical fitness had a 10.34 times higher risk of being overweight or obese (p = 0.004). (4) Conclusions: It has been shown that there is an independent and combined association between lifestyles and physical fitness on the body weight of the schoolchildren. We have suggested strategies to get children to adopt healthy lifestyles and good physical fitness to maintain a healthy body weight and prevent obesity.

Caracterización, epidemiología y tendencias de los trastornos de la conducta alimentaria / Characterization, epidemiology and trends of eating disorders

Introducción: los trastornos de la conducta alimentaria (TCA) son un grupo de afecciones en las cuales las creencias negativas sobre la comida, la forma del cuerpo y el peso corporal se acompañan de conductas que incluyen restricción de la ingesta, atracones, realización excesiva de ejercicio, provocación del vómito y uso de laxantes. Pueden llegar a ser graves, repercutir sobre la calidad de vida y conducir a múltiples complicaciones físicas y psiquiátricas, incluso con desenlace fatal. El propósito de este artículo es describir las características, la epidemiología y las tendencias de los TCA con información actualizada a partir de las publicaciones más recientes. Métodos: se ha realizado una búsqueda sistemática de la literatura en Medline, EMBASE, Cochrane y Web of Science. Los términos de búsqueda fueron “anorexia nervosa”, “bulimia nervosa”, “binge eating disorders” and “epidemiology” en título y resumen. Resultados y conclusiones: los TCA se presentan generalmente en adolescentes y adultos jóvenes. Los mejor caracterizados son la anorexia nerviosa (AN), la bulimia nerviosa (BN) y el trastorno por atracón (TA). Los estudios de prevalencia indican amplias diferencias en función del grupo de edad y el sexo, muy superior en las mujeres jóvenes (AN: 0,1-2 %; BN: 0,37-2,98 %; TA: 0,62-4,45 %). La prevalencia de los TCA es del 2,2 % (0,2-13,1 %) en Europa, del 3,5 % (0,6-7,8 %) en Asia y del 4,6 % (2,0-13,5 %) en América. La comorbilidad es elevada con problemas psiquiátricos como la depresión, la ansiedad, el déficit de atención e hiperactividad, el trastorno obsesivo-compulsivo y los trastornos de personalidad (AU)

Background: eating disorders are a group of conditions in which negative beliefs about food, body shape, and body weight together with behaviors such as restricted food intake, binge eating, excessive exercise, self-induced vomiting, and use of laxatives. They can become serious, affect quality of life, and lead to multiple physical and even psychiatric complications with a fatal outcome. The purpose of this chapter is to describe the characteristics, epidemiology, and trends of eating disorders with updated information based on the most recent publications. Methods: we conducted a systematic literature search in Medline, EMBASE, Cochrane, and Web of Science. The search terms were “anorexia nervosa”, “bulimia nervosa”, “binge eating disorders” and “epidemiology” both in titles and in abstracts. Results and conclusions: EDs generally occur in adolescents and young adults. The best characterized TCAs are anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (TA). Prevalence studies indicate wide differences by age group and sex, much higher in young women (NA, 0.1-2 %; BN, 0.37-2.98 %; BED, 0.62-4.45 %). The prevalence of EDs is 2.2 % (0.2-13.1 %) in Europe, 3.5 % (0.6-7.8 %) in Asia, and 4.6 % (2.0-13.5 %) in America. Comorbidity is high with psychiatric problems such as depression, anxiety, attention deficit/hyperactivity disorder, obsessive-compulsive disorder, and personality disorders (AU)

Publicidad y medios de comunicación en los trastornos de la conducta alimentaria / Advertising and the media in eating disorders

Los medios de comunicación, a través de la publicidad, transmiten un ideal de belleza no real asociado con rasgos positivos como popularidad, aprecio, aceptación, inteligencia, etc. Esto puede constituir uno de los factores que comprometen la salud emocional y física, siendo responsables de crear expectativas poco realistas e insatisfacción corporal y ejerciendo una influencia muy destacada en el desencadenamiento o mantenimiento de los malos hábitos alimentarios que pueden abocar en trastornos de la conducta alimentaria. La población más joven tiene una baja capacidad para prever los efectos nocivos de ciertos mensajes con intereses comerciales, por lo que se requiere la puesta en marcha de programas preventivos basados en la educación mediática, acompañada de un modelado del núcleo familiar en el que se promueva un estilo de vida saludable (AU)

The media, by means of advertising, convey an ideal of unreal beauty associated with positive traits such as popularity, esteem, acceptance, intelligence, etc. This can be one of the factors that compromise emotional and physical health, being responsible for creating unrealistic expectations and body dissatisfaction, and exerting a very important influence on the triggering or maintenance of bad eating habits that can lead to eating disorders. The youngest population has a low capacity to anticipate the harmful effects of certain messages with commercial interests, and this requires implementing preventive programs based on media education, accompanied by modeling in the family nucleus to promote a healthy lifestyle (AU)

Redes sociales y ciberacoso en los trastornos de la conducta alimentaria / Social media and cyberbullying in eating disorders

Los trastornos de la conducta alimentaria (TCA) son una patología multifactorial. En su inicio están implicadas múltiples variables a las que se les suma hoy en día un posible potenciador: la difusión y promoción de la cultura de la delgadez y la apología de los TCA a través de las redes sociales (RR. SS.) usadas por los más jóvenes. A través de las herramientas de feedback de las redes (likes, comments, visitas, retweets, etc.) y los elementos de comparación entre iguales de las RR. SS. más visuales, muchos usuarios llegan a desarrollar conductas de riesgo que a su vez retroalimentan a otros. Por otra parte, se crea la sensación de pertenencia a un grupo o tribu a través de comunidades cuyos miembros se sienten apoyados y donde se comparten de forma afectiva dietas muy restrictivas, así como formas de ocultarlas y otras conductas a quienes no pertenecen al grupo; ambos elementos dificultan la intervención por parte de los profesionales y la familia. Debido al uso extensivo de las RR. SS., a la rápida difusión de todo aquello que se publica y al escaso control que hay sobre el contenido que se comparte, resulta prácticamente imposible controlar los sitios donde se hace apología y se promueven las conductas que contribuyen al desarrollo o mantenimiento de los TCA. El ciberacoso o intimidación por medio de tecnologías digitales utiliza con frecuencia críticas sobre la imagen corporal que dañan la autoestima de los más vulnerables, y es un factor cada vez más presente en los jóvenes que han padecido un TCA. Se considera que la clave de la prevención reside en la alfabetización mediática del uso de las RR. SS., así como la supervisión parental de los más jóvenes. Las personas en riesgo o ya diagnosticadas de TCA encuentran en estas redes el apoyo social que buscan, pero sesgado hacia las conductas de riesgo, cuando sería posible explotarlas en beneficio de la promoción de hábitos saludables y para la recuperación de estos trastornos (AU)

Eating disorders (ED) are a multifactorial pathology. In their origin multiple variables are involved to which nowadays a possible enhancing factor is added: the diffusion and promotion of the culture of thinness and the apology of ED through the social media (SM) used by the youngest people. Through the feedback tools of the social networks (likes, comments, visits, retweets, etc.) and the elements of comparison between equals of the most visual SMs, many users come to develop risk behaviours that in turn give feedback to others. In addition, a sense of belonging to a group or tribe is created through communities whose members feel supported and where very restrictive diets are shared in an affective way, as well as ways of hiding these and other behaviours from those who do not belong to the group; both elements make it difficult for professionals and the family to intervene. Due to the extensive use of SMs, the rapid dissemination of all that is published, and the limited control over shared content, it is virtually impossible to control those sites that advocate and promote behaviours that contribute to the development or maintenance of ED. Cyberbullying or intimidation through digital technologies often uses body image criticisms that damage the self-esteem of the most vulnerable. This cyberbullying is a factor increasingly present in young people who have suffered an ED. The key to prevention is considered to be media literacy in the use of SM, as well as parental supervision of the youngest. People at risk or who have already been diagnosed with ED find in these networks the social support they seek but are biased towards risk behaviours, when it is possible for health professionals to use them to the benefit of promoting healthy habits and for recovery from these disorders (AU)

Artificial Stone Silicosis: Accumulation of errors in the resurgence of an occupational disease: A qualitative study.

BACKGROUND: Exposure to artificial stone machining, under the conditions in which marble workers work with this new product, can cause silicosis. OBJECTIVE: To examine the experiences of marble workers affected, both in workshop and during home installation of countertops, before diagnosis of silicosis. METHODS: Qualitative study in which 10 open-ended semistructured interviews were conducted with marble workers diagnosed with silicosis after machining artificial stone countertops in Cádiz, Spain. Interviews were recorded, transcribed, and coded using a directed content analysis. Codes were organized into themes. RESULTS: Interviews up to 120 minutes and transcript analysis revealed three themes: 1) Heavy exposure for piecework: construction boom in an environment of labor deregulation and high demand for the novel product; 2) Poor working conditions: dry machining of artificial stone without proper protection in the workshop and greater exposure during home installation of countertops; 3) Concatenated legal transgressions: deficiencies in prevention and health surveillance without safety conditions for the correct handling of artificial stone. CONCLUSIONS: The fight against an emerging occupational disease-artificial stone silicosis-should focus on detecting affected workers and avoiding new cases, forcing joint efforts to achieve rigorous compliance with health surveillance and protecting marble workers to achieve healthy and safe workplaces.

A Multimodal Intervention for Prevention of Overweight and Obesity in Schoolchildren. A Protocol Study "PREVIENE-CÁDIZ".

This paper describes the protocol for a study designed to address the high prevalence (40%) of childhood overweight and obesity in the province of Cádiz, Spain, as a reflection of what is happening worldwide. It is widely known that children who suffer from childhood obesity have a higher risk of developing chronic diseases in adulthood. This causes a decrease in the quality of life and an increase in health spending. In this context, it is necessary to intervene promoting healthy lifestyle habits from an early stage. The objective of this project will be to evaluate the effectiveness of a multimodal intervention (individual, school and family) called "PREVIENE-CÁDIZ" [CADIZ-PREVENT]. The intervention will be focused mainly on diet, physical activity, sedentary lifestyle and sleep, to prevent overweight and obesity in schoolchildren from 8 to 9 years old in the province of Cádiz. It will consist of a 10-session education program carried out in the classroom by the teachers. In addition, children will be assigned two workbooks, one to work on in class and the other at home with parents. A workshop aimed at parents will be included to help teach them how to obtain healthier lifestyle habits. The proposed study will involve a quasi-experimental design with a control group.

A Randomized Controlled Trial to Compare Analgesia and Functional Improvement After Continuous Neuroablative and Pulsed Neuromodulative Radiofrequency Treatment of the Genicular Nerves in Patients with Knee Osteoarthritis up to One Year After the Intervention.

OBJECTIVES: To compare the analgesic and functional outcomes of continuous neuroablative radiofrequency (CNARF) and pulsed neuromodulative radiofrequency (PNMRF) treatment of genicular nerves up to 1 year after the intervention and to identify predictors associated with a successful outcome (defined as an at least 50% reduction in the pre-interventional visual analog scale [VAS] rating) after genicular radiofrequency treatment. DESIGN: A prospective randomized controlled trial. SETTING: The Pain Department of the Jerez de la Frontera University Hospital, Cadíz, Spain, from January 2018 until May 2019. SUBJECTS: Patients with grade 3-4 gonarthritis suffering from knee pain, with a VAS score ≥5 for >6 months. METHODS: Eligible participants were randomly assigned to receive either CNARF or PNMRF of the superior medial, superior lateral, and inferior medial genicular nerves. The VAS and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores were assessed before and at 1, 6, and 12 months after treatment. Medication use was quantified before and at 6 months after the intervention. Potential characteristics associated with the efficacy of radiofrequency intervention were explored by using multivariable statistical models. RESULTS: A total of 188 participants were included. The magnitude and duration of beneficial effect and reduction in analgesic use were significantly greater in the CNARF group. Success at 6 months after radiofrequency treatment decreased with grade 4 gonarthritis; higher pre-interventional VAS score; and concomitant depression, anxiety disorder, and diabetes mellitus. CONCLUSIONS: Therapeutic efficacy and reduction in analgesic consumption were superior after CNARF. Treatment success at 6 months after radiofrequency intervention decreased with more severe gonarthritis; higher pre-interventional pain intensity; and concomitant depression, anxiety disorder, and diabetes mellitus.

Motivos de migración de los médicos de la provincia de Cádiz en 2017 / Reasons for doctors moving from the province of Cádiz in 2017

No disponible

Association of Adherence to Specific Mediterranean Diet Components and Cardiorespiratory Fitness in Young Adults.

OBJECTIVE: Cardiorespiratory fitness (CRF) and a healthy diet may be part of an overall healthy lifestyle. The association between cardiorespiratory fitness and adherence to an overall Mediterranean Diet (MedD) pattern and specific MedD foods has been assessed. DESIGN: Subjects completed a lifestyle survey and dietary pattern, using the validated MedD Adherence 14-item questionnaire and two self-reported 24-h dietary recalls. Participants' height, body weight, waist circumference (WC), and CRF (maximum oxygen uptake, VO2max, ml/kg/min) were measured. SETTING: University of Cádiz, Spain. SUBJECTS: A sample of young adults (n = 275, 22.2 ± 6.3 years). RESULTS: Mean VO2max was 43.9 mL/kg/min (SD 8.5 mL/kg/min). Most participants had healthy CRF (75.9%). The average MedD score was 6.2 points (SD 1.8 points). Participants who consumed more servings of nuts had higher VO2max. Those who showed low CRF performed less physical activity (PA) and had a higher body mass index (BMI) and WC compared with those classified as having healthy CRF. Nut consumption was positively associated with VO2max (ß = 0.320; 95% CI 2.4, 10.7; p < 0.002), adjusting for sex, age, smoking PA, BMI, WC, and energy intake, showing the subjects who consumed more nuts were fitter than young adults who consumed less. CONCLUSIONS: CRF is positively associated with nut consumption but not with the overall MedD pattern and all other MedD foods in the young adults. The subjects who consumed more servings of nuts were fitter than young adults who consumed less. Moreover, fitter subjects performed more PA and had a lower BMI and WC than those who had lower fitness levels.

Validez y limitaciones de los métodos para medir la ingesta y la eliminación de sal / Validity and limitations of methods to measure the intake and elimination of salt

La hipertensión arterial (HTA) es el principal factor de riesgo cardiovascular modificable. La HTA se puede relacionar con el consumo elevado de sal. Para medir la ingesta no todas las encuestas de alimentación son comparables y válidas. El procedimiento de referencia para valorar la ingesta de sal consiste en medir la excreción urinaria de sodio en orina recolectada durante 24 h, aunque se han propuesto métodos alternativos, como las recolecciones de muestras de orina puntuales y cronometradas. En esta revisión analizamos qué instrumentos permiten valorar la ingesta de sal y cuáles de ellos han aportado una mayor validez y fiabilidad a través de los estudios de concordancia con la eliminación de sodio en orina. Las encuestas actuales de consumo de alimentos son inadecuados debido a su amplia variabilidad y relativamente baja correlación con la eliminación de sodio en orina de 24 h. Su principal limitación es la necesidad de validación en diferentes grupos poblacionales. En Atención Primaria se debería valorar la ingesta de sal mediante la utilización de cuestionarios de frecuencia de consumo que recojan alimentos con elevado contenido en sal, el consumo de platos preelaborados y preguntas que cuantifiquen la adición de sal en la preparación de alimentos o en la mesa. Para la validación de estos cuestionarios debe emplearse como gold standard la eliminación de sodio en orina de 24 h ajustada según el aclaramiento de creatinina

High blood pressure (HBP) is the main modifiable cardiovascular risk factor. HBP can be related to high salt intake. To measure intake, not all feeding surveys are comparable and valid. The reference procedure for assessing salt intake consists of measuring the urinary excretion of sodium in urine collected during 24 hours, although alternative methods have been proposed, such as the collection of punctual and timed urine samples. In this review, we analyze which instruments allow the assessment of salt intake and which of them have provided greater validity and reliability through studies of concordance with the elimination of sodium in urine. Current food consumption surveys are inadequate because of their wide variability and relatively low correlation with the elimination of sodium in 24-hour urine. Its main limitation is the need for validation in different population groups. In primary care, salt intake should be assessed by using frequency-of-consumption questionnaires that collect foods with a high salt content, the consumption of preprepared dishes and questions that quantify the addition of salt in the preparation of food or at the table. For the validation of these questionnaires, the standard gold elimination of 24-hour urine sodium adjusted according to creatinine clearance should be used

[Validity and limitations of methods to measure the intake and elimination of salt]. / Validez y limitaciones de los métodos para medir la ingesta y la eliminación de sal.

High blood pressure (HBP) is the main modifiable cardiovascular risk factor. HBP can be related to high salt intake. To measure intake, not all feeding surveys are comparable and valid. The reference procedure for assessing salt intake consists of measuring the urinary excretion of sodium in urine collected during 24hours, although alternative methods have been proposed, such as the collection of punctual and timed urine samples. In this review, we analyze which instruments allow the assessment of salt intake and which of them have provided greater validity and reliability through studies of concordance with the elimination of sodium in urine. Current food consumption surveys are inadequate because of their wide variability and relatively low correlation with the elimination of sodium in 24-hour urine. Its main limitation is the need for validation in different population groups. In primary care, salt intake should be assessed by using frequency-of-consumption questionnaires that collect foods with a high salt content, the consumption of preprepared dishes and questions that quantify the addition of salt in the preparation of food or at the table. For the validation of these questionnaires, the standard gold elimination of 24-hour urine sodium adjusted according to creatinine clearance should be used.

Effects of lipid-based nutrient supplements v. micronutrient powders on nutritional and developmental outcomes among Peruvian infants.

OBJECTIVE: To determine the effects of lipid-based nutrient supplements (LNS) on children's Hb, linear growth and development, compared with supplementation with micronutrient powder (MNP). DESIGN: The study was a two-arm parallel-group randomized controlled trial, where participants received either LNS or MNP for daily consumption during 6 months. Supplements were delivered by staff at government-run health centres. Hb, anthropometric, motor development, language development and problem-solving indicators were measured by trained research assistants when children were 12 months of age. SETTING: The study was conducted in five rural districts in the Province of Ambo in the Department of Huánuco, Peru. SUBJECTS: We enrolled 6-month-old children (n 422) at nineteen health centres. RESULTS: Children who received LNS had a higher mean Hb concentration and lower odds of anaemia than those who received MNP. No significant differences in height-for-age, weight-for-height or weight-for-age Z-score, or stunting and underweight prevalence, were observed. Provision of LNS was associated with a higher pre-verbal language (gestures) score, but such effect lost significance after adjustment for covariates. Children in the LNS group had higher problem-solving task scores and increased odds of achieving this cognitive task than children in the MNP group. No significant differences were observed on receptive language or gross motor development. CONCLUSIONS: LNS between 6 and 12 months of age increased Hb concentration, reduced anaemia and improved cognitive development in children, but showed no effects on anthropometric indicators, motor or language development.

Relevance of specialized nutritional support in the statements of advance directives. A specialty hospital experience / Relevancia del soporte nutricional especializado en las declaraciones de voluntades anticipadas. Experiencia de un centro hospitalario de especialidades.

Introduction: The Statement of Advance Directives (SAD) is a written document that contains the preferences for health care and treatments desired to receive when the capacity to express is lost. Objective: To study the content of SAD registered in the office of Register of Advance Directives of the Hospital Universitario Puerta del Mar regarding Specialized Nutritional Support (SNS) and hydration in the period from November 2013 to December 2015. Method:Cross-sectional study on the content of the SAD written in the form of Decree 59/2012. Nine relevant variables related with SNS-H are studied in the DVA. Results: 414 SAD are analysed, 60% of which belong to women. The average age is 55.2 years. 41.7% of the SAD was registered by self-motivation. 84.78% do not wish to receive parenteral nutrition, 91.06% reject feeding through gastrostomy intubation, and 89.37% do not want to receive the nasogastric intubation. Hydration is rejected by 71.25%. The three possible options of SNS depend on the age of the declarant with statistical significance (p < 0.001), but not so for hydration. Both SNE and hydration are significantly associated with the reasons for the registration of Advance Directives (p < 0.001). Conclusions: Age is the main factor that determines the choice of accepting or rejecting SNS. By contrast, the choice of hydration is not conditioned by age. The reasons that drive respondents to register DVA is another determinant in the choice of whether to receive or not SNE and hydration.

Introducción: la declaración de voluntades anticipadas (DVA) es un documento que contiene las preferencias sobre los cuidados y tratamientos sanitarios que se desea recibir cuando no se tenga capacidad para expresarlos. Objetivo: estudiar el contenido de las DVA inscritas en la sede del Registro de Voluntades Anticipadas del Hospital Universitario Puerta del Mar, respecto al soporte nutricional especializado (SNE) e hidratación en el periodo de noviembre 2013 a diciembre 2015.Método: estudio transversal realizado sobre el contenido de las DVA inscritas en el modelo del Decreto 59/2012. Se estudian 9 variables de relevancia relacionadas con el SNE e hidratación en las DVA. Resultados: se analizan 414 DVA de las que el 60% corresponden a mujeres. La edad media de los declarantes es 55,2 años. El 41,7% inscribieron su DVA por automotivación. El 84,78% no desea recibir nutrición parenteral, el 91,06% rechaza la alimentación mediante tubo de gastrostomía y el 89,37% no desea recibir la sonda nasogástrica. La hidratación es rechazada por el 71,26%. Las tres posibles opciones de SNE dependen significativamente de la edad del declarante (p < 0,001) pero no así la hidratación. Ambos, SNE e hidratación, sí se asociaron significativamente con los motivos para inscribir las voluntades anticipadas (p < 0,001). Conclusiones: la edad es el principal factor que condiciona la opción de aceptación o rechazo de SNE. Por el contrario, la elección de la hidratación no está condicionada por la edad. Los motivos por los que se inscriben los otorgantes son otro determinante en la elección de si desean recibir o no SNE e hidratación.