Conocimientos, creencias y actitudes sobre la obesidad y el sobrepeso en una muestra de dietistas-nutricionistas de España / Knowledge, beliefs, and attitudes about obesity and overweight in a sample of dietitians-nutritionists in Spain

Introducción: el sobrepeso y la obesidad (SP/OB) conforman uno de los mayores retos de salud pública a escala mundial. Los profesionales de Dietética y Nutrición promueven la adquisición de hábitos saludables para adecuar el peso. Desde la psicología, existen aportaciones interesantes a ser consideradas.Objetivos:a) estudiar el vínculo entre las variables del estudio y la intervención terapéutica de los nutricionistas en el SP/OB; b) recabar las opiniones de los nutricionistas sobre los aspectos psicológicos implicados; c) analizar los factores predictores del éxito terapéutico.Métodos: estudio de corte transversal, descriptivo que, a través de una encuesta a dietistas-nutricionistas de España (n = 266), analiza los datos sociodemográficos, formativos y laborales, así como los conocimientos, las creencias y las intervenciones para el SP/OB, haciendo énfasis en los aspectos psicológicos. Se realizaron análisis del chi cuadrado para las variables cualitativas y análisis de regresión para estimar la percepción del éxito terapéutico.Resultados: la especialización en SP/OB se vinculó a las intervenciones de educación nutricional. La consideración de los aspectos psicológicos se asoció al abordaje de los problemas emocionales y sociales. La educación nutricional, el número de sesiones y el tiempo de atención por sesión predijeron la percepción del éxito terapéutico, explicando en conjunto el 46,5 % de la varianza.Conclusiones: los hallazgos informan de una alta formación específica, un uso limitado de las guías de práctica clínica, la atribución mayoritaria del SP/OB a factores ambientales y la preferencia por el trabajo en equipo. Los factores psicológicos se estiman muy necesarios en el abordaje de mayor preferencia, considerando la educación nutricional como el más eficiente. Es destacada la autopercepción del éxito terapéutico entre los profesionales (AU)

Introduction: overweight and obesity make up one of the greatest public health challenges worldwide. Dietitians-nutritionists promote the acquisition of healthy habits to adjust weight. There are interesting contributions by psychology to be considered.Objectives:a) to study the link between the variables included in the study and the therapeutic intervention of dietitians in overweight and obesity; b) to collect the opinions of dietitians on the psychological aspects involved; c) to analyze the predictors of therapeutic success.Methods: a descriptive cross-sectional study that, through a survey to dietitians-nutritionists in Spain (n = 266), analyzes demographic, training, and occupational data, as well as knowledge, beliefs, and interventions on obesity and overweight, with emphasis on psychological aspects. Chi-squared analyses were performed for qualitative variables, and a regression analysis was performed to estimate the perception of therapeutic success.Results: specialization in overweight and obesity was linked to nutrition education interventions. The consideration of psychological aspects was associated with addressing emotional and social problems. Nutritional education, number of sessions, and average time per session predicted the perception of therapeutic success, all of these explaining 46.5 % of the variance.Conclusions: the findings documented a highly specific training in obesity, and a limited use of clinical practice guidelines; the cause of obesity is mostly attributable to environmental factors, and teamwork is preferred by most. Psychological factors were considered very necessary in the approach to this problem, with nutritional education being most efficient. The professionals' self-perception of therapeutic success is remarkable (AU)

[Knowledge, beliefs, and attitudes about obesity and overweight in a sample of dietitians-nutritionists in Spain]. / Conocimientos, creencias y actitudes sobre la obesidad y el sobrepeso en una muestra de dietistas-nutricionistas de España.

INTRODUCTION: Introduction: overweight and obesity make up one of the greatest public health challenges worldwide. Dietitians-nutritionists promote the acquisition of healthy habits to adjust weight. There are interesting contributions by psychology to be considered. Objectives: a) to study the link between the variables included in the study and the therapeutic intervention of dietitians in overweight and obesity; b) to collect the opinions of dietitians on the psychological aspects involved; c) to analyze the predictors of therapeutic success. Methods: a descriptive cross-sectional study that, through a survey to dietitians-nutritionists in Spain (n = 266), analyzes demographic, training, and occupational data, as well as knowledge, beliefs, and interventions on obesity and overweight, with emphasis on psychological aspects. Chi-squared analyses were performed for qualitative variables, and a regression analysis was performed to estimate the perception of therapeutic success. Results: specialization in overweight and obesity was linked to nutrition education interventions. The consideration of psychological aspects was associated with addressing emotional and social problems. Nutritional education, number of sessions, and average time per session predicted the perception of therapeutic success, all of these explaining 46.5 % of the variance. Conclusions: the findings documented a highly specific training in obesity, and a limited use of clinical practice guidelines; the cause of obesity is mostly attributable to environmental factors, and teamwork is preferred by most. Psychological factors were considered very necessary in the approach to this problem, with nutritional education being most efficient. The professionals' self-perception of therapeutic success is remarkable.

INTRODUCCIÓN: Introducción: el sobrepeso y la obesidad (SP/OB) conforman uno de los mayores retos de salud pública a escala mundial. Los profesionales de Dietética y Nutrición promueven la adquisición de hábitos saludables para adecuar el peso. Desde la psicología, existen aportaciones interesantes a ser consideradas. Objetivos: a) estudiar el vínculo entre las variables del estudio y la intervención terapéutica de los nutricionistas en el SP/OB; b) recabar las opiniones de los nutricionistas sobre los aspectos psicológicos implicados; c) analizar los factores predictores del éxito terapéutico. Métodos: estudio de corte transversal, descriptivo que, a través de una encuesta a dietistas-nutricionistas de España (n = 266), analiza los datos sociodemográficos, formativos y laborales, así como los conocimientos, las creencias y las intervenciones para el SP/OB, haciendo énfasis en los aspectos psicológicos. Se realizaron análisis del chi cuadrado para las variables cualitativas y análisis de regresión para estimar la percepción del éxito terapéutico. Resultados: la especialización en SP/OB se vinculó a las intervenciones de educación nutricional. La consideración de los aspectos psicológicos se asoció al abordaje de los problemas emocionales y sociales. La educación nutricional, el número de sesiones y el tiempo de atención por sesión predijeron la percepción del éxito terapéutico, explicando en conjunto el 46,5 % de la varianza. Conclusiones: los hallazgos informan de una alta formación específica, un uso limitado de las guías de práctica clínica, la atribución mayoritaria del SP/OB a factores ambientales y la preferencia por el trabajo en equipo. Los factores psicológicos se estiman muy necesarios en el abordaje de mayor preferencia, considerando la educación nutricional como el más eficiente. Es destacada la autopercepción del éxito terapéutico entre los profesionales.

Adrenalectomy for solid tumor metastases: results of a multicenter European study.

BACKGROUND: We assessed the results of adrenalectomy for solid tumor metastases in 317 patients recruited from 30 European centers. METHODS: Patients with histologically proven adrenal metastatic disease and undergoing complete removal(s) of the affected gland(s) were eligible. RESULTS: Non-small cell lung cancer (NSCLC) was the most frequent tumor type followed by colorectal and renal cell carcinoma. Adrenal metastases were synchronous (≤6 months) in 73 (23%) patients and isolated in 213 (67%). The median disease-free interval was 18.5 months. Laparoscopic resection was used in 46% of patients. Surgery was limited to the adrenal gland in 73% of patients and R0 resection was achieved in 86% of cases. The median overall survival was 29 months (95% confidence interval, 24.69-33.30). The survival rates at 1, 2, 3, and 5 years were 80%, 61%, 42%, and 35%, respectively. Patients with renal cancer showed a median survival of 84 months, patients with NSCLC 26 months, and patients with colorectal cancer 29 months (P = .017). Differences in survival between metachronous and synchronous lesions were also significant (30 vs. 23 months; P = .038). CONCLUSION: Surgical removal of adrenal metastasis is associated with long-term survival in selected patients.

Prediction equations for single-breath diffusing capacity in subjects aged 65 to 85 years.

BACKGROUND: In senior subjects, diffusing capacity of the lung for carbon monoxide (Dlco) is interpreted using prediction equations derived from primarily younger adult populations. Our objectives were to provide reference equations for single-breath Dlco for a cohort of healthy, never-smoking, white, European adults between 65 and 85 years of age and to compare the predicted values of this sample with those from other studies involving middle-aged adults. METHODS: Reference equations were derived from a randomly selected sample from the general population of 431 healthy never smoker subjects aged 65 to 85 years (262 women and 169 men). Spirometry, lung volume determinations by plethysmography, and single-breath Dlco (corrected for hemoglobin) were performed following the American Thoracic Society/European Respiratory Society guidelines. Reference values and lower and upper limits of normal were derived using a piecewise polynomial model. RESULTS: In addition to age, our reference equations confirmed the height and body size dependence of Dlco and diffusing capacity for alveolar volume (Dlco/Va) in older subjects. Practically all of the reference values obtained by extrapolating reference equations of middle-aged adults underestimated the true diffusing capacity of the healthy elderly volunteers. Middle-aged reference equations underestimated Dlco by 2.1% to 22.3% in women and 2.8% to 37.8% in men. In addition, Dlco/Va was overestimated up to 18% and 39.8% in women and men, respectively, whereas other equations underestimated Dlco/Va up to 22.2% and 11.9% in women and men, respectively. CONCLUSIONS: These results underscore the importance of using prediction equations appropriate to the origin and age characteristics of the subjects being studied.

Lung volume reference values for women and men 65 to 85 years of age.

RATIONALE: In elderly subjects, static lung volumes are interpreted using prediction equations derived from primarily younger adult populations. OBJECTIVES: To provide reference equations for static lung volumes for European adults 65 to 85 years of age and to compare the predicted values of this sample with those from other studies including middle-aged adults. We compare the lung volumes by plethysmography and helium dilution in elderly subjects. METHODS: Reference equations were derived from a randomly selected sample from the general population of 321 healthy never-smoker subjects 65 to 85 years of age. Spirometry and lung volume determinations by plethysmography and multibreath helium equilibration method were performed following the American Thoracic Society/European Respiratory Society recommendations. Reference values and lower and upper limits of normal were derived using a piecewise polynomial model. MEASUREMENTS AND MAIN RESULTS: Plethysmography provided higher values than the dilutional method for all lung volumes, with wide limits of agreement. In addition to height, our reference equations confirm the age- and body size dependence of lung volumes in older subjects. Practically all the estimations performed by extrapolating reference equations of middle-aged adults overpredicted the true lung volumes of our healthy elderly volunteers. Middle-aged reference equations classify subjects as being below the total lung capacity lower limit of normal between 17.9 and 62.5% of the women and between 12.5 and 42.2% of the men of the current study. CONCLUSIONS: These results underscore the importance of using prediction equations appropriate to the origin, age, and height characteristics of the subjects being studied.

[Anthropoentomophagic biodiversity of the Zongolica region, Veracruz, Mexico]. / Biodiversidad antropoentomofágica de la región de Zongolica, Veracruz, México.

Anthropoentomophagic biodiversity of the Zongolica region, Veracruz, Mexico. During two and a half years (2003-2005) we recorded the insect species used as food at Zongolica, Veracruz State, Mexico. Interviews were made among people (200) of this municipality to know which insects they consumed. The total of registered species was 57 (Orthoptera, Hemiptera, Homoptera, Megaloptera, Coleoptera, Lepidoptera and Hymenoptera). The Orthoptera was the most frequently ingested. Twenty-four of these species were new records for edible insects of Mexico. They are eaten in immature stages or as adults, generally only roasted. Consumption is seasonal. Some species are commercialized in the "tianguis" (little town markets) and/or in the larger Zongolica market. There is a "protoculture" of three species, one cockroach (Periplaneta australasiae Fabricius) and two moths (Latebraria amphipyroides Guenée and Arsenura armida armida Cramer). In Zongolica, anthropoentomophagy is an ancestral habit.

Obstructive sleep apnoea-hypoapnoea syndrome reversibly depresses cardiac response to exercise.

AIMS: To evaluate cardiac response to exercise in middle-aged normotensive obstructive sleep apnoea-hypoapnoea syndrome (OSAHS) adults with normal resting left ventricular systolic function and to test the hypothesis that nasal continuous positive airway pressure (CPAP) therapy might improve cardiac performance during exercise. METHODS AND RESULTS: We performed a prospective, randomized, double-blind, placebo-controlled, cross-over clinical trial including 31 consecutive newly diagnosed OSAHS patients and 15 healthy subjects. Cardiopulmonary exercise testing with cardiac output measurement, blood pressure (BP) recordings, and urinary excretion of catecholamine levels were obtained at baseline and after 3 months on both effective and sham CPAP. OSAHS subjects had higher systolic and mean nocturnal BP and higher nocturnal levels of catecholamines. In contrast, they had lower increments in cardiac output (Qt) and in stroke volume (SV) in response to exercise than control subjects. CPAP therapy was associated with highly significant improvements in all the indices of left ventricular systolic performance response during exercise, whereas with sham CPAP, all of them remained unchanged. CONCLUSION: OSAHS patients with normal resting left ventricular systolic function and no hypertension had a worse cardiac response to exercise than healthy subjects. In these patients, 3 months of CPAP improved both Qt and SV responses to exercise.

Cardiac rhythm disturbances and ST-segment depression episodes in patients with obstructive sleep apnea-hypopnea syndrome and its mechanisms.

STUDY OBJECTIVES: To compare the frequency of daytime and nocturnal cardiac arrhythmias and ST-segment depression episodes among patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), snoring subjects, and healthy subjects, and to analyze the relationship between the cardiac disturbances, sleep characteristics, and sympathetic tone in patients with OSAHS. PATIENTS AND INTERVENTIONS: Twenty-one consecutive patients with OSAHS, 12 snorers without hypersomnolence, and 15 healthy subjects were selected. Polysomnography, 24-h Holter ECG recording, and urinary catecholamine determination were simultaneously performed on all subjects. RESULTS: Patients with OSAHS had more daytime and nocturnal episodes of sinus and supraventricular arrhythmias and couplets than the snoring and control groups. Moreover, nocturnal ST-segment depression episodes were more frequent in the OSAHS group than in control subjects (0.565 +/- 0.826/h vs 0 +/- 0/h [mean +/- SD]). In patients with OSAHS, arousal index and daytime epinephrine levels were related to daytime and nocturnal ST-segment depression episodes, whereas minimum arterial oxygen saturation was related to nocturnal sinus bradycardia and supraventricular tachycardia. Epinephrine and norepinephrine urinary concentrations correlated with sinus and supraventricular arrhythmias. CONCLUSIONS: Patients with OSAHS have a higher frequency of cardiac rhythm disturbances and ST-segment depression episodes than snoring and control subjects. Moreover, ST-segment changes are related to sympathetic tone and sleep fragmentation, whereas most of the rhythm disturbances in patients with OSAHS are associated with sleep fragmentation, nocturnal hypoxemia, and sympathetic tone.

White coat hypertension in patients with obstructive sleep apnea-hypopnea syndrome.

BACKGROUND: The strength of the association between obstructive sleep apnea-hypopnea syndrome (OSAHS) and systemic hypertension could be affected by methodologic problems in the definition of hypertension. STUDY OBJECTIVES: To determine the frequency of white coat hypertension (WCH) in patients with OSAHS, and to analyze the characteristics of patients with OSASH and WCH. PATIENTS AND INTERVENTIONS: Ninety-nine consecutive patients with OSAHS and 20 healthy control subjects were included into the study. Twenty-four-hour ambulatory BP monitoring (ABPM) and urinary catecholamines were determined simultaneously with the polysomnographic study. Arterial blood gases and lung volumes were also measured. RESULTS: Office hypertension was diagnosed in 45 patients, while the control group included 54 normotensive patients with OSAHS. After ABPM, hypertension was confirmed in 30 patients with OSAHS and office hypertension. WCH was diagnosed in the remaining 15 patients (33%). Patients with WCH presented higher values of sleep onset latency and wake after sleep onset than normotensive and sustained hypertensive patients. No other differences in sleep parameters, function tests, or urinary catecholamines were found between the OSAHS groups. CONCLUSION: The results indicate that WCH is a frequent phenomenon in patients with OSAHS, and that it is not predictable by clinical variables.

Relationship between exhaled carbon monoxide and airway hyperresponsiveness in asthmatic patients.

The study objectives were to analyze the changes in exhaled carbon monoxide (COex) induced by histamine provocation challenge in asthmatic patients and to evaluate the relationship between COex and airway sensitivity and reactivity. Levels of COex were measured in 105 nonsmoking mildly asthmatic subjects before and after histamine provocation challenge. Dose-response curves were characterized by their sensitivity (PD20) and reactivity. Dose-response slope (DRS), continuous index of responsiveness (CIR), and bronchial reactivity index (BRI) were determined as reactivity indices. Bronchial challenge was positive for 47 subjects and negative for 58. The COex levels rose significantly after bronchial challenge in the positive response group (4.49 +/- 0.4 vs. 5.74 +/- 0.57 ppm, p = 0.025) and in the negative response group (2.84 +/- 0.25 vs. 4.00 +/- 0.41 ppm, p = 0.000). An inverse relation between basal COex and PD20 was found (r = -0.318, p = 0.030). In all subjects, a proportional direct relationship between COex and DRS (r = 0.214, p = 0.015), CIR (r = 0.401, p = 0.000), and BRI (r = 0.208, p = 0.012) was observed. On stepwise multiple linear regression analysis, COex only significantly correlated with CIR (multiple r2 = 0.174, p = 0.000). In conclusion, exhaled CO determination is a noninvasive inflammatory marker of the respiratory tract, which shows an acceptable association with airway hyperresponsiveness.

Accuracy of noninvasive estimates of respiratory muscle effort during spontaneous breathing in restrictive diseases.

Mean inspiratory pressure (Pi), estimated from the occlusion pressure at the mouth and the inspiratory time, is useful as a noninvasive estimate of respiratory muscle effort during spontaneous breathing in normal subjects and patients with chronic obstructive pulmonary disease. The aim of this study was to compare the Pi with respect to mean esophageal pressure (Pes) in patients with restrictive disorders. Eleven healthy volunteers, 12 patients with chest wall disease, 14 patients with usual interstitial pneumonia, and 17 patients with neuromuscular diseases were studied. Pi, Pes, and mean transdiaphragmatic pressure were simultaneously measured. Tension-time indexes of diaphragm (TTdi) and inspiratory muscles (TTmu) were also determined. In neuromuscular patients, significant correlations were found between Pi and Pes, Pi and transdiaphragmatic pressure, and TTmu and TTdi. A moderate agreement between Pi and Pes and between TTmu and TTdi was found. No significant correlation between these parameters was found in the other patient groups. These findings suggest that Pi is a good surrogate for the invasive measurement of respiratory muscle effort during spontaneous breathing in neuromuscular patients.