Serum Phthalate Concentrations and Biomarkers of Oxidative Stress in Adipose Tissue in a Spanish Adult Cohort.

The relationship between phthalates, a group of chemical pollutants classified as endocrine disruptors, and oxidative stress is not fully understood. The aim of the present hospital-based study was to explore the associations between circulating levels of 10 phthalate metabolites and 8 biomarkers of oxidative stress in adipose tissue. The study population (n = 143) was recruited in two hospitals in the province of Granada (Spain). Phthalate metabolite concentrations were analyzed by isotope diluted online-TurboFlow-LC-MS/MS in serum samples, while oxidative stress markers were measured by commercially available kits in adipose tissue collected during routine surgery. Statistical analyses were performed by MM estimators' robust linear regression and weighted quantile sum regression. Mainly, positive associations were observed of monomethyl phthalate (MMP), monoiso-butyl phthalate (MiBP), and mono-n-butyl phthalate (MnBP) (all low molecular weight phthalates) with glutathione peroxidase (GPx) and thiobarbituric acid reactive substances (TBARS), while an inverse association was found between monoiso-nonyl phthalate (MiNP) (high molecular weight phthalate) and the same biomarkers. WQS analyses showed significant effects of the phthalate mixture on GSH (ß = -30.089; p-value = 0.025) and GSSG levels (ß = -19.591; p-value = 0.030). Despite the limitations inherent to the cross-sectional design, our novel study underlines the potential influence of phthalate exposure on redox homeostasis, which warrants confirmation in further research.

Relación entre la dieta, aspectos nutricionales y la calidad del sueño en población pediátrica / Relationship between diet, nutritional aspects and sleep quality in a pediatric population

La relación entre la dieta y el sueño ha sido escasamente estudiada en la población pediátrica. El objetivo de esta revisión fue analizar de forma narrativa la relación existente entre la dieta, determinados aspectos nutricionales y la calidad del sueño en esta población. Se seleccionaron estudios que midieran la dieta y valorasen el estado nutricional y el sueño en población infantil mediante la utilización de distintas herramientas. El riesgo de sesgo de los 14 estudios seleccionados se determinó con herramientas validadas. La adhesión a algunos patrones dietéticos como el mediterráneo, el alto consumo de frutas y verduras, la ingesta de triptófano o la sustitución de los ácidos grasos saturados por grasas insaturadas se relacionaron con una mejor calidad del sueño. El consumo de los productos ultraprocesados y la ingesta alta de azúcares simples dificultan un descanso adecuado. Por otro lado, se observó una asociación entre un índice de masa corporal alto y la falta de sueño en los jóvenes menores de 14 años. En conclusión, los estudios recogidos mostraron una asociación significativa entre algunos patrones dietéticos, grupos de alimentos y nutrientes con la calidad del sueño. Los factores dietéticos “poco saludables” se asociaron a una peor calidad del sueño. Sin embargo, hábitos y dietas más saludables y recomendados se relacionaron con una mejora de la higiene del sueño. Por otro lado, la falta de horas de descanso en la población juvenil se relaciona con el aumento de peso.(AU)

The relationship between diet and sleep has been studied in adults. However, there is little evidence in the pediatric population. The objective of this review was to analyze in a narrative way the relationship between diet, some nutritional aspects and sleep quality in population under 14 years. A quick review was performed in MEDLINE (PubMed) and Cochrane with a search strategy combining MeSH terms and keywords. Studies were selected to estimate diet and evaluate nutritional status and sleep in children using different tools. The risk of bias from the 14 selected studies was determined with validated tools (AMSTAR 2, Newcastle Ottawa scale [NOS] and Risk of Bias [Rob2]). Adherence to some dietary patterns such as the Mediterranean, high consumption of fruits and vegetables, tryptophan intake or substitution of saturated fatty acids by unsaturated fats were associated with better sleep quality. The consumption of ultra-processed products, the “unhealthy fast food” or the high intake of simple sugars hinder an adequate rest. On the other hand, an association between a high body mass index and lack of sleep was observed in young people under 14. In conclusion, the collected studies showed a significant association between some dietary patterns, food groups and nutrients with sleep quality. “Unhealthy” dietary factors were associated with poorer sleep quality. However, healthier and recommended habits and diets were associated with improved sleep hygiene. On the other hand, the lack of hours of rest in the youth population increases height, weight and BMI. Further research is needed in this direction.(AU)

[Relationship between diet, nutritional aspects and sleep quality in a pediatric population]. / Relación entre la dieta, aspectos nutricionales y la calidad del sueño en población pediátrica.

The relationship between diet and sleep has been studied in adults. However, there is little evidence in the pediatric population. The objective of this review was to analyze in a narrative way the relationship between diet, some nutritional aspects and sleep quality in population under 14 years. A quick review was performed in MEDLINE (PubMed) and Cochrane with a search strategy combining MeSH terms and keywords. Studies were selected to estimate diet and evaluate nutritional status and sleep in children using different tools. The risk of bias from the 14 selected studies was determined with validated tools (AMSTAR 2, Newcastle Ottawa scale [NOS] and Risk of Bias [Rob2]). Adherence to some dietary patterns such as the Mediterranean, high consumption of fruits and vegetables, tryptophan intake or substitution of saturated fatty acids by unsaturated fats were associated with better sleep quality. The consumption of ultra-processed products, the "unhealthy fast food" or the high intake of simple sugars hinder an adequate rest. On the other hand, an association between a high body mass index and lack of sleep was observed in young people under 14. In conclusion, the collected studies showed a significant association between some dietary patterns, food groups and nutrients with sleep quality. "Unhealthy" dietary factors were associated with poorer sleep quality. However, healthier and recommended habits and diets were associated with improved sleep hygiene. On the other hand, the lack of hours of rest in the youth population increases height, weight and BMI. Further research is needed in this direction.

Association of monetary diet cost of foods and diet quality in Spanish older adults.

Background: A major barrier to a healthy diet may be the higher price of healthy foods compared to low-quality foods. Objectives: This study aimed to assess the association between the monetary cost of food and diet quality in Spanish older adults at high risk of cardiovascular disease. Methods: Cross-sectional analysis was carried out in Spanish older adults (n = 6,838; 48.6% female). A validated food frequency questionnaire was used to assess dietary intake. Metabolic syndrome severity, adherence to the Mediterranean diet (MedDiet), adherence to a provegetarian dietary pattern, and dietary inflammatory index were assessed. The economic cost of the foods was obtained from the Spanish Ministry of Agriculture Fisheries and Food database (2015-2017, the period of time when the participants were recruited). The total cost of diet adjusted per 1,000 kcal was computed. Results: The healthier dietary pattern was associated with a higher cost of the diet. Higher adherence to the MedDiet, anti-inflammatory diet, and the healthy version of the provegetarian dietary pattern were related to higher costs of the diet. Conclusion: Higher diet quality was associated with a higher dietary cost of the diet per 1,000 kcal/day. Food prices can be an important component of interventions and policies aimed at improving people's diets and preventing diet-related chronic diseases. Clinical trial registry number: The trial was registered in 2014 at the International Standard Randomized Controlled Trial (ISRCT; http://www.isrctn.com/ISRCTN89898870) with the number 89898870.

Metabolic syndrome criteria and severity and carbon dioxide (CO2) emissions in an adult population.

BACKGROUND: Metabolic syndrome (MetS) has become a growing risk factor of some non-communicable diseases. Increase of greenhouse gas emissions affects the planet. AIMS: To assess the association between MetS severity and amount of carbon dioxide (CO2) emitted in an adult population. DESIGN: Cross-sectional study (n = 6646; 55-76-year-old-men; 60-75-year-old-women with MetS). METHODS: Dietary habits were assessed using a pre-validated semi quantitative 143-item food frequency questionnaire. The amount of CO2 emitted due to the production of food consumed by person and day was calculated using a European database, and the severity of the MetS was calculated with the MetS Severity Score. RESULTS: Higher glycaemia levels were found in people with higher CO2 emissions. The risk of having high severe MetS was related to high CO2 emissions. CONCLUSIONS: Low CO2 emissions diet would help to reduce MetS severity. Advantages for both health and the environment were found following a more sustainable diet. TRIAL REGISTRATION: ISRCTN, ISRCTN89898870 . Registered 05 September 2013.

Efficacy and Safety of New B Cell-Targeted Biologic Agent for the Treatment of Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis.

BACKGROUND: B cells are central to the pathogenesis of systemic lupus erythematosus (SLE). We aimed to analyze the efficacy and safety of new B cell-targeted drug therapies for SLE. METHODS: A systematic review of randomized controlled trials (RCTs) and reference lists of relevant articles published from inception to 2022 were selected from PubMed, Scopus and Web of Science databases. Random effects meta-analyses were performed to estimate an overall effect size for the risk of adverse events (AEs) and serious adverse events (SAEs) with belimumab and tabalumab treatment. Heterogeneity was assessed using the I2 statistic and meta-regression. Funnel asymmetry was evaluated using Egger's test. RESULTS: This study included 13 RCTs, of which three showed high risk of bias. Egger's test showed no asymmetry. The risk of SAEs and AEs was lower in the treatment group with belimumab treatment. The risk of AEs for tabalumab treatment was lower in the treatment group and lower for SAEs. CONCLUSION: Belimumab and tabalumab therapies are effective and safe in the treatment of SLE, although tabalumab does not show sufficient statistical power. Advances in understanding the underlying mechanisms of SLE will be directed towards correlating clinical manifestations with specific pathogenic pathways and the development of precision medicine.

Pandemic-related stress in pregnant women during the first COVID-19 lockdown and neonatal development.

BACKGROUND: Maternal stress and psychopathology have a negative effect on mothers and neonates. Maternal stress may affect neonatal growth and development both physically and psychologically. PURPOSE: To study the impact of pandemic-related pregnancy stress and maternal psychopathological symptoms during the COVID-19 lockdown in 2020 on neonatal development. METHODS: A two-phase prospective study was carried out on a sample of 181 pregnant women ranged from 18 to 40 years old in Spain (Europe). Phase 1: Pandemic-related pregnancy stress (PREPS), Prenatal Distress Questionnaire (PDQ), Perceived Stress Scale (PSS) and the revised version of the Symptom Checklist-90 (SCL-90-R) were used to assess psychological symptoms during the lockdown. In the follow-up (Phase 2), obstetric, birth-related and anthropometric variables were collected from 81 pregnant women-neonates dyads. RESULTS: Primiparous women showed higher psychopathological symptoms and higher levels of pandemic-related pregnancy stress than multiparous women. A multiple linear regression model showed that pandemic-related pregnancy stress could predict the length of neonate by adjusting for maternal age and gestational age, especially for primiparous women. IMPLICATIONS FOR RESEARCH: Studies assessing neonates development should evaluate the long-term effect of the COVID-19 pandemic on neonates´ length. IMPLICATIONS FOR PRACTICE: States the relation between pandemic-related pregnancy stress and neonatal development by being able to track the effects on neonates whose mothers had high levels of stress during the COVID-19 pandemic.

Differences in Psychological Symptoms in Pregnancy and Postpartum before and during COVID-19: A Cross-sectional Study / Las diferencias en los síntomas psicológicos durante el embarazo y el postparto antes y después del COVID-19: un estudio transversal

Rationale: Pregnant women are especially vulnerable to mental health problems, including stress, anxiety, and depression. This risk has been increased during the COVID-19 pandemic and differences in psychological symptoms in pregnancy and postpartum before and during COVID-19 exists. Mental health problems can have adverse effects on both the woman, and the neonate, including miscarriages, premature births, low birth weight, and higher rates of cesarean sections and instrument-assisted deliveries. Aim: To evaluate the prevalence of psychological symptoms of pregnant women before and during the COVID-19 pandemic. Method: A cross-sectional study was carried out to assess the psychological profile in a sample of pregnant women selected before the pandemic and a sample of women studied during the first wave of the pandemic. A total of 122 women were selected prior to the pandemic and 181 women during the COVID-19 outbreak. The Symptom Checklist-90 Revised (SCL-90-R) was used to assess depression and anxiety during pregnancy and in the postpartum period. Results: The prevalence of symptoms of depression and anxiety during pregnancy were higher in the sample of women studied during the pandemic (SCL-90-R: M = 54.6 vs. 42.6 and M = 62.6 vs. 51.7 respectively). In the postpartum the difference between both samples of women was even higher for depression and anxiety (SCL-90-R: M = 50.4 vs. 35.0 and M = 51.3 vs. 36.0 respectively). Being a pregnant woman at the COVID-19 outbreak was directly associated with a higher score of depression symptoms (aOR = 8.67, 95% CI [3.26, 23.02], p < .001). Anxiety during childbirth was more frequently reported by women before the pandemic (aOR = 5.13, 95% CI [2.53, 10.44], p < .001). The variable stage (before /during pandemic) was also associated with having a clinical SCL-90-R score above 70 (aOR = 7.61, 95% CI [2.7, 21.47], p < .001). (AU)

Justificación: Las mujeres embarazadas son especialmente vulnerables a los problemas de salud mental, como el estrés, la ansiedad y la depresión. Este riesgo se ha incrementado durante la pandemia de COVID-19, habiendo diferencias en los síntomas psicológicos en el embarazo y el puerperio antes y después de la pandemia. Los problemas de salud mental pueden tener efectos perjudiciales tanto en la mujer como en el recién nacido, como abortos espontáneos, partos prematuros, bajo peso al nacer y tasas más altas de cesáreas y partos asistidos. Objetivo: Evaluar la prevalencia de síntomas psicológicos de gestantes antes y durante la pandemia de COVID-19. Método: Se realizó un estudio transversal para evaluar el perfil psicológico en una muestra de mujeres embarazadas seleccionadas antes de la pandemia y una muestra de mujeres estudiadas durante la primera ola de la pandemia. Se seleccionó un total de 122 mujeres antes de la pandemia y 181 mujeres durante el brote de COVID-19. Se utilizó la Inventario de Verificación de Síntomas-90 Revisada (SCL-90-R) para evaluar la depresión y la ansiedad durante el embarazo y el puerperio. Resultados: La prevalencia de síntomas de depresión y ansiedad durante el embarazo fue mayor en la muestra de mujeres estudiadas durante la pandemia (SCL-90-R: M = 54.6 vs. 42.6 y M = 62.6 vs. 51.7 respectivamente). En el postparto la diferencia entre ambas muestras de mujeres fue aún mayor para depresión y ansiedad (SCL-90-R: M = 50.4 vs. 35.0 y M = 51.3 vs. 36.0 respectivamente). Ser mujer embarazada en el brote de COVID-19 se asoció directamente con una mayor puntuación de síntomas de depresión (aOR = 8.67, IC 95% [3.26, 23.02, p < .001). Las mujeres manifestaron ansiedad durante el parto con mayor frecuencia antes de la pandemia (aOR = 5.13, IC 95% 2.53, 10.44], p < .001). La variable estadio (antes/durante la pandemia) también se asoció con tener una puntuación clínica SCL-90-R superior a 70 (aOR = 7.61, IC 95% [2.7, 21.47], p < .001). (AU)

Comparative effects of glucagon-like peptide-1 receptors agonists, 4-dipeptidyl peptidase inhibitors, and metformin on metabolic syndrome.

AIMS: To assess the comparative effects of glucagon-like peptide-1 receptor agonists (GLP-1RA), 4-dipeptidyl peptidase inhibitors (DPP-4I), and metformin treatment during one year on metabolic syndrome (MetS) components and severity in MetS patients. METHODS: Prospective study (n = 6165 adults) within the frame of PREDIMED-Plus trial. The major end-point was changes on MetS components and severity after one- year treatment of GLP-1RA, DPP-4I, and metformin. Anthropometric measurements (weight, height and waist circumference), body mass index (BM), and blood pressure were registered. Blood samples were collected after overnight fasting. Plasma glucose, glycosylated hemoglobin (HbA1c), plasma triglycerides and cholesterol were measured. Dietary intakes as well as physical activity were assessed through validated questionnaires. RESULTS: MetS parameters improved through time. The treated groups improved glycaemia compared with untreated (glycaemia ∆ untreated: -1.7 mg/dL(± 13.5); ∆ metformin: - 2.5(± 23.9) mg/dL; ∆ DPP-4I: - 4.5(± 42.6); mg/dL ∆ GLP-1RA: - 4.3(± 50.9) mg/dL; and HbA1c: ∆ untreated: 0.0(± 0.3) %; ∆ metformin: - 0.1(± 0.7) %; ∆ DPP-4I: - 0.1(± 1.0) %; ∆ GLP-1RA: - 0.2(± 1.2) %. Participants decreased BMI and waist circumference. GLP-1RA and DPP-4I participants registered the lowest decrease in BMI (∆ untreated: -0.8(± 1.6) kg/m2; ∆ metformin: - 0.8(± 1.5) kg/m2; ∆ DPP-4I: - 0.6(± 1.3) kg/m2; ∆ GLP-1RA: - 0.5(± 1.2) kg/m2. and their waist circumference (∆ untreated: -2.8(± 5.2) cm; ∆ metformin: - 2.6(± 15.2) cm; ∆ DPP-4I: - 2.1(± 4.8) cm; ∆ GLP-1RA: - 2.4(± 4.1) cm. CONCLUSION: In patients with MetS and healthy lifestyle intervention, those treated with GLP-1RA and DPP-4I obtained better glycemic profile. Anthropometric improvements were modest.

Analysis of the Genetic Relationship between Atherosclerosis and Non-Alcoholic Fatty Liver Disease through Biological Interaction Networks.

Non-alcoholic fatty liver disease (NAFLD) seems to have some molecular links with atherosclerosis (ATH); however, the molecular pathways which connect both pathologies remain unexplored to date. The identification of common factors is of great interest to explore some therapeutic strategies to improve the outcomes for those affected patients. Differentially expressed genes (DEGs) for NAFLD and ATH were extracted from the GSE89632 and GSE100927 datasets, and common up- and downregulated DEGs were identified. Subsequently, a protein-protein interaction (PPI) network based on the common DEGs was performed. Functional modules were identified, and the hub genes were extracted. Then, a Gene Ontology (GO) and pathway analysis of common DEGs was performed. DEGs analysis in NAFLD and ATH showed 21 genes that were regulated similarly in both pathologies. The common DEGs with high centrality scores were ADAMTS1 and CEBPA which appeared to be down- and up-regulated in both disorders, respectively. For the analysis of functional modules, two modules were identified. The first one was oriented to post-translational protein modification, where ADAMTS1 and ADAMTS4 were identified, and the second one mainly related to the immune response, where CSF3 was identified. These factors could be key proteins with an important role in the NAFLD/ATH axis.

Maternal Psychopathological Profile during Childbirth and Neonatal Development during the COVID-19 Pandemic: A Pre-Posttest Study.

The coronavirus SARS-CoV-2 generated an alert that became a state of emergency in health issues worldwide, a situation that affected the entire population, including pregnant women. The present study aims to understand the effect of the psychopathological profile of a sample of pregnant women at the time of the COVID-19 pandemic on themselves during childbirth (Phase 1) and after childbirth and the anthropometric measures of the neonate at birth (Phase 2). The total sample comprises 81 pregnant women aged 32.07 years (SD = 5.45) and their neonates. Sociodemographic and obstetric data of the sample were collected. During pregnancy, psychopathology was measured by means of the SCL-90, as well as other psychological measures on stress and social support. Cluster k-means techniques were used to uncover the heterogeneous profiles of psychopathology in Phase 1. Two main psychopathological profiles were found (Cluster 1: High psychopathological symptoms; Cluster 2: Low psychopathological symptoms). The clusters generated show significant differences in all the SCL-90-R subscales used and in the general index at Phase 1. After childbirth, high psychopathology profile membership was associated with a greater probability of having a non-eutocic delivery. On the other hand, the low psychopathological symptoms cluster shows higher levels of depressive symptoms, hostility, paranoid ideation, and psychotic symptoms in Phase 2. In conclusion, there seemed to exist two heterogeneous profiles of psychopathology in pregnant women during the pandemic; the stress related to the pandemic seemed uninfluential on the development of a profile of high psychopathological symptoms and the psychopathology profile may influence delivery and postpartum outcomes.

Carbon dioxide (CO2) emissions and adherence to Mediterranean diet in an adult population: the Mediterranean diet index as a pollution level index.

BACKGROUND: Research related to sustainable diets is is highly relevant to provide better understanding of the impact of dietary intake on the health and the environment. AIM: To assess the association between the adherence to an energy-restricted Mediterranean diet and the amount of CO2 emitted in an older adult population. DESIGN AND POPULATION: Using a cross-sectional design, the association between the adherence to an energy-reduced Mediterranean Diet (erMedDiet) score and dietary CO2 emissions in 6646 participants was assessed. METHODS: Food intake and adherence to the erMedDiet was assessed using validated food frequency questionnaire and 17-item Mediterranean questionnaire. Sociodemographic characteristics were documented. Environmental impact was calculated through greenhouse gas emissions estimations, specifically CO2 emissions of each participant diet per day, using a European database. Participants were distributed in quartiles according to their estimated CO2 emissions expressed in kg/day: Q1 (≤2.01 kg CO2), Q2 (2.02-2.34 kg CO2), Q3 (2.35-2.79 kg CO2) and Q4 (≥2.80 kg CO2). RESULTS: More men than women induced higher dietary levels of CO2 emissions. Participants reporting higher consumption of vegetables, fruits, legumes, nuts, whole cereals, preferring white meat, and having less consumption of red meat were mostly emitting less kg of CO2 through diet. Participants with higher adherence to the Mediterranean Diet showed lower odds for dietary CO2 emissions: Q2 (OR 0.87; 95%CI: 0.76-1.00), Q3 (OR 0.69; 95%CI: 0.69-0.79) and Q4 (OR 0.48; 95%CI: 0.42-0.55) vs Q1 (reference). CONCLUSIONS: The Mediterranean diet can be environmentally protective since the higher the adherence to the Mediterranean diet, the lower total dietary CO2 emissions. Mediterranean Diet index may be used as a pollution level index.

Exploring the Role of Sclerostin as a Biomarker of Cardiovascular Disease and Mortality: A Scoping Review.

Sclerostin is most recognized for its role in controlling bone formation; however, it is also expressed in the heart, aorta, coronary, and peripheral arteries. Human studies have associated high circulating sclerostin levels with the presence of different cardiovascular diseases (CVD), surrogate CVD markers, and a high risk of cardiovascular events in some populations. However, this is still a matter of scientific debate, as the results have been very heterogeneous among studies. In the present review, the association between serum sclerostin levels and CVD and/or cardiovascular mortality was analyzed. For this purpose, a scoping review was performed in which articles measuring serum sclerostin levels and cardiovascular risk in patients were selected. Eleven articles answered the research question; of these articles, 8/11 evaluated the association between sclerostin and CVD, of which 4/8 found a positive association, 2/8 found a negative association, and 2/8 found no association between variables. Five (5/11) of the articles included in the study evaluated cardiovascular mortality, of which 3/5 found a positive association, 1/5 found a negative association, and 1/5 found no association between variables. In conclusion, we did not find sufficient results to be able to demonstrate an association between elevated sclerostin levels and the development of CVD and/or cardiovascular mortality in the general population due to heterogeneity in the results. However, there seems to be a tendency to consider increased sclerostin levels as a risk factor for both the development of cardiovascular events and cardiovascular mortality in specific populations. Further studies in this field will help to solve some of the inconsistencies found during this scoping review and allow for the future use of sclerostin measurement as a strategy in the prevention and diagnosis of CVD and/or cardiovascular mortality.

Risk Factors for Post-Traumatic Stress Disorder after Childbirth: A Systematic Review.

BACKGROUND: Post-traumatic stress disorder (PTSD) after birth has generated a growing interest in recent years. Although some risk factors associated with PTSD have been studied, information is still scarce to date on risk factors associated with PTSD. This systematic review aims to identify risk factors associated with the diagnosis of PTSD after childbirth. METHODS: We searched on PubMed, Web of Science and SCOPUS databases, from inception to May 2022. Quality assessment of the articles was performed using the Newcastle-Ottawa Quality Assessment ("NOQAS") scale. This systematic review was performed according to the PRISMA guidelines. Inclusion criteria were women with age ≥18 years; articles in English or Spanish; articles focused on physical, social, psychological, medical-obstetric, and environmental risk factors. RESULTS: A total of n = 17,675 women were included among the studies in this systematic review. The main risk factors associated with PTSD after birth were obstetric interventions and obstetric violence such as emergency caesarean section or a non-compliant birth plan, a previous mental illness, having suffered from of a traumatic event or depression and/or anxiety, and having poor social support throughout pregnancy and/or during birth. CONCLUSIONS: Obstetric interventions, obstetric violence, experiencing a traumatic event or depression and/or anxiety, and a previous mental illness are factors associated with the diagnosis of PTSD after birth. Protective factors are multiparity, adherence to the mother's birth plan and skin-to-skin contact.

Principales modelos de triaje extrahospitalario básico y avanzado / Main models of basic and advanced outpatient triage

Objetivo: describir los diferentes modelos de triaje extrahospitalario básico (TB) y avanzado (TA) más utilizados, sus conceptos básicos y sus procedimientos de actuación. Objetivos específicos: analizar sus parámetros, principales características, ventajas, inconvenientes, eficacia y tiempo de realización.Método: se efectuó una revisión panorámica según la metodología PRISMA, en MEDLINE (PubMed), SciELO, Google Scholar y la página del Consejo Español de Triage Prehospitalario y Hospitalario, hasta enero de 2021. Se incluyeron resultados sobre los principales modelos de triaje extrahospitalarios aplicados en incidentes de múltiples víctimas y catástrofes. Se excluyeron los relacionados con el coronavirus y con población pediátrica.Resultados: se recuperaron 465 referencias, de las cuales se seleccionaron finalmente 16. Los métodos de TB más empleados fueron START, SHORT, CareFlight y Sieve, y de TA el META. La mayoría de los modelos de TB derivaba del método START, que es el más conocido y aplicado a nivel mundial, aunque requiere más tiempo junto con Sieve, al contrario que SHORT y especialmente CareFlight que es el más rápido. El SHORT es el que tiene mayor sensibilidad y especificidad; por su parte, el SALT fue el más completo porque incluye las compresiones torácicas y la autoadministración de inyectables. En general, el modelo META fue superior al resto al realizar un mejor triaje de las víctimas.Conclusiones: la mayoría de métodos de triaje son válidos y útiles, siendo el META superior a los basados en el START. La elección del método dependerá del tipo de incidente, del sector donde se encuentre la víctima y de la formación del personal.(AU)

Objectives: to describe the different models of basic (BT) and advanced (AT) outpatient triage more widely used, their basic concepts and protocols of action. Secondary objectives: to analyse their parameters, main characteristics, advantages, drawbacks, efficacy and completion time.Method: a panoramic review was conducted according to the PRISMA methodology, in MEDLINE (PubMed), SciELO, Google Scholar and the Spanish Council of Outpatient and Hospital Triage website, until January 2021. The study included results about the main models of outpatient triage applied in incidents with multiple victims and catastrophes. Those associated with coronavirus and pediatric population were excluded.Results: for this study, 465 references were retrieved, and 16 out of these were finally selected. The most widely used BT methods were START, SHORT, CareFlight and Sieve, and META for AT. Most BT models are derived from the START method, which is the most widely known and applied at global level, even though it requires more time, the same as Sieve, and unlike SHORT and particularly CareFlight, which is the fastest. The SHORT method has the highest sensitivity and specificity; on the other hand, the SALT method is the most complete, because it includes chest compressions and self-administration of injectable drugs. Overall, the META model was superior to the rest, in terms of performing a better triage of victims.Conclusions: most triage methods are valid and useful; META is superior to those based on START. The choice of method will depend on the type of incident, its setting, and staff training.(AU)

Desired weight loss and its association with health, health behaviors and perceptions in an adult population with weight excess: One-year follow-up.

Background: Metabolic syndrome (MetS) worsens quality of life and increases mortality. Dissatisfaction with weight in patients with MetS may modify the effect of lifestyle interventions to achieve changes in health-related behaviors. Objective: To assess 1-year changes in cardiovascular risk scores, self-perceived general health and health-related behaviors according to observed changes in desired weight loss during the first year of intervention in a large cardiovascular prevention trial. Design: Prospective analysis of the PREDIMED-PLUS trial, including 5,499 adults (55-75 years old) with overweight or obesity at baseline. Methods: The desired weight loss was the difference between ideal and measured weight. Tertiles of change in desired weight loss (1 year vs. baseline) were defined by the following cut-off points: ≥0.0 kg (T1, n = 1,638); 0.0 to -4.0 kg (T2, n = 1,903); ≤-4.0 kg (T3, n = 1,958). A food frequency questionnaire assessed diet and the Minnesota-REGICOR questionnaire assessed physical activity. The Framingham equation assessed cardiovascular risks. The changes in the severity of MetS were also assessed. The Beck Depression Inventory assessed depressive symptoms and the SF-36 assessed health-related quality of life. Data were analyzed using general linear models. Results: BMI decreased at T2 and T3 (T1: 0.3, T2: -0.7, T3: -1.9). The most significant improvement in diet quality was observed at T3. Cardiovascular risk decreased at T2 and T3. Mean reductions in MetS severity score were: -0.02 at T1, -0.39 at T2 and -0.78 at T3. The perception of physical health increases in successive tertiles. Conclusions: In older adults with MetS, more ambitious desired weight loss goals were associated with improvements in diet, cardiovascular health and perceived physical health during the first year of a healthy lifestyle intervention programme. Weight dissatisfaction needs to be considered by health professionals. Clinical trial registration: http://www.isrctn.com/ISRCTN89898870, identifier 89898870.

Dihydrocapsiate does not increase energy expenditure nor fat oxidation during aerobic exercise in men with overweight/obesity: a randomized, triple-blinded, placebo-controlled, crossover trial.

Background: Prior evidence suggests that capsinoids ingestion may increase resting energy expenditure (EE) and fat oxidation (FATox), yet whether they can modulate those parameters during exercise conditions remains poorly understood. We hypothesized that dihydrocapsiate (DHC) ingestion would increase EE and specifically FATox during an acute bout of aerobic exercise at FATmax intensity (the intensity that elicits maximal fat oxidation during exercise [MFO]) in men with overweight/obesity. Since FATmax and MFO during aerobic exercise appear to be indicators of metabolic flexibility, whether DHC has an impact on FATox in this type of population is of clinical interest. Methods: A total of 24 sedentary men (age = 40.2 ± 9.2 years-old; body mass index = 31.6 ± 4.5 kg/m2 [n = 11 overweight, n = 13 obese]) participated in this randomized, triple-blinded, placebo-controlled, crossover trial (registered under ClinicalTrials.gov Identifier no. NCT05156697). On the first day, participants underwent a submaximal exercise test on a cycle ergometer to determine their MFO and FATmax intensity during exercise. After 72 hours had elapsed, the participants returned on 2 further days (≥ 72 hours apart) and performed a 60 min steady-state exercise bout (i.e. cycling at their FATmax, constant intensity) after ingesting either 12 mg of DHC or placebo; these conditions were randomized. Respiratory gas exchange was monitored by indirect calorimetry. Serum marker concentrations (i.e. glucose, triglycerides, non-esterified fatty acids (NEFAs), skin temperature, thermal perception, heart rate, and perceived fatigue) were assessed. Results: There were no significant differences (P > 0.05) between DHC and placebo conditions in the EE and FATox during exercise. Similarly, no significant changes were observed in glucose, triglycerides, or NEFAs serum levels, neither in the skin temperature nor thermal perception across conditions. Heart rate and perceived fatigue did not differ between conditions. Conclusions: DHC supplementation does not affect energy metabolism during exercise in men with overweight/obesity.

Undercarboxylated Osteocalcin: A Promising Target for Early Diagnosis of Cardiovascular and Glycemic Disorders in Patients with Metabolic Syndrome: A Pilot Study.

Lifestyle changes are causing an exponential increase in the prevalence of obesity and metabolic syndrome (MetS) worldwide. The most frequent complications of these are the development of diabetes (T2D) and cardiovascular disease (CVD). Accurate tools are needed to classify the cardiovascular risk (CVR) in the MetS population. In recent years, numerous biomarkers of bone metabolism have been associated with CVR. The aim of this study was to determine the levels of undercarboxylated osteocalcin (ucOC) in a cohort of patients with MetS and to analyse its association with MetS parameters and CVR as well as with T2D prevalence. A longitudinal study was conducted in which a MetS population was followed for one year. Weight change, adherence to the Mediterranean diet (MedDiet), ucOC levels, MetS parameters and CVR were analysed and CVR was calculated using different scores. Our results showed a decrease of CVR associated with a better adherence to the MetDiet resulting in higher HDL-C and ucOC levels though the improvement of MetS risk factors. This bone protein appeared as a potential biomarker to classify CVR in the MetS population, especially for MetS patients without prevalent T2D. Furthermore, ucOC serum levels could be good predictors of T2D prevalence.

Diagnosis and Challenges in Perinatal Health.

Perinatal health is a primary objective for health systems [...].

Influence of placebo effect in mental disorders research: A systematic review and meta-analysis.

BACKGROUND: Randomized controlled trials (RCT) in mental disorders research commonly use active control groups including psychotherapeutic shams or inactive medication. This meta-analysis assessed whether placebo conditions (active controls) had an effect compared to no treatment or usual care (passive controls). METHODS: PubMed, Scopus, PsycINFO, PsycARTICLES, Ovid, the Cochrane Central Register of Controlled Trials and Web of Science were searched from inception to April 2021 and reference lists of relevant articles. Three-arm RCTs, including active and passive control groups, were selected. Where individual standardized mean difference (SMD) was calculable, random effects meta-analyses were performed to estimate an overall effect size with 95% confidence intervals (CI) comparing active vs passive controls. Heterogeneity was assessed using I² statistic and meta-regression. Funnel asymmetry was evaluated using Egger's test (Prospero registration: CRD42021242940). RESULTS: 24 articles with 25 relevant RCTs were included in the review, of which 11 studies were of high risk of bias. There was an improvement in outcomes favouring the placebo conditions, compared to passive controls, overall (25 studies, SMD 0.24, 95% CI 0.06-0.42, I² = 43%) and in subgroups with anxiety (SMD 0.45, 95% CI 0.07-0.84, I² = 59%) or depression (SMD 0.22, 95% CI 0.04-0.39, I² = 0%). Meta-regression did not show a significant explanation for heterogeneity. Egger's test showed no asymmetry (p = .200). CONCLUSIONS: A small placebo effect was observed in mental disorders research overall, and in patients with anxiety or depression. These findings should be interpreted with caution in the light of heterogeneity and risk of bias.