Exploring the link between perceived physical literacy and academic performance outcomes: insights from the EHDLA study.

Objective: The aim of this study was to verify the relationship between perceived physical literacy (PPL) and academic performance outcomes among Spanish adolescents aged 12-17 years. Methods: This cross-sectional study is a secondary examination utilizing data derived from the Eating Healthy and Daily Life Activities (EHDLA) project. The Spanish Perceived Physical Literacy Instrument for Adolescents (S-PPLI) was used to evaluate the PPL of the participants. To determine academic performance, the numerical grades for each subject were added together and then divided by the total number of subjects. Results: Overall, a positive trend in the association between S-PPLI scores and academic performance was observed. We identified two significant ranges within the S-PPLI scores. First, there was a significant range between 9 and 33 points on the S-PPLI, indicating an inverse association with academic performance. Second, another significant range was observed at scores of 34 points or higher on the S-PPLI, suggesting a positive association with academic performance. Participants with low PPL had the lowest academic performance (mean = 6.4; bias-corrected and accelerated (BCa) bootstrapped 95% confidence interval (CI): 6.2-6.6). Conversely, those adolescents with high PPL had the highest academic performance (mean = 6.9; BCa bootstrapped 95% CI: 6.6-7.1). Significant differences were found between low PPL and medium PPL (p-adjusted = 0.031) and between low PPL and high PPL (p-adjusted = 0.031). Conclusions: Increased physical literacy could be a relevant factor for achieving greater academic performance in adolescents. This study has potential implications for physical education instructors, school leaders, and healthcare practitioners.

Cross-Sectional Association between Perceived Physical Literacy and Mediterranean Dietary Patterns in Adolescents: The EHDLA Study.

PURPOSE: The objective of the current study was to analyze the relationship between perceived physical literacy (PPL) and adherence to the Mediterranean Diet (MedDiet) and its specific components in a sample of Spanish adolescents. METHODS: In this cross-sectional study, we examined a sample of 845 adolescents (58.1% boys) aged 12-17 years from the Valle de Ricote (Region of Murcia, Spain). PPL was assessed by the Spanish Perceived Physical Literacy Instrument for adolescents (S-PPLI). To assess adherence to the MedDiet, the Mediterranean Diet Quality Index in children and adolescents (KIDMED) was applied. RESULTS: In unadjusted analyses, adolescents with medium or high PPL were more likely to have optimal adherence to the MedDiet (medium PPL: OR = 1.69, 95% CI 1.20-2.40, p-adjusted = 0.003; high PPL: OR = 2.90, 95% CI 2.03-4.17, p-adjusted < 0.001). These findings remained significant after adjusting for sex, age, socioeconomic status, body mass index, energy intake, overall sleep duration, physical activity, and sedentary behavior (medium PPL: OR = 1.51, 95% CI 1.05-2.19, p-adjusted = 0.003; high PPL: OR = 2.27, 95% CI 1.53-3.39, p-adjusted < 0.001). CONCLUSIONS: PPL could play a relevant role in the adoption of healthy eating habits among adolescents. Adolescents with low or medium PPL were less likely to report optimal adherence to the MedDiet. Adolescents with high PPL seem to consume more fruits, vegetables, fish, pulses, nuts, and dairies (for breakfast). Conversely, these adolescents tend to skip breakfast less, as well as to consume less commercially baked goods or pastries at this meal.

Beneficios de la dieta mediterránea y la actividad física en adolescentes / Benefits of the Mediterranean diet and physical activity in adolescents

Introducción: Más de 340 millones de niños y adolescentes en todo el mundo presentan sobrepeso oobesidad, lo que convierte la obesidad en un problema urgente para la población mundial. Este período dela vida es crucial ya que los rápidos cambios cognitivos, físicos, psicológicos y emocionales afectan la saludy el bienestar. Participar en comportamientos de estilo de vida saludables, como la actividad física o seguiruna dieta, se asocia con un menor riesgo de sufrir enfermedades crónicas y degenerativas en la edadadulta. Objetivo: Describir la importancia de la dieta y la actividad física en adolescentes, valorar el grado deadherencia a estos patrones y resaltar los beneficios que supone participar en estilos de vida saludables. Método: Búsqueda sistemática de la literatura científica publicada en materia de dieta mediterránea yactividad física en este grupo de población. Resultados: Los niños y adolescentes se han ido alejando de estos estilos de vida saludables, generandola necesidad de aplicar estrategias de intervención que promuevan nuevos hábitos en adolescentes, entrelos que se incluya una adecuada alimentación basada en la dieta mediterránea, asociada a un programade actividad física semanal, lo aporta múltiples beneficios tanto a nivel cardio respiratorio, metabólico,musculoesquelético, como cognitivo y emocional. Conclusiones: Se puede resaltar la importancia de aplicar la dieta mediterránea y la actividad física en loshábitos de vida de los adolescentes ya que incluyen numerosos beneficios a nivel físico, cognitivo ypsicológico, necesarios para un correcto desarrollo en esta etapa del desarrollo.(AU)

Introduction: Over 340 million children and adolescents worldwide are overweight or obese, which makesobesity an urgent problem for the world's population. This period of life is crucial since rapid cognitive,physical, psychological, and emotional changes affect health and well-being. Engaging in healthy lifestylebehaviors, such as being physically active or following a diet, is associated with a lower risk of chronic anddegenerative diseases in later life. Objective: Describe the importance of diet and physical activity in adolescents, assess the degree ofadherence to these patterns, and highlight the benefits of participating in healthy lifestyles.Method: Systematic search of the published scientific literature on the Mediterranean diet and physicalactivity in this population group. Results: Children and adolescents have been moving away from these healthy lifestyles, generating theneed to apply intervention strategies that promote new habits in adolescents, including an adequate dietbased on the Mediterranean diet, associated with a program of weekly physical activity, which providesmultiple benefits both at the cardio-respiratory, metabolic, musculoskeletal, cognitive, and emotional levels. Conclusions: The importance of applying the Mediterranean diet and physical activity to the lifestyle ofadolescents can be highlighted since they include numerous benefits at physical, cognitive, andpsychological levels, which are necessary for correct development at this stage of development.(AU)

Environmental tobacco smoke exposure and 24-h movement guidelines in Spanish young people.

Background: No prior research has investigated how exposure to environmental tobacco smoke is related to the combination of 24-h movement behaviors among young populations thus far. The aim of this study was to examine the associations between exposure to secondhand smoke and the 24-h movement guidelines. Methods: This is a cross-sectional study using data from the last available wave of the Spanish National Health Survey [2017], a nationally representative survey of the Spanish children and adult population. The final sample included 4,378 (49.0% girls) Spanish young people aged 2-14 years. Results: A lower likelikood of meeting screen time (ST) and all three 24-h movement guidelines were found in those exposed to environmental tobacco smoke in unadjusted models. After adjusting for several covariates, meeting screen time [odds ratio (OR) =0.76; 95% confidence interval (CI), 0.59-0.97], sleep duration (OR =0.75; 95% CI, 0.58-0.96), and all three 24-h movement guidelines (OR =0.63; 95% CI, 0.44-0.91) reached significance after adjusting for potential confounders. Conclusions: Given the inverse associations found, environmental tobacco smoke exposure should be a relevant factor to consider when promoting 24-h behaviors in the young population. Avoiding exposure to tobacco smoke in the environment is essential, as it can potentially influence the 24-h movement behaviors of young people, and consequently, the health benefits associated with such behaviors.

A Cluster Randomized Controlled Trial of the Archena Infancia Saludable Project on 24-h Movement Behaviors and Adherence to the Mediterranean Diet among Schoolchildren: A Pilot Study Protocol.

Objective: The aim of this paper is to describe the protocol of pilot cluster randomized controlled trial (RCT) that will evaluate the effects of a lifestyle-based intervention. The Archena Infancia Saludable project will have several objectives. The primary objective of this project is to determine the 6-month effects of a lifestyle-based intervention on adherence to 24-h movement behaviors and Mediterranean diet (MedDiet) in schoolchildren. The secondary objective of this project is to test the intervention effects of this lifestyle-based intervention on a relevant set of health-related outcomes (i.e., anthropometric measurements, blood pressure, perceived physical fitness, sleep habits, and academic performance). The tertiary objective is to investigate this intervention's "halo" effect on parents'/guardians' 24-h movement behaviors and adherence to the MedDiet. Methods: The Archena Infancia Saludable trial will be a cluster RCT submitted to the Clinical Trials Registry. The protocol will be developed according to SPIRIT guidelines for RCTs and CONSORT statement extension for cluster RCTs. A total of 153 eligible parents/guardians with schoolchildren aged 6-13 years will be randomized into an intervention group or a control group. This project focuses on two fundamental pillars: 24-h movement behaviors and MedDiet. It will mainly focus on the relationship between parents/guardians and their children. Behavior change strategies for dietary and 24-h movement behaviors in schoolchildren will be based on healthy lifestyle education for parents/guardians through infographics, video recipes, brief video clips, and videos. Conclusions: Most of the current knowledge on 24-h movement behaviors and adherence to the MedDiet is based on cross-sectional or longitudinal cohort studies, warranting a need to design and conduct RCTs to obtain more robust evidence on the effect of a healthy lifestyle program to increase 24-h movement behaviors and to improve adherence to the MedDiet in schoolchildren.

Cross-cultural adaptation, reliability, and validation of the Spanish perceived physical literacy instrument for adolescents (S-PPLI).

Objective: The aim of this study was to examine the reliability and validity of the Spanish Perceived Physical Literacy Instrument (S-PPLI) questionnaire in Spanish adolescents. Method: The participants of this study were 360 Spanish adolescents (aged 12-17 years) from three secondary schools in the Region of Murcia (Spain). A cultural adaptation process of the original version of the PPLI questionnaire was developed. Confirmatory factor analysis was applied to test the three-factor structure of physical literacy. Intraclass correlation coefficients were computed to estimate the test-retest concordance. Results: Using a confirmatory factor analysis, the factor loading of all items above the standard of 0.40 ranged from 0.53 to 0.77, suggesting that the observed variables sufficiently represented the latent variables. Analyses for convergent validity showed average variance extracted values that ranged from 0.40 to 0.52 and composite reliability values higher than 0.60. All the correlations were below the recommended cutoff point of 0.85, which indicated that the three physical literacy factors achieved adequate discriminant validity. Intraclass correlation coefficients ranged from 0.62 to 0.79 (p < 0.001 for all items), which indicated moderate/good reliability. Conclusions: Our results suggest that the S-PPLI is a valid and reliable measure of physical literacy among Spanish adolescents.

Impacto de la hipertensión arterial en el desarrollo de enfermedades cardivosaculares / Impact of arterial hypertension on the development of cardiovascular diseases

Introducción: Las enfermedades cardiovasculares (ECV) son la primera causa de muerte a nivel mundial. Están fuertemente influenciadas por unos factores de riesgo (FR), algunos de ellos modificables concambios en el estilo de vida. De todos los FR, uno de los más prevalentes en la población es la hipertensiónarterial (HTA), definida por unos valores de presión arterial ≥140-90mmHg. Objetivos: Conocer la relación entre la HTA y el resto FR con el desarrollo de las distintas ECV, identificarel umbral idóneo para evitar sobrediagnósticos y sobretratamientos de la HTA, y reconocer la importanciade unos buenos hábitos de vida como prevención. Resultados y Discusión: En el estudio de FÉLIX-REDONDO et al. se demostró que el FR más influyenteen las ECV era la HTA. Sin embargo, esto puede variar según la edad, tal y como observaron VERA-REMARTÍNEZ et al. con su estudio, cuya media de edad era de 30 años, y el factor más prevalente fue eltabaco. El control de los hábitos de vida que ayuden a reducir tanto la HTA como el resto de factores, serábeneficioso para la prevención primaria y secundaria de ECV. Para evitar un tratamiento demasiadointensivo, es recomendable un enfoque gradual, comenzando con objetivos de prevención para todos lospacientes, independientemente del riesgo, siguiendo con la estratificación del riesgo de ECV y la discusiónde los beneficios potenciales del tratamiento con el paciente. Conclusiones: Las ECV, concretamente la cardiopatía isquémica y las enfermedades cerebrovasculares,son la principal causa de muerte en el mundo, por lo que es muy importante el control de aquellos FR queaceleren la aparición de estas. El más prevalente de ellos, es la presión arterial elevada.(AU)

Introduction: Cardiovascular diseases (CVD) are the leading cause of death worldwide. They are stronglyinfluenced by some risk factors (RF), some of them modifiable with changes in lifestyle. Of all the RFs, oneof the most prevalent in the population is arterial hypertension (AHT), defined by blood pressure values≥140-90mmHg. Objectives: Know the relationship between HTA and the rest RF with the development of different CVDs,identify the ideal threshold to avoid overdiagnosis and overtreatment of HTN, and recognize the importanceof good lifestyle habits as prevention. Results and Discussion: In the study by FÉLIX-REDONDO et al. it was shown that the most influential RFin CVD was AHT. However, this may vary according to age, as observed by VERA-REMARTÍNEZ et al. withhis study, whose mean age was 30 years, and the most prevalent factor was tobacco. The control of lifestylehabits that help reduce both hypertension and the rest of the factors will be beneficial for the primary andsecondary prevention of CVD. To avoid overly intensive treatment, a stepwise approach is recommended,starting with prevention goals for all patients, regardless of risk, followed by CVD risk stratification anddiscussion of the potential benefits of treatment with the patient. Conclusions: CVD, specifically ischemic heart disease and cerebrovascular diseases, are the main causeof death in the world, so it is very important to control those RFs that accelerate their appearance. The mostprevalent of them is high blood pressure.(AU)

Prevalence of Disordered Eating and Its Associated Factors From a Socioecological Approach Among a Sample of Spanish Adolescents: The EHDLA Study.

Objectives: The aim of this study was twofold: a) to establish the prevalence of adolescents with disordered eating and b) to determine the factors associated with this prevalence in a sample of Spanish adolescents from the Valle de Ricote (Region of Murcia, Spain). Methods: This cross-sectional study analyzed data from 730 adolescents (56.2% girls) from the EHDLA study. To determine the prevalence of disordered eating, the Sick, Control, One stone, Fat, Food (SCOFF) questionnaire was used. A socioecological approach was used to identify individual-, interpersonal-, or organizational-level factors associated with disordered eating. Results: The prevalence of disordered eating was 30.1%. This condition was associated with female sex (odds ratio [OR] = 2.60; 95% confidence interval [CI], 1.81-3.73), immigrant status (OR = 2.22; 95% CI, 1.51-3.25), or excess weight (OR = 2.74; 95% CI, 1.93-3.89). Furthermore, for each additional hour slept, lower odds of having disordered eating were found (OR = 0.81; 95% CI, 0.67-0.98). Discussion: Almost one-third of the sample of Spanish adolescents analyzed reported disordered eating. Female sex, immigrant status and excess weight are individual aspects that seem to be related to disordered eating among Spanish adolescents.

Global Proportion of Disordered Eating in Children and Adolescents: A Systematic Review and Meta-analysis.

Importance: The 5-item Sick, Control, One, Fat, Food (SCOFF) questionnaire is the most widely used screening measure for eating disorders. However, no previous systematic review and meta-analysis determined the proportion of disordered eating among children and adolescents. Objective: To establish the proportion among children and adolescents of disordered eating as assessed with the SCOFF tool. Data Sources: Four databases were systematically searched (PubMed, Scopus, Web of Science, and the Cochrane Library) with date limits from January 1999 to November 2022. Study Selection: Studies were required to meet the following criteria: (1) participants: studies of community samples of children and adolescents aged 6 to 18 years and (2) outcome: disordered eating assessed by the SCOFF questionnaire. The exclusion criteria included (1) studies conducted with young people who had a diagnosis of physical or mental disorders; (2) studies that were published before 1999 because the SCOFF questionnaire was designed in that year; (3) studies in which data were collected during COVID-19 because they could introduce selection bias; (4) studies based on data from the same surveys/studies to avoid duplication; and (5) systematic reviews and/or meta-analyses and qualitative and case studies. Data Extraction and Synthesis: A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Main Outcomes and Measures: Proportion of disordered eating among children and adolescents assessed with the SCOFF tool. Results: Thirty-two studies, including 63 181 participants, from 16 countries were included in this systematic review and meta-analysis. The overall proportion of children and adolescents with disordered eating was 22.36% (95% CI, 18.84%-26.09%; P < .001; n = 63 181) (I2 = 98.58%). Girls were significantly more likely to report disordered eating (30.03%; 95% CI, 25.61%-34.65%; n = 27 548) than boys (16.98%; 95% CI, 13.46%-20.81%; n = 26 170) (P < .001). Disordered eating became more elevated with increasing age (B, 0.03; 95% CI, 0-0.06; P = .049) and body mass index (B, 0.03; 95% CI, 0.01-0.05; P < .001). Conclusions and Relevance: In this systematic review and meta-analysis, the available evidence from 32 studies comprising large samples from 16 countries showed that 22% of children and adolescents showed disordered eating according to the SCOFF tool. Proportion of disordered eating was further elevated among girls, as well as with increasing age and body mass index. These high figures are concerning from a public health perspective and highlight the need to implement strategies for preventing eating disorders.

Mediterranean Dietary Patterns Related to Sleep Duration and Sleep-Related Problems among Adolescents: The EHDLA Study.

PURPOSE: The aim of the present study was to examine the association of adherence to the Mediterranean Diet (MD) and its specific components with both sleep duration and sleep-related disorders in a sample of adolescents from the Valle de Ricote (Region of Murcia, Spain). METHODS: This cross-sectional study included a sample of 847 Spanish adolescents (55.3% girls) aged 12-17 years. Adherence to the MD was assessed by the Mediterranean Diet Quality Index for Children and Teenagers. Sleep duration was reported by adolescents for weekdays and weekend days separately. The BEARS (Bedtime problems, Excessive daytime sleepiness, Awakenings during the night, Regularity and duration of sleep, and Sleep-disordered breathing) screening was used to evaluate issues related to sleep, which include difficulties at bedtime, excessive drowsiness during the day, waking up frequently during the night, irregularity, length of sleep, and breathing issues while sleeping. RESULTS: Adolescents who presented a high adherence to the MD were more likely to meet the sleep recommendations (OR = 1.52, 95% CI 1.12-2.06, p = 0.008) and less likely to report at least one sleep-related problem (OR = 0.56, 95% CI 0.43-0.72, p < 0.001). These findings remained significant after adjusting for sex, age, socioeconomic status, waist circumference, energy intake, physical activity, and sedentary behavior, indicating a significant association of adherence to the MD with sleep outcomes (meeting sleep recommendations: OR = 1.40, 95% CI 1.00-1.96, p = 0.050; sleep-related problems: OR = 0.68, 95% CI 0.50-0.92, p = 0.012). CONCLUSIONS: Adolescents with high adherence to the MD were more likely to report optimal sleep duration and fewer sleep-related problems. This association was more clearly observed for specific MD components, such as fruits, pulses, fish, having breakfast, dairies, sweets, and baked goods/pastries.

Adherence to the Mediterranean Diet and Health-Related Quality of Life during the COVID-19 Lockdown: A Cross-Sectional Study including Preschoolers, Children, and Adolescents from Brazil and Spain.

Scientific literature has suggested positive associations between the Mediterranean diet (MD) and the health-related quality of life (HRQoL) in young populations. However, to our knowledge, this relationship is unexplored during a situation of social isolation (i.e., lockdown). The objective of the current study is to examine the relationship between the MD and HRQoL during the COVID-19 lockdown among preschoolers, children, and adolescents from Brazil and Spain. This cross-sectional study includes a sample of 1099 three- to seventeen-year-old participants (47.6% girls) who were recruited via social networks. The HRQoL was assessed with the EQ-5D-Y. The Quality Index for Children and Teenagers (KIDMED) questionnaire was applied to evaluate the relationship between the MD and HRQoL. The highest prevalence of reported problems was found for worried, sad, or unhappy participants (39.8%). Furthermore, the lowest proportion of HRQoL problems was observed for "mobility" (2.5%). The proportion of high adherence to the MD was 44.3%. Participants with greater MD adherence reported higher HRQoL mean scores when compared with those who did not adhere to the MD (83.7 ± 0.6 vs. 85.6 ± 0.7, respectively; p < 0.05). Adherence to the MD and especially daily fruit intake were related to higher HRQoL during the COVID-19 lockdown among Brazilian and Spanish young people aged three to seventeen years.

Food consumption patterns related to excess weight and obesity in Spanish preschoolers.

PURPOSE: The aims of this study were (1) to identify the different food consumption patterns among Spanish preschoolers and (2) to examine the association between having a different food consumption pattern and the odds of having excess weight (i.e., overweight or obesity) or obesity among this population. METHODS: This was a nationwide cross-sectional study with data from the Spanish National Health Survey-2017. All preschoolers (aged 3-5 years) with complete information on all the variables analyzed were selected. The frequency of consumption of the fourteen food groups was evaluated by a food frequency questionnaire. Excess weight/obesity were computed following the World Health Organization criteria. A hierarchical cluster analysis using Ward's method (i.e., based on squared Euclidean distances) and k-means were performed including all food group consumption. A total sample of 663 was included in the cluster analysis. RESULTS: Three different clusters were established. Compared to the healthiest food consumption pattern (Cluster 1), higher odds of excess weight (OR = 1.51; CI: 95%, 1.02-2.25) and obesity (OR = 1.59; CI: 95%, 1.01-2.51) were found for participants with the unhealthiest food consumption pattern (Cluster 3). CONCLUSION: Having a food consumption pattern considered unhealthy (i.e., low intake of vegetables/fruits, high consumption of confectionery products, sugar-sweetened beverages, fast-food, and snacks) was associated with presenting excess weight/obesity among Spanish preschoolers. IMPACT: No studies have examined the specific food consumption patterns associated with excess weight or obesity among Spanish preschoolers. The unhealthiest food consumption pattern was characterized by a food consumption pattern that included a lower intake of vegetables and fruits and a higher consumption of confectionery products, sugar-sweetened beverages, fast-food, and snacks. Having a food consumption pattern considered unhealthy was associated with a higher prevalence of excess weight and obesity in comparison with other healthier food consumption patterns.

Educación y ejercicio en el pie diabético / Education and exercise in diabetic foot

Una de las complicaciones que puede presentar la Diabetes Mellitus es el pie diabético, que se asocia a altos niveles de morbi-mortalidad al igual que a importantes costes económicos para los sistemas de salud. Los factores de riesgo son la neuropatía diabética, la enfermedad arterial periférica y/o alteraciones anatómicas del pie, una de las complicaciones finales son las amputaciones, que suceden 15 veces con mayor frecuencia en pacientes diabéticos que en pacientes sanos.Objetivos: Eficacia de la educación y del autocuidado por parte de los pacientes con úlceras del pie diabético (UPD) y valorar los efectos del ejercicio en pacientes con UPD.Método: Búsqueda en la base de datos Pubmed con los términos: “diabetic foot”, “prevention”, “education” y “offloading”.Resultados: En 2 estudios no mostraron datos a favor, en el resto consideran que una correcta formación del paciente y autoevaluación rutinaria de sus extremidades inferiores puede llegar a prevenir en parte la formación de heridas y úlceras. Mucha heterogeneidad de los estudios: Adherencia, seguimiento (entre 6 meses a 2 años). El aumento de la presión plantar que puede conllevar la actividad física es un factor que suele evitarse de forma general, no obstante, se establece que el ejercicio físico mejora la cicatrización de las úlceras, sin embargo, no se especifica el tipo de actividad ni el tiempo dedicado. Otros dos estudios valoran el efecto indirecto del ejercicio sobre esta patología con mejoras notables en los factores predisponentes a la UPD.Conclusiones: Los profesionales de la salud, deben instruir a los pacientes diabéticos mejorando su capacidad de control, enseñándoles a identificar los posibles problemas que pueden tener en el pie y motivándoles para su prevención. La actividad física debe ser una prioridad en la prevención primaria de los pacientes con riesgo de UPD, llevándose a cabo de forma supervisada e individualizada en función del paciente.(AU)

One of the complications that Diabetes Mellitus can present is the diabetic foot, a complication that is associated with high levels of morbidity and mortality as well as significant economic costs for health systems. The risk factors are diabetic neuropathy, peripheral arterial disease and/or anatomical alterations of the foot. One of the final complications is amputations, which occur 15 times more frequently in diabetic patients than in healthy patients.Objectives: Efficacy of education and self-care by patients with UPD and to assess the effects of exercise in patients with UPD.Method: Search in the Pubmed database with the terms: “diabetic foot”, “prevention”, “education” and “offloading”.Results: In 2 studies they did not show data in favor, in the rest they consider that a correct training of the patient and routine self-assessment of their lower extremities can partially prevent the formation of wounds and ulcers. Much heterogeneity of the studies: Adherence, Follow-up (between 6 months to 2 years). The increase in plantar pressure that physical activity can cause is a factor that is generally avoided, however, the work by Morica M. Tran et al. establishes that physical exercise improves ulcer healing, however, it does not specify the type of activity or the time spent. Two other studies assess the indirect effect of exercise on this pathology with notable improvements in the factors predisposing to UPD.Conclusions: Health professionals should instruct diabetic patients, improving their control capacity, teaching them to identify possible foot problems and motivating them for their prevention. Physical activity should be a priority in the primary prevention of patients at risk of DFU, carried out in a supervised and individualized manner depending on the patient.(AU)

La Real Academia de Medicina de Castilla la Mancha, ya es un hecho / The Royal Academy of Medicine of Castilla la Mancha, is already a fact

La Sociedad de Medicina y Cirugía de Albacete surge en 1968 para suplir la ausencia de Academia de Medicina en Castilla la Mancha, tras 52 años de trabajo e intensa actividad ha logrado constituirse en Real Academia de Medicina mediante su transformación con el Decreto 255/2019 del Gobierno de Castilla la Mancha y la reciente concesión de SM el Rey Felipe VI del título de “Real”.(AU)

The Society of Medicine and Surgery of Albacete arose in 1968 to make up for the absence of the Academy of Medicine in Castilla la Mancha, after 52 years of work and intense activity it has managed to become the Royal Academy of Medicine through its transformation with Decree 255 / 2019 of the Government of Castilla la Mancha and the recent granting of His Majesty King Felipe VI of the title of “Real”.(U)

Síndrome de muerte súbita del lactante / Sudden infant death síndrome

Objetivo: Analizar los factores de riesgo identificados sobre la muerte súbita del lactante y adoptar las medidas preventivas oportunas en las consultas de pediatría. Metodo: Se realizó una búsqueda estructurada y sistematizada de la bibliografía más actualizada acerca de la muerte súbita de lactante en los buscadores médicos Pubmed, Cuiden, Scielo, Cochrane Library y Cinahl. Dada la cantidad de artículos y revisiones obtenidas se seleccionaron de los primeros 554 resultados iniciales obtenidos en PUBMED, aquellos que se centraran en revisiones sistemáticas del tema, obteniéndose 144 resultados, delimitándose a 37 al acotar a aquellos que solo presentaran las palabras clave en el título. Resultados-Conclusiones: Dentro de los factores de riesgo, la posición en decúbito supino al dormir sería el factor modificable más determinante, siendo uno de los pilares básicos de las campañas de prevención primaria y con mayor repercusión sobre el descenso de la mortalidad en esta patología en los últimos 30 años. Otros factores de riesgo podrían englobarse en factores maternos (hábito tabáquico pre- y posnatal, y de algún conviviente en la etapa posnatal, consumo de otras drogas incluido el alcohol, la edad materna menor a 20 años, complicaciones durante el embarazo o el parto como anemia, preeclampsia/eclampsia, desprendimiento de placenta,…), factores del lactante (prematuridad, bajo peso al nacer, producto de embarazo múltiple, sexo masculino) y factores ambientales (dormir sobre una superficie blanda, objetos como peluches o almohadas en la superficie donde duerme, excesivo arropamiento y calor ambiental). Entre los factores que podríamos considerar protectores o de prevención, además del decúbito supino encontrábamos la lactancia materna, la succión no nutritiva con chupete durante el sueño, compartir habitación con los padres.(AU)

Objective: To analyze the risk factors identified for sudden infant death in the different studies in order to adopt the appropriate preventive measures in pediatric consultations. Method: A structured and systematized search of the most up-to-date bibliography on sudden infant death was carried out in the medical search engines Pubmed, Cuiden, Scielo, Cochrane Library and Cinahl. Given the number of articles and reviews obtained through the main medical search engines, from the first 554 initial results obtained in PUBMED, those that focused on systematic reviews of the subject were selected, obtaining 144 results, delimiting to 37 when limiting those that only present the keywords in the title. Results-Conclusions: Among the risk factors, the supine position when sleeping would be the most determining modifiable factor, this factor being one of the basic pillars of primary prevention campaigns and with the greatest impact on the decrease in mortality in this pathology in the last 30 years. Other risk factors could be included in maternal factors (pre- and postnatal smoking, and of a partner in the postnatal stage, consumption of other drugs including alcohol, maternal age less than 20 years, complications during pregnancy or childbirth such as anemia, pre-eclampsia / eclampsia, placental abruption, ...), infant factors (prematurity, low birth weight, multiple pregnancy product, male sex) and environmental factors (sleeping on a soft surface, objects such as stuffed animals or pillows on the surface where he sleeps, excessive clothing and ambient heat). Among the factors that we could consider protective or considered preventive factors, in addition to supine decubitus, we found breastfeeding, non-nutritive sucking with a pacifier during sleep, and sharing a room with parents.(AU)

Anxiety-Induced Sleep Disturbance and Associated Lifestyle Behaviors According to Sex in Argentine Adolescents.

Purpose: The aim of the current study was twofold: first, to determine the prevalence of anxiety-induced sleep disturbances among Argentine adolescents according to sex, and second, to identify the association between these sleep disturbances and lifestyle behaviors in this population. Methods: This is a cross-sectional study with data from the Global School-based Student Health Survey (GSHS) in Argentina (2018). A total of 32,393 adolescents (aged 12-17 years; 53.4% girls) were included in the final analysis. Anxiety-induced sleep disturbances were assessed with the question "During the past 12 months, how often have you been so worried about something that you could not sleep at night?" Results: The prevalence of anxiety-induced sleep disturbances was higher in girls (17.4%) than in boys (7.9%) (p < 0.001). In boys, results indicated that those who used marijuana (cannabis) (odds ratio [OR] = 1.46, 95% confidence interval [CI] 1.08-1.98), used amphetamine or methamphetamine (OR = 2.19, 95% CI 1.28-3.77), walked or biked to or from school (OR = 1.53, 95% CI 1.19-1.96), and spent 3 h or more in sedentary behaviors (OR = 1.35, 95% CI 1.05-1.74) were more likely to report anxiety-induced sleep disturbances. In girls, those who ate from a fast-food restaurant (OR = 1.24, 95% CI 1.05-1.47), consumed alcoholic beverages (OR = 1.45, 95% CI 1.19-1.75), smoked cigarettes (OR = 2.09, 95%CI 1.05-4.14), consumed any tobacco product (OR = 1.47, 95% CI 1.19-1.82), used amphetamine or methamphetamine (OR = 2.08, 95% CI 1.33-3.26), and those who spent 3 h or more in sedentary behaviors (OR = 1.32, 95% CI 1.11-1.57) were more likely to report frequent anxiety-induced sleep disturbances. Conclusion: In conclusion, considerable sex differences were observed with respect to the prevalence of anxiety-related sleep disturbances and associated lifestyle aspects.

Tratamiento antitrombótico en pacientes con fibrilación auricular tras intervención coronaria percutánea, un equilibrio difícil de conseguir / Antithrombotic treatment in patients with atrial fibrillation after percutaneous coronary intervention, a difficult balance to achieve

La combinación de tratamiento antitrombótico anticoagulante/antiagregante) que deben llevar aquellos pacientes con FA que sufren un SCA y/o deben someterse a ICP no está claro. La asociación de anticoagulación oral con un inhibidor de P2Y12 y aspirina, lo que se denomina triple terapia antitrombótica (TAT) asocia un elevado riesgo de hemorragia. Por otro lado, la terapia antitrombótica dual (DAT) sin aspirina conlleva un riesgo todavía desconocido de eventos isquémicos.(1) El tratamiento debe equilibrar el riesgo isquémico y hemorrágico alcanzando un beneficio clínico neto óptimo. El objetivo de esta revisión es establecer unas pautas más claras de tratamiento en estos pacientes. Analizamos 2 estudios observacionales previos para sentar el punto de partida y 5 ECA que incluían un total de 11532 pacientes. En ellos se comparó la DAT vs. TAT, en pacientes con FA que sufren un SCA y/o son sometidos a ICP.La DAT asoció menor tasa de sangrados frente a la TAT sin aumentar los eventos isquémicos. Sin embargo, ningún ensayo consiguió la suficiente potencia estadística para evaluar de forma consistente los resultados isquémicos de eficacia. De las distintas terapias, mostraron mejores resultados de eficacia aquellas que emplearon DAT frente a TAT y ACOD frente a AVK. Conclusión: En pacientes con FA que sufren un SCA y/o deben someterse a ICP, el régimen de DAT asocia menos eventos hemorrágicos, sin diferencias significativas en cuanto a eventos isquémicos; El uso de ACOD muestra un mejor perfil de beneficio frente a los AVK, por lo que son de preferencia.(AU)

The combination of antithrombotic treatment (anticoagulant / antiplatelet) that those who AF patients who have ACS and / or must undergo PCI is unclear. The association of oral anticoagulation with a P2Y 12 inhibitor and aspirin, called triple antithrombotic therapy (TAT) is associated with a high risk of bleeding. On the other hand, dual antithrombotic therapy (DAT) without Aspirin carries a still unknown risk of ischemic events.(1) Treatment must balance the ischemic and hemorrhagic risk reaching an optimal net clinical benefit. The purpose of this review is to establish clearer treatment guidelines in these patients. We analyzed 2 previous observational studies to establish the starting point and 5 RCTs that included a total of 11,532 patients. In them, DAT vs. TAT, in patients with AF who suffer from ACS and / or undergo PCI.DAT was associated with a lower rate of bleeding compared to TAT without increasing ischemic events. Without However, no trial achieved sufficient statistical power to consistently assess the ischemic efficacy results. Of the different therapies, they showed better efficacy results those that used DAT versus TAT and ACOD versus VKA. Conclusion: In patients with AF who suffer an ACS and / or must undergo PCI, the DAT regimen associates fewer bleeding events, without significant differences regarding ischemic events; The use of ACOD shows a better profile of benefit versus AVK, so they are preferred.(AU)

Diabetes e insuficiencia cardiaca. ¿Son los inhibidores del cotransportador de sodioglucosa tipo dos el futuro del tratamiento? / Diabetes and heart failure. Are type two sodium-glucose cotransporter inhibitors the future of treatment?

Introducción: La diabetes mellitus es una enfermedad metabólica cuya incidencia y prevalencia van en aumento. Produce múltiples complicaciones tales como enfermedad aterosclerótica e insuficiencia cardiaca, siendo esta última, una de las principales causas de muerte. La diabetes mellitus puede desembocar en insuficiencia cardiaca a través de la miocardiopatía diabética.Para el tratamiento de la misma, destacan los inhibidores del cotransportador sodio-glucosa tipo 2 (iSGLT2), fármacos que actúan en el túbulo contorneado proximal renal. Objetivos: conocer el impacto de los iSGLT2 en el tratamiento de la diabetes mellitus con insuficiencia cardiaca asociada, identificar los mecanismos que relacionan diabetes mellitus e insuficiencia cardiaca y conocer el manejo de este tipo de pacientes. Resultados y discusión: Los estudios de seguridad cardiovascular EMPAREG-OUTCOME, CANVAS DECLARE-TIMI 58 y CREDENCE, han demostrado que empagliflozina, canagliflozina y dapagliflozina disminuyen el riesgo de eventos cardiovasculares mayores, muerte por causa cardiovascular y reducen el porcentaje de hospitalizaciones por insuficiencia cardiaca. Su mecanismo de acción no está del todo claro, no obstante, sus efectos glucosúricos y natriuréticos resultan potencialmente beneficiosos sobre la presión arterial, peso corporal, remodelado cardiaco y función renal. Estos estudios también señalan la importancia de conocer los efectos secundarios y monitorizarlos para prevenirlos, que, aunque infrecuentes, pueden ocasionar infecciones o amputaciones. Conclusion: essegún la evidencia actual, los iSGLT2 constituyen la mejor opción terapéutica en pacientes con diabetes e insuficiencia cardiaca concomitante y aquellos con enfermedad renal crónica (FG entre 30-60 ml/min/1,73 m2), recomendándose además su empleo en aquellos pacientes con insuficiencia cardiaca sin diabetes.(AU)

Introduction: Diabetes mellitus is a metabolic disease whose incidence and prevalence are increase. It produces multiple complications such as atherosclerotic disease and cardiac insufficiency, heart disease, the latter being one of the main causes of death. Diabetes mellitus can lead to heart failure through diabetic cardiomyopathy. For its treatment, sodium-glucose cotransporter type 2 inhibitors stand out. (iSGLT2), drugs that act on the renal proximal convoluted tubule. Objective: to know the impact of iSGLT2 in the treatment of diabetes mellitus with nsufficiency associated heart failure, identify the mechanisms that relate diabetes mellitus and heart failure and know the management of this type of patients. Results and Discussion: Cardiovascular safety studies EMPAREG-OUTCOME, CANVAS DECLARE-TIMI 58 and CREDENCE have shown that empagliflozin, canagliflozin, and dapagliflozin they reduce the risk of major cardiovascular events, death due to cardiovascular causes and reduce the percentage of hospitalizations for heart failure. Its mechanism of action is not entirely clear, however, its glycosuric and natriuretic effects are potentially beneficial on the blood pressure, body weight, cardiac remodeling and renal function.These studies also point out the importance of knowing side effects and monitoring them to prevent them, which, although rare, can cause infections or amputations. Conclusion: saccording to current evidence, iSGLT2 constitute the best therapeutic option in patients with diabetes and concomitant heart failure and those with chronic kidney disease (GFR between 30-60 ml/min/1.73 m2), also recommending its use in those patients with heart failure without diabetes.(AU)

Valoración del tratamiento del bruxismo mediante toxina botulínica / Assessment of the treatment of bruxism by botulinum toxin

El bruxismo se caracteriza por ser una actividad relacionada la activación de los músculos masticatorios de forma repetitiva y habitualmente durante el sueño. La relevancia de esta entidad reside en su asociación con erosiones y movilidad dentarias, fracturas dentales, mialgia e hipertrofia del músculo masetero y o artralgia característica. Si bien de etiología no clara se relaciona con multitud de factores fisiopatológicos. En la actualidad existen multitud de líneas de tratamiento para este problema de salud, tales como: terapia cognitivo-conductual, férulas de oclusión o de descarga, opciones farmacológicas como benzodiacepinas, y dopamina. Estas medidas habitualmente sirven como manejo de los signos y síntomas derivados del bruxismo, pero la eficacia de todas ella no es total. Actualmente, ante la necesidad de búsqueda de otras opciones terapéuticas al problema del bruxismo, múltiples ensayos han centrado su atención en la utilización de la toxina botulínica como alternativa, teniendo en cuenta su eficacia para una amplia variedad de patologías médicas y estéticas.El objetivo de esta puesta al día es actualizar el conocimiento a fecha actual de la evidencia existente acerca de la utilización de la toxina botulínica en el tratamiento del bruxismo. Para ello se seleccionan las revisiones sistemáticas existentes que incluyen los principales ensayos clínicos aleatorizados disponibles.Método: Revisión bibliográfica en las principales bases de datos utilizando las palabras “bruxismo” y/o “toxina botulínica” Resultados: Tras el análisis de las diferentes revisiones podemos decir que todos los resultados apuntan en la misma dirección: que las inyecciones de toxina botulínica en el masetero y / o los músculos temporales pueden ser una opción de tratamiento válida en pacientes con bruxismo, ya que pueden mejorar la calidad de vida.(AU)

Bruxism is characterized by being an activity related to the activation of the chewing muscles repeatedly and usually during sleep. The relevance of this entity resides in its association with tooth erosions and mobility, dental fractures, myalgia and hypertrophy of the masseter muscle and or characteristic arthralgia. Although its etiology is not clear, it is related to a multitude of pathophysiological factors. Currently there are many lines of treatment for this health problem, such as: cognitive-behavioral therapy, occlusion or discharge splints, pharmacological options such as benzodiazepines, and dopamine. These measures usually serve to manage the signs and symptoms derived from bruxism, but the effectiveness of all of them is not total. Currently, faced with the need to search for other therapeutic options for the problem of bruxism, multiple trials have focused their attention on the use of botulinum toxin as an alternative, taking into account its efficacy for a wide variety of medical and aesthetic pathologies. The objective of this update is to update the knowledge to date of the existing evidence about the use of botulinum toxin in the treatment of bruxism. For this, the existing systematic reviews that include the main available randomized clinical trials are selected. Method: Bibliographic review in the main databases using the words "bruxism" and / or "botulinum toxin" Results: After the analysis of the different reviews we can say that all the results point in the same direction: that botulinum toxin injections in the masseter and / or temporal muscles can be a valid treatment option in patients with bruxism, since they can improve the quality of life. With the exception of the systematic review by Ågren et al, 28 who do not see evidence through the tests that record electromyographic activity and bite force to recommend the use of botulinum toxin as a treatment for bruxism at the present time.(AU)