Increased Fat Oxidation During Arm Cycling Exercise in Adult Men With Spinal Cord Injury Compared With Noninjured Controls.

People with spinal cord injury (SCI) tend to be more sedentary and increase fat accumulation, which could have a negative influence on metabolic flexibility. The aim of this study was to investigate the capacity to oxidize fat in a homogenous sample of men with thoracic SCI compared with healthy noninjured men during an arm cycling incremental test. Forty-one men, 21 with SCI and 20 noninjured controls, performed an incremental arm cycling test to determine peak fat oxidation (PFO) and the intensity of exercise that elicits PFO (Fatmax). PFO was expressed in absolute values (g/min) and relative to whole-body and upper-body lean mass ([mg·min-1]·kg-1) through three different models (adjusting by cardiorespiratory fitness and fat mass). Gross mechanical efficiency was also calculated. PFO was higher in SCI than in noninjured men (0.27 ± 0.07 vs. 0.17 ± 0.07 g/min; 5.39 ± 1.30 vs. 3.29 ± 1.31 [mg·min-1]·kg-1 whole-body lean mass; 8.28 ± 2.11 vs. 5.08 ± 2.12 [mg·min-1]·kg-1 upper-body lean mass). Fatmax was found at a significantly higher percentage of VO2peak in men with SCI (33.6% ± 8.2% vs. 23.6% ± 6.4%). Differences persisted and even increased in the fully adjustment model and at any intensity. Men with SCI showed significantly higher gross mechanical efficiency at 35 and 65 W than the noninjured group. Men with SCI showed higher fat oxidation when compared with noninjured men at any intensity, even increased after full adjustment for lean mass, fat mass, and cardiorespiratory fitness. These findings suggest that SCI men could improve their metabolic flexibility and muscle mass for greater efficiency, not being affected by their fat accumulation.

Cardiorespiratory fitness and arm bone mineral health in young males with spinal cord injury: the mediator role of lean mass.

Spinal cord injury (SCI) derives in loss of bone mineral content (BMC) and bone mineral density (BMD). However, physical activity is an important determinant in bone mass acquisition, which is partially mediated through the lean mass (LM). The aim was to examine the effect of cardiorespiratory fitness (CRF) on BMD and BMC arms of adult males with SCI and able-bodied controls using the arm LM as a mediator variable. Thirty able-bodied men and thirty men with SCI participated. BMC and BMD were analysed by DXA, and indirect calorimetry was used to calculate VO2peak during a progressive arm-cranking test. When groups were divided by the amount of LM, the subgroup with highest LM had significantly higher arm BMC compared to the lowest LM subgroup (p ≤ 0.05) in both SCI and able-bodied groups. Moreover, same differences were found when confidence intervals were analysed. Only in the SCI group, arm LM mediated the relationship between bone mass and CRF at 30.9%, as indicated by the Sobel test (z = 2.17 and z = 2.04 for BMC and BMD, respectively). In conclusion, LM mediates the indirect association between CRF and bone health, specifically in the arms. This finding highlights the importance of having an adequate CRF for the maintenance of good bone health in SCI men.

Load-controlled moderate and high-intensity resistance training programs provoke similar strength gains in young women.

INTRODUCTION: While current exercise guidelines recommend progressive, high-intensity resistance training (RT) to promote muscle hypertrophy and strength gains, controversy exists regarding the efficacy of lighter-load RT. We compared 2 work-matched RT interventions that differed in training intensity. METHODS: Fifteen women underwent 10 weeks of unilateral knee extensor RT. One leg was trained at increasing intensity (intensity leg, InL, 50-80% 1-repetition maximum [1-RM]), and training progression in the contralateral leg (volume leg, VoL, 50% 1-RM) was based on increasing training volumes. Quadriceps muscle size (ultrasound, dual energy X-ray absorptiometry) and strength (isokinetic dynamometry) were assessed on 4 occasions. RESULTS: Both training programs induced significant, yet comparable increases in muscle size (InL: +4.6-12%, VoL: +3.1-11%) and strength (InL: +10-16%, VoL: +10-14%). CONCLUSIONS: Training at lower than commonly suggested intensities may be an equally effective alternative form of RT. Factors other than training intensity, such as the total mechanical work during training, may strongly affect the training response.

Golf and Health, More than 18 Holes-A Bibliometric Analysis.

Despite golf's contribution to health, scientific production related to golf and health has been relatively scarce. This work aims to investigate the state of the art on golf and health and to identify existing gaps and the principal and most notable potential future research trends, contributing to connecting the reality of the facilities dedicated to the practice of this sport and its contribution to raising awareness of the importance of sport in maintaining health. A total of 179 articles were analyzed following the steps for systematic reviews and meta-analysis protocols based on the PRISMA 2020 methodology and QUORUM, and a bibliometric analysis was carried out. Research to date has mainly focused on the benefits of golf in improving health, preventing illness, slowing down aging, or as rehabilitation and on exploring the risks and injuries involved in playing golf. The different ways of promoting participation or changing the image of golf by showing its healthy side are outlined as research trends in the coming years. There is a lack of exploration of the use of technology, the effects of the sport on certain disorders related to psychosocial factors, and further knowledge of the relationships between playing intentions and health. This research provides essential information for researchers who plan to work with golf in the future.

The influence of teaching variables in the educational processes of students with rare diseases.

Introduction: Teachers have a key role in their students' educational inclusion processes. Numerous variables influence their professional work and determine how they approach teaching. Methods: In this study, 574 teachers teaching non-university educational stages in the Autonomous Community of Castilla-La Mancha were queried about their knowledge and perceptions regarding students with rare diseases, examining the extent to which there were personal variables that could have an impact on that. Results: The results indicate the need to expand training to increase levels of knowledge in the educational arena about rare diseases, especially about how they are conceptually described and their categorization and prevalence. All of the teaching variables evaluated were statistically significant, with p < 0.001 in most of the elements evaluated according to each of the following variables: sex, age, job position, teaching experience, and higher qualifications. This shows that there are teaching variables that influence the inclusion of students with rare diseases. Being aware of them should be a priority in order to increase teacher empowerment for the delivery of inclusive educational processes. Discussion: All students exhibit distinctive characteristics and teachers play an essential role in offering them quality individualized education. The full inclusion of all students is something educational systems have yet to achieve, and this study aimed to contribute to that goal, in this case for schoolchildren with rare diseases.

Body Composition as a Mediator between Cardiorespiratory Fitness and Bone Mass during Growth.

INTRODUCTION AND PURPOSE: To examine the effect of cardiorespiratory fitness (CRF) and muscle power output (MPO) on bone mass of prepubertal and pubertal children using lean mass (LM) and percentage of fat mass (%FM) as mediator variables. The hypothesis was that both LM and %FM would be independent mediators of the relationships during the sexual maturation period. METHODS: We analyzed 200 children (88 boys and 112 girls [11.5 ± 2.0 yr]). Body composition was analyzed by bone densitometry, and indirect calorimetry and cycle ergometer were used to calculate V˙O2peak (mL·kg·min) and MPO (W) during an incremental exercise test. Sample was divided by pubertal status. RESULTS: In the prepubertal group, LM and %FM acted independently as mediators in the relationship between bone mass and CRF or MPO (22%-25% for LM and 37%-50% for %FM, respectively). In pubertal children, LM acted as mediator at 37%. CONCLUSIONS: Although the independent mediator role of LM and %FM in the associations between CRF or MPO and bone mass was present during the prepubertal stage, only LM remain its mediator role in these associations during the postpubertal period. Therefore, with growth and sexual maturation, the full effect of LM seems to increase, whereas the influence of %FM seems to disappear.

Tonic status epilepticus in a centenarian woman.

Generalized tonic status epilepticus (TSE) is a rare epileptic condition. It occurs usually in the context of symptomatic generalized epilepsy, in particular, in subjects with a diagnosis of Lennox-Gastaut syndrome, atypical forms of idiopathic (genetic) generalized epilepsy, or as a paradoxical effect during treatment with diverse antiepileptic drugs. Herein, we describe the case of an elderly woman on chronic treatment with psychotropic drugs who developed an episode of generalized TSE. Motor manifestations were subtle and difficult to recognize as seizures, and a detailed video-EEG importantly contributed to accurate and prompt diagnosis. TSE was initially refractory to conventional anti-seizure drug therapy including levetiracetam and valproate but was finally controlled with lacosamide. Our case indicates a potential therapeutic effect of lacosamide on TSE in the elderly after treatment failure with first-line anti-seizure drugs. [Published with video sequence on www.epilepticdisorders.com].

Effects of a 3-month vigorous physical activity intervention on eating behaviors and body composition in overweight and obese boys and girls.

PURPOSE: This study aims to analyze the effects of a 3-month vigorous physical activity (VPA) intervention on eating behavior and body composition in overweight and obese children and adolescents. METHODS: Forty-seven participants (7-16 years) took part in the study: 28 were assigned to the intervention group (IG) (10 boys and 18 girls) and 19 in a control group (CG) (8 boys and 11 girls). Body composition (dual-energy X-ray absorptiometry), anthropometrics (body mass, height, and body mass index (BMI)), and eating behavior traits (Three-Factor Eating Questionnaire-R21C) were determined before and after the VPA intervention. RESULTS: A decrease in the percentage of body fat and BMI (-2.8% and -1.8%, respectively), and an increase in most lean mass variables were found in the IG (all p ≤ 0.05). In relation to the eating behavior traits, IG subjects showed a 14% reduction in the Emotional Eating score (p = 0.04), while Cognitive Restraint score did not change after the VPA intervention. The baseline factors of the questionnaire predicted changes in body mass and fat mass variables only in the CG. CONCLUSION: A 3-month VPA intervention influenced eating behaviors of overweight or obese young, especially the Emotional Eating factor, in the presence of favorable body composition changes.

Epilepsia partialis continua and cortical motor control: insights into physiology.

Motor epilepsia partialis continua is a widely described variant of simple focal motor status epilepticus. However, few studies have addressed associated pathophysiological anomalies that may help us understand the cortical organization, basic functioning and control of voluntary movement. We describe the clinical, video-EEG and neuroimaging findings from two cases of motor epilepsia partialis continua that support the hypothesis of the coexistence of both classic body and complex motor map models in the cortical organization of voluntary movement in humans. [Published with video sequence].

Postanoxic alpha, theta or alpha-theta coma: Clinical setting and neurological outcome.

AIM: The aim of this study was to determine the prognosis of 26 consecutive adults with alpha coma (AC), theta coma (TC) or alpha-theta coma (ATC) following CRA and to describe the clinical setting and EEG features of these patients. METHODS: We retrospective analyzed a prospectively collected cohort of adult patients diagnosed as having AC, TC or ATC after CRA between January 2008 and June 2016. None of patients included in this analysis underwent therapeutic hypothermia (TH). Neurological outcome was expressed as the best score 6 months after CRA using the five-point Glasgow-Pisttsburgh Cerebral Performance Categories (CPC) RESULTS: Twenty-six patients were identified with a diagnosis of postanoxic AC, TC or ATC coma. There were 20 (77%) men and 6 (23%) women. The mean age was 63 ±â€¯16 years. The most frequent EEG pattern was TC (21 patients, 80%), followed by AC (3 patients, 12%) and ATC (2 patients, 8%). The cardiac rhythm as primary origin of the CRA was ventricular fibrillation (VF) in 16 patients (61.5%), asystole in 8 patients (34.6%) and ventricular tachycardia (VT) in one patient (3.8%). The presence of EEG reactivity was present in 8 patients (30%). The mortality rate was 85%. Of the 4 surviving patients, two (3.8%) had moderate disability (CPC 2), one (3.8%) had severe disability (CPC 3) and one (3.8%) reached a good recovery. The age was significantly lower in survivors 46.2 ±â€¯10.8 versus nonsurvivors 63.3 ±â€¯15.5 (p = 0.04). There was increased association of EEG reactivity with survival (p = 0.07). CONCLUSION: Hypoxic-ischemic AC, TC and ATC are associated with a poor prognosis and a high rate of mortality. In younger patients with AC, TC and ATC and incomplete forms showing reactivity on the EEG, there is a greater probability of clinical recovery.

De novo absence status epilepticus of late onset (DNASLO) precipitated by oral treatment with cefuroxime: description of an ambulatory case.

We describe the case of an elderly woman with an episode of ambulatory de novo absence status epilepticus of late onset (DNASLO) after oral treatment with cefuroxime. A high level of suspicion of DNASLO in cases of unexplained confusion in adults or elderly subjects taking cephalosporins is essential to prompt an emergency EEG and, in turn, rapidly achieve an appropriate diagnosis and enable optimal treatment.

Influence of different sports on fat mass and lean mass in growing girls.

PURPOSE: The aim of this study was to analyze and compare the effects of different sports (swimming, football, basketball, and handball) on fat mass and lean mass in prepubertal and pubertal girls. METHODS: Two hundred girls (10.6 ± 1.5 years old, Tanner stages I-III) participated in the study and were divided into 5 groups: 40 swimmers, 40 football players, 40 basketball players, 40 handball players, and 40 controls. Fat and lean masses at whole body, arms, trunk, and legs were measured using dual-energy X-ray absorptiometry (DXA). Pubertal status was determined using Tanner test. Effects of different sports on fat and lean masses were assessed through analysis of covariance with height as covariates. Analyses were performed separately in 2 groups depending on the Tanner stage (prepubertal and pubertal). RESULTS: The girls of the control group had less lean mass and more fat mass compared to the girls who play sports (p < 0.05). There were differences in body fat between sports. The swimmers and football players had less body fat (p < 0.05). On the other hand, handball players showed the highest values in lean mass (p < 0.05). CONCLUSION: Impact sports (football, basketball, and handball) and low-impact sports (swimming) provide an appropriate development of lean mass in growing girls. We can conclude that people practicing sports at early ages ensure a lower fat mass and higher lean mass compared to those who do not practice. These results may be useful as a preventive method of adult obesity.

Frailty is associated with objectively assessed sedentary behaviour patterns in older adults: Evidence from the Toledo Study for Healthy Aging (TSHA).

OBJECTIVE: The aim of this study was to examine the association of sedentary behaviour patterns with frailty in older people. SETTING: Clinical setting. DESIGN: Cross-sectional, observational study. PARTICIPANTS AND MEASUREMENTS: A triaxial accelerometer was used in a subsample from the Toledo Study for Healthy Aging (519 participants, 67-97 years) to assess several sedentary behaviour patterns including sedentary time per day, the number and duration (min) of breaks in sedentary time per day, and the proportion of the day spent in sedentary bouts of 10 minutes or more. Frailty was assessed using the Frailty Trait Scale (FTS). Regression analysis was used to ascertain the associations between sedentary behaviour patterns and frailty. RESULTS: Sedentary time per day and the proportion of the day spent in sedentary bouts of 10 minutes or more, were positively associated with frailty in the study sample. Conversely, the time spent in breaks in sedentary time was negatively associated with frailty. CONCLUSION: In summary, breaking up sedentary time and time spent in sedentary behaviour are associated with frailty in older people.

Percepción de los médicos hospitalarios sobre los equipos de soporte de atención paliativa domiciliaria / Hospital medical doctors perception on palliative home care support team

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Impacto de la pandemia por COVID-19 en pacientes con necesidades paliativas atendidos por un equipo de soporte de atención domiciliaria / Impact of the COVID-19 pandemic on patients with palliative needs attended by a home care support team

Objetivo: Analizar si existen diferencias en la actividad de un Equipo de Soporte de Atención Paliativa Domiciliaria (ESAPD) entre el periodo del Estado de Alarma de 2020 y el último trimestre de 2019 y estimar la prevalencia de infección por COVID-19, la mortalidad y el lugar de fallecimiento de los pacientes.Método: Estudio observacional descriptivo con 2 cortes transversales: periodo de Estado de Alarma de 2020 (14 marzo-21 junio) y el último trimestre de 2019 (14 septiembre-21 diciembre). Se incluyeron los pacientes en seguimiento por un ESAPD de la Comunidad de Madrid al inicio de cada periodo y aquellos que entraron como pacientes nuevos durante los periodos de estudio.Resultados: En el trimestre de 2019 se atendieron 271 pacientes, 146 (53,87 %) eran pacientes nuevos. En periodo de Estado de Alarma 303 pacientes recibieron atención, 173 (57,10 %) eran nuevos, 238 (78,55 %) precisaron atención domiciliaria y 65 (21,45 %) atención telefónica. En 2019, la media de visitas/paciente fue 3,17 ± 2,42 frente a 2,73 ± 2,41 en Estado Alarma (p = 0,02). Los pacientes considerados caso COVID-19 fueron 57, estimándose una prevalencia de 18,81 % (IC 95 %: 14,78-23,64 %). Los pacientes COVID-19 era más probable que viviesen en residencia (OR: 8,16; IC 95 %: 4,22-15,79) y que tuvieran patología no oncológica (OR; 2,38; IC 95 %: 1,31-4,31). Los pacientes COVID-19 presentaron mayor mortalidad que los no COVID (OR: 2,07; IC 95 %: 1,13-3,77). En cuanto al lugar de fallecimiento de los pacientes COVID-19, fue más frecuente que no ocurriese en el domicilio (OR: 6,29; IC95 %: 2,55-15,51).Conclusiones: Durante el periodo de Estado de Alarma aumentó el número de pacientes atendidos por ESAPD, la mayoría precisó atención domiciliaria y disminuyeron las visitas por paciente comparado con un periodo prepandemia. En el grupo de pacientes COVID-19 predominó la enfermedad no oncológica, se produjo mayor mortalidad y más fallecimientos en residencia y menos en domicilio. (AU)

Objective: To analyze whether there were any differences in the activity of a Home Palliative Care Team between the State of Alarm period of 2020 and the last quarter of 2019, and to estimate the prevalence of COVID-19 infection, mortality, and place of death.Method: A cross-sectional, observational study: from the 2020 State of Alarm period (14 March-21 June) to the last quarter of 2019 (14 September-21 December). Patients in follow-up by a home palliative care team in the Community of Madrid at the beginning of each period, and those who entered as new patients during the study periods were included.Results: In the 2019 quarter 271 patients were seen, 146 (53.87 %) were new patients. In the 2020 State of Alarm period 303 patients received care, 173 (57.10 %) were new, 238 (78.55 %) required home care, and 65 (21.45 %) required telephone care. In 2019, the mean number of visits/patient was 3.17 ± 2.42 versus 2.73 ± 2.41 during the State of Alarm period (p = 0.02). There were 57 patients considered COVID-19 cases, with an estimated prevalence of 18.81 % (IC 95 %: 14.78-23.64 %). COVID-19 patients were more likely to live in nursing homes (OR: 8.16, 95 % CI: 4.22-15.79) and to have non-oncological disease (OR: 2.38, 95 % CI: 1.31-4.31). COVID-19 patients had a higher mortality rate than non-COVID-19 patients (OR: 2.07, 95 % CI: 1.13-3.77). Regarding the place fo death of COVID-19 patients, home was more common than elsewhere (OR: 6.29, 95 % CI: 2.55-15.51).Conclusions: During the State of Alarm period the number of patients cared for by a Home Palliative Care Team increased, the majority required home care, and visits per patient decreased compared to the pre-pandemic period. In the COVID-19 patient group non-oncological disease predominated, with higher mortality and more deaths occurring at nursing homes and fewer at home. (AU)

[Theory of Mind in a child with autism: how to train her?]. / Teoría de la Mente en un caso de autismo: ¿cómo entrenarla?

Theory of Mind is a metacognitive skill that, in many cases, is deficient in autism. In this paper, we present a clinical study conducted with a child diagnosed with autism, which verifies the effectiveness of a training protocol testing false beliefs, which has been considered to measure the Theory of Mind. Basically, the protocol incorporates a number of verbal prompts (such as emphasizing the elements of the narratives that indicate situational or temporary changes), trains many examples, extending the tests incorporating some games with more familiar objects from the child's daily life, applies differential contingencies to discriminate right from wrong in each child's responses and provides descriptive feedback. The results show that the training protocol achieved the highest level of correct trials and the child generalizes the ability to take the perspective of her natural context.

[Experiences of the caregivers of cardioverter defibrillator recipients during admission to the Virgin Macarena Hospital and after discharge]. / Experiencias de cuidadores principales de pacientes portadores de un desfibrilador durante el ingreso en el Hospital Virgen Macarena y tras el alta.

OBJECTIVE: To determine the needs of the main caregivers of implantable cardioverter defibrillator (ICD) recipients during admission to the Coronary Unit of the Virgin Macarena Hospital and after discharge. METHOD: A qualitative descriptive study was performed. Semi-structured and open interviews were carried out. Content analysis of the interviews was performed following Giorgi's method (1997). RESULTS: Twelve subjects participated. Notable findings during the hospitalization phase were poor communication between caregivers and nurses, the lack of caregivers' participation in providing care, and their difficulties to assimilate the information about ICD therapy. After hospital discharge, the first days at home were marked by fear and the need to overprotect the patient. Subsequent monitoring at the heart rhythm unit improved the process of adjustment to the new situation and confidence in the ICD. CONCLUSIONS: Families' needs for information and emotional support should be included in patients' care plans. Moreover, nurses should participate in the process of providing information about ICDs and their possible complications. This would allow personalized information to be progressively given and would help in preparation for discharge and adjustment to the new situation. The length of visiting hours should be modified according to the patient's and family's circumstances. Strategies aimed at improving communication between nurses and caregivers should be introduced.