The Pilates method and cardiorespiratory adaptation to training.

Although all authors report beneficial health changes following training based on the Pilates method, no explicit analysis has been performed of its cardiorespiratory effects. The objective of this study was to evaluate possible changes in cardiorespiratory parameters with the Pilates method. A total of 45 university students aged 18-35 years (77.8% female and 22.2% male), who did not routinely practice physical exercise or sports, volunteered for the study and signed informed consent. The Pilates training was conducted over 10 weeks, with three 1-hour sessions per week. Physiological cardiorespiratory responses were assessed using a MasterScreen CPX apparatus. After the 10-week training, statistically significant improvements were observed in mean heart rate (135.4-124.2 beats/min), respiratory exchange ratio (1.1-0.9) and oxygen equivalent (30.7-27.6) values, among other spirometric parameters, in submaximal aerobic testing. These findings indicate that practice of the Pilates method has a positive influence on cardiorespiratory parameters in healthy adults who do not routinely practice physical exercise activities.

Should arm span or height be used in calculating the BMI for the older people? Preliminary results.

AIMS AND OBJECTIVES: To consider using arm span rather than height for calculating the body mass index, as a parameter that offers greater long-term stability, for the nutritional assessment of persons aged over 65 years. BACKGROUND: The body mass index presents certain drawbacks for the nutritional screening of older people suffering malnutrition or at risk of malnutrition, due to the anthropometric changes that occur with increasing age, especially the progressive loss of height. DESIGN: Observational, cross-sectional study, using nonprobabilistic convenience sampling, with anthropometric measurements and nutritional screening in older men and women, divided into two groups: (1) aged 65-75 years and (2) aged over 75 years. METHODOLOGY: Height and arm span were measured to calculate two separate indices of body mass: body mass index (weight/height) and body mass index.1 (weight/arm span). Nutritional screening was conducted using the Mini Nutritional Assessment Short-Form, which includes the body mass index as an anthropometric measure. RESULTS: Our results reveal statistically significant differences between the two indices, for the sample analysed. Body mass index.1 classifies a larger number of older people as suffering malnutrition and fewer as being at nutritional risk. When this new index is used, there is a displacement of the subjects at risk, thus increasing the number considered at risk of malnutrition and in need of appropriate therapeutic intervention. Therefore, the use of body mass index.1 would enable more people suffering malnutrition, who would otherwise remain untreated, to be attended. CONCLUSIONS: As arm span, as an anthropometric measure, remains unchanged over time, it could be used instead of height, as an alternative index (body mass index.1) to the conventional body mass index. Further research is needed to determine the association between body mass index.1 and clinical status parameters to determine optimum cut-off points. RELEVANCE TO CLINICAL PRACTICE: This study describes the greater stability of body mass index.1 with respect to body mass index for nutritional screening, and the resulting benefits for nutritional monitoring and intervention for older people.

[Endocrine-metabolic adjustments during Ramadan fasting in young athletes]. / Ajustes endocrino-metabólicos durante el ayuno de Ramadán en jóvenes deportistas.

The Islamic precept of R implies important physiological modifications due to the hydric and dietetic restrictions along a whole month plus a day, all of which have a crucial repercussion over the physical and intellectual performance of Muslims, particularly in occidental societies, in which there is no hour readjustments for daily activities. Among the imposed modifications by Ramadan in daily habits, intermittent fasting along day and night causes adaptation mechanisms to optimize the energy consumption. The objective of this study was to analyze the metabolic-endocrine changes that happen during daily working hours, along the month of fasting in young subjects who have to continue their usual activities and sport training. Ten young muslim subjects, male, healthy, set to sport training, ages in between 18 and 25 who completed Ramadan. Plasma biochemical and hormonal parameters were analyzed in plasma, a week before Ramadan, in the first and fourth of the fasting month and a week after conclusion. During Ramadan, have been observed a drop of biochemical parameters along daytime, especially those related to glycemia, being these changes stronger in the first week. The concentration of cortisol found to be significantly high during the whole month as a consequence of adaptation to the change of circadian secretion rhythms. Ramadan obliges subject's organisms to readjust their endocrine and metabolic system in order to preserve the energetic efficiency during daytime. This auto control becomes more efficient as long as the month advances due to physiological adaptations.

Influence of exercise on mood in postmenopausal women.

AIM AND OBJECTIVE: To evaluate the influence of an exercise programme on postmenopausal women with symptoms of anxiety and depression. BACKGROUND: The menopause is a period of hormonal changes when mood variations are probably more severe than at any other period of women's lives. DESIGN: Prospective study with control group and pre- and post-treatment measures, after six months treatment. Conducted at two healthcare clinics, in the province of Granada (Spain). METHODS: A convenience sample of 60 postmenopausal women aged 60-70 years, with symptoms of depression and anxiety, was recruited. The women were randomly divided into two groups: (1) control group, no treatment (n = 30); (2) exercise group, which carried out a programme of mixed physical exercises with musical support (n = 30). All subjects answered questionnaires for the Hamilton Anxiety Scale and the Brink and Yesavage Geriatric Depression Scale before and after treatment. RESULTS: In the exercise group, statistically significant improvements were observed in subjects with moderate and severe depression (18 and 22%, respectively) and in those with symptoms of anxiety. No such changes were observed in the control group. CONCLUSIONS: A controlled programme of physical exercise for postmenopausal women alleviates symptoms of anxiety and depression, and its inclusion in primary healthcare programmes should be considered. RELEVANCE TO CLINICAL PRACTICE: Menopausal women may benefit from physical exercise, which attenuates the effects of the physiological and psychological changes associated with the menopause and prevents pathologic changes.

Quality assurance of nursing web sites: development and implications of the ALEU method.

This article presents a study that evaluated the physical accessibility, readability, and usability of Spanish nursing Web sites and discusses the quality assurance issues raised, which are relevant to the wider nursing community. The Internet is recognized as an important source of health information for both nurses and the general public. Although it makes health-related information universally available, the wide variation in the overall quality of health Web sites is problematic. This raises many questions for the nursing profession: about what constitutes a good-quality Web site, about the nature of the information that nurses are finding and using to support their professional education, research, and clinical practice, and about the impact that Internet information ultimately has on health interactions and nursing care. The process of completing this small study showed that it is possible to usefully assess dimensions of Web site quality and suggested that it may be feasible to develop tools to help nurses evaluate national and international nursing Web sites. More research is needed to understand how nurses use the Internet to support their everyday professional practices, but the development and application of international Web site quality assurance tools may be important for maintaining professional nursing standards in the Internet age.

[Functional level and quality of life in ankylosing spondylitis, pilot study after 16 weeks TNF blocker treatment]. / Nivel funcional y calidad de vida en espondilitis anquilosante. Estudio piloto tras 16 semanas de tratamiento anti-TNF.

BACKGROUND AND OBJECTIVES: The aim of the present study is to assess the impact of infliximab and etanercept, TNF-alpha (tumour necrosis factor-alpha blockers) on functional disability and quality of life in thirteen patients over 65 years-old with ankylosing spondylitis (AS). PATIENTS AND METHODS: We consecutively included patients over 65 years-old, attending our clinic from Rheumatology Service in Hospital Clínico de Granada. These patients were all refractory to conventional therapy with disease-modifying anti-rheumatic drugs (DMARD). Disease activity was assessed using BASDAI index (bath ankylosing spondylitis disease activity index). Functional disability was assessed using BASFI (bath ankylosing spondylitis functional index) and ASQol index (ankylosing spondylitis quality of life index). RESULTS: We present a pilot study with 13 patients over 65 years-old treated with TNF blockers for 16 weeks. A significant decrease in disease activity was observed. Mean values of VAS (visual analogue scale) pain scores and disease decreases significantly after treatment (from 6.72 to 3.67 and 6.15 to 2.79 respectively), less than 4, which is considered an acceptable BASDAI response. Functional ability (BASFI) and health related quality of life (HRQOL) improved significantly from 6.15 to 2.79 and 13.85 to 4.22. CONCLUSIONS: Our results are consistent with the data available in the literature about TNF blockers decreasing clinical signs of the disease. Disease activity had significantly decreased 16 weeks after the onset of TNF blocker therapy. Functionality and quality of life have been also improved in elderly people with AS.

Effects of an ergonomic program on the quality of life and work performance of university staff with physical disabilities: A clinical trial with three-month follow-up.

BACKGROUND: Problems related to physical disability may have an extremely negative impact in the work environment, reducing productivity and contributing to health problems and a worsening quality of life. OBJECTIVE: To assess the effects of an ergonomic intervention program on the quality of life and the work performance of people with physical disabilities working in a university environment. METHODS: A pilot clinical trial with three-month follow-up was conducted at the Physiotherapy Clinic of the Federal University of Paraíba (Brazil). Eight workers at the university took part in an ergonomic adjustment (using ErgoDis/IBV software) and physiotherapy program at their workplace for twelve weeks, in two 60-min sessions per week. The measuring instruments used were the WHOQoL-BREF questionnaire for quality of life and the Work Ability Index for work ability. A repeated-measures ANOVA analysis and Wilcoxon signed-rank test were also performed. RESULTS: Significant intra-group changes were observed in the QoL subscales for the physical dimension (F = 5.487, p = 0.017) and the environment dimension (F = 7.510, p = 0.006). The post-treatment analysis revealed significant changes for both the physical dimension (Z = -2.552, p = 0.011) and the environment dimension (Z = -2.201, p = 0.028). After the three-month follow-up period, only the environment dimension recorded a significant change (Z = -1.965, p = 0.049). The effect sizes were large. Regarding work ability, the repeated-measures ANOVA analysis showed a significant time effect (F = 5.067, p = 0.022), with large pre-post treatment improvement (Z = -2.555, p = 0.011, d = 0.914). CONCLUSIONS: The program based on ergonomic and physiotherapy program greatly enhanced the subjects' quality of life and work ability.

[Impact of cognitive deficit on survival among elderly residents in the community]. / Impacto del déficit cognitivo en la supervivencia de ancianos residentes en la comunidad.

OBJECTIVE: To analyze cognitive deficit as a risk factor for death in elderly residents in the community and its relationship with variables related to sociodemographic factors, physical health, and functional capacity. MATERIAL AND METHODS: A prospective study was carried out in the city of Santa Cruz, Brazil, in 310 randomly selected elderly individuals who were followed-up for 53 months. Predictive factors were sociodemographic and neuropsychiatric variables, physical health, and functional capacity. The statistical methods used were bivariate analysis (survival analysis), and Cox regression (multivariate analysis) with respective hazard ratios (HR). A value of P<.05 was considered statistically significant and 95% confidence intervals (CI) were calculated. RESULTS: A total of 60 (20.5%) elderly residents died during the study. The main cause of death was cardiovascular disease. The mean time until death was approximately 24.8 months. The main risk factors identified in Cox analysis were cognitive deficit (HR=4.22), stroke (HR=3.08) and dependency for basic activities of daily living (HR=3.55). CONCLUSIONS: Cognitive deficit is an independent risk factor for death. The results of the present study could be useful in formulating future health policies aiming to reduce mortality in the elderly.

Effect of a physical activity programme in the aquatic environment on haemodynamic constants in pregnant women. / Efecto de un programa de actividad física en el medio acuático sobre las constantes hemodinámicas en mujeres embarazadas.

OBJECTIVE: To evaluate the effect of a physical activity programme in the aquatic environment with immersion up to the neck, of six weeks duration, on haemodynamic constants in pregnant women. METHODS: A six-week physical activity programme in the aquatic environment was carried out with a total of 46 pregnant women, who were distributed into an experimental group (n = 18), which participated in the programme, and a control group (n = 28), which followed routine care. In both groups different haemodynamic measurements were evaluated before and after the program. RESULTS: At the beginning of the programme the mean systolic blood pressure was similar between groups, but diastolic blood pressure was slightly higher in the experimental group. When the measurements at the last session were compared, arterial pressures (systolic, diastolic and mean) were significantly higher in the control group (p <.050). Similarly, the initial plasma volume values did not differ between groups, but after the intervention, the control group women showed a higher mean (p <.010). The fraction of sodium excretion (FENa) increased significantly in the experimental group, after the programme, with a mean three times higher (p <.050). Aldosterone plasma levels did not show significant differences between the groups in the different measurements. CONCLUSION: A programme of swimming and immersion exercises in pregnant women contributes to hydrosaline balance, preventing an excessive increase in usual plasma volume during pregnancy and in the activity of the renin-aldosterone axis.

Evaluation of Functional Status Associated With Overweight in Adults With Cerebral Palsy.

PURPOSE: The aim of this study was to describe the motor disability level of ambulatory adults with overweight and cerebral palsy (CP) and to investigate the functional factors associated with weight gain in this population. DESIGN: Cross-sectional study. METHODS: Thirty adults with CP were classified according to their body mass index (BMI). Mobility, physical disability, functional independence, gait and balance, gross motor function, and maximum walking speed were assessed to evaluate their physical status. The influence of demographic and functional factors on BMI was analyzed using bivariate and multivariate regression analyses. FINDINGS: Multiple regression analyses showed that age (p = .012) and lower cardiorespiratory function/lower walking distance (p = .048) were significantly associated with higher BMI. Other functional outcomes were not associated with BMI. CONCLUSIONS: Greater age and reduced walking distance related to cardiorespiratory function seem to be the main factors associated with BMI. CLINICAL RELEVANCE: Cardiorespiratory rehabilitation is recommended in conjunction with nutritional nursing interventions.

Effectiveness of two home ergonomic programs in reducing pain and enhancing quality of life in informal caregivers of post-stroke patients: A pilot randomized controlled clinical trial.

BACKGROUND: Informal caregivers of post-stroke patients usually undergo high levels of pain and stress and have a reduced quality of life. OBJECTIVE: To evaluate the effectiveness of two home ergonomic interventions aimed at reducing pain intensity and perceived stress and enhancing the quality of life in informal caregivers of chronic post-stroke patients. METHODS: A randomized single-blind controlled clinical trial was conducted, with a sample of 33 informal caregivers of patients with stroke. Three groups were included: one received postural hygiene training and kinesiotherapy, for 12 weeks, two days a week, one hour per session; another received adaptation of the home environment, and the third was a control group. Pain intensity, stress level and general quality of life were evaluated at three-time points: pre-intervention, post-intervention, and after a follow-up period of three months. RESULTS: Neck pain decreased in the two experimental groups, and increased in the control group. Pain in the shoulders and knees was alleviated in the group that received postural hygiene and kinesiotherapy. In addition, regarding quality of life, this group obtained an improvement in the physical health dimension, while the home adaptation group reported improved social relationships. CONCLUSIONS: These results suggest that 12 weeks of training in postural hygiene, combined with kinesiotherapy, and home adaptations can reduce pain and improve several aspects of the quality of life of this population. CLINICALTRIALS. GOV ID: NCT03284580.

Effectiveness of a physical activity programme based on the Pilates method in pregnancy and labour. / Efectividad de un programa de actividad física mediante el método Pilates en el embarazo y en el proceso del parto.

OBJECTIVE: To assess the effectiveness and safety of a physical activity programme based on use of the Pilates method, over eight weeks in pregnant women, on functional parameters, such as weight, blood pressure, strength, flexibility and spinal curvature, and on labour parameters, such as, type of delivery, episiotomy, analgesia and newborn weight. METHOD: A randomized clinical trial was carried out on pregnant women, applying a programme of physical activity using the Pilates method, designed specifically for this population. A sample consisting of a total of 105 pregnant women was divided into two groups: intervention group (n=50) (32.87±4.46 years old) and control group (n=55) (31.52±4.95 years old). The intervention group followed a physical activity programme based on the Pilates method, for 2 weekly sessions, whereas the control group did not follow the program. RESULTS: Significant improvements (p<0.05) in blood pressure, hand grip strength, hamstring flexibility and spinal curvature, in addition to improvements during labour, decreasing the number of Caesareans and obstructed labour, episiotomies, analgesia and the weight of the newborns were found at the end of the intervention. CONCLUSION: A physical activity programme of 8 weeks based on the Pilates method improves functional parameters in pregnant women and benefits delivery.

[Quality of life related to health in a population of healthy pregnant women after a program of physical activity in the aquatic environment.] / Calidad de vida relacionada con la salud en una población de gestantes sanas tras un programa de actividad física en el medio acuático (PAFMAE).

OBJECTIVE: Moderate physical exercise brings benefits to pregnant women during pregnancy. The aim of this research is to evaluate the effect on the quality of life of a six-week aquatic physical activity program in healthy pregnant women. METHODS: A six-week physical activity program was conducted in the aquatic environment, from May to July 2016 in a sports center, to a total of 46 pregnant women, who were distributed in Experimental (n = 18) and Control (n = 28) groups, to which the health-related quality of life questionnaire SF-36 v2 was applied before and after the program. The t-student test for paired samples was statistically applied for intragroup means, and for the differences between groups, the t-student test for independent samples. RESULTS: At the end of the physical activity program, it was clearly established that it acted positively on the following dimensions whose mean values were: perception of Body Pain (BP) before 66.1 and after 68.4 perception of General Health (GH) before 81.3 and then 83.6, Emotional Role (ER) before 89.0 and Then 93.5 and Mental Health (MH) 80.7 before and 84.2 after. CONCLUSIONS: The practice of a program of physical activity in the aquatic environment for pregnant women provides benefits related to the perception of health-related quality of life.

OBJETIVO: El ejercicio físico moderado aporta beneficios a la mujer gestante durante el embarazo. La finalidad de este trabajo fue evaluar el efecto sobre la calidad de vida de un programa de actividad física en el medio acuático, de seis semanas de duración, en mujeres gestantes sanas. METODOS: Se llevó a cabo un programa de actividad física en el medio acuático, desde mayo hasta julio de 2016 en un centro deportivo, de seis semanas de duración a un total de 46 mujeres embarazadas, que fueron distribuidas en grupo Experimental (n=18) y grupo Control (n=28), a las que se le aplicó el cuestionario de calidad de vida relacionada con la salud "SF- 36 v2" antes y después del programa. Estadísticamente se aplicó para medias intragrupo la prueba t-student para muestras pareadas, y para las diferencias entre grupos, la prueba t-student para muestras independientes. RESULTADOS: Al finalizar el programa de actividad física se constató como el mismo actuó positivamente sobre las siguientes dimensiones, cuyos valores de la media fueron: percepción de Dolor Corporal (DC) antes 66,1 y después 68,4 percepción de Salud General (SG) antes 81,3 y después 83,6, Rol Emocional (RE) antes 89,0 y después 93,5 y Salud Mental (SM) 80,7 antes y 84,2 después. CONCLUSIONES: La práctica de un programa de actividad física en el medio acuático para embarazadas sanas brinda beneficios relacionados con la percepción de calidad de vida relacionada con la salud.

Effectiveness of a flamenco and sevillanas program to enhance mobility, balance, physical activity, blood pressure, body mass, and quality of life in postmenopausal women living in the community in Spain: a randomized clinical trial.

OBJECTIVE: This study aimed to test the effectiveness of a dance therapy program in improving mobility, balance, physical activity, blood pressure (BP), body mass, and quality of life in postmenopausal women in Spain. METHODS: Fifty-two sedentary postmenopausal women (mean age 69.27 ±â€Š3.85 y) were randomly assigned to receive either dance therapy (n = 27) or self-care treatment advice (n = 25). The intervention group participated in 2 months of dance therapy, three sessions weekly, based on Spanish folk dance (flamenco and sevillanas). The control group was provided a booklet containing physical activity recommendations. Mobility, balance, physical activity, BP, body mass, and quality of life were assessed at baseline and posttreatment in both groups. Statistical analysis was performed using a 2 × 2 analysis of variance (ANOVA). RESULTS: Women in the intervention group showed significant improvements in mobility and balance (timed up-and-go test [P = 0.022], cognitive timed up-and-go [P = 0.029], and one-leg stance test results [P = 0.001]), physical activity (total time index [P = 0.045], energy expenditure [P = 0.007], vigorous physical activity [P = 0.001], leisure activity [P = 0.001], moving [P < 0.001], and activity dimension summary [P = 0.001]), and fitness (overall fitness [P = 0.039], cardiorespiratory fitness [P < 0.001], speed-agility [P = 0.001], and flexibility [P = 0.007]) compared with those in the control group. No differences were observed in BP, body mass, or quality of life. CONCLUSIONS: Spanish dance therapy may be effective to improve mobility, balance, and levels of physical activity and fitness in sedentary postmenopausal women.

Efectos de un programa de danzaterapia en la composición corporal y calidad de vida de mujeres mayores españolas con sobrepeso.

Objetivo: este estudio tuvo como objetivo probar la eficacia de un programa de danzaterapia en la composición corporal y calidad de vida en mujeres mayores de 65 años, que no realizan ejercicio físico de forma habitual. Métodos: cincuenta y dos mujeres sedentarias (edad media de 69,27 ± 3,85 años) fueron asignadas al azar para realizar un programa de danzaterapia (n = 27) o formar parte del grupo control (n = 25). El grupo de danza, participó durante ocho semanas en un programa de danza, tres sesiones semanales de 50 minutos cada una, basado en danza popular española (sevillanas) y ballet. Ambos grupos reciben información sobre la importancia de la alimentación y del ejercicio físico al comienzo y mitad del estudio. La circunferencia de la cintura, la presión arterial, el índice de masa corporal y la calidad de vida se evaluaron al inicio y después del tratamiento en ambos grupos. El análisis estadístico se realizó con un 2 × 2 ANOVA.Resultados: las mujeres del grupo de danza mostraron reducción significativa de la circunferencia de la cintura (p = 0,001) en comparación con las del grupo control. Los cambios en el IMC y la calidad de vida, aunque mejoraron en el grupo de danza, no alcanzaron significación estadística. Conclusión: la danzaterapia española es una forma de ejercicio físico eficaz para reducir la grasa visceral y prevenir comorbilidades en mujeres mayores, contribuyendo a cambiar estilos de vida poco saludables.

Health-Related Quality of Life, Gender, and Culture of Older People Users of Health Services in the Multicultural Landscape of the City of Ceuta (Spain): A Cross-Sectional Study.

INTRODUCTION: Perceptions of health-related quality of life (HRQOL) are influenced by sociodemographic variables and by cultural-religious concepts of health, disease, and old age, among others. PURPOSE: To assess the HRQOL of older people in a population with a long history of multiculturalism, the city of Ceuta (Spain), and to compare the results with Spanish reference values. METHOD: A total of 372 individuals (55.4% females) were interviewed using the Spanish version of the Short Form-36 questionnaire. The subjects' mean age was 70.9 (SD = 5) years: 253 were Christians, 93 Muslims, and 26 Jews, representing the proportions in the overall population of these cultural-religious groups. RESULTS: HRQOL differs according to the cultural-religious affiliation, which specifically affects social and psychological dimensions. DISCUSSION AND CONCLUSIONS: All groups obtained lower social function scores than the reference values, especially the Muslim and Jewish groups. IMPLICATIONS FOR PRACTICE: Health care providers may consider integrating culturally sensitive interventions to improve HRQOL.

[Effects of a dance therapy programme on quality of life, sleep and blood pressure in middle-aged women: A randomised controlled trial]. / Efectos de un programa de terapia de baile en la calidad de vida, el sueño y la presión arterial en mujeres de mediana edad: un ensayo controlado aleatorizado.

BACKGROUND AND OBJECTIVE: Evidence suggests that dance therapy may have positive effects in areas such as cardiovascular parameters and sleep. The aim of the present study is to explore whether a dance therapy programme improves sleep and blood pressure in a population of middle-aged pre-hypertensive and hypertensive women. METHODS: A randomised controlled trial was conducted, in which participants were assigned to one of 2 groups: standard care (with usual activities and medication) or dance therapy (in which the participants followed a dance therapy programme, in addition to their medication). The intervention was an 8-week, 3-times-per-week, progressive and specific group dance-training programme. The dance steps were specifically designed to improve balance by shifting the body and relocating the centre of gravity. The main measures obtained were blood pressure, sleep quality and quality of life, measured by the Pittsburgh Sleep Quality Index and the European Quality of Life Questionnaire. RESULTS: Sixty-seven pre-hypertensive and hypertensive middle-aged women were randomised to either an intervention group (n=35) or a control group (n=32) after baseline testing. The intervention group reported a significant improvement in blood pressure values (P<.01), as well as in sleep quality (P<.05) and quality of life (P<.001), compared to the control group. CONCLUSION: The dance therapy programme improved blood pressure, sleep and quality of life in pre-hypertensive and hypertensive middle-aged women, and constitutes an interesting basis for larger-scale research.

[The emotional impact of a hospital]. / El impacto emotivo del hospital.

In light of the challenge to offer future nurses a quality university education, the authors identify and evaluate the diverse activities which nurses carry out during their clinical stays, which cause a major emotional impact; therefore, these require greater attention, more knowledge and psychological resources which will aid them to successfully comply with this important aspect of their careers. With this goal in mind, the authors complied an inventory of specific stress factors for our context which was applied to a sample of 87 students at the school of nursing in Melilla. The results enabled the authors to establish a hierarchal order among the clinical experiences evaluated as having a greater stress load. These are those experiences, in descending order: terminal phase patients and death, tolerating external suffering, and hospital environment followed by oncology patients, psychiatric patients, tolerating aggressiveness, and infectious diseases. In light of the results, the authors offer some suggestions for the design of an operational program which shall mitigate and prevent as is possible the emotional impact of stress caused by clinical experiences.

OVERWEIGHT OBESITY AND CARDIOVASCULAR RISK IN MENOPAUSAL TRANSITION.

INTRODUCTION: the hormonal decline that is characteristic of the menopause, in conjunction with the associated weight gain, is considered a determinant factor of cardiovascular risk. OBJETIVE: to examine weight status in relation to clinical symptoms during the menopausal transition, in women referred from primary care to an endocrinology specialist, to determine potential cardiovascular risk profiles. METHOD: observational analytic cross-sectional study, conducted with data from medical records created at time of referral. STUDY POPULATION: 805 women aged 40 years or older, a sufficient number of subjects and medical records for cardiovascular risk to be estimated. RESULTS: hierarchic cluster analysis distinguished four clusters. The prevalence of obesity in each one exceeded 60%. The highest mean cardiovascular risk was observed in women who were older and presented obesity and hypertension. In younger age groups, the risk was low, rising to levels similar to those of the older women by the age of 65 years. CONCLUSION: these results suggest that preventive and therapeutic monitoring of obesity and modifiable risk factors should be conducted during the menopausal transition, to reduce the risk attributable to these factors, a risk that increases with time.

Introducción: el declive hormonal característico de la menopausia, junto al aumento ponderal añadido, está considerado como un factor determinante de riesgo cardiovascular. Propósito: examinar la situación ponderal en relación con la sintomatología clínica, durante la transición menopáusica, en mujeres derivadas desde atención primaria a la especialidad de endocrinología, para describir los posibles perfiles de riesgo cardiovascular. Método: se realizó un diseño observacional, analítico, de corte transversal, con los datos registrados en las historias clínicas en el momento de la derivación. 805 mujeres con 40 y más años de edad disponían de los registros necesarios para la estimación del riesgo cardiovascular. Resultados: la agrupación jerárquica distingue cuatro grupos. La frecuencia de obesidad en todos ellos superó el 60%, observándose los mayores promedios de riesgo cardiovascular en las mujeres de mayor edad y elevada frecuencia de obesidad e hipertensión arterial. En los grupos de menor edad, la estimación del riesgo fue baja, incrementándose hasta niveles similares a los de mayor edad, al proyectarlo a 65 años. Conclusión: estos resultados sugieren la necesidad de un seguimiento preventivo y terapéutico de la obesidad y los factores de riesgo modificables durante la transición menopáusica, para reducir el riesgo atribuible a dichos factores con el paso de los años.