Associations of serum phthalate metabolites with thyroid hormones in GraMo cohort, Southern Spain

These results would not have been achieved without the selfless collaboration of the staff from Santa Ana and San Cecilio Hospitals and the participants who took part in the study. Dr. JP Arrebola is under contract within the Ramon y Cajal Program (RYC-2016-20155, Ministerio de Economia, Industria y Competitividad, Spain) and Dr. C Donat-Vargas is under contract within the Atraccion de Talento (from the community of Madrid, Spain) . This study was supported by research grants from Instituto de Salud Carlos III (PI20/01568, PI16/01858) .The general population is continuously exposed to phthalates via various consumer products. Epidemiological research relating phthalate exposure to thyroid function during non-developmental periods is limited. This study aimed to investigate the associations between specific serum phthalate metabolites and indicators of thyroid function in adults. We measured 10 serum phthalate metabolites and thyroid hormones - total triiodothymnine (TT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) - in a subsample of 207 adults from the GraMo cohort. This subsample was made up of men and women (in equal proportions) of middle age (49 +/- 17 years) and from Southern Spain (province of Granada). Data on age, sex, body mass index, residence area, tobacco use, alcohol consumption and attained education were obtained from a questionnaire. Phthalate metabolites were log-transformed and categorized into tertiles. Cross-sectional associations of each metabolite with thyroid hormones were analyzed using multivariable-adjusted linear regression models. The mixture effect of metabolite phthalates was assessed using weighted quantile sum regression. After multivariable-adjustment, the following phthalate metabolites were significantly associated with TT3 in a dose-response manner: MMP (beta = 0.90: 95% confidence interval 0.68,1.12), MEP (beta = 0.67: 0.44, 0.90), MiBP (beta = 0.49: 0.21, 0.77), MiDP (beta = 0.27: 0.03, 0.52), MBzP (beta = 0.51: 0.28, 0.73), MEHP (beta = -0.59: -0.82, -0.35) and MiNP (beta = -0.43: -0.71, -0.14), when comparing highest vs. lowest exposed. The sum of all metabolites was also linked to FT4 levels. No significant associations were observed for TSH except for MiNP. Although phthalate metabolites with different molecular weight showed opposite associations, overall metabolite concentrations seem to associate with increased TT3 and FT4 serum levels. The cross-sectional nature of this analysis limits causal inference.Ramon y Cajal Program (Ministerio de Economia, Industria y Competitividad, Spain) RYC-2016-20155Instituto de Salud Carlos III European Commission PI20/01568 PI16/0185

Pengembangan Media Pembelajaran Fisika Berbasis Multimedia Interaktif Terintegrasi Dengan Lks Pokok Bahasan Hukum Newton Tentang Gerak Kelas X Sma/ma

Penelitian ini bertujuan untuk: (1) mengembangkan media pembelajaran fisika berbasis multimedia interaktif dengan menggunakan software adobe flash dan XML pada pokok bahasan Hukum Newton tentang gerak; (2) mengetahui kelayakan media pembelajaran fisika berbasis multimedia interaktif menggunakan software adobe flash dan XML pada pokok bahasan Hukum Newton tentang gerak yang dikembangkan; (3) mengetahui pencapaian hasil belajar siswa setelah mengikuti proses pembelajaran menggunakan media pembelajaran fisika berbasis multimedia interaktif terintegrasi dengan lembar kerja siswa hasil pengembangan. Penelitian ini merupakan penelitian dan pengembangan (R&D) yang mengacu pada model yang dikemukakan oleh Sugiyono. Kelayakan media divalidasi oleh ahli materi, ahli media dan praktisi. Subjek Ujicoba penelitian ini adalah siswa kelas X SMA N 3 Sukoharjo tahun akademik 2013/2014 sebanyak 43 siswa dengan rincian 10 siswa sebagai subjek ujicoba produk dan 33 siswa sebagai subjek ujicoba pemakaian. Berdasarkan hasil analisis data disimpulkan: (1) media pembelajaran fisika berbasis multimedia interaktif terintegrasi dengan lembar kerja siswa berhasil dikembangkan dengan menggunakan Software Adobe Flash dan XML dengan hasil produk dikemas dalam keping CD yang didalamnya berisi software utama media dan beberapa file pendukung dari media tersebut. Media disajikan dengan dua pembagian materi yaitu materi pembelajaran dan materi penjelasan yang diproteksi serta berisi bank soal yang dapat diupdate. Media pembelajaran dikembangkan dengan mengacu pada langkah yang diberikan oleh Sugiyono dan telah tervalidasi; (2) media pembelajaran fisika berbasis multimedia interaktif terintegrasi dengan lembar kerja siswa yang dikembangkan layak digunakan dengan kategori baik; (3) pencapaian hasil belajar peserta didik setelah mengikuti proses pembelajaran menggunakan media pembelajaran fisika berbasis multimedia interaktif terintegrasi dengan lembar kerja siswa mengalami peningkatan pada aspek pengetahuan

Effect of different types of exercise on health-related quality of life during and after cancer treatment: a protocol for a systematic review and network meta-analysis

INTRODUCTION: Cancer (and survival) is known to affect the quality of life. Strategies as physical activity and exercise during and after cancer may improve health-related qualify of life (HRQOL) outcomes and are, therefore, of clinical and public health importance. To the best of our knowledge, comparative evidence of the effect of the different types of exercise on improving HRQOL in cancer patients has not been synthesised thus far. We aim to conduct a systematic review and network meta-analysis in order to synthesise all available evidence regarding the effect of different types of exercise interventions on HRQOL during and after cancer treatment. METHODS AND ANALYSIS: MEDLINE (via PubMed), Web of Science, Embase, The Cochrane Library and SPORTDiscus will be searched from inception to December 2018 for relevant randomised controlled trials (RCTs) and non-RCTs. Studies assessing physical activity and exercise interventions in cancer patients (during treatment) and survivors (after treatment) will be selected. Two independent reviewers will identify eligible studies. After quality appraisal and data extraction, we will conduct meta-analyses for outcomes of interest, including data from mental and physical dimensions of cancer-specific and/or generic HRQOL questionnaires. Risk of bias assessments will be completed using the Quality Assessment Tool for Quantitative Studies. Study heterogeneity will be measured by the I2 statistic. Bayesian (and traditional approach) network meta-analysis will be performed when possible to determine the comparative effect of the different physical activity or exercise interventions. ETHICS AND DISSEMINATION: This systematic review and network meta-analysis will synthesise evidence on the effect of different types of exercise interventions on HRQOL during and after cancer treatment. The results will be disseminated by publication in a peer-reviewed journal and through scientific conferences and symposia. Ethical approval will not be required because the data used for this work will be exclusively extracted from published studies

Public healthcare costs associated with long-term exposure to mixtures of persistent organic pollutants in two areas of Southern Spain: A longitudinal analysis

Background: Polychlorinated biphenyls and organochlorine pesticides are persistent organic pollutants (POPs) that had been banned or restricted in many countries, including Spain. However, their ubiquity still poses environmental and human health threats. Objective: To longitudinally explore public healthcare costs associated with long-term exposure to a mixture of 8 POPs in a cohort of residents of two areas of Granada Province, Southern Spain. Methods: Longitudinal study in a subsample (n = 385) of GraMo adult cohort. Exposure assessment was performed by analyzing adipose tissue POP concentrations at recruitment. Average primary care (APC) and average hospital care (AHC) expenditures of each participant over 14 years were estimated using the data from their medical records. Data analyses were performed by robust MM regression, weighted quantile sum regression (WQS) and G-computation analysis. Results: In the adjusted robust MM models for APC, most POPs showed positive beta coefficients, being Hexachlorobenzene (HCB) significantly associated (beta 1.87; 95% Confidence interval (95%CI): 0.17, 3.57). The magnitude of this association increased (beta: 3.72; 95%CI: 0.80, 6.64) when the analyses were restricted to semirural residents, where p-HCH was also marginally-significantly associated to APC (beta: 3.40; 95%CI: -0.10, 6.90). WQS revealed a positive but non-significant mixture association with APC (beta: 0.14; 95%CI: -0.06, 0.34), mainly accounted for by p-HCH (54%) and HCB (43%), that was borderline-significant in the semi-rural residents (beta: 0.23; 95%CI: -0.01, 0.48). No significant results were observed in G-Computation analyses. Conclusion: Long-term exposure to POP mixtures might represent a modifiable factor increasing healthcare costs, thus affecting the efficiency of the healthcare systems. However, and owing the complexity of the potential causal pathways and the limitations of the present study, further research is warranted to fully elucidate ascertain whether interventions to reduce human exposure should be considered in healthcare policies.CIBER de Epidemiologia y Salud Publica (CIBERESP), Instituto de Salud Carlos III, Spain PI16/01858 PI18/01573 PI20/01568European CommissionRamon y Cajal Program (Ministerio de Economia, Industria y Competitividad, Spain) RYC-2016-20,155PFIS (Instituto de Salud Carlos III, Spain) FI17/00310Universidad de Granada/CBU

Quality of family life in people with acquired brain injury: The case of the Nueva Opción association

El impacto del daño cerebral adquirido supone una pérdida de calidad de vida relacionada con la salud y la vida cotidiana, laboral y comunitaria. Además, sus consecuencias también repercuten en la red familiar. Desde la asociación Nueva Opción se pretende describir la calidad de vida en el entorno familiar de las personas con daño cerebral adquirido, así como determinar la satisfacción que experimentan las familias frente a las secuelas, contemplando la variable de edad y sexo. Para su análisis, se ha adaptado la Escala de calidad de vida familiar a la población atendida, midiendo así las relaciones intrafamiliares, el estado de salud y sus relaciones sociales y de ocio, entre otras, con el objetivo de determinar los apoyos que la persona con daño cerebral adquirido y su familia requieren para lograr su mejor inclusión y desarrollo. Como resultado principal cabe destacar que las variables sexo y edad implican distinción entre los sentimientos expresados

Composición química IGF para el tratamiento y prevención de enfermedades neurodegenerativas

Traducción de Patente Europea E03744388 (fecha de solicitud, 21/02/2003).-- Prioridad: ES20020228200200491.-- Titulares: Consejo Superior de Investigaciones Científicas (CSIC), Universidad Complutense de Madrid (UCM).La invención se refiere a nuevas composiciones terapéuticas de administración lenta de IGF-I, a un procedimiento de preparación y obtención de las mismas y a su empleo para la elaboración de medicamentos para el tratamiento y prevención de enfermedades neurodegenerativas como, entre otras, la enfermedad de Alzheimer o la ataxia cerebelar.Estas composiciones se corresponden con microesferas de tamaño menor de 5 micrometros, entre otras características, y con cápsulas de implantación subcutánea.Peer reviewe

Spanish Version of the Death Attitude Profile-Revised. Translation and Validation Into Spanish

The Death Attitude Profile-Revised (DAP-R) was developed in English-speaking cultures with the aim of measuring attitudes towards death. This measure consists of 32 items, grouped into five factors (Fear of Death, Avoidance of Death, Neutral Acceptance, Approach Acceptance, and Escape Acceptance). The DAP-R was translated and adapted to Spanish (DAP-RSp), and the psychometric properties were analyzed accross a general sample. The face validity was evaluated by 20 experts in palliative care. N = 417 (X = 39.06 years) took part in the validation. DAP-RSp showed adequate internal consistency (Cronbach's alpha ranging from 0.67 for Neutral Acceptance to 0.95 for Escape a Acceptance, and 0.88 for the total), a multitrait scaling analysis and a confirmatory factor analysis reproduced the five dimensions of the original scale. The Spanish version of the DAP-R can be used as a valid scale to assess attitudes towards death in Spanish speaking population.Depto. de Personalidad, Evaluación y Psicología ClínicaFac. de PsicologíaTRUEpu

Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review

Question: In intubated adult patients receiving mechanical ventilation, does multimodality respiratory physiotherapy prevent ventilator-associated pneumonia, shorten length of intensive care unit (ICU) stay, and reduce mortality? Design: A systematic review with meta-analysis of randomised controlled trials. Participants: Intubated adult patients undergoing mechanical ventilation who were admitted to an intensive care unit. Intervention: More than two respiratory physiotherapy techniques such as positioning or postural drainage, manual hyperinflation, vibration, rib springing, and suctioning. Outcomes measures: Incidence of ventilator-associated pneumonia (VAP), duration of ICU stay, and mortality. Results: Five trials were included in the meta-analysis. Random-effects models were used to calculate pooled weighted mean difference (WMD) for length of ICU stay and pooled risk ratio (RR) for incidence of VAP, and fixed-effects model was used to calculate pooled RR for mortality. The effect on the incidence of VAP was unclear (RR 0.73 in favour of multimodality respiratory physiotherapy, 95% CI 0.38 to 1.07). The effect on length of stay was also unclear (WMD –0.33 days shorter with multimodality respiratory physiotherapy, 95% CI –2.31 to 1.66). However, multimodality respiratory physiotherapy significantly reduced mortality (RR 0.75, 95% CI 0.58 to 0.92). Conclusion: Multimodality respiratory physiotherapy appeared to reduce mortality in ICU patients. It was unclear whether this occurred via a reduction in the incidence of VAP and/or length of stay because the available data provided very imprecise estimates of the effect of multimodality respiratory physiotherapy on these outcomes. These very imprecise estimates include the possibility of very worthwhile effects on VAP incidence and length of ICU stay; therefore, these outcomes should be the focus of further investigation in rigorous trials. Registration: PROSPERO CRD42018094202. [Pozuelo-Carrascosa DP, Torres-Costoso A, Alvarez-Bueno C, Cavero-Redondo I, López Muñoz P, Martínez-Vizcaíno V (2018) Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review. Journal of Physiotherapy 64: 222–228] Key words: Respiratory physical therapy, Meta-analysis, Mortality, Prevention, Ventilator-associated pneumoni

Associations of serum phthalate metabolites with thyroid hormones in GraMo cohort, Southern Spain.

The general population is continuously exposed to phthalates via various consumer products. Epidemiological research relating phthalate exposure to thyroid function during non-developmental periods is limited. This study aimed to investigate the associations between specific serum phthalate metabolites and indicators of thyroid function in adults. We measured 10 serum phthalate metabolites and thyroid hormones - total triiodothyronine (TT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) - in a subsample of 207 adults from the GraMo cohort. This subsample was made up of men and women (in equal proportions) of middle age (49 ± 17 years) and from Southern Spain (province of Granada). Data on age, sex, body mass index, residence area, tobacco use, alcohol consumption and attained education were obtained from a questionnaire. Phthalate metabolites were log-transformed and categorized into tertiles. Cross-sectional associations of each metabolite with thyroid hormones were analyzed using multivariable-adjusted linear regression models. The mixture effect of metabolite phthalates was assessed using weighted quantile sum regression. After multivariable-adjustment, the following phthalate metabolites were significantly associated with TT3 in a dose-response manner: MMP (β = 0.90: 95% confidence interval 0.68,1.12), MEP (β = 0.67: 0.44, 0.90), MiBP (β = 0.49: 0.21, 0.77), MiDP (β = 0.27: 0.03, 0.52), MBzP (β = 0.51: 0.28, 0.73), MEHP (β = -0.59: -0.82, -0.35) and MiNP (β = -0.43: -0.71, -0.14), when comparing highest vs. lowest exposed. The sum of all metabolites was also linked to FT4 levels. No significant associations were observed for TSH except for MiNP. Although phthalate metabolites with different molecular weight showed opposite associations, overall metabolite concentrations seem to associate with increased TT3 and FT4 serum levels. The cross-sectional nature of this analysis limits causal inference