Metabolic Syndrome, depression and patient safety culture in Mexican resident physicians

Background: Medical residence can affect the well-being and health of resident physicians (rp), which are directly related to the quality of medical care and patient safety. El objective was to identify the prevalence of metabolic syndrome (MetS), depressive symptoms, and evaluate the culture of patient safety in resident physicians. Methods: Cross-sectional analytical survey of 106 physicians residing in 13 medical specialties of a public hospital in Mexico. MetS was defined according to who criteria and depressive symptoms using the cesd-r scale; the culture of patient safety was evaluated with the Spanish version of the Hospital Survey on Patient safety. Results: 53.7% had a combined prevalence of overweight/obesity and insulin resistance was found in 33%. 8.5% of rp had prediabetes and 2.5% diabetes. 23.6% of the sample presented two MetS components. The prevalence of MetS was 8.5% and depressive symptoms were found in 21.7% of rp. The evaluation of the culture of patient safety showed strength in the dimensions of teamwork in the unit-service, organizational learning- continuous improvement, expectations and actions of the direction and frequency of reported events, perception of patient safety culture was found in 8/10 rp. Conclusions: A high prevalence of cardiometabolic alterations and depressive symptoms was found in Mexican rp. It is necessary to promote self-care for health and to strengthen the concept of patient safety culture among resident physicians

Metabolic Syndrome, depression and patient safety culture in Mexican resident physicians

Background: Medical residence can affect the well-being and health of resident physicians (rp), which are directly related to the quality of medical care and patient safety. El objective was to identify the prevalence of metabolic syndrome (MetS), depressive symptoms, and evaluate the culture of patient safety in resident physicians. Methods: Cross-sectional analytical survey of 106 physicians residing in 13 medical specialties of a public hospital in Mexico. MetS was defined according to who criteria and depressive symptoms using the cesd-r scale; the culture of patient safety was evaluated with the Spanish version of the Hospital Survey on Patient safety. Results: 53.7% had a combined prevalence of overweight/obesity and insulin resistance was found in 33%. 8.5% of rp had prediabetes and 2.5% diabetes. 23.6% of the sample presented two MetS components. The prevalence of MetS was 8.5% and depressive symptoms were found in 21.7% of rp. The evaluation of the culture of patient safety showed strength in the dimensions of teamwork in the unit-service, organizational learning- continuous improvement, expectations and actions of the direction and frequency of reported events, perception of patient safety culture was found in 8/10 rp. Conclusions: A high prevalence of cardiometabolic alterations and depressive symptoms was found in Mexican rp. It is necessary to promote self-care for health and to strengthen the concept of patient safety culture among resident physicians

A high dietary glycemic index increases total mortality in a Mediterranean population at high cardiovascular risk

OBJECTIVE: Different types of carbohydrates have diverse glycemic response, thus glycemic index (GI) and glycemic load (GL) are used to assess this variation. The impact of dietary GI and GL in all-cause mortality is unknown. The objective of this study was to estimate the association between dietary GI and GL and risk of all-cause mortality in the PREDIMED study. MATERIAL AND METHODS: The PREDIMED study is a randomized nutritional intervention trial for primary cardiovascular prevention based on community-dwelling men and women at high risk of cardiovascular disease. Dietary information was collected at baseline and yearly using a validated 137-item food frequency questionnaire (FFQ). We assigned GI values of each item by a 5-step methodology, using the International Tables of GI and GL Values. Deaths were ascertained through contact with families and general practitioners, review of medical records and consultation of the National Death Index. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) and their 95% CI for mortality, according to quartiles of energy-adjusted dietary GI/GL. To assess repeated measures of exposure, we updated GI and GL intakes from the yearly FFQs and used Cox models with time-dependent exposures. RESULTS: We followed 3,583 non-diabetic subjects (4.7 years of follow-up, 123 deaths). As compared to participants in the lowest quartile of baseline dietary GI, those in the highest quartile showed an increased risk of all-cause mortality [HR = 2.15 (95% CI: 1.15-4.04); P for trend  = 0.012]. In the repeated-measures analyses using as exposure the yearly updated information on GI, we observed a similar association. Dietary GL was associated with all-cause mortality only when subjects were younger than 75 years. CONCLUSIONS: High dietary GI was positively associated with all-cause mortality in elderly population at high cardiovascular risk

A high dietary glycemic index increases total mortality in a Mediterranean population at high cardiovascular risk

Objective: Different types of carbohydrates have diverse glycemic response, thus glycemic index (GI) and glycemic load (GL) are used to assess this variation. The impact of dietary GI and GL in all-cause mortality is unknown. The objective of this study was to estimate the association between dietary GI and GL and risk of all-cause mortality in the PREDIMED study. Material and Methods: The PREDIMED study is a randomized nutritional intervention trial for primary cardiovascular prevention based on community-dwelling men and women at high risk of cardiovascular disease. Dietary information was collected at baseline and yearly using a validated 137-item food frequency questionnaire (FFQ). We assigned GI values of each item by a 5-step methodology, using the International Tables of GI and GL Values. Deaths were ascertained through contact with families and general practitioners, review of medical records and consultation of the National Death Index. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) and their 95% CI for mortality, according to quartiles of energy-adjusted dietary GI/GL. To assess repeated measures of exposure, we updated GI and GL intakes from the yearly FFQs and used Cox models with time-dependent exposures. Results: We followed 3,583 non-diabetic subjects (4.7 years of follow-up, 123 deaths). As compared to participants in the lowest quartile of baseline dietary GI, those in the highest quartile showed an increased risk of all-cause mortality [HR = 2.15 (95% CI: 1.15–4.04); P for trend = 0.012]. In the repeated-measures analyses using as exposure the yearly updated information on GI, we observed a similar association. Dietary GL was associated with all-causemortality only when subjects were younger than 75 years. Conclusions: High dietary GI was positively associated with all-cause mortality in elderly population at high cardiovascular risk

Effect of a mediterranean diet intervention on dietary glycemic load and dietary glycemic index: the predimed study

Objective. To compare the one year effect of two dietary interventions with MeDiet on GL and GI in the PREDIMED trial. Methods. Participants were older subjects at high risk for cardiovascular disease. This analysis included 2866 nondiabetic subjects. Diet was assessed with a validated 137-item food frequency questionnaire (FFQ). The GI of each FFQ item was assigned by a 5-step methodology using the International Tables of GI and GL Values. Generalized linear models were fitted to assess the relationship between the intervention group and dietary GL and GI at one year of follow-up, using control group as reference. Results. Multivariate-adjusted models showed an inverse association between GL and MeDiet + extra virgin olive oil (EVOO) group: β = -8.52 (95% CI: -10.83 to -6.20) and MeDiet + Nuts group: β = -10.34 (95% CI: -12.69 to -8.00), when comparing with control group. Regarding GI, β = -0.93 (95% CI: -1.38 to -0.49) for MeDiet + EVOO, β = -1.06 (95% CI: -1.51 to -0.62) for MeDiet + Nuts when comparing with control group. Conclusion. Dietary intervention with MeDiet supplemented with EVOO or nuts lowers dietary GL and GI

Índice glucémico y carga glucémica de la dieta mediterránea: Relación con el cáncer de mama y la mortalidad en el estudio Predimed

Los hidratos de carbono (HC) digeribles de los alimentos tienen diferentes efectos en el incremento de los niveles de glucosa postprandial. Para poder medir este incremento, se han desarrollado los conceptos de índice glucémico (IG) y carga glucémica (CG) que evalúan la calidad de los HC digeribles de los alimentos en términos de respuesta glucémica. Con los valores de IG y CG de los alimentos, se puede estimar la media individual diaria o IG de la dieta (IGD), que es un indicador de la calidad de los HC consumidos en términos de respuesta glucémica, y la CG de la dieta (CGD), que integra tanto la cantidad como la calidad de los HC consumidos diariamente por un individuo. En la actualidad, la investigación se ha extendido al papel del IGD y CGD en la prevención y estudio de distintas enfermedades. No obstante, la evidencia es inconsistente y es necesario realizar más estudios epidemiológicos en distintas poblaciones para lograr la inclusión de estos índices en las recomendaciones dietéticas. La Dieta Mediterránea (Diet Med) es un patrón de dieta saludable y sostenible que se ha relacionado con un menor riesgo de enfermedades crónico-degenerativas. Una gran proporción de alimentos que conforman la base de la Diet Med tienen un bajo IG, como las frutas, verduras, legumbres y los frutos secos. Algunos ensayos clínicos como el estudio “PREvención con DIeta MEDiterránea” (PREDIMED), han sido cruciales para demostrar los beneficios del patrón de Diet Med en adultos mayores con riesgo cardiovascular. Cuando el ensayo clínico terminó formalmente, ofreció la oportunidad de dar seguimiento a largo plazo a una cohorte observacional de sujetos con alto riesgo cardiovascular en un contexto Mediterráneo. Desde entonces, el estudio PREDIMED ha sido de gran utilidad para el estudio de distintos objetivos secundarios, demostrando los beneficios de la Diet Med en la disminución de riesgo de distintas enfermedades como la diabetes, la hipertensión o la depresión. No obstante, en el estudio PREDIMED, no se había evaluado la relación de la calidad y cantidad de los HC con la Diet Med, ni la asociación del IGD o CGD de la dieta de esta población en riesgo cardiovascular con la incidencia de cáncer de mama, enfermedades cardiovasculares o mortalidad total, por lo que surgió la hipótesis de evaluar dichas asociaciones a partir de los datos del estudio PREDIMED. El objetivo de la presente tesis doctoral fue determinar el papel del IGD y CGD de la Diet Med sobre la incidencia de cáncer de mama y la mortalidad en adultos mayores con factores de riesgo cardiovascular de la cohorte del estudio PREDIMED. Con este fin, se establecieron tres objetivos específicos: 1) Identificar el efecto de la intervención con Diet Med suplementada con aceite de oliva virgen (Diet Med + AOV) o frutos secos (Diet Med + FS) frente a una dieta control sobre el IGD y CGD después de un año de seguimiento en el estudio PREDIMED; 2) Evaluar prospectivamente la asociación entre el IGD y CGD y la incidencia de cáncer de mama en una cohorte de mujeres posmenopáusicas con presencia de factores de riesgo cardiovascular y 3) Valorar prospectivamente la asociación entre el IGD y CGD y la incidencia de eventos cardiovasculares mayores y la mortalidad total en una cohorte de sujetos con factores de riesgo cardiovascular.Tesis Univ. Granada. Programa de Doctorado en: Nutrición HumanaEl estudio PREDIMED ha sido financiado por el organismo de financiación oficial para la Investigación Biomédica del gobierno español, el Instituto de Salud Carlos III, a través de subvenciones otorgadas a las redes de investigación desarrolladas específicamente para el ensayo clínico [RTIC G03/140, a Emilio Ros; RTIC RD 06/0045, a Miguel Ángel Martínez González] y a través del Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn); Centro Nacional de Investigaciones Cardiovasculares [CNIC 06/2007]; Fondo de Investigación Sanitaria–Fondo Europeo de Desarrollo Regional [PI04-2239, PI 05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407, PI10/02658, PI11/01647, PI11/01791, P11/02505 y PI13/01090]; Ministerio de Ciencia e Innovación [AGL-2009-13906-C02 y AGL2010-22319-C03]; Fundación Mapfre 2010; Agencia Canaria de Investigación, Innovación y Sociedad de la Información-EU FEDER [PI 2007/050]; Consejería de Salud de la Junta de Andalucía [PI0105/2007]; Área de Salud Pública del Departamento de Salud Generalitat de Catalunya; Generalitat Valenciana [ACOMP06109, GVACOMP2010-181, GVACOMP2011-151, CS2010-AP-111, y CS2011-AP-042]; Gobierno de Navarra [P27 / 2011]; Gobierno de las Islas Baleares y fondos FEDER [35/2011]

Valoración de la ingesta de bebidas y el estado de hidratación

Water is the main constituent of the human body. It is involved in practically all its functions. It is particularly important for thermoregulation and in the physical and cognitive performance. Water balance reflects water intake and loss. Intake of water is done mainly through consumption of drinking water and beverages (70 to 80%) plus water containing foods (20 to 30%). Water loss is mainly due to excretion of water in urine, faeces and sweat. The interest in the type and quantity of beverage consumption is not new, and numerous approaches have been used to assess beverage intake, but the validity of these approaches has not been well established. There is no standardized questionnaire developed as a research tool for the evaluation of water intake in the general population. Sometimes, the information comes from different sources or from different methodological characteristics which raises problems of the comparability. In the European Union, current epidemiological studies that focus exclusively on beverage intake are scarce. Biomarkers of intake are able to objectively assess dietary intake/status without the bias of self-reported dietary intake errors and also overcome the problem of intra-individual diet variability. Furthermore, some methods of measuring dietary intake used biomarkers to validate the data it collects. Biological markers may offer advantages and be able to improve the estimates of dietary intake assessment, which impact into the statistical power of the study. There is a surprising paucity of studies that systematically examine the correlation of beverages intake and hydration biomarker in different populations. A pilot investigation was developed to evaluate the comparative validity and reliability of newly developed interactive multimedia (IMM) versions compared to validated paper-administered (PP) versions of the Hedrick et al. beverage questionnaire. The study showed that the IMM appears to be a valid and reliable measure to assess habitual beverage intake. Similar study was developed in China, but in this case, the use of Smartphone technology was employed for beverage assessment. Conclusion: The methodology for measuring beverage intake in population studies remains controversial. There are few validated and reproducible studies, so there is still lacking an ideal method (ie, short, easy to administer, inexpensive and accurate) in this regard. Clearly, this is an area of scientific interest that is still in development and seems to be very promising for improving health research.El agua es el principal constituyente del cuerpo humano. Está implicado en prácticamente la totalidad de sus funciones. Es especialmente importante en la termorregulación y en el rendimiento físico y cognitivo. El balance de agua refleja la ingesta y la pérdida de agua. La ingesta se realiza principalmente a través del consumo de agua potable y de bebidas (70 a 80%) más el agua que contienen los alimentos (20 a 30%). La pérdida de agua se realiza gracias a su excreción a través de la orina, las heces y el sudor. El interés por el tipo y la cantidad de bebidas consumidas no es nuevo, y numerosos enfoques se han utilizado para evaluarla, pero la validez de estos enfoques no se han establecido correctamente. Aún no existe, en población general, un cuestionario estandarizado desarrollado como herramienta de investigación para la evaluación de la ingesta de agua. El uso de información de diferentes fuentes y diferentes características metodológicas plantea problemas de comparabilidad entre estudios. En Europa los estudios epidemiológicos actuales que se centran exclusivamente en el consumo de bebidas son escasos. Los biomarcadores de ingesta permiten evaluar objetivamente la ingesta dietética sin el sesgo producido por los errores del auto-reporte. Además permiten superar el problema de la variabilidad intra-individual. Algunos métodos para medir ingesta alimentaria utilizan biomarcadores para validar los datos que recoge. Los marcadores biológicos ofrecen ventajas y son capaces de mejorar las estimaciones de la evaluación de ingesta dietética. Sin embargo, existen muy pocos estudios que examinen sistemáticamente la correlación entre la ingesta de bebidas y los biomarcadores de hidratación en diferentes poblaciones. Utilizando el cuestionario de bebidas de Hedrick y col. se realizó un estudio piloto para evaluar la validez y fiabilidad de un modelo multimedia interactivo (IMM) y para compararlo con una versión en papel-auto administrado (PP). El estudio mostró que el IMM parece ser un modelo válido y fiable para evaluar la ingesta de bebidas habitual. Un estudio similar se realizó en China, pero en este caso, se empleó para evaluar ingesta de bebidas la tecnología Smartphone. Conclusión: La metodología para valorar el consumo de bebidas en estudios poblacionales sigue siendo un tema controvertido. Existen pocos estudios validados y reproducibles, por lo que todavía no se dispone de un método ideal (corto, fácil de administrar, económico y preciso). Esta es un área de interés científico que aún está en desarrollo y que parece ser muy prometedora para mejorar las investigaciones en el área de la salud.Sin financiación1.497 JCR (2015) Q3, 60/80 Nutrition & DieteticsUE

Glycemic index, glycemic load, and metabolic syndrome in Mexican adolescents: a cross-sectional study from the NHNS-2012

Abstract Background The role of dietary glycemic index (GI) and dietary glycemic load (GL) on metabolic syndrome (MetS) in youth populations remains unclear. The aim of the present study was to evaluate the association among dietary GI, dietary GL, and MetS and its components in Mexican adolescents. Methods This study was conducted within the framework of the National Health and Nutrition Survey 2012, a cross-sectional, probabilistic, population-based survey with a multistage stratified cluster sampling design. We analyzed a sample of 1346 subjects aged 12–19 years, representing 13,164,077 adolescents. Dietary habits were assessed through a validated semiquantitative food-frequency questionnaire. We assigned GI values using the International Tables of GI values. We defined MetS according to the International Diabetes Federation criteria developed for adolescents. Multiple logistic regression models were used to estimate odds ratios (ORs) and their 95% confidence intervals (CIs) to evaluate the association between categories of dietary GI and GL and the prevalence of MetS and its components. Results We observed no associations between dietary GI or GL and MetS prevalence. Female adolescents in the highest category of dietary GI had higher odds of abnormal blood pressure (OR = 3.66; 95% CI, 1.46–9.22; P for trend = 0.012). A high dietary GL was also associated with higher odds of abnormal blood pressure in female adolescents (OR = 5.67; 95% CI, 1.84–17.46; P for trend = 0.003). Conclusions We found higher odds of abnormal blood pressure for female adolescents with a high dietary GI and dietary GL

Metabolic Syndrome, depression and patient safety culture in Mexican resident physicians

Background: Medical residence can affect the well-being and health of resident physicians (rp), which are directly related to the quality of medical care and patient safety. El objective was to identify the prevalence of metabolic syndrome (MetS), depressive symptoms, and evaluate the culture of patient safety in resident physicians. Methods: Cross-sectional analytical survey of 106 physicians residing in 13 medical specialties of a public hospital in Mexico. MetS was defined according to who criteria and depressive symptoms using the cesd-r scale; the culture of patient safety was evaluated with the Spanish version of the Hospital Survey on Patient safety. Results: 53.7% had a combined prevalence of overweight/obesity and insulin resistance was found in 33%. 8.5% of rp had prediabetes and 2.5% diabetes. 23.6% of the sample presented two MetS components. The prevalence of MetS was 8.5% and depressive symptoms were found in 21.7% of rp. The evaluation of the culture of patient safety showed strength in the dimensions of teamwork in the unit-service, organizational learning- continuous improvement, expectations and actions of the direction and frequency of reported events, perception of patient safety culture was found in 8/10 rp. Conclusions: A high prevalence of cardiometabolic alterations and depressive symptoms was found in Mexican rp. It is necessary to promote self-care for health and to strengthen the concept of patient safety culture among resident physicians

Dietary Carbohydrates and Insulin Resistance in Adolescents from Marginalized Areas of Chiapas, México

Evidence of the role that dietary carbohydrates (total carbohydrates, dietary fiber, total sugars, dietary glycemic index (GI) and glycemic load (GL)) exerts on insulin levels in adolescents is controversial. Thus, the aim of this study was to assess the association between dietary carbohydrates and insulin resistance in adolescents from Chiapas, México. A cross-sectional study was conducted in 217 adolescents. Sociodemographic, anthropometric, dietary and biochemical data were obtained. Total carbohydrates, dietary fiber, total sugars, dietary GI and GL were calculated from 24 h recalls. Two validated cut-off points for the homeostasis model assessment of insulin resistance (HOMA-IR) were used as surrogates of insulin resistance. Fasting insulin levels ≥ 14.38 μU/mL were considered as abnormal. Multivariate logistic regression models were fitted to assess the association between tertiles of dietary carbohydrates and insulin resistance or hyperinsulinemia. In our study, adolescents with the highest dietary fiber intake had lower odds of HOMA-IR > 2.97 (OR = 0.34; 95% CI: 0.13–0.93) when adjusted for sex, age, body fat percentage and saturated fatty acids intake. No significant associations were found for the rest of the carbohydrate variables. In summary, high-fiber diets reduce the probability of insulin resistance in adolescents from marginalized areas of Chiapas, México