Actividad física y cognición: inseparables en el aula

Tradicionalmente, la educación ha tendido a compartimentar el pensamiento abstracto, la emoción y la actividad física. Sin embargo, la evidencia neurocientífica sugiere que estos tres elementos están estrechamente vinculados con el proceso de aprendizaje. En la “Introducción” de este artículo se repasa el contexto actual: cómo la tradicional clase magistral relega a los estudiantes a un papel pasivo y sedentario que impide el movimiento físico; cómo en los colegios se van reduciendo las horas de recreo y suprimiendo las clases de educación física o aquellas asignaturas que involucran todo el cuerpo (teatro, música, actividades al aire libre), con lo cual se limita aún más la presencia de la actividad física en el entorno de aprendizaje. La evidencia neurocientífica sugiere que el sedentarismo no solo tiene un impacto nocivo en el bienestar físico, sino también en la salud cerebral. El ser humano está diseñado para moverse, para interrelacionarse con su medioambiente, con el movimiento: la actividad física es un factor clave que contribuye al funcionamiento saludable del cerebro. En la sección 2, “Aportes de la investigación neurocientífica”, las autoras presentan y analizan diversos estudios y metaanálisis que destacan la asociación positiva entre la actividad física y la cognición en estudiantes de Educación Primaria y Secundaria.  En estas investigaciones examinan este vínculo en tres niveles: el incremento de la vascularización (que incrementa el oxígeno y la glucosa en el cerebro); la liberación de neurotransmisores y el factor neurotrófico derivado del cerebro (BDNF en sus siglas en inglés) que favorecen la neurogénesis, la memoria, la atención y la motivación; y el desarrollo de circuitos neurales complejos relacionados con el movimiento y su interconexión con las funciones ejecutivas del cerebro. En la sección 3, “Discusión”, se repasan las limitaciones y las aplicaciones de la evidencia examinada. El artículo concluye con unas recomendaciones para que los docentes puedan integrar la actividad física en el aula o en el entorno de aprendizaje. Teniendo en cuenta esta evidencia y la realidad educacional actual, que generalmente considera al aprendizaje como una actividad abstracta, divorciada de nuestra corporalidad, las autoras argumentan la necesidad de incorporar la actividad física al entorno de aprendizaje

Changes in greenhouse gas emissions from food supply in the United Kingdom

Food systems contribute 23–42% of global greenhouse gas emissions. Reducing food system emissions is an essential component of climate change mitigation, and a system-wide approach, including production, processing, trade and demand-side transformations, will be needed. Long-term analysis of greenhouse gas (GHG) emissions of food supply is crucial for informing this transformation, and understanding the processes contributing to existing trends can reveal opportunities for future mitigation strategies. To address these needs we used data on food supply, trade and emission intensity to quantify changes in GHG emissions between 1986 and 2017 resulting from food supply in the United Kingdom (UK). Uniquely, the relative contributions of supply-side and demand-side changes to historical trends in food emissions were assessed, and the gap between current UK food consumption and EAT-Lancet recommended diets was used to estimate the additional GHG emission reductions that could be achieved by shifting to the Planetary Health Diet (PHD). It was estimated that in the UK, per-capita GHG emissions from food fell by 32% (from 4.6 tCO2eq/capita to 3.1 tCO2eq/capita) between 1986 and 2017. Of this 32% reduction, 21% was due to supply-side changes (a fall in emission intensity per unit of production due to increased efficiency of farming practices), 10% was due to demand-side changes (including dietary change and waste reduction), and 2% was due to changing trade patterns. Relative to the PHD, however, the average UK citizen still greatly over-consumes beef, lamb and pork, tubers and starchy vegetables and dairy products, and under-consumes vegetables, nuts, and legumes. It was estimated that by adopting the PHD, UK per capita food emissions could be reduced by a further 42% to 1.8 tCO2eq/capita. These results expose the historic contributions of both supply- and demand-side changes to reductions in GHG emissions from food, and highlight the underutilised potential of dietary change in contributing to mitigation of GHG emissions from food.PS is supported by the Wellcome Trust (grant no. 216021/Z/19/Z & 205200/Z/16/Z) and the af Jochnick Foundation. AB is supported by a Royal Society Wolfson Research Merit Award. EEG was supported by a Natural Environment Research Council Studentship (Grant NE/L002507/1) and is supported by a philanthropic donation from a British retailer. The retailer had no role in the article

Changes in greenhouse gas emissions from food supply in the United Kingdom

Food systems contribute 23–42% of global greenhouse gas emissions. Reducing food system emissions is an essential component of climate change mitigation, and a system-wide approach, including production, processing, trade and demand-side transformations, will be needed. Long-term analysis of greenhouse gas (GHG) emissions of food supply is crucial for informing this transformation, and understanding the processes contributing to existing trends can reveal opportunities for future mitigation strategies. To address these needs we used data on food supply, trade and emission intensity to quantify changes in GHG emissions between 1986 and 2017 resulting from food supply in the United Kingdom (UK). Uniquely, the relative contributions of supply-side and demand-side changes to historical trends in food emissions were assessed, and the gap between current UK food consumption and EAT-Lancet recommended diets was used to estimate the additional GHG emission reductions that could be achieved by shifting to the Planetary Health Diet (PHD). It was estimated that in the UK, per-capita GHG emissions from food fell by 32% (from 4.6 tCO2eq/capita to 3.1 tCO2eq/capita) between 1986 and 2017. Of this 32% reduction, 21% was due to supply-side changes (a fall in emission intensity per unit of production due to increased efficiency of farming practices), 10% was due to demand-side changes (including dietary change and waste reduction), and 2% was due to changing trade patterns. Relative to the PHD, however, the average UK citizen still greatly over-consumes beef, lamb and pork, tubers and starchy vegetables and dairy products, and under-consumes vegetables, nuts, and legumes. It was estimated that by adopting the PHD, UK per capita food emissions could be reduced by a further 42% to 1.8 tCO2eq/capita. These results expose the historic contributions of both supply- and demand-side changes to reductions in GHG emissions from food, and highlight the underutilised potential of dietary change in contributing to mitigation of GHG emissions from food

Make EU trade with Brazil sustainable

Brazil, home to one of the planet's last great forests, is currently in trade negotiations with its second largest trading partner, the European Union (EU). We urge the EU to seize this critical opportunity to ensure that Brazil protects human rights and the environment

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research