Core outcome sets for trials of interventions to prevent and to treat multimorbidity in adults in low and middle-income countries:the COSMOS study

INTRODUCTION: The burden of multimorbidity is recognised increasingly in low- and middle-income countries (LMICs), creating a strong emphasis on the need for effective evidence-based interventions. Core outcome sets (COS) appropriate for the study of multimorbidity in LMICs do not presently exist. These are required to standardise reporting and contribute to a consistent and cohesive evidence-base to inform policy and practice. We describe the development of two COS for intervention trials aimed at preventing and treating multimorbidity in adults in LMICs.METHODS: To generate a comprehensive list of relevant prevention and treatment outcomes, we conducted a systematic review and qualitative interviews with people with multimorbidity and their caregivers living in LMICs. We then used a modified two-round Delphi process to identify outcomes most important to four stakeholder groups (people with multimorbidity/caregivers, multimorbidity researchers, healthcare professionals and policymakers) with representation from 33 countries. Consensus meetings were used to reach agreement on the two final COS.REGISTRATION: https://www.comet-initiative.org/Studies/Details/1580.RESULTS: The systematic review and qualitative interviews identified 24 outcomes for prevention and 49 for treatment of multimorbidity. An additional 12 prevention and 6 treatment outcomes were added from Delphi round 1. Delphi round 2 surveys were completed by 95 of 132 round 1 participants (72.0%) for prevention and 95 of 133 (71.4%) participants for treatment outcomes. Consensus meetings agreed four outcomes for the prevention COS: (1) adverse events, (2) development of new comorbidity, (3) health risk behaviour and (4) quality of life; and four for the treatment COS: (1) adherence to treatment, (2) adverse events, (3) out-of-pocket expenditure and (4) quality of life.CONCLUSION: Following established guidelines, we developed two COS for trials of interventions for multimorbidity prevention and treatment, specific to adults in LMIC contexts. We recommend their inclusion in future trials to meaningfully advance the field of multimorbidity research in LMICs.PROSPERO REGISTRATION NUMBER: CRD42020197293.</p

Problemas de adaptación escolar, como consecuencia de una discontinuidad metodológica y didáctica en los alumnos del primer curso del ciclo básico

Licenciada en Ciencias de la Educación. Especialidad Psicología Educativa y Orientación VocacionalCuenc

Cuidados paliativos domiciliarios en enfermedades crónico-degenerativas y catastróficas

Palliative home care, is based on activities developed by nursing, to promote, maintain and recover the dignity and totality of being, being the objective of the article to plan comprehensive home nursing care, individuals with Chronic-catastrophic diseases and their families. Through a quantitative qualitative methodology of action research participation, which begins with the application of a survey of 65 users, based on 11 functional patterns of M. Gordon, a care plan was designed, educational sessions were executed. 78.5% of patients with better emotional stability; 23.85% of relatives trained in palliative care; 80% of patients received therapies: meditation, massage and music therapy; 100% of patients receive alternative treatment to mitigate pain. Home palliative care provides timely, humanistic care and strengthens autonomous and comprehensive nursing care.El cuidado paliativo domiciliario, se fundamenta en actividades desarrolladas por enfermería, para promover, mantener y recuperar la dignidad y totalidad del ser, siendo el objetivo del articulo planear una atención integral domiciliaria de enfermería,  a individuos con Enfermedades Crónicas-catastróficas y sus familiares. Mediante una metodología cuanti-cualitativo, de investigación acción participación, que inicia con la aplicación de una encuesta a 65 usuarios, en base a 11 patrones funcionales de M. Gordon, se diseñó un plan de cuidados, se ejecutó sesiones educativas. Un 78.5% de pacientes con mejor estabilidad emocional; 23.85% de familiares adiestrados en cuidados paliativo; 80% de pacientes recibieron terapias: meditación, masajes y musicoterapia; 100% de pacientes reciben tratamiento alternativo para mitigar el dolor. El cuidado paliativo domiciliario, brinda una atención oportuna, humanista y fortalece el cuidado autónomo y comprensivo de enfermería

Beliefs and motives related to eating and body size: a comparison of high-BMI and normal-weight young adult women from rural and urban areas in Mexico

Background: Effective treatment and prevention of obesity and its co-morbidities requires the recognition and understanding of cultural and social aspects of eating practices. The objective of the present study was to identify social factors and beliefs that may explain undesirable eating practices among women with high body mass index (HBMI) compared with normal-weight (NW) women from rural and urban areas classified as middle-low socioeconomic status (SES) in the State of Querétaro, Mexico. Methods: A qualitative technique with individual in-depth interviews was used. Fifty-five women with either NW or HBMI from rural and urban areas participated in the study. The responses were analyzed by coding and grouping text fragments into categories in a data matrix, in order to make comparisons between BMI groups and between rural and urban women. Results: The habit of skipping breakfast prevailed among women with HBMI who also reported childhood food deprivation. Feelings related to eating seemed to be more important than losing weight among women with HBMI from urban and rural areas. Thus, overweight might be interpreted as a social symbol of the enjoyment of a good life, primarily in rural areas. Overweight was socially accepted when it occurred in children and in married woman, mainly because it is a symbol of the good life that the head of the household provides, and also because women may feel more relaxed about their weight when they already have a partner. The study also revealed that women with HBMI were not sufficiently motivated to lose weight unless they experience a physical indication of poor health. Conclusion: The findings from this study are helpful in the understanding of the reasons why strategies for the prevention and treatment of obesity may not be as effective as expected. The belief system of particular social groups within different SESs should be considered in order to understand the etiology of obesity and develop effective strategies

Zinc, vitamin A, and vitamin C status are associated with leptin concentrations and obesity in Mexican women: Results from a cross-sectional study

Background: The prevalence of obesity among Mexican women is high and it could be related to micronutrient status. We evaluated in a cross-sectional study the associations of zinc and vitamins A, C and E concentrations with BMI, central adiposity, body fat and leptin concentration. Methods: Women aged 37 ± 7.5 years (n = 580) from 6 rural communities in Mexico were evaluated. Anthropometric measurements included weight, height, waist and hip circumference. A fasting blood sample was taken for the analysis of glucose, lipid profile, leptin, zinc, and vitamins A, C and E. Body composition was determined by DEXA (Hologic Mod Explorer). Results: The prevalence of overweight and obesity was 36% (BMI>25 Kg/m ) and 44% (BMI>30 Kg/m ), respectively. Prevalence of zinc and vitamins C and E deficiencies were similar in obese, overweight and normal weight women. No vitamin A deficiency was found. Vitamin C was negatively associated with BMI, waist-to-height ratio, and leptin concentrations (