An Energy-Reduced Mediterranean Diet, Physical Activity, and Body Composition

[ENG]Importance Strategies targeting body composition may help prevent chronic diseases in persons with excess weight, but randomized clinical trials evaluating lifestyle interventions have rarely reported effects on directly quantified body composition. OBJECTIVE To evaluate the effects of a lifestyle weight-loss intervention on changes in overall and regional body composition. DESIGN, SETTING, AND PARTICIPANTS The ongoing Prevención con Dieta Mediterránea-Plus (PREDIMED-Plus) randomized clinical trial is designed to test the effect of the intervention on cardiovascular disease prevention after 8 years of follow-up. The trial is being conducted in 23 Spanish research centers and includes men and women (age 55-75 years) with body mass index between 27 and 40 and metabolic syndrome. The trial reported herein is an interim subgroup analysis of the intermediate outcome body composition after 3-year follow-up, and data analysis was conducted from February 1 to November 30, 2022. Of 6874 total PREDIMED-Plus participants, a subsample of 1521 individuals, coming from centers with access to a dual energy x-ray absorptiometry device, underwent body composition measurements at 3 time points. INTERVENTION Participants were randomly allocated to a multifactorial intervention based on an energy-reduced Mediterranean diet (MedDiet) and increased physical activity (PA) or to a control group based on usual care, with advice to follow an ad libitum MedDiet, but no physical activity promotion. MAIN OUTCOMES AND MEASURES The outcomes (continuous) were 3-year changes in total fat and lean mass (expressed as percentages of body mass) and visceral fat (in grams), tested using multivariable linear mixed-effects models. Clinical relevance of changes in body components (dichotomous) was assessed based on 5% or more improvements in baseline values, using logistic regression. Main analyses were performed in the evaluable population (completers only) and in sensitivity analyses, multiple imputation was performed to include data of participants lost to follow-up (intention-to-treat analyses). RESULTS A total of 1521 individuals were included (mean [SD] age, 65.3 [5.0] years; 52.1% men). In comparison with the control group (n=761), participants in the intervention arm (n=760) showed greater reductions in the percentage of total fat (between group differences after 1-year, −0.94% [95% CI, −1.19 to −0.69]; 3 years, −0.38% [95% CI, −0.64 to −0.12] and visceral fat storage after 1 year, -126 g [95% CI, −179 to −73.3 g]; 3 years, −70.4 g [95% CI, −126 to −15.2 g] and greater increases in the percentage of total lean mass at 1 year, 0.88% [95% CI, 0.63%-1.12%]; 3-years 0.34% [95%CI, 0.09%-0.60%]). The intervention group was more likely to show improvements of 5% or more in baseline body components (absolute risk reduction after 1 year, 13% for total fat mass, 11% for total lean mass, and 14% for visceral fat mass; after 3-years: 6% for total fat mass, 6% for total lean mass, and 8% for visceral fat mass). The number of participants needed to treat was between 12 and 17 to attain at least 1 individual with possibly clinically meaningful improvements in body composition. CONCLUSIONS AND RELEVANCE The findings of this trial suggest a weight-loss lifestyle intervention based on an energy-reduced MedDiet and physical activity significantly reduced total and visceral fat and attenuated age-related losses of lean mass in older adults with overweight or obesity and metabolic syndrome. Continued follow-up is warranted to confirm the long-term consequences of these changes on cardiovascular clinical end points.S

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care

<p>Abstract</p> <p>Background</p> <p>Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial.</p> <p>Methods/Design</p> <p>This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid.</p> <p>The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference.</p> <p>Discussion</p> <p>Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient.</p

Factores relacionados con el bienestar de las mujeres en la etapa del climaterio

RESUMEN Con este estudio se pretendió analizar los factores relacionados con el bienestar durante la etapa del climaterio, el nivel de satisfacción vital, los hábitos de vida y la presencia de manifestaciones en los grupos de PRE y POST menopausia, evaluando los Patrones Funcionales de Marjory Gordon. Metodología. Se realizó un estudio observacional de cohorte transversal y se seleccionó una muestra de 256 mujeres entre 45 y 65 años, residentes de las pedanías del Sur de Murcia. El instrumento utilizado fue un cuestionario en el que se recopilaron variables sociodemográficas, hábitos de vida y manifestaciones físico- psico- sociales de la escala Cervantes, que modificamos y la satisfacción vital, que se evaluó mediante Satisfaction With Life Scale. Por otra parte, se agruparon los ítems por los Patrones Funcionales. Como paso previo al empleo de la escala de satisfacción vital, se analizó la confiabilidad obteniendo un alpha de Cronbach de 0,858. Se analizó la normalidad de la distribución de los datos para las variables cuantitativas mediante el test de Kolgomorov-Smirnof. Los resultados fueron expresados por media, mediana, desviación estándar, percentiles 25-75, frecuencias absolutas y el porcentaje válido. La relación entre variables cuantitativas no paramétricas se realizó mediante un estudio de correlación de Spearman, un análisis diferencial con la prueba de la Ji-cuadrado y una regresión logística binaria bivariante. Para analizar la relación entre satisfacción vital como variable dependiente dicotómica y el resto de variables del estudio como variables independientes ajustadas por edad se realizó una regresión logística binaria multivariante, considerando significativa una p-valor<0,25. Resultados. La mayoría de las mujeres habían superado la menopausia (N=203), eran casadas un 68,4 %, activas laboralmente un 60,5 %, con estudios básicos un 46,1 % y con hijos un 90,2 %. Se encontraron diferencias estadísticamente significativas con respecto a la situación laboral (p=0,002), nivel de estudios (p<0,001) y la menopausia, predominando las mujeres laboralmente activas y de nivel de estudios medio y alto en el grupo PRE menopausia. Un 79,9 % de las mujeres nunca tomaron tratamiento hormonal u otros, casi un 82 % cuidaban su imagen, un 71,5 % dormían las horas necesarias, casi el total seguían una alimentación saludable, un 62,5 % practicaban actividad física y un 96,9 %, realizaban controles de salud, de lo que se desprende que un 90 % de las mujeres estaban satisfechas con su vida. En la división por grupos, encontramos mayor número de no fumadoras y que su descanso era adecuado en el grupo de PRE menopausia. Ambos grupos presentaron ansiedad o depresión (78,91 %), inapetencia e insatisfacción sexual (73,44 %) (65,62 %), desmotivación (45,7 %), desinterés social y por la vida (13,67 %) (13 %) e infelicidad con su pareja (57,81 %); la mayoría de las encuestadas refirió la presencia de dolor muscular o articular (83,59 %), que se observó más en el grupo POST menopausia (85,18 %), al igual que el resto de manifestaciones. Así mismo, las posibilidades de tener un nivel de satisfacción con la vida fue superior en mujeres jóvenes (p=0,009) con mayor nivel de estudios (p=0,002), laboralmente activas (p<0,001), las cuales dedicaban más tiempo a ellas mismas (p<0,001), cuidaban su alimentación (p<0,05), realizaban actividad física (p=0,001), dormían las horas necesarias (p=0,012) y no se encontraban deprimidas, eran positivas en su actitud y felices en sus relaciones de pareja (p<0,05; p<0,001; p<0,05). Conclusiones. Los resultados de nuestra investigación señalaron que las participantes gozan de un adecuado bienestar y no se observa relación de éste con respecto a la menopausia, aunque sí con el paso de los años. Sus hábitos de vida son saludables y presentan algunas manifestaciones tales como: dolor muscular, seguido de ansiedad o depresión, pérdida de interés sexual, infelicidad en la relación de pareja e insatisfacción sexual. En general, las mujeres estudiadas declaran una alteración de los patrones de Autopercepcion-Autoconcepto, Rol–Relaciones, y de Eliminación y con mayor intensidad se presentan en el grupo de POST menopausia los de Tolerancia al Estrés, Cognitivo-Perceptivo y Sexualidad-Reproducción. Por otra parte, las mujeres PRE menopáusicas están más satisfechas con sus vidas, gozando de un mejor nivel de bienestar, por lo que anticiparse a la etapa de la postmenopausia puede ser una medida eficaz para que las mujeres mejoren su bienestar y calidad de vida, elaborando programas y desarrollando estrategias educativas oportunas.   ABSTRACT This study aimed to analyse the factors related to well-being during climacteric phase, life satisfaction level, lifestyle, and the presence of manifestations in PRE and POST menopausal groups, through Marjory Gordon´s Functional Health Patterns. Method. A sample of 256 women between the ages of 45 and 65 years old, residing in the districts of southern Murcia, was selected for this observational, cohort and cross-sectional study. A survey was the tool used to collect socio-demographic variables, lifestyle and physical and psycho-social manifestations from Cervantes´s scale that we modified, and life satisfaction was assessed by Satisfaction With Life Scale. The items were also clustered by Functional Health Patterns. Reliability was analysed previously to the use of the Life Satisfaction scale, obtaining Cronbach´s alpha of 0,858. The normal distribution of data for quantitative variables was analysed through the Kolgomorov-Smirnof test, and the results obtained were expressed by mean, media, standard deviation and percentiles 25-75. For qualitative variables, the results were expressed by absolute frequencies and valid percentage. Relationship between nonparametric quantitative variables was established through a Spearman´s correlation study, a differential analysis within Chi-square test, and a bivariate binary logistic regression. A multivariate binary logistic regression was also carried out to analyse the relationship between life satisfaction, as dichotomous dependent variable and the rest of the variables of this study as independent variables adjusted for age. Variables included in the multivariate analysis were those obtaining a p value <0,25 in an initial bivariate logistic regression analysis, and those with statistical significance in the correlation analysis. Results. Most of women were beyond menopause (N=203). 68,4 % of the sample were married women, 60,5 % were employed, 46,1 % had basic education, and 90,2 % had children. Significant differences were found in regard to the employment status (p=0,002), educational attainment (p<0,001), and menopause. Working women with medium and high educational attainment were dominant in the PRE-menopausal group. 79,9 % of women were never put under hormone therapy or other treatments, nearly 82 % of them took care of their image, 71,5 % slept the necessary hours, almost 100 % had a healthy diet, and 96.9 % had health controls, verifying that 90 % of women were satisfied with their lives. In the division into groups, we found a larger number of non-smokers and that their rest was adequate in the PRE-menopausal group. In both groups, women showed symptoms of anxiety or depression (78,91 %), lack of sexual desire and sexual dissatisfaction (73,44 %) (65,62 %), lack of motivation (45,7 %), lack of interest in social activities and daily living (13,67 %) (13 %), and felt unhappy with their partners (57,81 %). Most participants cited muscle or joint soreness (83,59 %), that was more present among women from the POST menopausal group (85,18 %), as well as the rest of the symptoms. Moreover, the chance of having a level of life satisfaction was higher in young women (p=0,009) with higher educational attainment (p=0,002) who were employed (p<0.001), who devoted more time to themselves (p<0,001), who watched their diet (p<0,05), who were physically active (p=0,001), who slept the necessary hours (p=0,012), who were not depressed, and who maintained a positive attitude and felt happy in their romantic relationship (p<0,05; p<0,001; p<0,05). Conclusions. The results of our study pointed out that participants possess a proper level of well-being, and no relationship between this one and menopause has been observed, but with the passage of time. Participants’ lifestyles are healthy and they show manifestations such as muscle soreness, followed by anxiety or depression, lack of sexual desire, unhappiness in their romantic relationship and sexual dissatisfaction. Overall, the women who were studied reveal alterations of Self-Perception—Self-Concept, Role-Relationship and Elimination patterns. Women from the POST-menopausal group strongly reveal alterations of Coping-Stress Tolerance, Cognitive-Perceptual and Sexuality-Reproductive patterns. Otherwise, PRE-menopausal women are more satisfied with their lives and have a higher level of well-being; thus, anticipating the POST-menopausal phase could be an effective measure to improve women´s well-being and quality of life, by the development of suitable programs and educational strategies

Competencia de Enfermería en la Identificación Universal e Inequívoca de los Pacientes de un Hospital Universitario

El objetivo fue evaluar la correcta Identificación Universal e Inequívoca de pacientes en un Hospital Universitario. El diseño de la investigación se plantea como cuantitativo y transversal. La población de estudio fueron todos los pacientes ubicados en el Servicio de Urgencias y la Unidad de Cuidados Intensivos en el periodo de estudio. El instrumento de recogida de datos es una plantilla de elaboración propia para registrar la correcta identificación o no. La recogida de datos se realizó en el segundo semestre de 2014. El análisis de datos se realizó con el programa estadístico SPSS (v.19). Los resultados del estudio dejan de manifiesto que del total de los pacientes evaluados, el 75.5% estaba correctamente identificado, mientras que el 24.5% restante no estaba correctamente identificado. Por Servicios el porcentaje de pacientes identificados fue en Boxes de Urgencias el 86%, en Observación de Urgencias el 89.3% y en la Unidad de Cuidados Intensivos el 29.5%. Las políticas de identificación deben garantizar la filiación de todos los pacientes mediante métodos inequívocos de implantación universal y así mejorar la Seguridad del Paciente y por tanto, una mejora en la calidad asistencial. La conveniencia de establecer un ciclo de mejora sobre todo en la Unidad de Cuidados Intensivos a fin de formar tanto a profesionales como a supervisores en la cultura de seguridad del paciente, lo cual evitará errores asociados, mejorando así la seguridad del paciente y por ende una mejora en la calidad asistencial

Competencia de Enfermería en la Identificación Inequívoca de los Pacientes de un Hospital Universitario

Objectives. The objective was to evaluate the correct unambiguous identification of patients in a University Hospital. The research design is presented as quantitative and transverse. The study population included all patients located in the Emergency Department and the Intensive Care Unit in the study period. The data collection instrument is a homemade template to record the correct identification or not. Data collection was conducted in the second half of 2014. Data analy-sis was performed using SPSS (v.19) statistical program. Results. The results of the study make it clear that the total number of patients evaluated, 75.5% were correctly identified, while the remaining 24.5% were not correctly identified. Per service, the percentage of patients was identified in Emergency Boxes 86%, in Emergency Observation and 89.3% in the Intensive Care Unit 29.5%.Identification policies must ensure affiliation of patients by universal unambiguous implementation methods. The desi-rability of establishing a cycle of improvement especially in the Intensive Care Unit to educate both professionals and supervisors in the culture of patient safety, which prevent associated errors, thereby improving patient safety and the-refore an improvement in the quality of health careObjetivo. El objetivo fue evaluar la correcta Identificación Inequívoca de pacientes en un Hospital Universitario. El diseño de la investigación se plantea como cuantitativo y transversal. La población de estudio fueron todos los pacientes ubica-dos en el Servicio de Urgencias y la Unidad de Cuidados Intensivos en el periodo de estudio. El instrumento de recogida de datos es una plantilla de elaboración propia para registrar la correcta identificación o no. La recogida de datos se realizó en el segundo semestre de 2014. El análisis de datos se realizó con el programa estadístico SPSS (v.19).Resul-tados. Los resultados del estudio dejan de manifiesto que del total de los pacientes evaluados, el 75.5% estaba correc-tamente identificado, mientras que el 24.5% restante no estaba correctamente identificado. Por Servicios el porcentaje de pacientes identificados fue en Boxes de Urgencias el 86%, en Observación de Urgencias el 89.3% y en la Unidad de Cuidados Intensivos el 29.5%. Las políticas de identificación deben garantizar la filiación de todos los pacientes mediante métodos inequívocos de im-plantación universal. La conveniencia de establecer un ciclo de mejora sobre todo en la Unidad de Cuidados Intensivos a fin de formar tanto a profesionales como a supervisores en la cultura de seguridad del paciente, permitirá evitar errores asociados, mejorando así la seguridad del paciente y por ende una mejora en la calidad asistencial

Adquisición de materiales curriculares básicos

Se propone que el alumnado adquiera materias instrumentales básicas, como la lecto-escritura, para garantizar la escolaridad de la mayor parte de ellos. Los objetivos son determinar los alumnos con dificultades de aprendizaje en lectura y escritura, fomentar la utilización de materiales didácticos específicos, estrategias educativas y sistemas de organización que favorezcan su desarrollo, y trabajar aspectos como la diversidad, dificultades de aprendizaje, necesidades educativas especiales y adaptaciones. Se aplica una metodología especializada y muy participativa. Desarrolla contenidos referidos a aspectos pedagógicos y de necesidades educativas especiales, diagnóstico de dificultades de aprendizaje y elaboración de programas de reeducación. La valoración por los alumnos es positiva, pues observan que son atendidos individualmente.Madrid (Comunidad Autónoma). Consejería de Educación y CulturaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

Bustarviejo. Propuestas bioclimáticas en el espacio público.

Bustarviejo. Propuestas bioclimáticas en el espacio público. Publicación digital de los trabajos elaborados por los estudiantes del curso 2017/18 de la asignatura La Ciudad y el Medio de la Escuela Técnica Superior de Arquitectura de Madrid de la Universidad Politécnica de Madrid. Muestra una serie de propuestas elaboradas en la asignatura para mejorar bioclimáticamente diferentes espacios públicos municipales en el marco del acuerdo realizado entre el Departamento de Urbanística y Ordenación del Territorio y el Excmo. Ayuntamiento de Bustarviejo (Madrid)