Diseño de un programa educativo y preventivo de disfunciones del suelo pélvico a mujeres instrumentistas de viento

Introducción: El suelo pélvico (SP) es una estructura anatómica importante. Las disfunciones del suelo pélvico (DSP) son comunes en mujeres, obesas y actividades que aumentan la presión abdominal, como en instrumentistas de viento. La fisioterapia puede prevenir estas disfunciones mediante la educación, entrenamiento del SP y la mejora de la postura y respiración.Objetivos: Diseñar y evaluar un programa de educación de la salud para prevenir DSP en mujeres instrumentistas de viento. Metodología: se plantea un estudio de casos (n=4) mediante 3 talleres teorico-prácticos basados en educar sobre el SP, reconocer factores de riesgo asociados a la práctica musical e instruir pautas de prevención de DSP, como contraer el SP y transverso del abdomen. Para la evaluación se pasó un cuestionario sobre “conocimientos del SP” antes y después de los talleres y otro final de “satisfacción y calidad del programa”.Resultados y discusión: inicialmente, los sujetos mostraron un conocimiento medio del SP de 4,25/10. Tras el programa, esta cifra aumentó a un 8,25/10. Finalmente, el 100% de los sujetos supieron identificar la correcta instrucción de contraer del SP y transverso abdomen. La satisfacción general del programa fue muy elevada.Conclusión: Un programa de educación para la salud mediante talleres teorico-prácticos logró aumentar los conocimientos del SP en mujeres instrumentistas de viento y reconocer factores de riesgo del SP. Aunque no se evaluó el efecto de la instrucción en pautas de prevención de DSP, se enseñó la contracción del SP y transverso abdomen utilizando el instrumento musical.Palabras clave: "women", "pelvic floor", "education", "physical therapy <br /

Seasonal effects of waterfowl grazing on submerged macrophytes: The role of flowers

Seasonal effects of waterfowl (Fulica atra and Anas platyrhynchos) grazing on submerged macrophytes (Ruppia cirrhosa and Potamogeton pectinatus) and the mediating role of flowers on plant consumption were evaluated by exclusion cages and tethering experiments deployed in a Mediterranean lagoon throughout the annual cycle. Despite the low waterfowl abundance recorded in summer, exclusion-cage experiments evidenced intense herbivory on the biomass, canopy height and flowers of R. cirrhosa (flowers abundance was ∼8 times higher inside exclusion cages; 1015.7 ± 269.8 flw m−2). For P. pectinatus, exclusion cage experiments did not evidence waterfowl consumption, in spite of the presence of flowers, which suggest preference for reproductive tissues of R. cirrhosa. In addition, the higher abundance of R. cirrhosa flowers compared to P. pectinatus (∼10 times higher inside the exclusion cages) was likely influenced by more intense herbivory on the former species. Although waterfowl abundance increased in autumn and winter, experiments did not evidence herbivory effects during that period, possibly because of enhanced availability of alternative resources and decreased plant biomass and canopy height reducing encounter rates. Hence, our results suggest that waterfowl effects on submerged macrophytes in Mediterranean aquatic ecosystems are strongly influenced by seasonal changes in the availability of food resources and its flowering events. The higher herbivory on R. cirrhosa and its flowers in summer suggest that waterfowl grazing may be driven by food preference for reproductive tissues, and could have a strong effect on the community structure and abundance of submerged macrophytes

Health and economic impact of the correct diagnosis of transthyretin cardiac amyloidosis in Spain

Objective: to estimate the health and economic impact of the reduction in mortality and cardiovascular hospitalizations, associated with correct diagnosis of cardiac transthyretin amyloidosis (ATTR-CM), from the Spanish National Health System (NHS) perspective. Methods: a costs and effects analysis were performed (probabilistic Markov model) with time horizons between 1 and 15 years, comparing the correct diagnosis of ATTR-CM versus the non-diagnosis. Transition probabilities were obtained from the ATTR-ACT study (placebo arm) and from the literature. Costs and healthcare resources were obtained from Spanish sources ( 2019) and from a panel of Spanish clinical experts. Results: after 1, 5, 10 and 15 years, the diagnosis of ATTR-CM would generate a gain of 0.031 (95%CI 0.025; 0.038); 0.387 (95%CI 0.329; 0.435); 0.754 (95%CI 0.678; 0.781) and 0.944 (95%CI 0.905; 0.983) life years per patient, respectively, with savings of 212 (95%CI -632; 633), 2,289 (95%CI 2,250; 2,517), 2,859 (95%CI 2,584; 3,149) and 2,906 (95%CI 2,669; 3,450) per patient, respectively, versus the non-diagnosis. Conclusions: just by correctly diagnosing ATTR-CM, years of life would be gained, cardiovascular hospitalizations would be avoided, and savings would be generated for the NHS, compared to the non-diagnosis of the disease

Impact of mediterranean diet promotion on environmental sustainability: a longitudinal analysis

[EN]This article aims to estimate the differences in environmental impact (greenhouse gas [GHG] emissions, land use, energy used, acidification and potential eutrophication) after one year of promoting a Mediterranean diet (MD). Methods Baseline and 1-year follow-up data from 5800 participants in the PREDIMED-Plus study were used. Each participant's food intake was estimated using validated semi-quantitative food frequency questionnaires, and the adherence to MD using the Dietary Score. The influence of diet on environmental impact was assessed through the EAT-Lancet Commission tables. The influence of diet on environmental impact was assessed through the EAT-Lancet Commission tables. The association between MD adherence and its environmental impact was calculated using adjusted multivariate linear regression models.SIPublicación en abierto financiada por el Consorcio de Bibliotecas Universitarias de Castilla y León (BUCLE), con cargo al Programa Operativo 2014ES16RFOP009 FEDER 2014-2020 DE CASTILLA Y LEÓN, Actuación:20007-CL - Apoyo Consorcio BUCL

Comprehensive description of clinical characteristics of a large systemic Lupus Erythematosus Cohort from the Spanish Rheumatology Society Lupus Registry (RELESSER) with emphasis on complete versus incomplete lupus differences

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multiple organ involvement and pronounced racial and ethnic heterogeneity. The aims of the present work were (1) to describe the cumulative clinical characteristics of those patients included in the Spanish Rheumatology Society SLE Registry (RELESSER), focusing on the differences between patients who fulfilled the 1997 ACR-SLE criteria versus those with less than 4 criteria (hereafter designated as incomplete SLE (iSLE)) and (2) to compare SLE patient characteristics with those documented in other multicentric SLE registries. RELESSER is a multicenter hospital-based registry, with a collection of data from a large, representative sample of adult patients with SLE (1997 ACR criteria) seen at Spanish rheumatology departments. The registry includes demographic data, comprehensive descriptions of clinical manifestations, as well as information about disease activity and severity, cumulative damage, comorbidities, treatments and mortality, using variables with highly standardized definitions. A total of 4.024 SLE patients (91% with ≥4 ACR criteria) were included. Ninety percent were women with a mean age at diagnosis of 35.4 years and a median duration of disease of 11.0 years. As expected, most SLE manifestations were more frequent in SLE patients than in iSLE ones and every one of the ACR criteria was also associated with SLE condition; this was particularly true of malar rash, oral ulcers and renal disorder. The analysis-adjusted by gender, age at diagnosis, and disease duration-revealed that higher disease activity, damage and SLE severity index are associated with SLE [OR: 1.14; 95% CI: 1.08-1.20 (P < 0.001); 1.29; 95% CI: 1.15-1.44 (P < 0.001); and 2.10; 95% CI: 1.83-2.42 (P < 0.001), respectively]. These results support the hypothesis that iSLE behaves as a relative stable and mild disease. SLE patients from the RELESSER register do not appear to differ substantially from other Caucasian populations and although activity [median SELENA-SLEDA: 2 (IQ: 0-4)], damage [median SLICC/ACR/DI: 1 (IQ: 0-2)], and severity [median KATZ index: 2 (IQ: 1-3)] scores were low, 1 of every 4 deaths was due to SLE activity. RELESSER represents the largest European SLE registry established to date, providing comprehensive, reliable and updated information on SLE in the southern European population

Prevención, diagnóstico y tratamiento de la sepsis neonatal: Guía de práctica clínica basada en evidencias del Instituto Nacional Materno Perinatal del Perú

Introduction. Neonatal sepsis is a set of clinical signs and symptoms caused by a systemic infection, associated with maternal, neonatal or&nbsp;hospital risk factors. Objective. Provide informed recommendations for the best available evidence for the prevention, diagnosis and treatment&nbsp;of neonatal sepsis. Methods an Evidence-based Clinical Practice Guide (CPG) was developed through an adaptation process, in charge of&nbsp;a team of methodologists and neonatologists who are experts in the clinical management of neonatal sepsis. The search and pre-selection&nbsp;of CPGs that respond to the scope and objectives set were carried out, using the AGREE-II instrument, the methodological quality of the&nbsp;guides was evaluated and their adaptation decided. To identify the evidence that answers the questions in the guideline, a systematic&nbsp;search was carried out in multiple databases: Medline / PubMed, Embase / Ovid, Cochrane Library and LILACS. These were selected and&nbsp;critically analyzed by clinical and methodological peers, the recommendations were elaborated using the GRADE approach. Results. 16&nbsp;clinical questions and recommendations based on evidence were formulated, which were reached, through a deliberative dialogue of clinical&nbsp;experts from different reference hospitals for the management of neonatal sepsis in Peru. The recommendations address the identification&nbsp;of risk factors, the use of confirmatory methods and antibiotic treatment as prophylaxis and during disease management. Conclusions. The&nbsp;CPG allows standardizing the clinical management of neonatal sepsis, as well as the identification of research needs to be carried out in the&nbsp;Peruvian context.Introducción. La sepsis neonatal es un conjunto de signos y síntomas clínicos causados por una infección sistémica, asociada a&nbsp;factores de riesgo de tipo materno, neonatal u hospitalario. Objetivo. Brindar recomendaciones informadas por la mejor evidencia&nbsp;disponible para la prevención, diagnóstico y tratamiento de la sepsis neonatal. Métodos. Se desarrolló una guía de práctica clínica&nbsp;(GPC) basada en evidencias, mediante un proceso de adaptación, a cargo de un equipo de metodólogos y médicos neonatólogos&nbsp;expertos en el manejo clínico de la sepsis neonatal. Se realizó la búsqueda y preselección de GPC que respondan al alcance y&nbsp;objetivos planteados, utilizando el instrumento AGREE-II se evalúo la calidad metodológica de las guías para decidir su adaptación.&nbsp;Se realizó una búsqueda sistemática en múltiples bases de datos: Medline/PubMed, Embase/Ovid, Cochrane Library y LILACS,&nbsp;para identificar la evidencia que responda a las preguntas de la guía. Estas fueron seleccionadas y analizadas críticamente por&nbsp;pares clínicos y metodológicos, las recomendaciones fueron elaboradas usando el enfoque GRADE. Resultados. Se formularon 16&nbsp;preguntas clínicas y recomendaciones basadas en evidencia a las que se llegó, mediante un diálogo deliberativo de expertos clínicos&nbsp;de diferentes hospitales de referencia para el manejo de la sepsis neonatal en el Perú. Las recomendaciones abordan la identificación&nbsp;de factores de riesgo, el uso de métodos confirmatorios y el tratamiento antibiótico como profilaxis y durante manejo de la enfermedad.&nbsp;Conclusiones: La GPC permite estandarizar el manejo clínico de la sepsis neonatal, así como la identificación de necesidades de&nbsp;investigación a realizarse en el contexto peruano

Clinical validation of risk scoring systems to predict risk of delayed bleeding after EMR of large colorectal lesions

[Background and Aims]: The Endoscopic Resection Group of the Spanish Society of Endoscopy (GSEED-RE) model and the Australian Colonic Endoscopic Resection (ACER) model were proposed to predict delayed bleeding (DB) after EMR of large superficial colorectal lesions, but neither has been validated. We validated and updated these models.[Methods]: A multicenter cohort study was performed in patients with nonpedunculated lesions ≥20 mm removed by EMR. We assessed the discrimination and calibration of the GSEED-RE and ACER models. Difficulty performing EMR was subjectively categorized as low, medium, or high. We created a new model, including factors associated with DB in 3 cohort studies.[Results]: DB occurred in 45 of 1034 EMRs (4.5%); it was associated with proximal location (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.31-6.16), antiplatelet agents (OR, 2.51; 95% CI, .99-6.34) or anticoagulants (OR, 4.54; 95% CI, 2.14-9.63), difficulty of EMR (OR, 3.23; 95% CI, 1.41-7.40), and comorbidity (OR, 2.11; 95% CI, .99-4.47). The GSEED-RE and ACER models did not accurately predict DB. Re-estimation and recalibration yielded acceptable results (GSEED-RE area under the curve [AUC], .64 [95% CI, .54-.74]; ACER AUC, .65 [95% CI, .57-.73]). We used lesion size, proximal location, comorbidity, and antiplatelet or anticoagulant therapy to generate a new model, the GSEED-RE2, which achieved higher AUC values (.69-.73; 95% CI, .59-.80) and exhibited lower susceptibility to changes among datasets.[Conclusions]: The updated GSEED-RE and ACER models achieved acceptable prediction levels of DB. The GSEED-RE2 model may achieve better prediction results and could be used to guide the management of patients after validation by other external groups. (Clinical trial registration number: NCT 03050333.)Research support for this study was received from “La Caixa/Caja Navarra” Foundation (ID 100010434;project PR15/11100006)

Associations Between the Modified Food Standard Agency Nutrient Profiling System Dietary Index and Cardiovascular Risk Factors in an Elderly Population

Background: Helping consumers to improve the nutritional quality of their diet is a key public health action to prevent cardiovascular diseases (CVDs). The modified version of the Food Standard Agency Nutrient Profiling System Dietary Index (FSAm-NPS DI) underpinning the Nutri-Score front-of-pack label has been used in public health strategies to address the deleterious consequences of poor diets. This study aimed to assess the association between the FSAm-NPS DI and some CVD risk factors including body mass index (BMI), waist circumference, plasma glucose levels, triglyceride levels, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, and diastolic and systolic blood pressure. Materials and Methods: Dietary intake was assessed at baseline and after 1 year of follow-up using a 143-item validated semi-quantitative food-frequency questionnaire. Dietary indices based on FSAm-NPS applied at an individual level were computed to characterize the diet quality of 5,921 participants aged 55-75 years with overweight/obesity and metabolic syndrome from the PREDIMED-plus cohort. Associations between the FSAm-NPS DI and CVD risk factors were assessed using linear regression models. Results: Compared to participants with a higher nutritional quality of diet (measured by a lower FSAm-NPS DI at baseline or a decrease in FSAm-NPS DI after 1 year), those participants with a lower nutritional quality of diet (higher FSAm-NPS DI or an increase in score) showed a significant increase in the levels of plasma glucose, triglycerides, diastolic blood pressure, BMI, and waist circumference (beta coefficient [95% confidence interval]; P for trend) (1.67 [0.43, 2.90]; <0.001; 6.27 [2.46, 10.09]; <0.001; 0.56 [0.08, 1.05]; 0.001; 0.51 [0.41, 0.60]; <0.001; 1.19 [0.89, 1.50]; <0.001, respectively). No significant associations in relation to changes in HDL and LDL-cholesterol nor with systolic blood pressure were shown. Conclusion: This prospective cohort study suggests that the consumption of food items with a higher FSAm-NPS DI is associated with increased levels of several major risk factors for CVD including adiposity, fasting plasma glucose, triglycerides, and diastolic blood pressure. However, results must be cautiously interpreted because no significant prospective associations were identified for critical CVD risk factors, such as HDL and LDL-cholesterol, and systolic blood pressure

Ultra-processed foods consumption as a promoting factor of greenhouse gas emissions, water, energy, and land use: A longitudinal assessment

Background: Dietary patterns can produce an environmental impact. Changes in people's diet, such as the increased consumption of ultra-processed food (UPF) can not only influence human health but also environment sustainability. Objectives: Assessment of the impact of 2-year changes in UPF consumption on greenhouse gas emissions and water, energy and land use. Design: A 2-year longitudinal study after a dietary intervention including 5879 participants from a Southern European population between the ages of 55-75 years with metabolic syndrome. Methods: Food intake was assessed using a validated 143-item food frequency questionnaire, which allowed classifying foods according to the NOVA system. In addition, sociodemographic data, Mediterranean diet adherence, and physical activity were obtained from validated questionnaires. Greenhouse gas emissions, water, energy and land use were calculated by means of the Agribalyse® 3.0.1 database of environmental impact indicators for food items. Changes in UPF consumption during a 2-year period were analyzed. Statistical analyses were conducted using computed General Linear Models. Results: Participants with major reductions in their UPF consumption reduced their impact by -0.6 kg of CO2eq and -5.3 MJ of energy. Water use was the only factor that increased as the percentage of UPF was reduced. Conclusions: Low consumption of ultra-processed foods may contribute to environmental sustainability. The processing level of the consumed food should be considered not only for nutritional advice on health but also for environmental protection

IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study

Background: Patients with coronavirus disaese 2019 (COVID-19) can develop a cytokine release syndrome that eventually leads to acute respiratory distress syndrome requiring invasive mechanical ventilation (IMV). Because IL-6 is a relevant cytokine in acute respiratory distress syndrome, the blockade of its receptor with tocilizumab (TCZ) could reduce mortality and/or morbidity in severe COVID-19. Objective: We sought to determine whether baseline IL-6 serum levels can predict the need for IMV and the response to TCZ. Methods: A retrospective observational study was performed in hospitalized patients diagnosed with COVID-19. Clinical information and laboratory findings, including IL-6 levels, were collected approximately 3 and 9 days after admission to be matched with preadministration and postadministration of TCZ. Multivariable logistic and linear regressions and survival analysis were performed depending on outcomes: need for IMV, evolution of arterial oxygen tension/fraction of inspired oxygen ratio, or mortality. Results: One hundred forty-six patients were studied, predominantly males (66%); median age was 63 years. Forty-four patients (30%) required IMV, and 58 patients (40%) received treatment with TCZ. IL-6 levels greater than 30 pg/mL was the best predictor for IMV (odds ratio, 7.1; P < .001). Early administration of TCZ was associated with improvement in oxygenation (arterial oxygen tension/fraction of inspired oxygen ratio) in patients with high IL-6 (P = .048). Patients with high IL-6 not treated with TCZ showed high mortality (hazard ratio, 4.6; P = .003), as well as those with low IL-6 treated with TCZ (hazard ratio, 3.6; P = .016). No relevant serious adverse events were observed in TCZ-treated patients. Conclusions: Baseline IL-6 greater than 30 pg/mL predicts IMV requirement in patients with COVID-19 and contributes to establish an adequate indication for TCZ administrationThis study was funded by Spanish Ministry of Economy, Industry and Competitiveness (MINECO) and Instituto de Salud Carlos III (grant nos. RD16/0011/0012 and PI18/ 0371 to I.G.A., grant no. PI19/00549 to A.A., and grant no. SAF2017-82886-R to F.S.-M.) and co-funded by the European Regional Development Fund. The study was also funded by ‘‘La Caixa Banking Foundation’’ (grant no. HR17-00016 to F.S.-M.) and ‘‘Fondos Supera COVID19’’ by Banco de Santander and CRUE. None of these sponsors have had any role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publicatio