Implantación de una unidad de prevención de caídas y fracturas en un área sanitaria

Introducción: El síndrome de caídas tiene una alta prevalencia en las personas mayores, es de etiología múltiple y compromete la capacidad funcional. La incidencia anual de caídas se sitúa en el 25% entre los 65-75 años y el 45% en los mayores de 75. Las Unidades de Prevención de Caídas y Fracturas (UPCF) son recursos donde se realiza una evaluación e intervención multidisciplinar en los sujetos con alto riesgo de caídas. Material y métodos: Se realizó un estudio en dos niveles. Nivel 1, estudio cuasi experimental con intervención educativa a personal sanitario e impacto poblacional. En este nivel se intervino en tres Centros de Salud (CS) y tres Centros Socio Sanitarios (CSS). Nivel 2, estudio cuasi experimental de intervención multidisciplinar a la muestra de pacientes remitida para valoración por fragilidad y riesgo de caídas desde los CS y CSS de intervención. En este nivel se recogieron parámetros clínicos y analíticos relacionados con función física y cognitiva. Resultados: Nivel 1: Intervención comunitaria. En el área de los CS de intervención se redujo el número de fracturas de fémur proximal un 23,3%, mientras que en los CS donde no se intervino, aumentó un 23,4%. En los CSS de intervención se redujo la incidencia de caídas un 20,5%. Nivel 2: Intervención individual. De los 149 sujetos derivados a la UPCF, 87 fueron incluidos siguiendo los criterios de elegibilidad. Edad media 85,18 años, 63.2% mujeres. A todos los sujetos se le ofertó participar en un programa de ejercicio multicomponente grupal dirigido como parte de la intervención multidisciplinar. 59 realizaron el programa de entrenamiento, observándose una importante mejoría funcional y cognitiva y disminuyendo el número de caídas y de visitas a urgencias. Tras terminar el programa grupal de entrenamiento, se prescribió ejercicio físico de forma individualizada a todos los sujetos. A los tres meses, 41 de los 59 sujetos habían seguido la prescripción. A los seis meses 34 mantenían el ejercicio prescrito. Los datos muestran que aquellos que realizaban el ejercicio mantenían la situación funcional y cognitiva alcanzada tras la intervención y la reducción en el número de caídas, ingresos y visitas a Urgencias, pero los que no siguieron la prescripción habían perdido toda la mejoría funcional alcanzada, aunque mantenían la cognitiva. Conclusion: Los resultados de este estudio sugieren que la implantación de una Unidad de Prevención de Caídas y Fracturas que desarrolle una intervención como la descrita en este trabajo, mejora la situación cognitiva, el estado de ánimo y la situación funcional, revierte la fragilidad y disminuye el número de caídas y eventos adversos de salud de los sujetos sobre los que interviene. A nivel comunitario parece que se reduce el número de fracturas de fémur proximal en el área de influencia, pero se necesitarían nuevos trabajos para confirmar este punto

El consumo moderado y continuado de vino tinto promueve el metabolismo fenólico intestinal

Los polifenoles presentes en el vino son ampliamente metabolizados por la microbiota a lo largo del tracto gastrointestinal. Estos metabolitos fenólicos de origen microbiano parecen tener un papel relevante en los efectos beneficiosos para la salud derivados del consumo moderado de vino. Entre otros efectos, los polifenoles del vino y/o sus metabolitos pueden modificar o modular selectivamente la microbiota oral y del intestino. Con el objetivo de dilucidar como el consumo de vino afecta al metabolismo fenólico intestinal y conocer la relevancia fisiológica de estos efectos, se ha realizado un estudio de intervención en humanos que incluye a 41 voluntarios sanos (33 casos y 8 controles), basado en el consumo moderado (250mL/día) de vino tinto, durante 4 semanas. Antes y después de la intervención, se recolectaron muestras de heces procedentes de los voluntarios. El análisis de metabolitos fenólicos mediante UPLC-ESI-MS/MS ha revelado un aumento significativo en el contenido total de metabolitos de origen microbiano, principalmente de ácidos benzoicos y 4-hidroxivaléricos, en las heces de los voluntarios tras la ingesta de vino, lo que demuestra que el perfil metabólico microbiano de las heces se modifica significativamente por la ingesta moderada de polifenoles del vino.Los autores agradecen al MINECO y al CSlC la financiación obtenida para este estudio.Peer reviewe

Moderate intake of red wine promotes a significant increase of phenolic metabolites in human faeces

With the final aim of ascertaining consistent data about the changes of phenolic metabolites in faeces after a regular wine consumption, the present paper compiles the data from two previous human intervention studies: a) a pilot study (n = 8), that compared the ingestion of de-alcoholised red wine (272 mL/day), red wine (272 mL/day), or gin (100 mL/day) during 20 days, and b) a large trial study (n = 41, 33 cases and 8 controls), that assessed variability among individuals after the intake of red wine (250 mL/day, 28 days). Great coincidence was observed in the main phenolic metabolites identified in the faecal samples from both studies that included benzoic acids, phenols, hippuric acids, phenylacetic acids, phenylpropionic acids, valeric acids, valerolactones and cinnamic acids. However, significant differences (P < 0.05) in the total phenolic content between faecal samples before and after the wine intervention was only observed for the large trial study (358 ± 270 and 625 ± 380 μg/g faeces, corresponding to the mean values before and after the intervention, respectively), emphasizing the large variability in the phenolic-metabolizing gut-microbial capacity among individuals. The overall results confirm that consumption of wine enhances phenolic metabolism, which might have physiological relevancy at the gut level.This work was funded by the MINECO (AGL2009-13361-C02-01, AGL2012- 04172-C02-01, and CONSOLIDER INGENIO 2010 (FUN-C-FOOD, CSD2007-063, Projects), and the Comunidad de Madrid (ALIBIRD P2009/AGR-1469 Project). AJ-G and IM-G would like to thank the European Social Fund and Jae-Doc (CSIC) and FPI Programs for their research contracts, respectively.Peer Reviewe

Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial

Cognitive function; Falls; FracturesFunción cognitiva; Caídas; FracturasFunció cognitiva; Caigudes; FracturesBackground Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult’s population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown effectiveness for reducing fall rates, evidence around their putative cumulative effects on falls and fall-related complications (such as fractures, reduced quality of life and functional limitations) in frail individuals remains scarce. The main aim of this study is to explore the effectiveness program combining an individualized exercise program and an executive function-based cognitive training (VIVIFRAIL-COGN) compared to usual care in the prevention of falls and fall-related outcomes over a 1-year follow-up. Methods This study is designed as a four-center randomized clinical trial with a 12-week intervention period and an additional 1-year follow-up. Three hundred twenty frail or pre-frail (≥ 1 criteria of the Frailty Phenotype) older adults (≥ 75 years) with high risk of falling (defined by fall history and gait performance) will be recruited in the Falls Units of the participating centers. They will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will participate in a home-based intervention combining the individualized Vivifrail multicomponent (aerobic, resistance, gait and balance and flexibility) exercise program and a personalized executive function-based cognitive training (VIVIFRAIL-COGN). The CG group will receive usual care delivered in the Falls Units, including the Otago Exercise Program. Primary outcome will be the incidence of falls (event rate/year) and will be ascertained by self-report during three visits (at baseline, and 6 and 12 weeks) and telephone-based contacts at 6, 9 and 12 months after randomization. Secondarily, effects on measures of physical and cognitive function, quality of life, nutritional, muscle quality and psychological status will be evaluated. Discussion This trial will provide new evidence about the effectiveness of an individualized multidomain intervention by studying the effect of additive effects of cognitive training and physical exercise to prevent falls in older frail persons with high risk of falling. Compared to usual care, the combined intervention is expected to show additive effects in the reduction of the incidence of falls and associated adverse outcomes.The present study is funded by a grant from the Spanish Ministry of Science and Innovation and the Instituto de Salud Carlos III (PI20/01546). Funder Agencies do not play any role in the conducting of the study. Instituto de Salud Carlos III,PI20/01546,Alvaro Casas-Herrer

Evaluación del metabolismo colónico de un vino tinto mediante el empleo de un nuevo modelo de simulación gastrointestinal dinámico (SIMGI)

Este libro recoge el amplio y significativo elenco de estudios recientemente realizados por los grupos de investigación de la red GIENOL (Grupos de investigación enológica).Los polifenoles del vino pueden influir positivamente en la salud del hombre modificando la actividad metabólica y/o composición de la microbiota intestinal. El objetivo de este trabajo ha sido evaluar el metabolismo colónico de un vino tinto mediante el empleo de un nuevo modelo de simulación dinámico del tracto gastrointestinal (denominado SIMGI), utilizando heces humanas de donantes sanos (n=2). Para los tres compartimentos del colon ‐ascendente, transverso y descendente‐ se llevó a cabo la monitorización de diferentes parámetros metabólicos (compuestos fenólicos del vino y sus metabolitos, ion amonio y ácidos grasos de cadena corta (SCFA)) y microbiológicos (recuentos, qPCR), incluyendo la comparativa tras la alimentación del sistema con vino sintético (sin polifenoles). Los resultados mostraron que la ingesta moderada de vino activaba el metabolismo de la microbiota colónica. Se encontraron aumentos significativos para los ácidos gálico, protocatéquico, 3‐Ometilgálico, 4‐hidroxibenzoico, 3,4‐dihidroxifenilpropiónico, vainillínico, siríngico, y salicílico después de la alimentación con vino. Simultáneamente, se observó una disminución en la formación del ion amonio y un incremento en la proporción del ácido butanoico. A nivel microbiológico, los principales cambios tuvieron lugar en el colon ascendente. En conclusión, estos resultados ponen de manifiesto que el vino modula la actividad metabólica de la microbiota intestinal in vitro, y demuestran la utilidad del SIMGI como modelo de simulación gastrointestinal dinámico.Este trabajo ha sido financiado por el MINECO a través del proyecto AGL2012‐40172‐C02‐01, el Programa de la Comunidad Madrid ALIBIRD‐CM S2013/ABI ‐2728 y el Proyecto Intramural CSIC 201270E065.Peer Reviewe

Simulador gastrointestinal dinámico (simgi®): Una herramienta potencialmente útil en nutrición clínica

The human gastrointestinal tract harbours the most complex and abundant community of the human body, the colon being where the highest microbial concentration is found (10 12 cell/g). The intestinal microbiota exerts metabolic, trophic and protective functions which are important in the maintenance of the host health. Over recent decades, numerous studies have attempted to provide scientific evidence about the environmental factors that can impact on human health through the modulation of the intestinal microbiota composition. However, this approach is changing, and a new focus on assessing changes at functional level is being developed. If we apply this dual approach to the role played by the diet, it is obvious the need of dynamic gastrointestinal simulation models such as simgi®, that allow to evaluate the transformations undergone by food and/or food ingredients during their transit through the gastrointestinal tract, as well as to determine potential changes in the composition and functionality of the intestinal microbiota after food ingestion. So far the studies using the simgi® have confirmed its potential applications in the area of food as a prior step to its application in clinical nutrition to prevent and/or treat diseases associated with intestinal dysbiosis and metabolic disorders. Likewise, this review includes feasible perspectives of the use of simgi® in clinical research concerning to diseases related to the intestinal microbiota.Dentro de la microbiota humana, el tracto gastrointestinal alberga el ecosistema más complejo y abundante del cuerpo humano, siendo el colon donde se encuentra la concentración más alta de microorganismos (1012 cel/g). La microbiota intestinal desempeñaa funciones metabólicas, tróficas y de protección que son de gran importancia para el hospedador. Durante las últimas décadas, son numerosos los estudios que han tratado de aportar evidencias científicas acerca de los factores que, a través de cambios en la composición de la microbiota intestinal, influyen en la salud humana. Sin embargo, esta aproximación está cambiando, y son cada vez más los expertos que apuestan por evaluar cambios a nivel de funcionalidad de la microbiota. Si aplicamos este enfoque dual al papel desempeñado por la dieta, resulta obvia la necesidad de disponer de modelos dinámicos de simulación gastrointestinal, como es el simgiR, que permitan evaluar las transformaciones que sufren los alimentos y/o ingredientes alimentarios durante el tránsito por el tracto gastrointestinal, así como para determinar los posibles cambios en la composición y funcionalidad de la microbiota intestinal derivados de la ingesta de alimentos. Los estudios llevados a cabo hasta el momento con el simgiR constatan sus potenciales aplicaciones en el área de los alimentos como paso previo a su aplicación en nutrición clínica, para prevenir y/o tratar enfermedades asociadas a disbiosis intestinal, así como trastornos metabólicos. Asimismo, esta revisión recoge posibles perspectivas de utilización del simgiR en la investigación clínica relativa a enfermedades vinculadas con disfunciones de la microbiota intestinalEste trabajo ha sido realizado gracias a la financiación del MINECO (proyecto AGL2015- 64522-C2-R) y la Comunidad de Madrid (Programa ALIBIRD-CM S2013/ABI-2728-CM). Alba Tamargo es beneficiaria de un contrato en el Programa de Garantía Juvenil-CSIC financiado gracias al Fondo Social Europeo. Irene Gil Sánchez es beneficiaria de una beca FPU del MECD (FPU14/0576

Active Gains in brain Using Exercise During Aging (AGUEDA): protocol for a randomized controlled trial

Alzheimer’s disease is currently the leading cause of dementia and one of the most expensive, lethal and severe diseases worldwide. Age-related decline in executive function is widespread and plays a key role in subsequent dementia risk. Physical exercise has been proposed as one of the leading non-pharmaceutical approaches to improve executive function and ameliorate cognitive decline. This single-site, two-arm, single-blinded, randomized controlled trial (RCT) will include 90 cognitively normal older adults, aged 65–80 years old. Participants will be randomized to a 24-week resistance exercise program (3 sessions/week, 60 min/session, n = 45), or a wait-list control group (n = 45) which will be asked to maintain their usual lifestyle. All study outcomes will be assessed at baseline and at 24-weeks after the exercise program, with a subset of selected outcomes assessed at 12-weeks. The primary outcome will be indicated by the change in an executive function composite score assessed with a comprehensive neuropsychological battery and the National Institutes of Health Toolbox Cognition Battery. Secondary outcomes will include changes in brain structure and function and amyloid deposition, other cognitive outcomes, and changes in molecular biomarkers assessed in blood, saliva, and fecal samples, physical function, muscular strength, body composition, mental health, and psychosocial parameters. We expect that the resistance exercise program will have positive effects on executive function and related brain structure and function, and will help to understand the molecular, structural, functional, and psychosocial mechanisms involvedRTI2018-095284-J-100 funded by MCIN/AEI/10.13039/501100011033/ and “ERDF A way of making Europe”RYC2019-027287-I funded by MCIN/AEI/10.13039/501100011033/ and “ESF Investing in your future”“Margarita Salas” grant from the Spanish Ministry Universities. Plan Andaluz de Investigación (PAIDI) (Convocatoria 2020, Ref: P20_00124) 2021–2022.Ministerio de Economía y Competitividad–Proyectos I + D + I RETOS (Convocatoria 2020, Ref: PID2020-120249RB-I00).EXERNET Research Network on Exercise and Health (DEP2005- 00046/ACTI; 09/UPB/19; 45/UPB/20; 27/UPB/21).University of Granada “Proyectos de investigación precompetitivos para jóvenes investigadores” (Convocatoria 2021, Ref: PPJIA2021-39)

Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial

Mat complBackground: Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult’s population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown efectiveness for reducing fall rates, evidence around their puta‑ tive cumulative efects on falls and fall-related complications (such as fractures, reduced quality of life and functional limitations) in frail individuals remains scarce. The main aim of this study is to explore the efectiveness program combining an individualized exercise program and an executive function-based cognitive training (VIVIFRAIL-COGN) compared to usual care in the prevention of falls and fall-related outcomes over a 1-year follow-up. Methods: This study is designed as a four-center randomized clinical trial with a 12-week intervention period and an additional 1-year follow-up. Three hundred twenty frail or pre-frail (≥1 criteria of the Frailty Phenotype) older adults (≥75 years) with high risk of falling (defned by fall history and gait performance) will be recruited in the Falls Units of the participating centers. They will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will participate in a home-based intervention combining the individualized Vivifrail multicomponent (aerobic, resistance, gait and balance and fexibility) exercise program and a personalized executive function-based cognitive training (VIVIFRAIL-COGN). The CG group will receive usual care delivered in the Falls Units, including the Otago Exercise Program. Primary outcome will be the incidence of falls (event rate/year) and will be ascertained by self-report during three visits (at baseline, and 6 and 12 weeks) and telephone-based contacts at 6, 9 and 12 months after randomization. Secondarily, efects on measures of physical and cognitive function, quality of life, nutritional, muscle quality and psychological status will be evaluated. Discussion: This trial will provide new evidence about the efectiveness of an individualized multidomain interven‑ tion by studying the efect of additive efects of cognitive training and physical exercise to prevent falls in older frail persons with high risk of falling. Compared to usual care, the combined intervention is expected to show additive efects in the reduction of the incidence of falls and associated adverse outcomes. Trial registration: NCT04911179 02/06/2021. © 2022, The Author(s).The present study is funded by a grant from the Spanish Ministry of Science and Innovation and the Instituto de Salud Carlos III (PI20/01546). Instituto de Salud Carlos III, PI20/01546, Alvaro Casas-Herrer

Heterozygous and Homozygous Variants in SORL1 Gene in Alzheimer's Disease Patients: Clinical, Neuroimaging and Neuropathological Findings

In the last few years, the SORL1 gene has been strongly implicated in the development of Alzheimer’s disease (AD). We performed whole-exome sequencing on 37 patients with early-onset dementia or family history suggestive of autosomal dominant dementia. Data analysis was based on a custom panel that included 46 genes related to AD and dementia. SORL1 variants were present in a high proportion of patients with candidate variants (15%, 3/20). We expand the clinical manifestations associated with the SORL1 gene by reporting detailed clinical and neuroimaging findings of six unrelated patients with AD and SORL1 mutations. We also present for the first time a patient with the homozygous truncating variant c.364C>T (p.R122*) in SORL1, who also had severe cerebral amyloid angiopathy. Furthermore, we report neuropathological findings and immunochemistry assays from one patient with the splicing variant c.4519+5G>A in the SORL1 gene, in which AD was confirmed by neuropathological examination. Our results highlight the heterogeneity of clinical presentation and familial dementia background of SORL1-associated AD and suggest that SORL1 might be contributing to AD development as a risk factor gene rather than as a major autosomal dominant gene.This work was supported by the Instituto de Salud Carlos III (PI17/01067) and AGAUR from the Autonomous Catalan Government (2017SGR1134). Dr. Víctor Antonio Blanco-Palmero is supported by the Instituto de Salud Carlos III (ISCIII, Spanish Biomedical Research Institute) through a “Río Hortega” contract (CM18/0095). Dr. Sara Llamas-Velasco is supported by the Instituto de Salud Carlos III (ISCIII; Spanish Biomedical Research Institute) through a “Juan Rodés” contract (JR 18/00046).S

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true