Effects and Mechanisms of Cognitive, Aerobic Exercise, and Combined Training on Cognition, Health, and Brain Outcomes in Physically Inactive Older Adults: The Projecte Moviment Protocol

Introduction: Age-related health, brain, and cognitive impairment is a great challenge in current society. Cognitive training, aerobic exercise and their combination have been shown to benefit health, brain, cognition and psychological status in healthy older adults. Inconsistent results across studies may be related to several variables. We need to better identify cognitive changes, individual variables that may predict the effect of these interventions, and changes in structural and functional brain outcomes as well as physiological molecular correlates that may be mediating these effects. Projecte Moviment is a multi-domain randomized trial examining the effect of these interventions applied 5 days per week for 3 months compared to a passive control group. The aim of this paper is to describe the sample, procedures and planned analyses. Methods: One hundred and forty healthy physically inactive older adults will be randomly assigned to computerized cognitive training (CCT), aerobic exercise (AE), combined training (COMB), or a control group. The intervention consists of a 3 month home-based program 5 days per week in sessions of 45 min. Data from cognitive, physical, and psychological tests, cardiovascular risk factors, structural and functional brain scans, and blood samples will be obtained before and after the intervention. Results: Effects of the interventions on cognitive outcomes will be described in intention-to-treat and per protocol analyses. We will also analyze potential genetic, demographic, brain, and physiological molecular correlates that may predict the effects of intervention, as well as the association between cognitive effects and changes in these variables using the per protocol sample. Discussion: Projecte Moviment is a multi-domain intervention trial based on prior evidence that aims to understand the effects of CCT, AE, and COMB on cognitive and psychological outcomes compared to a passive control group, and to determine related biological correlates and predictors of the intervention effects.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03123900

Arteriopatía periférica de extremidades inferiors y morbimortalidad en pacientes diabéticos tipo 2

ObjetivoEstudiar la relación entre lapresencia de arteriopatía periférica (AP) y morbimortalidad a los 6 años, y el valor delíndice tobillo-brazo (ITB) como predictorde morbimortalidad en la diabetes mellitus tipo 2.DiseñoEstudio de cohorte retrospectivo.Seguimiento de 6 años.EmplazamientoCentro de salud urbano.ParticipantesEn total, 269 diabéticos no insulinodependientes, de los cuales 63 tenían AP en 1996: 20 estaban previamente diagnosticados y 43 presentaban un ITB≤0,90.Mediciones principalesSe citó a los pacientespara conocer la incidencia de eventosmicrovasculares y macrovasculares mortales yno mortales y se revisaron las historias. Seexcluyó a 6 por no disponer de todos los datos.ResultadosHan fallecido 39 pacientes, 19 de los cuales presentaban AP en 1996(30,1%) y 20 no (9,7%) (p=0,001).Fallecieron 16 pacientes en el grupo con ITB≤0,9 (30,2%) y 21 (10,1%) en el grupocon valores de ITB normales (p=0,001).Murieron por causa cardiovascular 7 pacientes (13,2%) con ITB patológico y 8(3,9%) con exploración normal (p=0,009).La presencia de AP se ha asociado con unamayor probabilidad de presentar un episodiono mortal de cardiopatía isquémica (p=0,04), un accidente cerebrovascular (ACV) (p<0,001) y úlceras (p=0,006). Un ITB bajo se ha asociado con una mayorprobabilidad de presentar un eventocardiovascular, mortal o no (p<0,001).Tras el análisis multivariable se observa unaumento de morbimortalidad cardiovascular(odds ratio [OR]=2,81; intervalo deconfianza [IC] del 95%, 1,16-6,78), ACV(OR=3,47; IC del 95%, 1,19-10,07) einsuficiencia cardíaca (OR=6,75; IC del95%, 1,34-33,81) en los diabéticos con ITB=0,90.ConclusionesLos diabéticos tipo 2 con AP presentan una mayor morbimortalidad. ElITB es un buen predictor de morbimortalidad cardiovascular e insuficiencia cardíaca.ObjectiveTo study the relationship between the presence of peripheral artery disease(PAD) and the morbidity and mortality at 6years, and the ankle-brachial index (ABI) as a predictor of morbidity and mortality in type 2 diabetes mellitus.DesignRetrospective cohort study. Six years follow-up.SettingUrban health centre.ParticipantsA total of 269 type 2 diabetics,of which 63 had PAD in 1996: 20 were previously diagnosed and 43 had an ABI of≤0.90.Principal measurementsAn appointed was made with the patients to find out the incidence of fatal and non-fatal microvascular and macrovascular events and the histories were reviewed. Six patients were excluded as all their data were not available.ResultsThirty nine patients had died, of whom 19 had PAD in 1996 (30.1%) and 20 did not (9.7%) (P=.001).Sixteen patients died in the group with an ABI≤0.9 (30.2%) and 21 (10.1%) in the group with normal ABI values (P=.001).7 (13.2%) patients died due to a cardiovascular cause with a pathological ABI, and 8 (3.9%) with a normal value (P=.009).The presence of PAD has been associated witha higher probability of having a non-fatal episode of ischaemic cardiac disease (P=.04), a cerebrovascular accident (CVA) (P<.001) and ulcers (P=.006). A low ABI has been associated with a higher probability of presenting with a fatal or non-fatal cardiovascular event (P<.001).After the multivariate analysis an increase was observed in cardiovascular (odds ratio [OR]=2.81; 95% confidence interval [CI], 1.16-6.78), CVA (OR=3.47; 95% CI, 1.19-10.07),and cardiac failure (OR=6.75; 95% CI, 1.34-33.81), morbidity and mortality in diabetics with an ABI of ≤0.90.ConclusionsThe type 2 diabetics with PAD present with a higher morbidity and mortality.The ABI is a good predictor of cardiovascular disease and heart failure morbidity and mortality

Level of distress, somatisation and beliefs on health-disease in newly arrived immigrant patients attended in primary care centres in Catalonia and definition of professional competences for their most effective management: PROMISE Project

Background: Newly arrived immigrant patients who frequently use primary health care resources have difficulties in verbal communication. Also, they have a system of beliefs related to health and disease that makes difficult for health care professionals to comprehend their reasons for consultation, especially when consulting for somatic manifestations. Consequently, this is an important barrier to achieve optimum care to these groups. The current project has two main objectives: 1. To define the different stressors, the level of distress perceived, and its impact in terms of discomfort and somatisation affecting the main communities of immigrants in our area, and 2. To identify the characteristics of cross-cultural competence of primary health care professionals to best approach these reasons for consultation. Methods/Design: It will be a transversal, observational, multicentre, qualitative-quantitative study in a sample of 980 people from the five main non-European Union immigrant communities residing in Catalonia: Maghrebis, Sub-Saharans, Andean South Americans, Hindustanis, and Chinese. Sociodemographic data, level of distress, information on the different stressors and their somatic manifestations will be collected in specific questionnaires. Through a semi-structured interview and qualitative methodology, it will be studied the relation between somatic manifestations and particular beliefs of each group and how these are associated with the processes of disease and seeking for care. A qualitative methodology based on individual interviews centred on critical incidents, focal groups and in situ questionnaires will be used to study the cross-cultural competences of the professionals. Discussion: It is expected a high level of chronic stress associated with the level of somatisations in the different non-European Union immigrant communities. The results will provide better knowledge of these populations and will improve the comprehension and the efficacy of the health care providers in prevention, communication, care management and management of resources