Clinical protocol of leg length inequality

[Abstract] Objectives: To propose a clinical protocol valid and reliable for the study of the differences in length of lower limb (hereinafter DLMI) scan.Materials and Methods: Literature review in scientific databases, and descriptive study with a total sample of 115 participants: study of different methods of determination and measurement of DLMI.Results: There is no consensus as to the reliability and validity of methods and measurement instruments existing in the literature. It has been proven the reliability of the proposed protocol, according to the results of other authors and the data obtained in our study.Conclusions: The Weber-Barstow maneuver, study with tape measure, PALM® and tablets and pelvic compensation level for clinical determination of DLMI is proposed. The anteroposterior telemetry lower limb load as a complementary test, and the Foot Posture Index (hereinafter FPI) and Navicular Drop Test (hereinafter NDT) for the analysis of the position of the foot[Resumen] Objetivos: Proponer un protocolo clínico de exploración válido y fiable para el estudio de las diferencias de longitud de miembro inferior (en adelante DLMI).Material y método: Revisión bibliográfica en bases de datos científicas, y estudio descriptivo sobre con una muestra total de 115 participantes: estudio de los diferentes métodos de determinación y medición de las DLMI.Resultados: No existe consenso en cuanto a la fiabilidad y validez de los métodos e instrumentos de medida existentes en la bibliografía consultada. Se ha comprobado la fiabilidad del protocolo propuesto, según los resultados de otros autores y por los datos obtenidos en nuestro estudio.Conclusiones: Se propone la maniobra Weber-Barstow, estudio con cinta métrica, PALM® y compensación con tablillas y nivel pélvico para la determinación clínica de las DLMI. La telemetría anteroposterior de miembros inferiores en carga como prueba complementaria, y el Foot Posture Index (en adelante, FPI) y Navicular Drop Test (en adelante, NDT) para el análisis de la posición del pi

Trends in adherence to physical activity guidelines from 1997 to 2018 among adults with obesity: An analysis from the US National Health Interview Survey

The aim of this study was to estimate the temporal trends in adherence rates to the physical activity (PA) guidelines for aerobic and muscle‐strengthening activities (MSA) among United States (US) adults with obesity. We retrieved data from 22 consecutive rounds of the National Health Interview Survey (NHIS) conducted between 1997 and 2018. Meeting with the PA guidelines recommended by the World Health Organization was determined as follows: individuals achieving ≥150 weekly minutes of moderate physical activity (MPA), ≥75 weekly minutes of vigorous physical activity (VPA), and ≥2 weekly MSA training sessions. The prevalence of meeting PA guidelines increased from 9.4% in 1997 to 15.0% in 2018, although less than 2 in 10 adults with obesity met the guidelines throughout the study period. Overall, compared to females, males with obesity were more likely to adhere to PA recommendations (odds ratio (OR) = 2.03 [95% confidence interval (CI), 1.94 to 2.12]). Also, each age year significantly reduced the odds of adhering to PA recommendations overall (OR = 0.97 [95% CI, 0.97 to 0.98]). Compared with their White counterparts, Black and other races people with obesity have higher significant odds of adhering to PA recommendations with, respectively, OR = 1.18 (95% CI, 1.12 to 1.24) and OR = 1.30 (95% CI, 1.18 to 1.43). In representative samples of adults with obesity from the US, there was an increasing trend for meeting PA guidelines, although only less than 2 in 10 met them

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

Background Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Dose-response association of an accelerometer-measured physical activity with all-cause mortality and cardiovascular disease incidence: Prospective cohort with 76,074 participants

Objective To investigate the prospective dose-response association of accelerometer-measured moderate-to-vigorous physical activity (PA;MVPA) with all-cause mortality and cardiovascular disease (CVD) incidence. Methods This prospective cohort of 76,074 participants from the UK Biobank study contained one week of individual accelerometer-based PA data collected between June 1, 2013 and December 23, 2015. Using restricted cubic splines to allow for potential non-linearity, we examined dose-response associations of MVPA with all-cause mortality and incident CVD, respectively. Results The median follow-up time was 8.0 years (IQR 7.5–8.5). The dose-response association of MVPA with all-cause mortality and CVD showed a similar L-shaped association, with significant risk reductions already from 10 min of MVPA per week for all-cause mortality (hazard ratio [HR], 0.98 [95 % CI,0.98–0.99]) and 15 min per week for CVD incidence (HR, 0.99 [95 % CI,0.98–0.99]). Doing more MVPA was associated with further risk reduction, but beyond around 500 min per week the benefits levelled off at HR's around 0.6 to 0.7. The highest additional benefit of adding more minutes per week for all-cause mortality and CVD incidence were observed between 100 and 250 weekly minutes of MVPA. From this point forward, the mean risk reduction rates decreased and were close to 0 beyond 500 weekly minutes. Conclusions Significant, but small, risk reductions in all-cause mortality and CVD incidence can be achieved with as little as 10 and 15 min of MVPA per week, respectively. However, public health organizations should promote the attainment of 250 min of MVPA per week (with 100 min as a possible first target for inactive individuals), as these thresholds are associated with the greatest efficiency. Beyond that, less pronounced risk reductions can be achieved by accumulating additional MVPA, with hardly any additional benefits beyond 500 weekly minutes

Optimal dose and pattern of physical activity to prevent diagnosed depression:prospective cohort study

BACKGROUND: Little is known about the dose and pattern of moderate-to-vigorous physical activity (MVPA) to prevent depression. We aimed to assess the prospective association of dose and pattern of accelerometer-derived MVPA with the risk of diagnosed depression.METHODS: We included 74,715 adults aged 40-69 years from the UK Biobank cohort who were free of severe disease at baseline and participated in accelerometer measurements (mean age 55.2 years [SD 7.8]; 58% women). MVPA at baseline was derived through 1-week wrist-worn accelerometry. Diagnosed depression was defined by hospitalization with ICD-10 codes F32.0-F32.A. Restricted cubic splines and Cox regression determined the prospective association of dose and pattern of MVPA with the risk of incident depression.RESULTS: Over a median 7.9-year follow-up, there were 3,089 (4.1%) incident cases of depression. Higher doses of MVPA were curvilinearly associated with lower depression risk, with the largest minute-per-minute added benefits occurring between 5 (HR 0.99 [95% CI 0.96-0.99]) and 280 (HR 0.67 [95% CI 0.60-0.74]) minutes per week (reference: 0 MVPA minutes).CONCLUSION: Regardless of pattern, higher doses of MVPA were associated with lower depression risk in a curvilinear manner, with the greatest incremental benefit per minute occurring during the first 4-5 h per week. Optimal benefits occurred around 15 h/week.</p

Joint associations of handgrip strength and physical activity with incident cardiovascular disease and overall mortality in the UK Biobank

Background & aims Questions remain whether higher handgrip strength confers additional health advantages beyond adherence to current physical activity guidelines. We aimed to evaluate prospective associations of joint objectively measured handgrip strength and physical activity with incident cardiovascular disease (CVD) and all-cause mortality. Methods We analysed the UK Biobank study in a cohort of participants who wore accelerometers for one week, with follow-up based on hospital records until 2022. Patterns of physical activity were compared: participants who met current moderate-vigorous physical activity guidelines (150 min per week) and those who did not. Handgrip strength was classified into sex- and age-specific tertiles. CVD events were identified as primary or secondary by examination of inpatient records and data extracted from the death registry. CVD-related deaths were also identified from the death registry. We examined prospective associations of moderate-vigorous physical activity with incident CVD and all-cause mortality by level of handgrip using Cox regressions, adjusted for confounding factors. Results A total of 76 074 persons were included (mean 55.2 years). Meeting physical activity guidelines is necessary to reduce all-cause mortality in those at the lower and middle thirds of handgrip strength. However, meeting physical activity guidelines did not confer additional reduction of all-cause mortality of those with high handgrip strength. Those with the lowest handgrip strength showed the greatest benefit from meeting physical activity guidelines for reducing all-cause mortality (HR 0.74; 95 % CI 0.65–0.85). Conclusion Our results indicate that, while following physical activity guidelines does not reduce mortality in individuals with high handgrip strength, it is essential for preventing cardiovascular disease across all levels of handgrip strength. This underscores the importance of these guidelines for cardiovascular health

Corrigendum: COVID-19 Confinement and Health Risk Behaviors in Spain

In the original article, the reference for Chen et al. (2009) was incorrectly written as “Chen, P., Mao, L., Nassis, G. P., Harmer, P., Ainsworth, B. E., and Li, F. (2009). Wuhan coronavirus (2019-nCoV): the need to maintain regular physical activity while taking precautions. J. Sport Health Sci. 9, 103–104. doi: 10.1016/j.jshs.2020.02.001”. It should be “Chen, P., Mao, L., Nassis, G. P., Harmer, P., Ainsworth, B. E., and Li, F. (2020). Coronavirus disease (COVID-19): The need to maintain regular physical activity while taking precautions. J. Sport Health Sci. 9, 103–104. doi: 10.1016/j.jshs.2020.02.001”. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.</p

Joint associations of handgrip strength and physical activity with incident cardiovascular disease and overall mortality in the UK Biobank

Background & aims: Questions remain whether higher handgrip strength confers additional health advantages beyond adherence to current physical activity guidelines. We aimed to evaluate prospective associations of joint objectively measured handgrip strength and physical activity with incident cardiovascular disease (CVD) and all-cause mortality. Methods: We analysed the UK Biobank study in a cohort of participants who wore accelerometers for one week, with follow-up based on hospital records until 2022. Patterns of physical activity were compared: participants who met current moderate-vigorous physical activity guidelines (150 min per week) and those who did not. Handgrip strength was classified into sex- and age-specific tertiles. CVD events were identified as primary or secondary by examination of inpatient records and data extracted from the death registry. CVD-related deaths were also identified from the death registry. We examined prospective associations of moderate-vigorous physical activity with incident CVD and all-cause mortality by level of handgrip using Cox regressions, adjusted for confounding factors. Results: A total of 76 074 persons were included (mean 55.2 years). Meeting physical activity guidelines is necessary to reduce all-cause mortality in those at the lower and middle thirds of handgrip strength. However, meeting physical activity guidelines did not confer additional reduction of all-cause mortality of those with high handgrip strength. Those with the lowest handgrip strength showed the greatest benefit from meeting physical activity guidelines for reducing all-cause mortality (HR 0.74; 95 % CI 0.65-0.85). Conclusion: Our results indicate that, while following physical activity guidelines does not reduce mortality in individuals with high handgrip strength, it is essential for preventing cardiovascular disease across all levels of handgrip strength. This underscores the importance of these guidelines for cardiovascular health

Actividad física y absentismo laboral debido a enfermedad

El absentismo laboral debido a enfermedad es un fenómeno multicausal influido por las características del entorno laboral, el puesto de trabajo y el estilo de vida. Su elevado coste es soportado por empresas e instituciones públicas en base a la legislación vigente, y representa una parte importante del presupuesto para muchos países. Sin embargo, no se trata únicamente de una cuestión económica, sino también de una cuestión de salud pública; el absentismo laboral por enfermedad de larga duración ha sido asociado tanto a un mayor riesgo de experimentar pensión por incapacidad permanente, como a un mayor riesgo de mortalidad. Entre sus causas más relevantes se ha señalado a diferentes condiciones y enfermedades crónicas, en ocasiones, específicas de determinadas profesiones y sectores laborales. Así, el dolor de espalda (i.e. zona lumbar y zona cervical), los trastornos mentales (i.e. ansiedad y depresión), y diferentes enfermedades cardiovasculares han sido observadas entre las condiciones más prevalentes en trabajadores de diferentes poblaciones que experimentan absentismo laboral por enfermedad de larga duración. Por otro lado, niveles moderados y altos de actividad física, en especial cuando se realizan en el tiempo libre o con motivo de desplazamiento al centro de trabajo, han sido asociados a menores niveles de, por un lado, absentismo laboral por enfermedad y, por otro, a algunas de las enfermedades crónicas más extendidas en poblaciones generales y específicas de trabajadores. Además, esta asociación inversa se ha observado más pronunciada con niveles mayores de actividad física en el tiempo libre. El objetivo de estos estudios fue el de ampliar el conocimiento acerca de estas relaciones entre actividad física y absentismo laboral por enfermedad, haciendo especial énfasis en su observación con diferentes muestras de trabajadores españoles, trabajadores daneses, poblaciones de trabajadores específicas y condiciones o enfermedades crónicas asociadas a estas situaciones.Los estudios llevados a cabo son de carácter observacional, y utilizaron datos de muestras de poblaciones de trabajadores españoles y daneses. El artículo I es una revisión sistemática de la literatura. Los artículos II y III analizaron dos muestras de trabajadores universitarios (n=1025 y n=757). Los artículos IV y VI realizaron el seguimiento de una muestra tanto general (n=10427) como específica de trabajadores daneses (n=4699). Los artículos V, VII y VIII investigaron muestras generales de trabajadores españoles (n=9512 y n=9885). Herramientas como el Cuestionario Internacional de Actividad Física (IPAQ) fueron usadas para estimar los niveles de actividad física, mientras que el absentismo laboral por enfermedad fue evaluado mediante pregunta incluida en cuestionarios o a través del registro danés para la evaluación de la marginalidad (DREAM). Los análisis fueron ajustados por diferentes variables de control señaladas por la literatura y recogidas en los cuestionarios.Los resultados de la presente Tesis Doctoral mostraron una asociación inversa entre actividad física y absentismo laboral por enfermedad en trabajadores españoles. Dicha asociación se observó más pronunciada con mayores niveles de actividad física y en determinados subgrupos de trabajadores. En la misma línea, también se observó una asociación inversa entre actividad física y determinadas condiciones (dolor de espalda crónico, depresión, ansiedad, hipertensión, diabetes, estrés laboral y limitación de la actividad cotidiana). Por otro lado, la actividad física en el tiempo libre redujo el riesgo de absentismo laboral de larga duración en trabajadores daneses. En conclusión, los resultados sugieren que niveles altos de actividad física se asocian con menor prevalencia y riesgo de absentismo laboral por enfermedad. Estrategias basadas en la promoción de la actividad física en el tiempo libre podrían resultar beneficiosas para la reducción del absentismo laboral por enfermedad.<br /

Risk profile and mode of transmission of monkeypox: A rapid review and individual patient data meta-analysis of case studies

Since May 2022, an outbreak of monkeypox in non-endemic countries has become a potential public health threat. The objective of this rapid review was to examine the risk profile and modes of transmission of monkeypox. PubMed, Web of Science, and Scopus were searched from inception through July 30 to collect case reports/series on patients with monkeypox infection. For meta-analysis, data on the total number of participants and deaths by binary categories of exposure (age, sex, country, other co-infections or existing conditions, and mode of contagion) were used. A total of 62 studies (4659 cases) were included. Most cases came from Africa (84.3%), followed by Europe (13.9%). In 63.6% of the cases, the mode of contagion was human contact, while 22.8% of the cases were by animal contact, and 13.5% were unknown or not reported. The mortality rate was 6.5% throughout these studies. The risk of mortality was higher in the younger age group (risk difference: 0.19; 95% CI: 0.02–0.36), in cases with other co-infections or current chronic conditions (risk difference: 0.03; 95% CI: 0.01–0.05) and in the category of low- and middle-income countries (risk difference: 0.06; 95% CI: 0.05–0.08). There were no significant differences with respect to sex or mode of contagion. These results help to understand the major infection pathways and mortality risk profiles of monkeypox and underscores the importance of preventing outbreaks in specific settings, especially in settings densely populated by children, such as day care centres and schools