Mediterranean Diet and Atherothrombosis Biomarkers: A Randomized Controlled Trial

Scope To assess whether following a Mediterranean diet (MedDiet) improves atherothrombosis biomarkers in high cardiovascular risk individuals. Methods and results In 358 random volunteers from the PREvención con DIeta MEDiterránea trial, the 1‐year effects on atherothrombosis markers of an intervention with MedDiet, enriched with virgin olive oil (MedDiet‐VOO; n = 120) or nuts (MedDiet‐Nuts; n = 119) versus a low‐fat control diet (n = 119), and whether large increments in MedDiet adherence (≥3 score points, versus compliance decreases) and intake changes in key food items are associated with 1‐year differences in biomarkers. Differences are observed between 1‐year changes in the MedDiet‐VOO intervention and control diet on the activity of platelet activating factor acetylhydrolase in high‐density lipoproteins (HDLs) (+7.5% [95% confidence interval: 0.17; 14.8]) and HDL‐bound α1‐antitrypsin levels (−6.1% [−11.8; −0.29]), and between the MedDiet‐Nuts intervention and the control arm on non‐esterified fatty acid concentrations (−9.3% [−18.1; −0.53]). Large MedDiet adherence increments are associated with less fibrinogen (−9.5% [−18.3; −0.60]) and non‐esterified fatty acid concentrations (−16.7% [−31.7; −1.74]). Increases in nut, fruit, vegetable, and fatty fish consumption, and decreases in processed meat intake are linked to enhancements in biomarkers. Conclusion MedDiet improves atherothrombosis biomarkers in high cardiovascular risk individuals.This work was supported by grants of Instituto de Salud Carlos III [OBN17PI02, PIE14/00045_INFLAMES, CB06/03/0019, CB06/03/0028, and CD17/00122 (A.H.)], and Agència de Gestió d'Ajuts Universitaris i de Recerca (2017 SGR 222)

Yearly attained adherence to Mediterranean diet and incidence of diabetes in a large randomized trial.

Background: Several large observational prospective studies have reported a protection by the traditional Mediterranean diet against type 2 diabetes, but none of them used yearly repeated measures of dietary intake. Repeated measurements of dietary intake are able to improve subject classification and to increase the quality of the assessed relationships in nutritional epidemiology. Beyond observational studies, randomized trials provide stronger causal evidence. In the context of a randomized trial of primary cardiovascular prevention, we assessed type 2 diabetes incidence according to yearly repeated measures of compliance with a nutritional intervention based on the traditional Mediterranean diet. Methods: PREDIMED (''PREvención con DIeta MEDiterránea'') was a Spanish trial including 7447 men and women at high cardiovascular risk. We assessed 3541 participants initially free of diabetes and originally randomized to 1 of 3 diets: low-fat diet (n = 1147, control group), Mediterranean diet supplemented with extra virgin olive (n = 1154) or Mediterranean diet supplemented with mixed nuts (n = 1240). As exposure we used actual adherence to Mediterranean diet (cumulative average), yearly assessed with the Mediterranean Diet Adherence Screener (scoring 0 to 14 points), and repeated up to 8 times (baseline and 7 consecutive follow-up years). This score was categorized into four groups: < 8, 8-< 10, 10- < 12, and 12-14 points. The outcome was new-onset type 2 diabetes. Results: Multivariable-adjusted hazard ratios from time-varying Cox models were 0.80 (95% confidence interval, 0.70-0.92) per + 2 points in Mediterranean Diet Adherence Screener (linear trend p = .001), and 0.46 (0.25-0.83) for the highest (12-14 points) versus the lowest (< 8) adherence. This inverse association was maintained after additionally adjusting for the randomized arm. Age- and sex-adjusted analysis of a validated plasma metabolomic signature of the Mediterranean Diet Adherence Screener (constituted of 67 metabolites) in a subset of 889 participants also supported these results. Conclusions: Dietary intervention trials should quantify actual dietary adherence throughout the trial period to enhance the benefits and to assist results interpretation. A rapid dietary assessment tool, yearly repeated as a screener, was able to capture a strong inverse linear relationship between Mediterranean diet and type 2 diabetes. Trial registration ISRCTN35739639

Communication in health practices: integrative literature review

Objectivethis study aims to describe the main thematic axes explored in the communication field in health practices in the scenarios of the Unified Health System (SUS). Methodintegrative literature review conducted by means of search for articles in the databases Latin American Literature on Health Sciences (LILACS), International Literature on Health Sciences (MedLine), and Science Direct, using the descriptors: health communication or communication. A crossing of the descriptors communication and health education was provided. Resultfour themes were constructed: 1) communication to establish relationships between health professionals and users; 2) (in)communication: barriers to the communicative act, 3) communication and health professional education; and 4) communicative health models: search for the dialogic model. Conclusionby understanding dialogic communication, which must be observed in communication, the new requirements posed by the legalization of SUS have shown weaknesses of the single-line and vertical communication model and the need to provide health professionals, since the undergraduate course, with knowledge that enable dialogic communication practices. The challenge of reflective and participatory experiences in the various health care settings still remains, in order to promote a sharing of knowledge that leads to understanding between the interlocutors involved in the communicative act.Objetivoeste artigo tem por objetivo descrever os principais eixos temáticos explorados no campo da comunicação nas práticas em saúde nos cenários do Sistema Único de Saúde (SUS). Métodorevisão integrativa da literatura realizada a partir da busca de artigos nas bases de dados Literatura Latino-Americana em Ciências da Saúde (Lilacs), Literatura Internacional em Ciências da Saúde (MedLine) e Science Direct, utilizando os descritores: comunicação em saúde ou comunicação. Procedeu-se ao cruzamento dos descritores comunicação e educação em saúde. Resultadoforam construídas quatro temáticas: 1) a comunicação no estabelecimento de relações entre profissionais da saúde e usuários; 2) (des)comunicação: barreiras ao ato comunicativo; 3) comunicação e formação do profissional da saúde; e 4) modelos comunicativos em saúde: a busca pelo modelo dialógico. Conclusãoa partir do entendimento da comunicação dialógica, que deve estar presente na comunicação, as novas demandas da legalização do SUS vêm mostrando fragilidades do modelo unilinear e verticalizado de comunicação e a necessidade de instrumentalizar os profissionais da saúde, desde a graduação, com saberes que proporcionem práticas comunicativas dialógicas. Persiste o desafio de vivências reflexivas e participativas nos vários cenários de assistência à saúde, de forma a promover um compartilhamento de saberes que conduza ao entendimento entre os interlocutores envolvidos no ato comunicativo.Universidade Federal de PernambucoUniversidade Federal de Pernambuco Departamento de FonoaudiologiaUniversidade Federal de São Paulo (UNIFESP) Centro de Desenvolvimento do Ensino Superior em SaúdeUniversidade Federal de Pernambuco Departamento de EnfermagemUNIFESP, Centro de Desenvolvimento do Ensino Superior em SaúdeSciEL

Spread of a SARS-CoV-2 variant through Europe in the summer of 2020.

Following its emergence in late 2019, the spread of SARS-CoV-21,2 has been tracked by phylogenetic analysis of viral genome sequences in unprecedented detail3–5. Although the virus spread globally in early 2020 before borders closed, intercontinental travel has since been greatly reduced. However, travel within Europe resumed in the summer of 2020. Here we report on a SARS-CoV-2 variant, 20E (EU1), that was identified in Spain in early summer 2020 and subsequently spread across Europe. We find no evidence that this variant has increased transmissibility, but instead demonstrate how rising incidence in Spain, resumption of travel, and lack of effective screening and containment may explain the variant’s success. Despite travel restrictions, we estimate that 20E (EU1) was introduced hundreds of times to European countries by summertime travellers, which is likely to have undermined local efforts to minimize infection with SARS-CoV-2. Our results illustrate how a variant can rapidly become dominant even in the absence of a substantial transmission advantage in favourable epidemiological settings. Genomic surveillance is critical for understanding how travel can affect transmission of SARS-CoV-2, and thus for informing future containment strategies as travel resumes. © 2021, The Author(s), under exclusive licence to Springer Nature Limited

HTLV-1 infection in solid organ transplant donors and recipients in Spain

HTLV-1 infection is a neglected disease, despite infecting 10-15 million people worldwide and severe illnesses develop in 10% of carriers lifelong. Acknowledging a greater risk for developing HTLV-1 associated illnesses due to immunosuppression, screening is being widely considered in the transplantation setting. Herein, we report the experience with universal HTLV testing of donors and recipients of solid organ transplants in a survey conducted in Spain. All hospitals belonging to the Spanish HTLV network were invited to participate in the study. Briefly, HTLV antibody screening was performed retrospectively in all specimens collected from solid organ donors and recipients attended since the year 2008. A total of 5751 individuals were tested for HTLV antibodies at 8 sites. Donors represented 2312 (42.2%), of whom 17 (0.3%) were living kidney donors. The remaining 3439 (59.8%) were recipients. Spaniards represented nearly 80%. Overall, 9 individuals (0.16%) were initially reactive for HTLV antibodies. Six were donors and 3 were recipients. Using confirmatory tests, HTLV-1 could be confirmed in only two donors, one Spaniard and another from Colombia. Both kidneys of the Spaniard were inadvertently transplanted. Subacute myelopathy developed within 1 year in one recipient. The second recipient seroconverted for HTLV-1 but the kidney had to be removed soon due to rejection. Immunosuppression was stopped and 3 years later the patient remains in dialysis but otherwise asymptomatic. The rate of HTLV-1 is low but not negligible in donors/recipients of solid organ transplants in Spain. Universal HTLV screening should be recommended in all donor and recipients of solid organ transplantation in Spain. Evidence is overwhelming for very high virus transmission and increased risk along with the rapid development of subacute myelopathy