Association between multimorbidity with cognitive dysfunction in a Peruvian population

Background:Previous studies have shown that multimorbidity is a risk factor for cognitive dysfunction (CD).Type 2 diabetes mellitus (T2DM) and hypertension (HT) are very common risk factors.The association between multimorbidity due to both diseases and CD has been understudied in low and middle-income countries, in which the strength of the association might be stronger. Aim: To evaluate the association between multimorbidity due to T2DM and HT with CD among adults ≥50 years in Tumbes. Materials and methods: A secondary analysis of a population-based cross-sectional study was conducted. The exposure variable was the presence of both T2DM and HT, split into categories: without HT or T2DM, only T2DM, only HT, and with T2DM and HT; whereas CD was the outcome variable, defined as a score ≤26 in the Leganes Cognitive Test. Crude and adjusted generalized linear models were used to estimate the association of interest, and prevalence ratio (PR) and 95% confidence interval (95%CI) were reported. Results: 688 participants were analyzed. The prevalence of CD was 39.1%. There was a 56.1% of participants without TDM2 nor HT, 8.3% with T2DM, 28.9% with HT and 6.7% with both diseases. A significant association was found between multimorbidity and CD (PR = 1.43, 95%CI 1.04–1.97). Multimorbidity had a statistically significant association with CD in the group of participants with ≥7 years of education (PR = 2.56,95%CI 1.55–4.21), but no in the group with <7 years. Conclusions: There is association between the morbidity of T2DM and HT, and CD among adults ≥50 years of age in Tumbes. Education was an effect modifier of the association between HT and T2DM on the presence of CD.Revisión por pare

Mejora en la sensibilidad a la insulina con un programa intensivo de cambio en el estilo de vida para control de obesidad en niños y adolescentes en el primer nivel de atención

El objetivo del estudio fue evaluar el efecto de un programa intensivo de cambio en el estilo de vida para el control de peso sobre la sensibilidad a la insulina en niños y adolescentes en el primer nivel de atención. El estudio incluyó a 42 niños y adolescentes de 9 a17 años (n=23 grupo intensivo, n=19 grupo control) que participaron en un estudio clínico aleatorizado para el tratamiento de obesidad. El programa intensivo de cambio en el estilo de vida incluyó consultas mensuales con el médico del primer nivel de atención, asesoría dietética con el nutriólogo (semanal los primeros 3 meses y luego mensual) y 12 sesiones grupales en un protocolo de cambio de conducta. El grupo control incluyó solamente las consultas médicas mensuales. La sensibilidad a la insulina se estimó por el índice de sensibilidad a la insulina (ISI(0,120)) al inicio y a los 6 meses de intervención. Los niños y adolescentes del programa intensivo mostraron un mayor efecto en la sensibilidad a la insulina a los 6 meses en comparación al grupo control ([media ± DE], + 46.8 ± 56 vs. + 5.6 ± 47, diferencia 41.2 [IC 95%, 8.5, 73.9], p= 0.01) y 65% lograron aumentar la sensibilidad a la insulina >9 unidades vs. 32% en el grupo control (p=0.03). Este estudio muestra evidencia preliminar que un programa intensivo de cambio en el estilo de vida puede ser un modelo alternativo para mejorar la sensibilidad a la insulina en los niños y adolescentes con obesidad en el primer nivel de atención

Translational study of obesity management using the Diabetes Prevention Program “Group Lifestyle Balance” in primary care clinics and public hospitals from Mexico: study protocol

Introduction: Obesity is the main modifiable risk factor for the development of chronic diseases in Mexico. Several randomized controlled trials have shown that intensive lifestyle programs are efficacious for the management of obesity. These programs include frequent sessions (14 or more contacts in the first 6 months) focused on diet and physical activity and use a behavior change protocol. However, most Mexican primary care clinics and public hospitals apply traditional treatments for obesity management with limited results on weight loss. The purpose of the study is to evaluate the effectiveness of the Diabetes Prevention Program (DPP) “Group Lifestyle Balance” for weight loss among adults with overweight and obesity from baseline to 6 months and from baseline to 12 months in primary care clinics and public hospitals from Sonora, Mexico. Material and Methods: This is a translational, multi-center, non-controlled, 6 and 12-month follow-up clinical study with a pre-test and post-test design. Healthcare providers from two primary care clinics, two hospitals and one university clinic will be trained with the DPP protocol to implement on their overweight and obese adult patients. Body weight, body mass index, waist circumference, systolic and diastolic blood pressure, depression, quality of life and stress scales will be measured in participants receiving the program at baseline, 6 and 12 months. Biochemical parameters will be measured at baseline and 12 months. The primary outcome is the change in body weight at 6 and 12 months. Discussion: This study will provide scientific evidence of the effectiveness of the DPP protocol as a model for obesity management in real world clinical practice among the adult Mexican population

Modeling the potential distribution and conservation status of three species of oak gall wasps (Hymenoptera: Cynipidae) in the Iberian range

Cynipids (Hymenoptera: Cynipidae) induce a wide variety of complex galls on plants of different botanical families, particularly on Quercus species. Cynipid galls are well known to host large communities of insects, providing fundamental ecological niches for different animal taxa, which are organized in structured and relatively isolated communities at the microhabitat level. Gall communities of Quercus woodlands could be a conservation concern considering some risks, which affect several species of the Parasitica group of Hymenoptera, within which gall wasps and their parasitoids and inquilines are included. These risks concerning Parasitica species are mainly due to three causes: their high trophic level, high host specialization and the lack of knowledge of their biology. In this paper, a preliminary approach to this issue is presented for the Iberian–Balearic range. We model and study the ecological niche of three cynipid gall species that induce galls on Quercus species (Andricus quercustozae, Biorhiza pallida and Plagiotrochus quercusilicis). The cynipid gall species were selected for their different sets of host species and life cycle. The Ecological Niche Factor Analysis and two niche models built for each species (MAXENT and Mahalanobis Distances) support the interpretation that the bioclimatic variables considered have effects on cynipids through their respective sets of host plants. In addition, the results regarding A. quercustozae are consistent with the hypothetical existence of cryptic sexual generation (exposed in other works) parasitizing cork oak (Quercus suber), which could have another key role in its conservation