Calidad de vida y enfermedad pulmonar obstructiva crónica

La Enfermedad Pulmonar Obstructiva Crónica (EPOC) tiene un carácter progresivo e irreversible y está asociada a la triada de la disnea, la limitación del ejercicio y el evidente deterioro en la calidad de vida. En Estados Unidos la prevalencia de EPOC en la población adulta es aproximadamente del 6 % en hombres y de 1 a 3% en las mujeres y es la cuarta causa de mortalidad por enfermedades crónicas no transmisibles. En 1993 el National Health Interview Surgery, estimó que 12 millones de americanos sufrían bronquitis crónica y 2 millones tenían enfisema pulmonar, siendo estas dos afecciones responsables de más del 13 % de las hospitalizaciones. A medida que esta afección progresa, los pacientes experimentan una disminución de la calidad de vida relacionada con la salud (CVRS), su capacidad para trabajar empeora y disminuye su participación en actividades físicas y sociales. Sin embargo, se ha confirmado que la evaluación aislada de la gravedad de la EPOC, definida por el grado de descenso del volumen espiratorio forzado en el primer segundo (FEV1), no proporciona la información suficiente para conocer el estado de salud percibido por los pacientes. El hecho de que la CVRS sea el resultado de la interacción de múltiples factores físicos, psicológicos y sociales, únicos para cada individuo, puede explicar este hallazgo. Este documento, es una aproximación general y actualizada al manejo integral de los pacientes con EPOC, y discute el concepto de calidad de vida relacionada con el mejoramiento de la salud.The Chronic Obstructive Pulmonary Disease (COPD) has a progressive and irreversible character and it’s associated to the triad of dyspnea, exercise limitation and the evident deterioration of quality of life. In the United States the prevalence of COPD in adult population is approximately of 6% in men, and 1 to 3% in women and it’s the fourth cause of mortality by no transmissible chronic diseases. In 1993, the National Health Interview Surgery considered that 12 millions of Americans suffer from chronic bronchitis and 2 million had emphysema. These two affections are responsible for more than 13% of the hospitalizations. As this affection progresses, patients experience a diminution in quality of life related to health (CVRS), their capacity to work get worse and their participation in physical and social activities reduces. Nevertheless, it has been confirmed that the isolated evaluation of COPD seriousness, defined by the reduction of the Forced Expiratory Volume in the First Second (FEV1), does not provide enough information to know the health state perceived by the patients. The fact that the CVRS is the result of the interaction of multiple physical, psychological and social factors, unique for each individual, can explain this finding. This paper is a general and updated approach to the integral handling of patients with COPD, and it discusses the concept of quality of life, related to health improvement

Embarazo y calidad de vida relacionada con la salud : Estudio transversal

Objective: To evaluate and identify determinants of health related quality of life (HRQoL) during pregnancy. Methods: In this descriptive exploratory study in sixty-four nulliparous pregnant women, completed the questionnaire: HRQoL (Colombian standard version of the Medical Outcome Study Short-Form Health Survey -SF12v2-), and sociodemographic determinants (i.e., age, place of origin, education, marital status, and occupation) during the second trimester. Results: Mean age of patients included was 19.1±2.7 years old and gestational age was 17.6 ± 3.4 weeks. The participants reported higher HRQoL scores in the vitality domain (56±11), followed by mental health (5110), and general health (50±11). Moreover, the lowest score was demonstrated in the domains of emotional role (18±5) and physical role (25±4). Having a higher household socioeconomic level was significantly correlated with higher scores in the physical role, general health, social functioning, emotional role, and mental health. Being married or cohabiting was significantly correlated with all the SF-12v2 domains, with the exception of the Bodily pain domain. Conclusions: While we have included a comprehensive assessment of socioeconomic variables needed to assess and identify the factors determining the HRQoL during pregnancy, further studies are needed that can guide the expectations of women, their health care providers, and public policy. Objetivo: Evaluar e identificar los factores determinantes de la calidad de vida relacionada con la salud (CVRS) durante el embarazo. Métodos: Estudio descriptivo exploratorio en 64 gestantes nulíparas. Las participantes completaron el cuestionario de CVRS SF-12v2 (versión colombiana estándar del Medical Outcome Study Short-Form Health Survey-SF12-), y encuesta de factores determinantes sociodemográficos (edad, procedencia, nivel de educación, estado civil y situación laboral) durante el segundo trimestre del embarazo. Resultados: La edad media de las participantes fue 19.1±2.7 años y la edad gestacional 17.6 ±3.4 semanas. Las puntuaciones más altas de la CVRS se presentaron en los dominios de vitalidad (56±11), seguido de salud mental (51±10) y salud general (50±11). Por otra parte, la puntuación de CVRS más baja fue acusada en los dominios rol emocional (18±5) y rol físico (25±4). Un mayor nivel socioeconómico se correlacionó significativamente con mejor puntuación en el Cuestionario de Salud SF-12v2 en los dominios función física, salud general, función social, rol emocional y salud mental. Estar casada o en unión libre se correlacionó significativamente con todos los dominios del SF-12v2, con excepción del dominio dolor corporal. Conclusiones: Si bien se ha incluido una evaluación exhaustiva de las variables socioeconómicas necesarias para evaluar e identificar los factores determinantes en la CVRS durante el embarazo, se necesitan más estudios que puedan guiar las expectativas de las mujeres, sus proveedores de atención de salud y políticas públicas

Precision physical activity and exercise prescriptions for disease prevention: the effect of interindividual variability under different training approaches

Papers in this research topic highlight the notion that personalized exercise is a feasible and effective lifestyle modification strategy, for all individuals with, or at risk of, non-communicable chronic diseases. Accordingly, more research is needed to compare the training paradigms in defined subgroups, for instance, at-risk subjects, and at different stages of disease join to the point. With many issues unresolved, further research is warranted before exercise can conscientiously be prescribed as “precision medicine” to address cardiometabolic risk factors and their progression to many non-communicable diseases.This study has been funded in part by a research grant PI17/01814 of the Ministerio de Economia, Industria y Competitividad (ISCIII, FEDER)

Resistance training and clinical status in patients with postdischarge symptoms after COVID‑19: protocol for a randomized controlled crossover trial “The EXER‑COVID Crossover Study”

Background: Physical exercise induces a coordinated response of multiple organ systems, including the immune system. In fact, it has been proposed that physical exercise may modulate the immune system. However, the potential effect of an exercise program on COVID-19 survivors has not been investigated. Thus, the aim of this study is to evaluate the modifications in immunological parameters, physical condition, inflammatory profile, and perceived persistent symptoms after 6 weeks of supervised resistance training (RT), in addition to the standard care on the clinical status of patients with persistent COVID-19 symptoms. The objective of this protocol is to describe the scientific rationale in detail and to provide information about the study procedures. Methods/design: A total of 100 patients with postdischarge symptoms after COVID-19 will be randomly allocated into either a group receiving standard care (control group) or a group performing a multicomponent exercise program two times a week over a period of 6 weeks. The main hypothesis is that a 6-week multicomponent exercise program (EXER-COVID Crossover Study) will improve the immunological and inflammatory profile, physical condition, and persistent perceived symptoms (fatigue/tiredness, musculoskeletal pain, and shortness of breath) in patients with postdischarge symptoms after COVID-19. Discussion: Our results will provide insights into the effects of a multicomponent exercise program on immunological parameters, physical condition, inflammatory profile, and persistent perceived symptoms in patients with postdischarge symptoms after COVID-19. Information obtained by this study will inform future guidelines on the exercise training rehabilitation of patients with postdischarge symptoms after COVID-19."Proyectos de I+D+i" de los Programas Estatales de Generacion de Conocimiento y Fortalecimiento Cientifico y Tecnologico del Sistema de I+D+i Orientada a los Retos de la Sociedad, en el marco del Plan Estatal de Investigacion Cientifica y Tecnica y de Inno PID2020-113098RB-I0

Lipidomic signatures from physically frail and robust older adults at hospital admission

Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This study was funded by a Gobierno de Navarra project Resolucion grant 2186/2014 and acknowledged with the "Beca Ortiz de Landazuri" as the best research clinical project in 2014, as well as by a research grant PI17/01814 of the Ministerio de Economia, Industria y Competitividad (ISCIII, FEDER). A.G.-H. is a Miguel Servet Fellow (Instituto de Salud Carlos III -CP18/0150). N.M.-V. received funding from "la Caixa" Foundation (ID 100010434), under agreement LCF/PR/PR15/51100006. R.R.-V. is funded in part by a Postdoctoral Fellowship Resolution ID 420/2019 of the Universidad Publica de Navarra.Identifying serum biomarkers that can predict physical frailty in older adults would have tremendous clinical value for primary care, as this condition is inherently related to poor quality of life and premature mortality. We compared the serum lipid profile of physically frail and robust older adults to identify specific lipid biomarkers that could be used to assess physical frailty in older patients at hospital admission. Fortythree older adults (58.1% male), mean (range) age 86.4 (78–100 years) years, were classified as physically frail (n = 18) or robust (n = 25) based on scores from the Short Physical Performance Battery (≤ 6 points). Nontargeted metabolomic study by ultra-high performance liquid chromatography coupled to mass spectrometry (UHPLC-MS) analysis with later bioinformatics data analysis. Once the significantly different metabolites were identified, the KEGG database was used on them to establish which were the metabolic pathways mainly involved. Area under receiver-operating curve (AUROC) analysis was used to test the discriminatory ability of lipid biomarkers for frailty based on the Short Physical Performance Battery. We identified a panel of five metabolites including ceramides Cer (40:2), Cer (d18:1/20:0), Cer (d18:1/23:0), cholesterol, and phosphatidylcholine (PC) (14:0/20:4) that were significantly increased in physically frail older adults compared with robust older adults at hospital admission. The most interesting in the physically frail metabolome study found with the KEGG database were the metabolic pathways, vitamin digestion and absorption, AGERAGE signaling pathway in diabetic complications, and insulin resistance. In addition, Cer (40:2) (AUROC 0.747), Cer (d18:1/23:0) (AUROC 0.720), and cholesterol (AUROC 0.784) were identified as higher values of physically frail at hospital admission. The non-targeted metabolomic study can open a wide view of the physically frail features changes at the plasma level, which would be linked to the physical frailty phenotype at hospital admission. Also, we propose that metabolome analysis will have a suitable niche in personalized medicine for physically frail older adults.Gobierno de Navarra project Resolucion grant 2186/2014Spanish Government PI17/01814Instituto de Salud Carlos III III -CP18/0150La Caixa Foundation 100010434 LCF/PR/PR15/51100006Universidad Publica de Navarra 420/2019CRUE-CSIC agreementSpringer Natur

Relació entre la composició corporal i la capacitat d’exercici, i el risc de malalties cròniques no transmissibles en dones joves

Objectiu: Estudiar la composició corporal, la capacitat d’exercici i la seva relació amb el risc de desenvolupar malalties cròniques no transmissibles (MCNT) en dones joves. Disseny: Estudi transversal, observacional i descriptiu, en 310 dones, agrupades segons la seva composició corporal i capacitat d’exercici per MET, en grups d’alt risc (GAR, n=89) i de baix risc (GBR, n=221) de desenvolupar MCNT. Resultats: Es van observar diferències significatives en comparar els subjectes classificats segons la seva capacitat d’exercici per MET, amb els indicadors antropomètrics IMC, % de greix, circumferència de cintura (CC), p<0,01. En el grup d’alt risc es van trobar correlacions entre les variables: pes corporal, IMC i els factors de risc d’MCNT: % de greix, CC, PAS en repòs i MET (p<0,01). També entre el % de greix, CC i els factors de risc IMC, PAS en repòs i PAD en repòs (p<0,01). Finalment, una correlació inversa entre la capacitat d’exercici per MET i els factors de risc: IMC, % de greix, p<0,01 i amb la CC (p<0,05). Conclusions: Es va trobar que una baixa capacitat d’exercici per MET i valors més alts en la composició corporal es relacionen amb un alt risc de desenvolupar MCNT en dones joves

Ideal cardiovascular health predicts lower risk of abnormal liver enzymes levels in the Chilean National Health Survey (2009–2010)

High levels of gamma glutamyltransferase (gamma-GT) and alanine aminotransferase (ALT), as well as fatty liver index (FLI) has been associated with higher cardiovascular disease risk factors in adults. The aim of this study was to examine the relationship between gamma-GT, ALT, and fatty liver index FLI levels across a gradient number of ideal cardiovascular health metrics in a representative sample of adults from the Chilean National Health Survey 2009–2010. Data from 1,023 men and 1,449 women (≥ 15 years) from the Chilean Health Survey 2009–2010 were analyzed. Ideal cardiovascular health was defined as meeting ideal levels of the following components: four behaviours (smoking, body mass index, physical activity and diet adherence) and three factors (total cholesterol, blood pressure and fasting glucose). Adults were grouped into three categories according to their number of ideal cardiovascular health metrics: ideal (5–7 metrics), intermediate (3–4 metrics), and poor (0–2 metrics). Blood levels of gamma-GT and ALT were measured and the FLI was calculated. A higher number of ideal cardiovascular health index metric was associated with lower gamma-GT, ALT and FLI (p from trend analysis <0.001). Also, adults meeting at least 3–4 metrics were predicted less likely to have prevalence of abnormal levels of gamma-GT and FLI (p<0.001) compared to adults who met only 0–2 metrics. These findings reinforce the usefulness of the ideal cardiovascular health metrics proposed by the American Heart Association as a tool to identify target subjects and promote cardiovascular health in South-American adults

Ideal cardiovascular health predicts lower risk of abnormal liver enzymes levels in the Chilean National Health Survey (2009–2010)

High levels of gamma glutamyltransferase (gamma-GT) and alanine aminotransferase (ALT), as well as fatty liver index (FLI) has been associated with higher cardiovascular disease risk factors in adults. The aim of this study was to examine the relationship between gamma-GT, ALT, and fatty liver index FLI levels across a gradient number of ideal cardiovascular health metrics in a representative sample of adults from the Chilean National Health Survey 2009–2010. Data from 1,023 men and 1,449 women (≥ 15 years) from the Chilean Health Survey 2009–2010 were analyzed. Ideal cardiovascular health was defined as meeting ideal levels of the following components: four behaviours (smoking, body mass index, physical activity and diet adherence) and three factors (total cholesterol, blood pressure and fasting glucose). Adults were grouped into three categories according to their number of ideal cardiovascular health metrics: ideal (5–7 metrics), intermediate (3–4 metrics), and poor (0–2 metrics). Blood levels of gamma-GT and ALT were measured and the FLI was calculated. A higher number of ideal cardiovascular health index metric was associated with lower gamma-GT, ALT and FLI (p from trend analysis <0.001). Also, adults meeting at least 3–4 metrics were predicted less likely to have prevalence of abnormal levels of gamma-GT and FLI (p<0.001) compared to adults who met only 0–2 metrics. These findings reinforce the usefulness of the ideal cardiovascular health metrics proposed by the American Heart Association as a tool to identify target subjects and promote cardiovascular health in South-American adults

Effects of Supervised Multimodal Exercise Interventions on Cancer-Related Fatigue: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective. Cancer-related fatigue (CRF) is the most common and devastating problem in cancer patients even after successful treatment. This study aimed to determine the effects of supervised multimodal exercise interventions on cancer-related fatigue through a systematic review and meta-analysis. Design. A systematic review was conducted to determine the effectiveness of multimodal exercise interventions on CRF. Databases of PubMed, CENTRAL, EMBASE, and OVID were searched between January and March 2014 to retrieve randomized controlled trials. Risk of bias was evaluated using the PEDro scale. Results. Nine studies (n=772) were included in both systematic review and meta-analysis. Multimodal interventions including aerobic exercise, resistance training, and stretching improved CRF symptoms (SMD=-0,23; 95% CI: −0.37 to −0.09; P=0,001). These effects were also significant in patients undergoing chemotherapy (P<0,0001). Nonsignificant differences were found for resistance training interventions (P=0,30). Slight evidence of publication bias was observed (P=0,04). The studies had a low risk of bias (PEDro scale mean score of 6.4 (standard deviation (SD) ± 1.0)). Conclusion. Supervised multimodal exercise interventions including aerobic, resistance, and stretching exercises are effective in controlling CRF. These findings suggest that these exercise protocols should be included as a crucial part of the rehabilitation programs for cancer survivors and patients during anticancer treatments.This paper and own authors data described in this paper were supported by the grant from Vicerrectoría de Investigaciones, Universidad de Santo Tomás (Contract no. 617-3-2013)