Impact of a Web-Based Exercise and Nutritional Education Intervention in Patients Who Are Obese With Hypertension: Randomized Wait-List Controlled Trial

Background: Internet-based interventions are a promising strategy for promoting healthy lifestyle behaviors. These have a tremendous potential for delivering electronic health interventions in scalable and cost-effective ways. There is strong evidence that the use of these programs can lead to weight loss and can lower patients’ average blood pressure (BP) levels. So far, few studies have investigated the effects of internet-based programs on patients who are obese with hypertension (HTN). Objective: The aim of this study is to investigate the short- and long-term efficacy, in terms of body composition and BP parameters, of a self-administered internet-based intervention involving different modules and learning techniques aimed at promoting lifestyle changes (both physical activity and healthy eating) in patients who are obese with HTN. Methods: A randomized wait-list controlled trial design was used. We recruited 105 adults with HTN who were overweight or obese and randomly assigned them to either a 3-month internet-based intervention group (n=55) or the wait-list control group (n=50). We assessed BMI (primary outcome), body fat mass (BFM), systolic (S)BP and diastolic (D)BP, blood glucose and insulin levels, physical activity levels, and functional capacity for aerobic exercise at Time 0 (preintervention) and Time 1 (postintervention). All the patients in the wait-list control group subsequently received the intervention, and a secondary within-group analysis, which also included these participants, was conducted at Time 2 (12-month follow-up). Results: A 2-way mixed analysis of covariance showed a significant decrease in BMI, BFM, and blood glucose at 3 months in the internet-based intervention group; the effect size for the BMI and BFM parameters was moderate to large, and there was also a borderline significant trend for DBP and insulin. These results were either maintained or improved upon at Time 2 and showed significant changes for BMI (mean difference −0.4, 95% CI −0.1 to −0.6; P=.005), BFM (mean difference −2.4, 95% CI −1.1 to −3.6; P<.001), DBP (mean difference −1.8, 95% CI −0.2 to −3.3; P=.03), and blood glucose (mean difference −2, 95% CI 0 to −4; P=.04). Conclusions: Implementation of our self-administered internet-based intervention, which involved different learning techniques aimed to promote lifestyle changes, resulted in positive short- and long-term health benefits in patients who are obese with HTN

An internet-based self-administered intervention for promoting healthy habits and weight loss in hypertensive people who are overweight or obese: a randomized controlled trial

Background The prevalence of overweight and obesity is on the rise worldwide with severe physical and psychosocial consequences. One of the most dangerous is hypertension. Lifestyle changes related to eating behaviour and physical activity are the critical components in the prevention and treatment of hypertension and obesity. Data indicates that the usual procedures to promote these healthy habits in health services are either insufficient or not efficient enough. Internet has been shown to be an effective tool for the implementation of lifestyle interventions based on this type of problem. This study aims to assess the efficacy of a totally self-administered online intervention programme versus the usual medical care for obese and overweight participants with hypertension (from the Spanish public health care system) to promote healthy lifestyles (eating behaviour and physical activity). Method A randomized controlled trial will be conducted with 100 patients recruited from the hypertension unit of a public hospital. Participants will be randomly assigned to one of two conditions: a) SII: a self-administered Internet-based intervention protocol; and b) MUC-medical usual care. The online intervention is an Internet-delivered, multimedia, interactive, self-administered programme, composed of nine modules designed to promote healthy eating habits and increase physical activity. The first five modules will be activated at a rate of one per week, and access for modules 5 to 9 will open every two weeks. Patients will be assessed at four points: before the intervention, after the intervention (3 months), and at 6 and 12 months (follow-up). The outcome variables will include blood pressure, and Body Mass Index, as primary outcome measures, and quality of life and other lifestyle and anthropometrical variables as secondary outcome measures. Discussion The literature highlights the need for more studies on the benefits of using the Internet to promote lifestyle interventions. This study aims to investigate the efficiency of a totally self-administered Internet − +based programme for promoting healthy habits and improving the medical indicators of a hypertensive and overweight population.MM is grateful to CAPES/Brazil (Coordination for the Improvement of Higher Level Personnel) for the doctoral scholarship. This project is funded in part by grants PSI2010-17563-PSIC; CIBER Fisiopatologia de la Obesidad y Nutricion-ISCIII CB06/03/0052; Red de Excelencia PSI2014-56303-REDT: PROMOSAM: Research in Processes, Mechanisms and Psychological Treatments for Mental Health Promotion, from the Ministerio de Economía y Competitividad (2014)

“Own doctor” presence in a web-based lifestyle intervention for adults with obesity and hypertension: A randomized controlled trial

Introduction: Online interventions have long been shown to be an effective means to promote a healthy lifestyle, thereby helping to control body weight and blood pressure figures. Likewise, using video modeling is also considered an effective way to guide patients through behavioral interventions. Nonetheless, to the best of our knowledge, this study is the first to analyze how the presence of patients' “own doctor” in the audiovisual content of a web-based lifestyle program (“Living Better”) aimed at promoting regular physical exercise and healthy eating behavior, compared with an “unknown doctor,” influences the outcomes of adults with obesity and hypertension. Materials and methods: A total of 132 patients were randomly assigned either to the experimental (n = 70) or control (n = 62) group (“own doctor” or “unknown doctor”, respectively). The body mass index, systolic and diastolic blood pressure, number of antihypertensive drugs used, physical activity level, and quality of life was assessed and compared at baseline and post-intervention (12 weeks).Results: The intention-to-treat analysis showed intragroup significant improvements in both groups in terms of the body mass index (control group: mean difference −0.3, 95% CI [−0.5, −0.1], p = 0.002; experimental group: −0.4 [−0.6, −0.2], p &amp;lt; 0.001) and systolic blood pressure (control group: −2.3 [−4.4, −0.2], p = 0.029; experimental group: −3.6 [−5.5, −1.6], p&amp;lt; 0.001). In addition, there were also significant improvements in the experimental group for the diastolic blood pressure (−2.5 [−3.7, −1.2], p &amp;lt; 0.001), physical activity (479 [9, 949], p = 0.046), and quality of life (5.2 [2.3, 8.2], p = 0.001). However, when comparing the experimental with the control group, no between-group significant differences were found in these variables.Conclusions: This study suggests that the presence of patients' “own doctor” in the audiovisual content of a web-based intervention, aimed at promoting a healthy lifestyle among adults with obesity and hypertension, do not show significant additional benefits over the efficacy of e–counseling.Trial registrationClinicalTrials.gov NCT04426877. First Posted: 11/06/2020. https://clinicaltrials.gov/ct2/show/NCT04426877

Analysis of the efficacy of an internet-based self-administered intervention (“Living Better”) to promote healthy habits in a population with obesity and hypertension: An exploratory randomized controlled trial

Introduction: Changes in unhealthy lifestyles are key elements in the prevention and treatment of obesity and hypertension. Internet-based programs offer great potential for the implementation of evidence-based interventions focused on promoting healthy habits. We evaluate the efcacy of an Internet-based self-administered program (“Living Better”) that addresses people diagnosed as being overweight or having type I obesity and hypertension. Methods: The sample was composed of a total of 106 participants (age Mean = 53; 59 males) from a public hospital in Spain, diagnosed as being overweight or having type I obesity and hypertension and randomized into two groups—the intervention group (IG; Internet-based intervention) and the control group (CG; usual medical treatment). The intervention used cognitive-behavioral strategies and psychoeducation to promote healthy habits. Anthropometric data (i.e., Body Mass Index –BMI-, waist circumference, and hip circumference) and lifestyle/psychological data (i.e., quality of life, physical activity, eating styles, motivation, mood, and self-efcacy) were assessed before and after the intervention, and at 6 and 12-month follow-ups. Results: Signifcant differences were observed between the IG and the CG in anthropometrical variables after intervention (i.e., BMI and waist circumference), external eating style, and anxiety and stress scores (p < 0.05). Follow-up data showed that changes were maintained in BMI, waist and hip circumference, and external eating in the IG. After receiving the Internet-based treatment, the CG also improved its clinical condition. Discussion: This study demonstrates that the Internet is a viable alternative for the delivery and dissemination of interventions focused on promoting healthy habits, and a totally self-administered intervention can produce long-term positive results

Medición de parámetros fisicos, biológicos y químicos en el tramo estuarino del río Ebro

En este artículo se describen las campañas de campo CYTMAR I y II realizadas en la primavera y el verano de 1997, con el fin de estudiar los procesos y los flujos físicos, biológicos y químicos en la zona del Delta del Ebro, tanto en el tramo estuarino del río como en la pluma de agua dulce que se forma en las cercanías de la desembocadura. Aquí el estudio se ha centrado en la zona estuarina, presentando algunos resultados preliminares y analizando las diferencias estacionales observadas

Análisis de la situación de los estudios agronómicos y forestales en Europa. Anexo III: análisis de los estudios europeos

El documento que se presenta es el resultado del análisis de la situación actual en estas ingenierías y del estudio del futuro de las mismas. Todas las propuestas que aquí se hacen se han consensuado en las sesiones del Plenario del grupo de trabajo. Por ello, es justo reconocer la aportación que este trabajo puede suponer a la futura Convergencia Europea en la Educación Superior

Therapy-Induced Senescence Enhances the Efficacy of HER2-Targeted Antibody–Drug Conjugates in Breast Cancer

Eficàcia; Conjugats de fàrmacs; Càncer de mamaEficacia; Conjugados de medicamentos; Cáncer de mamaEfficacy; Drug conjugates; Breast cancerAntibody–drug conjugates (ADC) are antineoplastic agents recently introduced into the antitumor arsenal. T-DM1, a trastuzumab-based ADC that relies on lysosomal processing to release the payload, is approved for HER2-positive breast cancer. Next-generation ADCs targeting HER2, such as [vic-]trastuzumab duocarmazine (SYD985), bear linkers cleavable by lysosomal proteases and membrane-permeable drugs, mediating a bystander effect by which neighboring antigen-negative cells are eliminated. Many antitumor therapies, like DNA-damaging agents or CDK4/6 inhibitors, can induce senescence, a cellular state characterized by stable cell-cycle arrest. Another hallmark of cellular senescence is the enlargement of the lysosomal compartment. Given the relevance of the lysosome to the mechanism of action of ADCs, we hypothesized that therapies that induce senescence would potentiate the efficacy of HER2-targeting ADCs. Treatment with the DNA-damaging agent doxorubicin and CDK4/6 inhibitor induced lysosomal enlargement and senescence in several breast cancer cell lines. While senescence-inducing drugs did not increase the cytotoxic effect of ADCs on target cells, the bystander effect was enhanced when HER2-negative cells were cocultured with HER2-low cells. Knockdown experiments demonstrated the importance of cathepsin B in the enhanced bystander effect, suggesting that cathepsin B mediates linker cleavage. In breast cancer patient-derived xenografts, a combination treatment of CDK4/6 inhibitor and SYD985 showed improved antitumor effects over either treatment alone. These data support the strategy of combining next-generation ADCs targeting HER2 with senescence-inducing therapies for tumors with heterogenous and low HER2 expression. Significance: Combining ADCs against HER2-positive breast cancers with therapies that induce cellular senescence may improve their therapeutic efficacy by facilitating a bystander effect against antigen-negative tumor cells.This work was supported by Breast Cancer Research Foundation (BCRF-20-008), Instituto de Salud Carlos III (project reference numbers AC15/00062, CB16/12/00449 and PI19/01181), the EC under the framework of the ERA-NET TRANSCAN-2 initiative co-financed by FEDER, Fundación Mutua Madrileña and Asociación Española Contra el Cáncer. S. Duro-Sánchez is supported by the Spanish Ministerio de Universidades by the grant Formación de Profesorado Universitario (FPU20/05388). A. Esteve-Codina is funded by ISCIII /MINECO (PT17/0009/0019) and co-funded by FEDER. The authors acknowledge Alyson MacInnes for reviewing and editing the article

Medición de parámetros fisicos, biológicos y químicos en el tramo estuarino del río Ebro

[ES] En este artículo se describen las campañas de campo CYTMAR I y II realizadas en la primavera y el verano de 1997, con el fin de estudiar los procesos y los flujos físicos, biológicos y químicos en la zona del Delta del Ebro, tanto en el tramo estuarino del río como en la pluma de agua dulce que se forma en las cercanías de la desembocadura. Aquí el estudio se ha centrado en la zona estuarina, presentando algunos resultados preliminares y analizando las diferencias estacionales observadas.Este trabajo forma parte del proyecto FANS (contrato No. MAS3-CT95-0037) del Programa MAST-III de la Unión Europea y del proyecto MAR96-1856 del Programa CYTMAR de la Comisión Interministerial de Ciencia y Tecnología (CICYT). También se agradece la contribución de todos los que participaron en las campañas de campo. Finalmente cabe destacar la colaboración de la Confederación Hidrográfica del Ebro, que proporcionó los datos de caudales del río y del Centro de Estudios de Puertos y Costas (CEPYC) del CEDEX, que prestó algunos de los equipos utilizados en las campañas.Sierra Pedrico, JP.; González Del Río Rams, J.; Flos Bassols, J.; Sánchez-Arcilla Conejo, A.; Movellán Mendoza, E.; Rodilla, M.; Mösso Aranda, C.... (2001). Medición de parámetros fisicos, biológicos y químicos en el tramo estuarino del río Ebro. Ingeniería del Agua. 8(4):459-468. https://doi.org/10.4995/ia.2001.2879SWORD45946884Bruno, M., Fraguela, B., Alonso, J.J., Ruiz Cañavate, A., Mañanes, R. and Rico, J. (1997). Atmospheric pressure variations and water mass exchange between the continental shelf and the Bay of Cadiz. Scientia Marina, 61, pp. 379-387.Day, J.W., J.F. Martin, L. Cardoch and P.H. Templet (1997). System functioning as a basis for sustainable management of deltaic ecosystems. Costal Management, 25, pp. 115-153.Geyer, W.R. and Farmer, D.M. (1989). Tide induced variation in the dynamics of a salt wedge estuary. J. Physical Oceanography, 19, pp. 1060-1072.Huisman, J. and Weissing, F.J. (1995). Competition for nutrients and light among phytoplankton species in a mixed water column: theoretical studies. Water Sci. Tech., 32, pp. 143-147.Ibáñez, C. (1993). Dinámica hidrológica y funcionamiento ecológico del tramo estuarino del río Ebro. Tesis doctoral, Universidad de Barcelona, 196 p.Ibáñez, C., Pont, D. and Prat, N. (1997). Characterization of the Ebre and Rhone estuaries: A basis for defining and classifying salt-wedge estuaries. Limnol. Oceanogr., 42, pp. 89-101.Morris, A.W., Bale, A.J. and Howland, R.J.M. (1981). Nutrient distributions in an estuary: evidence of chemical precipitation of dissolved silicate and phosphate. Estuarine, Coastal and Shelf Science, 12, pp. 205-216.Smith, N.P. (1986). Subtidal Exchanges between Corpus Christi Bay and Texas Inner Shelf Waters. Lecture Notes on Coastal and Estuarine Studies. Ed. Van Kreeke, Springer Verlag, 16, pp. 143-152.Valle-Levinson, A. (1995). Observations of barotropic and baroclinic exchanges in the lower Chesapeake Bay. Continental Shelf Research, 15, pp. 1631-1647.Velasco, M.J. (1998). Descripción de los procesos hidro-biogeoquímicos en el Delta del Ebro. Tesina de graduación. Universitat Politècnica de Catalunya, 133p.Zessner, M. et al. (1996). Regional materials accounting of nitrogen in upper Austria. Water Sci. Tech., 33, pp. 89-97

Impact of Arterial Stiffness on All-Cause Mortality in Patients Hospitalized With COVID-19 in Spain

Older age and cardiovascular comorbidities are well-known risk factors for all-cause mortality in patients with coronavirus disease 2019 (COVID-19). Hypertension and age are the 2 principal determinants of arterial stiffness (AS). This study aimed to estimate AS in patients with COVID-19 requiring hospitalization and analyze its association with all-cause in-hospital mortality. This observational, retrospective, multicenter cohort study analyzed 12 170 patients admitted to 150 Spanish centers included in the SEMI-COVID-19 Network. We compared AS, defined as pulse pressure ≥60 mm Hg, and clinical characteristics between survivors and nonsurvivors. Mean age was 67.5 (±16.1) years and 42.5% were women. Overall, 2606 (21.4%) subjects died. Admission systolic blood pressure (BP) <120 and ≥140 mm Hg was a predictor of higher all-cause mortality (23.5% and 22.8%, respectively, P<0.001), compared with systolic BP between 120 and 140 mm Hg (18.6%). The 4379 patients with AS (36.0%) were older and had higher systolic and lower diastolic BP. Multivariate analysis showed that AS and systolic BP <120 mm Hg significantly and independently predicted all-cause in-hospital mortality (adjusted odds ratio [ORadj]: 1.27, P=0.0001; ORadj: 1.48, P=0.0001, respectively) after adjusting for sex (males, ORadj: 1.6, P=0.0001), age tertiles (second and third tertiles, ORadj: 2.0 and 4.7, P=0.0001), Charlson Comorbidity Index (second and third tertiles, ORadj: 4.8 and 8.6, P=0.0001), heart failure, and previous and in-hospital antihypertensive treatment. Our data show that AS and admission systolic BP <120 mm Hg had independent prognostic value for all-cause mortality in patients with COVID-19 requiring hospitalization

Twenty-Four-Hour Central (Aortic) Systolic Blood Pressure: Reference Values and Dipping Patterns in Untreated Individuals.

Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18-94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBPMAP/DBPcal), or bSBP/diastolic blood pressure (cSBPSBP/DBPcal), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBPMAP/DBPcal were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBPSBP/DBPcal, respectively. We pragmatically propose as upper normal limit for 24-hour cSBPMAP/DBPcal 135 mm Hg and for 24-hour cSBPSBP/DBPcal 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was -10.6 % in young participants and decreased with increasing age. Central SBPSBP/DBPcal dipping was less pronounced (-8.7% in young participants). In contrast, cSBPMAP/DBPcal dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigation