Bajo peso al nacer, morfometría renal y cifras de tensión arterial en adolecentes femeninas

Fundamento: la hipertensión arterial constituye un problema de salud en la actualidad, siendo una causa directa de discapacidad y muerte. Datos epidemiológicos sugieren que la nutrición pre y posnatal puede ser un factor importante en la etiopatogenia de esta enfermedad. Objetivo: evaluar la influencia del bajo peso al nacimiento sobre la tensión arterial y el tamaño del riñón de las adolescentes. Métodos: se realizó un estudio transversal en 50 adolescentes del sexo femenino del municipio Marianao, La Habana. Se midieron las siguientes variables: peso, talla, tensión arterial sistólica y diastólica, peso y talla al nacimiento e índice de masa corporal. Mediante ultrasonido se midió longitud, ancho, parénquima y volumen del riñón. Resultados: no hubo diferencias apreciables en los valores de tensión arterial de acuerdo al peso y la talla al nacimiento. Tampoco las variables renales mostraron cambios significativos de acuerdo a la clasificación de las adolescentes según su peso al nacimiento. Se encontró una relación significativa entre la tensión arterial sistólica y dos indicadores del tamaño relativo del riñón. Conclusión: los resultados no evidenciaron una asociación entre el bajo peso al nacer y las cifras de tensión arterial altas. Se reafirma que las cifras de tensión arterial se relacionan positivamente con la adiposidad corporal y con el tamaño relativo pequeño del riñón

Cifras de tensión arterial asociadas al bajo peso al nacer en adolescentes del sexo femenino

La prevalencia de hipertensión en los adolescentes no se conoce con precisiónporque suele cursar sin manifestaciones clínicas. Datos epidemiológicos sugierenque la nutrición pre y postnatal puede ser un factor importante en la etiopatogeniade esta enfermedad. En el presente estudio, se propuso confirmar la influencia delbajo peso al nacimiento y la edad de la menarquia sobre la tensión arterial de lasadolescentes y el efecto mediador de esta última y el índice de masa corporal (IMC)entre el peso al nacimiento y las cifras de tensión arterial. Se estudiaron 112adolescentes femeninas entre 10 y 15 años de edad. Se midieron 4 variablesantropométricas, la tensión arterial sistólica y diastólica, el IMC y la edad de lamenarquia, Se obtuvo información retrospectiva sobre el peso y la longitud alnacimiento. Todo el análisis de datos se basó en el estudio de la correlación entrelas variables independientes y de respuesta, y entre ambas y las variablessupuestamente mediadoras. No se encontró asociación del peso al nacimiento conla edad de la menarquia ni con las cifras de tensión arterial, ni entre estas dosúltimas; sí se confirmó la asociación de las cifras de TA con la circunferencia de lacintura y con el IMC. No se confirmó ninguna de las conjeturas derivadas de laliteratura posiblemente por la imposibilidad práctica de controlar la edadgestacional, que no pudo recuperarse de los registros retrospectivos.Palabras clave: Adolescentes, Tensión arterial, Medidas antropométricas

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

A global experiment on motivating social distancing during the COVID-19 pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

A global experiment on motivating social distancing during the COVID-19 pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e. a controlling message) compared to no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly-internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared to the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly-internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing: Controlled motivation was associated with more defiance and less long-term behavioral intentions to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges

Cifras de tensión arterial asociadas al bajo peso al nacer en adolescentes del sexo femenino Blood pressure levels in adolescents associated with low birth weight

La prevalencia de hipertensión en los adolescentes no se conoce con precisión porque suele cursar sin manifestaciones clínicas. Datos epidemiológicos sugieren que la nutrición pre y postnatal puede ser un factor importante en la etiopatogenia de esta enfermedad. En el presente estudio, se propuso confirmar la influencia del bajo peso al nacimiento y la edad de la menarquia sobre la tensión arterial de las adolescentes y el efecto mediador de esta última y el índice de masa corporal (IMC) entre el peso al nacimiento y las cifras de tensión arterial. Se estudiaron 112 adolescentes femeninas entre 10 y 15 años de edad. Se midieron 4 variables antropométricas, la tensión arterial sistólica y diastólica, el IMC y la edad de la menarquia, Se obtuvo información retrospectiva sobre el peso y la longitud al nacimiento. Todo el análisis de datos se basó en el estudio de la correlación entre las variables independientes y de respuesta, y entre ambas y las variables supuestamente mediadoras. No se encontró asociación del peso al nacimiento con la edad de la menarquia ni con las cifras de tensión arterial, ni entre estas dos últimas; sí se confirmó la asociación de las cifras de TA con la circunferencia de la cintura y con el IMC. No se confirmó ninguna de las conjeturas derivadas de la literatura posiblemente por la imposibilidad práctica de controlar la edad gestacional, que no pudo recuperarse de los registros retrospectivos.The prevalence of hypertension in adolescents is unknown due to lack of clinical symptoms. Epidemiologic studies suggest that prenatal and postnatal nutrition can be an important factor in the pathogenesis of this disease. In our work we intended to confirm the association of low birth weight and age of menarche with the adolescent's blood pressure and at the mediating effect of menarche and body mass index. 112 female adolescents between 10 and 15 years of age were studied. Blood pressure, body mass index, age at menarche and four anthropometric variables were measured. Backward information on birth weight and length was also collected. Linear models were fitted to study the association between birth weight and blood pressure, adjusting for presumably mediator variables. None of the conjectures derived from recent literature could be confirmed, most likely due to the practical impossibility to control for gestational age

What is the impact of mother’s bed incline on episodes of decreased oxygen saturation in healthy newborns in skin-to-skin contact after delivery: Study protocol for a randomized controlled trial

Abstract Background Early mother–child skin-to-skin contact (SSC) in the first 2 h postpartum is highly beneficial for both mother and child. However, cases have been reported of newborns who have experienced apparently life-threatening events (ALTEs) or sudden death during this procedure. The causes of these events are unknown. Newborn’s prone position could influence the onset of these events but there is very little evidence to support any recommendation. We hypothesize that newborns’ breathing obstruction episodes increase as mothers lie more horizontally. The main objective of this study is to compare the occurrence of desaturation and bradycardia episodes as a function of mother’s bed incline. The study is designed as a randomized, controlled, assessor blind, multicenter, superiority trial with two parallel groups and 1:1 allocation ratio. Methods The study participants will be full-term healthy mother–newborn dyads from ten hospitals in Spain. Participants will be randomly assigned to one of two study arms defined by mother’s bed inclination (45° or 15°). The planned sample size is 5866. Centralized permuted blocks randomization and assessor blinding will be implemented. The newborns will be monitored remotely with pulse oximetry, from 10 min to 2 h after delivery. We established SO2 and heart rate (HR) limit alarms, as well as an action protocol in the event of alarm activation. The primary outcome is the number of healthy newborns who undergo episodes of SO2 ≤ 90%. Secondary outcomes are the mean SO2 level, the number of newborns who experience episodes of SO2 ≤ 85%, the time to SSC discontinuation due to abnormal SO2 or HR, and episodes of HR  180 bpm. Subgroups and pooled analysis will be performed to identify if breast-feeding and mother and child positions favor the occurrence of desaturation or bradycardia episodes. Discussion A simple intervention such as modifying mother’s bed angle of inclination while in SSC with her child during the first 2 h postpartum could favor newborn’s hemodynamic and respiratory stabilization and thus contribute to reducing the onset of ALTEs. Trial registration ClinicalTrials.gov, NCT02585492. Registered on 22nd October 2015. Protocol version 2 (30th June 2015)