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In this work it is demonstrated the capacity of the sol–gel process to obtain materials with different phases, using the same chemical composition, and modifying only the conditions of hydrolysis and condensation. This method combined with the polymer sponge replica technique allowed to obtain a porous and three-dimensional scaffold, called core, consisting mainly of calcium phosphates. Additionally, due to the versatility of the sol–gel process, this core was coated with additional phases, constituted by silicon and magnesium, obtaining multilayer scaffolds. The scaffolds were physically and chemically characterized and the in vitro bioactivity was evaluated by immersion in simulated body fluid. The results of in vitro bioactivity showed that the core revealed a lamellar microstructure with some apatite precipitates after 14 days, while the multilayer scaffolds presented precipitates over the whole surface in only 3 days. The accelerated bioactivity and the general properties of the multiphase and multilayer scaffolds show the potential of this material in the area of tissue engineering.

Resumen Objetivo Evaluar el uso de la terapia con beneficio cardiovascular en pacientes con DM tipo 2 previo al ingreso en servicios de medicina interna. Metodos Estudio transversal en un dia de los pacientes con DM tipo 2 hospitalizados en servicios de medicina interna. Se recogieron variables demograficas y antropometricas, datos de laboratorio y utilizacion de farmacos antihiperglucemiantes. La variable desenlace fue la proporcion y los determinantes de uso de inhibidores del cotransportador sodio-glucosa 2 (iSGLT2) y de agonistas del receptor del peptido similar al glucagon tipo 1 (AR-GLP1). Resultados Se incluyeron 928 pacientes pertenecientes a 74 hospitales. La edad media fue 78,9 anos (DE: 10,86), un 50% varones. Un total de 557 (60%) presentaba cardiopatia isquemica, 189 (20,4%) enfermedad cerebrovascular, 293 (31,6%) insuficiencia cardiaca, 274 (29,5%) enfermedad renal cronica y 129 (13,9%) enfermedad arterial periferica. Los antihiperglucemiantes utilizados previo al ingreso fueron: sulfonilureas (5.7%), biguanidas (49.1%), inhibidores de la alfa-glucosidasa (0,2%), pioglitazona (0%), iDPP4 (39%), iSGLT2 (5,8%), AR-GLP1 (2,6%) y analogos de insulina basal (24%). La edad mayor de 75 anos fue el factor determinante principal para no utilizar iSGLT2 (OR ajustada 0,28; intervalo de confianza al 95%: 0,10-0,74; p = 0,039) o AR-GLP1 (OR ajustada 0,09; intervalo de confianza al 95%: 0,02-0,46; p = 0,006). Discusion Una gran proporcion de pacientes ancianos con DM tipo 2 de muy alto riesgo cardiovascular no recibe terapia antihiperglucemiante con farmacos de probado beneficio cardiovascular. El tratamiento mas frecuentemente utilizado fue metformina e iDPP4. Existe un margen de mejora en el tratamiento en esta poblacion de muy alto riesgo.

Introducción: La dieta mediterránea (DMed) reduce la morbimortalidad. El confinamiento ocurrido en España entre los meses de marzo y mayo de 2020 podría generar cambios conductuales, entre ellos la adherencia a la DMed. El objetivo del presente estudio ha sido valorar la citada adherencia al concluir dicho confinamiento y compararla con la situación previa al mismo. Métodos: Los datos se obtuvieron mediante dos cuestionarios en línea uno al comienzo del confinamiento y otro al final, en personas adultas procedentes de población española, las cuales respondieron de forma anónima y voluntaria. La valoración de la adherencia a la DMed se realizó a través de dos cuestionarios: Mediterranean Diet Adherence Screener (MEDAS) y PREDIMED modificado, los cuales contenían 14 cuestiones cada uno. Otras variables incluidas fueron: edad, género, índice de masa corporal (IMC), Comunidad Autónoma de procedencia, tipo de convivencia en domicilio y nivel de estudios alcanzado. Al concluir el confinamiento la comparación entre los cambios se realizó con el estadístico t de Student y la prueba de McNemar. Resultados: Participaron 207 personas (137 mujeres), edad media de 51,3±12,4 años, intervalo de edad: 20-83 años. Transcurrido el confinamiento el IMC permaneció sin cambios (24,55±3,7 kg/m2 inicial y 24,57±3,7 kg/m2 final, p=0,752), y sí el consumo de pescado (51,2% inicial y 60,9% al final, p=0,003) a expensas fundamentalmente de las mujeres y la adherencia a la DMed, aumentando la puntuación total por término medio tanto en MEDAS (10,6±2,0) al inicio y 10,57±2,0 al final; p=0,001) como en PREDIMED modificado (9,47±2,1 al inicio y 9,93±2,1 al final, p

Puntos para una lectura rapida • La infiltracion es la inyeccion de medicamentos en el lugar anatomico donde se producen mecanismos patogenicos de la enfermedad (intra y extraarticulares) con el fin de disminuir la inflamacion, aliviar el dolor y mejorar la impotencia funcional. • La efectividad de la infiltracion va a depender de un estricto conocimiento de la anatomia, del dominio de la tecnica, de la correcta eleccion del farmaco utilizado y de la adecuada indicacion en cada momento. • La tecnica de infiltracion (como todo tratamiento en medicina) tiene que realizarse despues de haber valorado los pros y los contras que supone este procedimiento para el paciente. • Los principales objetivos de las tecnicas de infiltracion son: paliar el dolor y la sintomatologia inflamatoria, prevenir o restablecer la limitacion funcional, facilitar la recuperacion del proceso, reducir el uso de tratamientos mas agresivos y evitar secuelas. • No existe una norma unica sobre la frecuencia entre las infiltraciones, y se ha podido comprobar que la administracion de varias infiltraciones en una misma articulacion es efectiva. En la bibliografia revisada se aconseja separarlas entre 1 y 4 semanas. • Debe emplearse siempre material esteril desechable, asegurandose previamente de que no esta caducado. • En principio, en atencion primaria las infiltraciones locales se limitan al uso de anestesicos locales y corticoides.

Objective To analyze obesity, level of adherence to the Mediterranean diet, physical activity and body dissatisfaction in people aged 16–50 years in the Region of Murcia, Spain. Method Descriptive and cross-sectional study. A total of 85 people (58 men) aged 16–50 years (28.68 ± 8.846) from 3 sports centers with similar sociodemographic characteristics participated in the study. Anthropometric values were recorded. They were tested for adherence to the Mediterranean diet, International Physical Activity Questionnaire (IPAQ) and test for dissatisfaction with their body (BSQ) and it was statistically related. Results It can be seen that the level of physical activity of both men and women is low, according to the IPAQ questionnaire, the men presented a METs/min per week of 3687.9 (DT = 3137.2) significantly higher than women’s. In body dissatisfaction we see that women’s concern with their bodies (59.3%) is greater than men’s (31%), with a statistically significant difference (p = 0.013). Eating habits and BMI do not have statistically significant differences according to sex. When applying the Mediterranean diet adherence test, it is observed that 95.3% of those with weight overload have a medium or low score, and only 4.7% have a discharge score (p = 0.128). Those with weight overload have a score of 2935.73 MET/min per week (DT = 2633.16) and those without weight overload have a value of 3826.73 (DT = 3164.93, p = 0.268). There are significant differences regarding the values of body dissatisfaction. The level of concern of those with weight overload is 53.5%, compared to those without weight overload who have a level of concern of 26.2% (p = 0.014). Conclusions Weight overload is associated with body dissatisfaction and a low score in the test of adherence to the Mediterranean diet in people aged 16–50 years. The concern about body image in women was 59.3%.

Introduction: The Niño Jesús Hospital procedural sedation scale (Madrid) (NJHPSS) has not been validated. Patients and methods: A prospective analytical study was conducted in 2 hospitals on patients ≥6 months undergoing invasive procedures using sedation-analgesia with propofol or midazolam and fentanyl. All were monitored using the bispectral index (BIS). Videos were made of each procedure, which were then edited and randomised. A total of 150 videos were rated by four observers using the NJHPSS, the University of Michigan sedation scale (UMSS), and the Ramsay Scale (RS). These observers were blinded to the BIS, and at the time of drug administration. To assess test-retest reliability, 50 of the initial 150 randomly selected videos were re-assessed. Results: The study included a total of 65 patients. Construct validity was demonstrated by changes in scores after administering sedatives (p

Resumen: Introducción: La escala de sedación para procedimientos del Hospital Niño Jesús (ESPHNJ) no ha sido validada. Pacientes y métodos: Estudio analítico prospectivo bihospitalario. Se reclutaron prospectivamente pacientes ≥ 6 meses sometidos a procedimientos invasivos bajo sedoanalgesia con propofol o midazolam y fentanilo. Todos fueron monitorizados con el índice biespectral (IB). Se realizaron videos de cada procedimiento, que fueron editados y aleatorizados. Ciento cincuenta videos fueron puntuados por cuatro observadores con la ESPHNJ, la escala de sedación de la Universidad de Michigan (ESUM) y la Escala de Ramsay (ER). Dichos observadores estaban cegados al IB y al momento de administración de fármacos. Para evaluar la fiabilidad test-retest, 50 videos de los 150 iniciales seleccionados aleatorizadamente fueron reevaluados. Resultados: Fueron incluidos 65 pacientes. La concordancia intraobservadores fue alta (ρ = 0,793). La ESPHNJ presentó una fiabilidad interobservador buena al comparar con la ESUM (CCI = 0,88) y con la ER (CCI = 0,86), y no hubo con el IB. La consistencia interna fue moderada (α = 0,68). La validez de constructo fue demostrada por los cambios en las puntuaciones tras administrar sedantes (p

Resumen Objetivo Analizar la obesidad, adherencia a la dieta mediterranea, actividad fisica e insatisfaccion corporal en personas de 16 a 50 anos de la Region de Murcia. Metodo Estudio descriptivo y transversal. Se incluyo a 85 personas (58 hombres) de 16 a 50 anos de 3 centros deportivos con caracteristicas sociodemograficas homogeneas. Se registraron los valores antropometricos. Posteriormente se les paso un test de adherencia a la dieta mediterranea, el cuestionario internacional de actividad fisica (IPAQ) y el test de insatisfaccion con su cuerpo (BSQ) y se relacionaron estadisticamente. Resultados Se puede observar que el nivel de actividad fisica tanto de hombres como de mujeres es bajo, segun el cuestionario IPAQ. Los hombres presentaron un MET/min semanales de 3.687,9 (DE = 3.137,2) significativamente superior al de las mujeres. En la insatisfaccion corporal vemos que la preocupacion de las mujeres con su cuerpo (59,3%) es mayor que la que tienen los hombres (31%), con diferencia estadisticamente significativa (p = 0,013). Los habitos alimenticios y el IMC no tienen diferencias significativamente estadisticas en funcion del sexo. Al aplicar el test de adherencia a la dieta mediterranea se observa que el 95,3% de los que tienen sobrecarga ponderal tiene una puntuacion media/baja, y solo el 4,7% tiene una puntuacion alta (p = 0,128). La puntuacion de los que tienen sobrecarga ponderal tienen es de 2.935,73 MET/min semanales (DE = 2.633,16) y la de los que no tienen sobrecarga ponderal es de 3.826,73 (DE = 3.164,93; p = 0,268). Hay diferencias significativas con respecto a los valores de insatisfaccion corporal. El nivel de preocupacion de los que tienen sobrecarga ponderal es de 53,5%, respecto a los que no la tienen, cuyo nivel de preocupacion es del 26,2% (p = 0,014). Conclusiones La sobrecarga ponderal se asocia con una insatisfaccion corporal y una baja puntuacion en el test de adherencia a la dieta mediterranea en personas de 16 a 50 anos. La preocupacion por la imagen corporal en las mujeres fue del 59,3%.

This work examines the in vitro bioactivity and biocompatibility of new biphasic scaffolds from eutectoid ceramic composition corresponding to the sub-system Ca3(PO4)2–Ca5SiP2O12, to evaluate their possible approach in bone tissue engineering. Scaffolds were synthesized by polymer replica method. Polyurethane sponges with desired pore size and geometry were used as templates, which were impregnated in barbotine and sintered by heat treatment. In vitro bioactivity was evaluated by different soaking times in simulated body fluid (SBF), according to Kokubo's method. Biocompatibility of adult human mesenchymal stem cells (ah-MSCs), in terms of adhesion and proliferation, were studied in vitro on the scaffolds' surface. Samples were characterized from mineralogical, chemical and microstructural point of view. Results showed that the bioactivity raised with increasing soaking time in SBF, giving place to a bone-like apatite surface transformation within 21 days. The ah-MSCs adhered and proliferated on the scaffolds' surface, establishing a close contact between them and forming an extensive monolayer to 21 days. Scaffolds presented a good in vitro bioactivity and biocompatibility then, they might be effective in future applications for bone tissue engineering.

Resumen Objetivo Conocer las caracteristicas epidemiologicas, clinicas y terapeuticas de los pacientes con diagnostico de IC atendidos en atencion primaria de 2 zonas de salud de Albacete, Zona 5 A (caracteristicas de centro urbano) y Casas Ibanez (caracteristicas de centro rural), asi como destacar las principales diferencias entre ambos. Metodo Estudio descriptivo y transversal, correspondiente a la primera fase del estudio ALBAPIC. Se han registrado a todos los pacientes de la zona desde el 1 de enero del 2018 hasta el 30 de junio del 2019 que cumplieran el criterio de inclusion: tener diagnostico de IC en el programa TURRIANO (programa de consulta clinica en Atencion Primaria de Castilla-La Mancha). Se registraron las caracteristicas demografico-antropometricas y clinicas, los datos analiticos, las exploraciones diagnosticas complementarias, las pautas terapeuticas y las hospitalizaciones durante 12 meses previos a la inclusion. Se realizaron una exploracion fisica y controles electrocardiograficos y bioquimicos en la visita de inclusion. Resultados Han participado 384 pacientes diagnosticados de IC en ambas zonas de salud (161 en zona urbana y 223 en la rural). Edad media ± desviacion estandar 82,24 ± 10,51 anos (81,24 ± 9,59 anos en zona urbana y 83,37 ± 11 anos en rural, con diferencias significativas, p En relacion con la prevalencia de factores de riesgo cardiovascular, tenemos que la hipertension sobre todo y las dislipidemias son los mas frecuentes, existiendo diferencias segun el medio en el que viven. En el medio rural hay mayores tasas de cardiopatias (principalmente isquemicas y por valvulopatia). Los pacientes con IC tienen numero alto de enfermedades cronicas concomitantes, siendo entre 4 y 6 mas del 60% de los casos en el medio urbano y entre 1 y 4 en el medio rural. Aproximadamente, un 14% tiene tambien una enfermedad oncologica en el medio urbano frente a un 21% en el rural. Segun los datos de exploracion y analitica, las principales variables se encuentran aceptablemente controladas, estando peor controlados los parametros lipidicos en el centro rural. La media de farmacos prescritos por cada paciente fue de 6,3 en rural y 7,2 urbano. En cuanto a los tratamientos que estan tomando se observa que los diureticos y las estatinas son los mas utilizados tanto en el medio rural como urbano. Conclusiones Existe un aceptable control de los factores de riesgo cardiovascular en ambos medios, existiendo diferencias en cuanto a los metodos diagnosticos y tratamientos utilizados.

New multilayer porous ceramic scaffolds, constituted by a core covered with external layers, are proposed as future bone tissue implants. The core with composition SiO2 - 25P2O5 – 68CaO–6Li2O (mol%) provided suitable compressive strength (0.9–1.6 MPa) to act as an initial support during bone tissue regeneration. The external layers with composition 29SiO2 - 3P2O5 - (68-x) CaO - xFe2O3 (mol%) (x = 0.3 and 1) (samples C/EL-1Fe and C/EL-3Fe, respectively) conferred a bioactive character to scaffolds. The surfaces of both samples showed apatite precipitates after coming into contact with simulated body fluid (SBF). Sample C/EL-1Fe exhibited noncontinuous bioactive behavior, with precipitates of apatite that precipitated and dissolved between days 1 and 28. Sample C/EL-3Fe showed precipitates after 8 days that remained until the end of the study time. This variation in material, achieved by modifying the amounts of iron in external layers, represents an important advance in the ability to control an implant's bioactivity in line with requirements of future applications.

To know the epidemiological, clinical and therapeutic characteristics of patients with a diagnosis of HF treated in primary care of 2Health Areas of Albacete, Zone 5 A (characteristics of the Urban Center) and Casas Ibañez (characteristics of the Rural Center) as well as to highlight The main differences between the two.Descriptive and cross-sectional study, corresponding to the first phase of the ALBAPIC study. All patients in the area who met the inclusion criteria have been registered: Having a diagnosis of HF in the TURRIANO program (consultation program in Primary Care of Castilla la Mancha). Demographic-anthropometric and clinical characteristics, analytical data, complementary diagnostic examinations, therapeutic guidelines and hospitalizations were recorded for 12 months prior to inclusion. A physical examination and electrocardiographic and biochemical controls were performed at the inclusion visit.384 patients diagnosed with HF in both Health Zone (161 in urban areas and 223 in rural areas) have participated. Average age 82.24±10.51 years (81.24±9.59 years in urban areas and 83.37±11 years in rural areas with significant differences P.005, 54.3% are women (54% in urban areas and 54.7% in rural areas) We have an incidence of CI of 1% in urban areas and 1.8% in rural areas. The prevalence of CVRF has that hypertension above all and dyslipidemia are the most frequent, with differences depending on the environment in which they live. In the rural environment there are higher rates of heart disease. Patients with HF have a high number of concomitant chronic diseases, being between 4 and 6 more than 60% of cases in the urban environment and between 1 and 4 in the rural environment. Approximately 14% also have an oncological disease in the urban environment compared to 21% in the rural. According to the exploration and analytical data, the main variables are acceptably controlled, the lipid parameters in the rural center being worse controlled. The average number of drugs prescribed by each patient was 6.3 in rural and 7.2 urban. As for the treatments they are taking, it is observed that diuretics and statins.There is an acceptable control of cardiovascular risk factors in both media, there being differences in the diagnostic methods and treatments used.

Resumen Introduccion El sedentarismo es senalado en la literatura internacional como una de las principales causas de la aparicion de algunos factores de riesgo cardiovascular. Objetivo Valorar la influencia de un programa de ejercicio fisico terapeutico en diferentes indicadores clinicos relacionados con la dislipidemia (colesterol total, HDL y LDL), en sujetos sedentarios que presentan algun factor de riesgo cardiovascular. Metodo Estudio de intervencion con evaluacion antes y despues de una muestra formada por 340 pacientes (132 varones y 208 mujeres) derivados de los 2 centros de atencion primaria del municipio de Molina de Segura (Murcia) y que participaron en un programa de 30 semanas de ejercicio fisico que combinaba circuitos de trabajo de acondicionamiento muscular con otros de resistencia cardiorrespiratoria. En cuanto a los indicadores clinicos, los profesionales sanitarios recogieron en el historial medico aquellos indicadores de salud correspondientes a la evolucion biologica del proceso por el cual los sujetos estudiados habian iniciado el programa de ejercicio fisico. Resultados Los analisis estadisticos muestran una mejora significativa (p Conclusiones La prescripcion de ejercicio fisico en sujetos dislipemicos desde los centros de atencion primaria se debe valorar como recurso para la mejora de los indicadores clinicos propios de su enfermedad.

In this study, multilayer ceramic scaffolds were prepared by sol-gel and polymeric replication methods. The objective was to fabricate scaffolds based on two different compositions: a core with composition SiO2–25P2O5–68CaO–6Li2O (mol%) to confer mechanical resistance and external layers with composition 29SiO2–3P2O5-(68-x)CaO-xSrO (mol%) (x = 0, 0.7, 2, 7, 17 and 34) to provide modulated bioactivity. The obtained scaffolds were characterized by X-ray diffraction (XRD), Fourier Transform Infrared Spectroscopy (FTIR), Scanning Electron Microscopy with Energy Dispersive X-Ray Spectroscopy (SEM-EDX) and Mercury Porosimetry Techniques. In vitro bioactivity was evaluated by soaking samples in simulated body fluid (SBF). The results revealed that the core was not bioactive, but bioactivity could be modulated when the core was covered with external layers. The samples doped with 0.7 and 7 mol% SrO showed bioactivity after 3 days in SBF, while the sample doped with 2 mol% SrO displayed bioactivity after 14 days. The samples doped with 17 and 34 mol% SrO presented no bioactivity, rather precipitates on the surface after 14 days and 7 days, respectively, which could correspond to a modified apatite. Variation in bioactivity with increasing dopant concentrations is attributed to the fact that a certain amount of Ca2+ ions substituted for Sr2+ can distort the network at different levels. This makes the material more unstable, which favors the ion exchange needed for hydroxyapatite nucleation.

The goal of this work is to develop multilayer scaffolds with a high durability core and bioactive external layers. Different ceramics were analysed by Scanning Electron Microscope fitted with Energy-Dispersive X-Ray Spectroscopy, X-Ray Diffraction and they were subjected to in vitro testing using simulated body fluid. A non-bioactive porous ceramic scaffold, composed fundamentally of calcium pyrophosphate and tricalcium phosphate, constituted the core of the final multilayer ceramic. Otherwise, a highly bioactive ceramic, composed fundamentally of a major amorphous calcium silicate phase with traces of Zn in its composition, constituted the external layers of the final multilayer ceramic. When the multilayer ceramic was analysed, the mineralogical phases changed compared with core ceramic individually, and it was demonstrated that bioactive external layers provided this capacity to the core ceramic, constituted by a material that was initially non-bioactive.

Objective To assess the effect of a motivated physical activity program on the lipid parameters most related to excess weight (triglycerides [TG], and high density lipoprotein cholesterol [HDL]) in a weight-loss intervention in obese and overweight patients. Methods A randomised and controlled, 2-arm, clinical trial and a 12-months follow-up was conducted. The patients included in the study were randomised into 2 intervention groups: motivational intervention of obesity with a previously trained nurse (G1), motivational group, with digital platform support and motivated physical activity program (iwopi [G2]). The anthropometric variables measured were height, weight, body mass index (BMI), as well as the analytical variables, total cholesterol, TG and HDL- C . Results A total of 123 patients participated in the study, of which 61 were randomised to G1, and 62 to G2. Both groups significantly decreased weight at the end of the study, with the decrease in G1 being 4.898 kg, and 6.292 kg in G2. In both groups there was also a significantly decrease (p Conclusions Weight reduction is accompanied by favourable changes in lipid parameters related to overweight and obesity, being more intense the greater the weight loss.

Resumen Objetivo Valorar el efecto de un programa de actividad fisica motivada sobre los parametros lipidicos mas relacionados con el exceso de peso (trigliceridos [TG] y colesterol de las lipoproteinas de alta densidad [cHDL]) en una intervencion para reducir peso en pacientes con sobrepeso y obesidad. Metodos Ensayo clinico, aleatorizado y controlado, con 2 brazos y un seguimiento de 12 meses. Los pacientes incluidos en el estudio fueron aleatorizados en 2 grupos de intervencion: intervencion motivacional de obesidad con enfermera entrenada previamente (G1), grupo motivacional, con apoyo de plataforma digital y programa de actividad fisica motivada (iwopi [G2]). Las variables antropometricas medidas fueron estatura, peso, indice masa corporal (IMC) y las analiticas, colesterol total, TG y cHDL. Resultados Han participado en el estudio 123 pacientes, de los que 61 fueron aleatorizados al G1 y 62 al G2. Todos los grupos disminuyeron significativamente el peso al final del estudio, siendo la disminucion en el G1 (−4,898 kg) y del G2 (−6,292 kg). Tambien todos los grupos disminuyeron significativamente (p Conclusiones La reduccion de peso se acompana de cambios favorables en los parametros lipidicos relacionados con el sobrepeso y la obesidad, siendo mas intensos cuanto mayor es la perdida de peso.

A material, whose composition was based on the SiO2–CaO–P2O5 system, was used to prepare 3D porous ceramic scaffolds made by the foam replication technique linking the sol-gel route or ceramic slurry in barbotine suspension processes. With an appropriate heat treatment, it was possible to obtain a 3D-scaffold containing two crystalline phases or more, and a controlled nano-to microscale microstructure. The obtained scaffolds presented an interconnected and well-defined porous structure. Its pore size was 0.060–600 μm. It had a rough pore wall that could potentially benefit ingrowth and cell adhesion. In terms of hydroxycarbonate apatite formation in simulated body fluid (SBF), the 3D scaffolds’ bioactivity was confirmed after 3 and 14 days of immersion in SBF. This clearly confirms that these new scaffolds are suitable for bone regeneration applications. Processing technology allows 3D scaffolds to be adapted with particular microstructures to increase/decrease their in vitro behavior.

Resumen Objetivo Analizar el efecto de la utilizacion/implementacion de 3 metodos para reducir peso en pacientes con sobrepeso u obesidad, durante un ano de seguimiento. Material y metodos El diseno corresponde a un ensayo clinico, aleatorizado y controlado, doble ciego, con 3 brazos y 12 meses de seguimiento. Los pacientes se aleatorizaron en 3 grupos de intervencion: intervencion motivacional de obesidad con enfermera entrenada previamente en intervencion motivacional por psicologos expertos (G1; n = 60); intervencion en consulta de menor intensidad, sin grupo motivacional, con apoyo de plataforma digital (G2; n = 61) y un tercer grupo que recibia recomendacion de perder peso y seguimiento en consulta de Atencion Primaria (G3; n = 59). Se midieron las variables antropometricas (peso, talla y perimetro de cintura abdominal) y se considero como principal medida de la efectividad del tratamiento el porcentaje de pacientes que lograron al ano reducir su peso ≥5%. Resultados Todos los grupos disminuyeron significativamente el peso al final del estudio. Fue mas intensa la disminucion en el G1 (−5,6 kg), seguido del G2 (−4,3 kg) y del G3 (−1,7 kg); media en su conjunto: −3,9 kg. Los indicadores de relevancia clinica fueron en el G1/G3: riesgo relativo (RR): 4,99 (IC 95%: 2,71 a 9,18); reduccion relativa del riesgo (RRR): 399,1% (de 171,3 a 818,0); reduccion absoluta del riesgo (RAR): 65,3% (de 51,5 a 79,1) y NNT: 2 (de 2 a 2). En los grupos G2/G3: RR: 3,01 (de 1,57 a 5,76); RRR: 200,5% (de 57,0 a 475,5); RAR: 32,8% (de 16,9 a 48,7) y NNT: 4 (de 3 a 6). En los grupos G1/G2: RR: 1,66 (de 1,25 a 2,20); RRR: 66,1% (de 25,3 a 120,1); RAR: 32,5% (de 16,6 a 48,4) y NNT: 4 (de 3 a 7). Conclusiones Los 3 grupos consiguieron reducir el peso, si bien el grupo con intervencion motivacional alcanzo la mayor disminucion y los indicadores de relevancia clinica mas favorables.

Summary Introduction To evaluate the effectiveness of obesity intervention with telemedicine support technology in patients who have been recently diagnosed as overweight or obese, in comparison to usual protocols currently implemented in our area. Material and methods Randomized, controlled, double-blind, parallel clinical trial comparing 2 arms, multicentre study in overweight or obese patients with a 12-month follow-up. Patients were randomized into two groups: Intervention in primary care centres with a telematic platform support (G1) and a control group provided constantly with guidelines to lose weight and follow-up in primary care centres (G2). Variables were collected: weight, height, BMI, waist circumference, lipid parameters, blood pressure and glycaemia. After the interventions were conducted, indicators of clinical relevance were studied, i.e. relative risk (RR), absolute risk reduction (ARR), relative risk reduction (RRR) and number needed to treat (NNT) both by intention-to-treat and by biological efficacy. Results One hundred and sixteen patients were included in the study where 61 were randomized to group 1 and 55 to group 2. Of the study population, 58.6% were women and 41.4% were men. Patients’ weight in both groups descended in each of the visits, observing an overall average weight reduction at the end of the study of 3.06 kg, being 4.3 kg in group 1 and 1.8 kg in the control group. It also was noted that cholesterol levels in both groups were reduced. On the other hand, the triglycerides levels were significantly reduced only in the study group G1, and HDL was increased in both groups, but more in G1. Regarding of clinically relevant parameters were G1 versus G2: RR: 1.21 to 3.57; RRR: 21.3 to 256.8; ARR: 8.7 to 42.4, and NNT: 3 to 12. Discussion and conclusions Both groups were able to reduce the weight while the group with the telemedicine support based on Medtep digital platform showed significant differences.

Resumen Introduccion La infancia y la adolescencia son etapas clave para promocionar un estilo de vida saludable. Objetivo Analizar la relacion entre el estado de peso, la actividad fisica y la dieta mediterranea en escolares de la Region de Murcia. Metodos Estudio descriptivo transversal con 520 escolares de 8-17 anos. El estado de peso se calculo a traves del indice de masa corporal. La adherencia a la dieta mediterranea se hallo a traves del cuestionario KIDMED, y la actividad fisica se estimo utilizando los cuestionarios IPAQ- C e IPAQ-A. Resultados La dieta mediterranea no se asocia significativamente con el sexo (p Conclusion Se confirma el fenomeno «fat but fit» aplicado a la dieta mediterranea.

Understanding the interspecific variation in body size across macroclimatic gradients has been of paramount importance to naturalists and biogeographers. Bergmann’s rule, which describes a trend of increasing body size polewards, is arguably the best-known ecogeographical rule in terrestrial environments but remains largely unexplored in the marine realm. In this study we tested Bergmann's rule in marine ray-finned fishes (Pisces, Actinopterygii), analyzing the relationship between body size and latitude in 5662 species. To examine possible underlying mechanisms, we adopted a cross-species approach to evaluate the association of body size with four predictors: Sea Surface Temperature, Net Primary Productivity, Salinity, and Human impact. We analyzed the relationships between body size and environmental and anthropogenic variables building mixed linear models, which considered the taxonomic structure in the data. We conducted complementary analyses dividing the data into five latitudinal bands. Actinopterygii showed a clear Bergmannian pattern, with the largest species observed in temperate regions, being the first global analysis on ray-finned fishes showing a pattern consistent with Bergmann’s rule. Sea Surface Temperature and Net Primary Productivity were the best predictors, in accordance with the time to sexual maturity and resource availability hypotheses. Our analyses based on latitudinal bands showed a differential response of body size to the environment, with temperature, salinity and human impact more strongly associated with size variation at cold environments. These results agree with previous studies on Bergmann’s rule for terrestrial ectothermic, freshwater and marine fishes. Our findings suggest that temperature rise in the ocean and growing human impact may have effects on the distribution of body size, thus altering ecosystem functioning. Fundamental differences often assumed to exist between marine and terrestrial systems are not so evidently reflected in the emergence of large-scale body size gradients.

Resumen Objetivo Analisis de situacion de la insuficiencia cardiaca en una zona de salud y evaluacion de criterios de calidad. Metodo Estudio observacional transversal de los pacientes diagnosticados de insuficiencia cardiaca mediante historia clinica en el programa informatico «Turriano». Se analizan las variables: comorbilidades, control de factores de riesgo cardiovascular (FRCV), tratamientos, numero de enfermedades cronicas e ingresos. Tambien se analiza el grado de adherencia terapeutica para farmacos en relacion con la insuficiencia cardiaca mediante la determinacion del cociente entre el porcentaje de farmacos prescritos y el de farmacos retirados de farmacia, segun el programa de prescripcion de Turriano. El estudio consiste en un ciclo de mejora o ciclo evaluativo, siguiendo la metodologia propuesta por Palmer para evaluar la calidad de la asistencia ambulatoria. Resultados Se incluyo a 161 pacientes, con una edad media de 81,24 anos; un 54,6% eran mujeres. Las dolencias asociadas eran hipertension arterial (95%), diabetes (42,2%), dislipidemias (8,9%), obesidad (49,1%) y neoplasias (13,7%). Un 62,2% tenian diagnosticado algun tipo de cardiopatia: el 29,2% cardiopatia isquemica, el 46,6% arritmias cardiacas y el 20,5% valvulopatias. Mas del 60% tenian entre 4 y 6 enfermedades concomitantes. En cuanto a los FRCV, se observa un aceptable control. Un 70% tomaban tratamiento de diureticos, un 32 y un 35% inhibidores de la enzima conversora de la angiotensina y antagonistas del receptor de la angiotensina II. Mas del 20% han tenido 1-2 ingresos en el ultimo ano, con descompensacion cardiaca como principal causa. Hubo un 16% de mortalidad. Conclusiones Los pacientes con insuficiencia cardiaca tienen importante numero de enfermedades cronicas concomitantes, si bien hay un aceptable control de los FRCV.

Objective To analyse the heart failure situation in a health area, as well quality criteria. Method Cross-sectional observational study of patients diagnosed with heart failure by collecting data from their clinical history in the “Turriano” computer program. The variables analysed were, comorbidities, control of cardiovascular risk factors, treatments, number of chronic diseases, and admissions. The level of adherence to drugs in relation to heart failure by determining the ratio between the percentage of prescribed drugs and drugs withdrawn from pharmacy is also analysed using the Turriano prescription program. The study consisted of an improvement cycle or evaluative cycle, following the methodology proposed by Palmer to evaluate the quality of ambulatory care. Results A total of 161 patients were included, with a mean age of 81.24 years, and 54.6% were women. Almost all of them (95%) had disease associated high blood pressure, including diabetes 42.2%, dyslipidaemia 8.9%, obesity 49.1%, and cancer 13.7% Some type of heart disease was diagnosed in 62.2% of patients with 29.2% ischaemic heart disease, 46.6% cardiac arrhythmias, and 20.5% valve diseases. More than 60% had between 4 and 6 concomitant diseases. An acceptable control is observed as regards the cardiovascular risk factors. Diuretic treatment was taken by 70%, with 32% and 35% taking angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists. More than 20% have had 1–2 admissions in the last year, with cardiac decompensation being the main cause. There was 16% mortality. Conclusions Patients with heart failure have a significant number of chronic concomitant diseases, although there is an acceptable cardiovascular risk factors control. There are quality criteria that can be improved.

Introduction Several variables have been associated with a better prognosis of periapical surgery. The aim of this study was to evaluate the influence of 2 hemostatic agents on the prognosis of periapical surgery at 12 months. Methods A prospective study was designed with 2 randomized parallel groups established depending on the hemostatic agent used: epinephrine or aluminum chloride. The analysis of the hemorrhage control was recorded as 0 (no hemorrhage control), 1 (slight but apparent intermittent bleeding persisted after application of the material), or 2 (complete hemorrhage control). At 12 months, periapical lesion healing was determined clinically and radiologically as success, improvement, or failure. Results Ninety-five patients (67 women and 28 men) with periapical lesions involving a single tooth were enrolled in this study; in 45 teeth, epinephrine was used and in 50 teeth aluminum chloride. In the epinephrine group, 28 teeth were classified as successes, 10 as improvements, and 7 as failures. In the aluminum chloride group, 34 teeth were classified as successes, 11 as improvements, and 5 as failures. No statistically significant difference was found. Conclusions The present study found no association between the use of epinephrine or aluminum chloride as hemostatic agents on the prognosis of periapical surgery. The efficacy of hemostatic agents at the time of surgery showed no relationship with the healing outcome.