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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.

Background: Mild cognitive impairment (MCI) due to Alzheimer’s disease (AD) diagnosis is based on cerebrospinal fluid (CSF) or neuroimaging biomarkers. Currently, non-invasive and inexpensive blood-based biomarkers are being investigated, such as neuronal-derived plasma exosomes (NPEs). Neuroinflammation and early vascular changes have been described in AD pathogenesis and can be traced in plasma and NPEs. However, they have not been studied in early onset MCI (EOMCI). Objective: To describe the rationale, design, and baseline characteristics of the participants from the BIOFACE cohort, a two-year observational study on EOMCI conducted at Fundació ACE. The study goal is to characterize the different phenotypes from a clinical, neuropsychological, and biomarker point of view and to investigate the CSF and plasma proteomics as well as the role of NPEs as early biomarkers of AD. Methods: Participants underwent extended neurological and neuropsychological batteries, multimodal biomarkers including brain MRI, blood, saliva, CSF, anthropometric, and neuro-ophthalmological examinations. Results: Ninety-seven patients with EOMCI were recruited. 59.8%were women. Mean age at symptom onset was 57 years; mean MMSE was 28. First degree and presenile family history of dementia was present in 60.8%and 15.5%, respectively. Depressive and anxiety disorders along with vascular risk factors were the most frequent comorbidities. 29%of participants were APOE ɛ4 carriers, and 67%showed a CSF normal ATN profile. Conclusion: BIOFACE is a two-year study of clinical, cognition, and biomarkers that will shed light on the physiopathology and the potential utility of plasma and NPEs as non-invasive early diagnostic and prognostic biomarkers in people younger than 65 years.

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

Introduction Innovative patient engagement models are required to identify people with prodromal and mild Alzheimer's disease who are “hidden” in their communities and not normally found in a memory clinic setting. Methods A marketing campaign and a web‐based pre‐screening tool were used to identify individuals at risk of dementia in five European countries. Harmonized clinical evaluation of these patients was performed in participating memory clinics within the MOPEAD project. Results A total of 1487 individuals completed the pre‐screening, with 547 of them found to be at risk of dementia (36.8%). Among the subset of 91 patients with a positive pre‐screening result that underwent full clinical evaluation, 49 (53.8%) were diagnosed with either mild cognitive impairment or Alzheimer's disease. Conclusion This novel web‐based pre‐screening tool showed to be a valid strategy to identify undiagnosed people with cognitive impairment.

BackgroundTo explore whether the combination of white matter hyperintensities (WMHs) and amyloid-beta (Aβ) deposition is associated with worse cognitive performance on cognitive composites (CCs) domain scores in individuals with subjective cognitive decline (SCD).MethodsTwo hundred participants from the FACEHBI cohort underwent structural magnetic resonance imaging (MRI),18F-florbetaben positron emission tomography (FBB-PET), and neuropsychological assessment. WMHs were addressed through the Fazekas scale, the Age-Related White Matter Changes (ARWMC) scale, and the FreeSurfer pipeline. Eight CCs domain scores were created using the principal component analysis (PCA). Age, sex, education, and apolipoprotein E (APOE) were used as adjusting variables.ResultsAdjusted multiple linear regression models showed that FreeSurfer (B − .245; 95% CI − .1.676, − .393,p = .016) and β burden (SUVR) (B − .180; 95% CI − 2.140, − .292;p = .070) were associated with face–name associative memory CCs domain score, although the latest one was not statistically significant after correction for multiple testing (p = .070). There was non-significant interaction of these two factors on this same CCs domain score (p = .54). However, its cumulative effects on face–name associative performance indicated that those individuals with either higher WMH load or higher Aβ burden showed the worst performance on the face–name associative memory CCs domain score.ConclusionsOur results suggest that increased WMH load and increased Aβ are independently associated with poorer episodic memory performance in SCD individuals, indicating a cumulative effect of the combination of these two pathological conditions in promoting lower cognitive performance, an aspect that could help in terms of treatment and prevention.

BACKGROUND The Ramsay scale is the most widely used scale during pediatric procedures although it has not been formally validated. OBJECTIVE To validate the Ramsay scale during invasive procedures under sedation in pediatrics. METHODS A prospective analytic study was conducted in two hospitals. All patients ≥6 months that were undergoing invasive procedures under sedation were enrolled. All were recorded, and these videos were edited and randomized. 150 videos were scored by four observers (a pediatrician, a pediatric intensive care unit nurse, an anesthetist, and an operating room nurse). All videos were scored with the Ramsay scale and University of Michigan Sedation Scale. Observers were blinded to drug administration. Construct validity was measured through Wilcoxon test paired samples after administration of sedatives. Criterion validity, intra-observer reliability, and interobserver correlation were evaluated by comparing the scores of the scales using Spearman's correlation coefficient. Interobserver agreement was measured using the intraclass correlation coefficient. To assess test-retest reliability, 50 videos were randomly selected and reevaluated. RESULTS Sixty-five patients were included. Construct validity was demonstrated through changes in the Ramsay scale scoring after administration of sedatives (p

Background and Purpose: The minor stroke concept has not been analyzed in intracerebral hemorrhage (ICH) patients. Our purpose was to determine the optimal cut point on the NIH Stroke Scale (NIHSS) for defining a minor ICH (mICH) in patients with primary ICH. Methods: An ICH was considered minor if associated with a favorable 3-month outcome (modified Rankin Scale score ≤2). For supratentorial ICH, the discovery cohort consisted of 478 patients prospectively admitted at University Hospital del Mar. Association between NIHSS at admission and 3-month outcome was evaluated with area under the curve-receiver operating characteristics (AUC-ROC) and Youden’s index to identify the optimal NIHSS cutoff point to define mICH. External validation was performed in a cohort of 242 supratentorial ICH patients from University Hospital Sant Pau. For infratentorial location, patients from both hospitals ( n = 85) were analyzed together. Results: The best ­NIHSS cutoff point defining supratentorial-mICH was 6 (AUC-ROC = 0.815 [0.774–0.857] in the discovery cohort and AUC-ROC = 0.819 [0.756–0.882] in the external validation cohort). For infratentorial ICH, the best cutoff point was 4 (AUC-ROC = 0.771 [0.664–0.877]). Using these cutoff points, 40.5% of all primary ICH cases were mICH. Of these, 70.2% were living independently at 3-month follow-up (72% for supratentorial ICH and 56.1% for infratentorial ICH) and 6.5% had died (5.3% for supratentorial ICH, and 14.6% for infratentorial ICH). For patients identified as non-mICH, good 3-month outcome was observed in 11.3% of cases; mortality was 51%. Conclusions: The definition of mICH using the NIHSS cutoff point of 6 for supratentorial ICH and 4 for infratentorial ICH is useful to identify good outcome in ICH patients.

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

Aims Providing a ready-to-use reverse transcriptase qPCR (RT-qPCR) method fully validated to detect the SARS-CoV-2 with a higher exclusivity than this shown by early published RT-qPCR designs. Methods and Results The specificity of the GPS™ CoVID-19 dtec-RT-qPCR test by analysis of sequence alignments was approached and compared with other RT-qPCR designs. The GPS™ CoVID-19 dtec-RT-qPCR test was validated following criteria of UNE/EN ISO 17025:2005 and ISO/IEC 15189:2012. Diagnostic validation was achieved by two independent reference laboratories, the Instituto de Salud Carlos III, (Madrid, Spain), the Public Health England (Colindale, London, UK), and received the label CE-IVD. The GPS design showed the highest exclusivity and passed all parameters of validation with strict acceptance criteria. Results from reference laboratories 100% correlated with these obtained by using reference methods and showed 100% of diagnostic sensitivity and specificity. Conclusions The CE-IVD GPS™ CoVID-19 dtec-RT-qPCR test, available worldwide with full analytical and diagnostic validation, is the more exclusive for SARS-CoV-2 by far. Significance and Impact of the Study Considering the CoVID-19 pandemic status, the exclusivity of RT-qPCR tests is crucial to avoid false positives due to related coronaviruses. This work provides of a highly specific and validated RT-qPCR method for detection of SARS-CoV-2, which represents a case of efficient transfer of technology successfully used since the pandemic was declared.

Background: The COVID-19 pandemic has brought great disruption to health systems worldwide. This affected ongoing clinical research, particularly among those most vulnerable to the pandemic, like dementia patients. Fundació ACE is a research center and memory clinic based in Barcelona, Spain, one of the hardest-hit countries. Objective: To describe the ad-hoc strategic plan developed to cope with this crisis and to share its outcomes. Methods: We describe participants’ clinical and demographic features. Additionally, we explain our strategic plan aimed at minimizing the impact on clinical trial research activities, which included SARS-CoV-2 RT-PCR and IgG serological tests to all participants and personnel. The outcomes of the plan are described in terms of observed safety events and drop-outs during the study period. Results: A total of 130 patients were participating in 16 active clinical trials in Fundació ACE when the lockdown was established. During the confinement, we performed 1018 calls to the participants, which led to identify adverse events in 26 and COVID-19 symptoms in 6. A total of 83 patients (64%) could restart on-site visits as early as May 11, 2020. All SARS-CoV-2 RT-PCR diagnostic tests performed before on-site visits were negative and only three IgG serological tests were positive. Throughout the study period, we only observed one drop-out, due to an adverse event unrelated to COVID-19. Discussion: The plan implemented by Fundació ACE was able to preserve safety and integrity of ongoing clinical trials. We must use the lessons learned from the pandemic and design crisis-proof protocols for clinical trials.

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.

BACKGROUND: Fundacio ACE is a non-profit organization providing care based on a holistic model to persons with cognitive disorders and their families for 25 years in Barcelona, Spain. Delivering care to this vulnerable population amidst the COVID-19 pandemic has represented a major challenge to our institution. OBJECTIVE: To share our experience in adapting our model of care to the new situation to ensure continuity of care. METHODS: We detail the sequence of events and the actions taken within Fundacio ACE to swiftly adapt our face-to-face model of care to one based on telemedicine consultations. We characterize individuals under follow-up by the Memory Unit from 2017 to 2019 and compare the number of weekly visits in 2020 performed before and after the lockdown was imposed. RESULTS: The total number of individuals being actively followed by Fundacio ACE Memory Unit grew from 6,928 in 2017 to 8,147 in 2019. Among those newly diagnosed in 2019, most patients had mild cognitive impairment or mild dementia (42% and 25%, respectively). Weekly visits dropped by 60% following the suspension of face-to-face activity. However, by April 24 we were able to perform 78% of the visits we averaged in the weeks before confinement began. DISCUSSION: We have shown that Fundacio ACE model of care has been able to successfully adapt to a health and social critical situation as COVID-19 pandemic. Overall, we were able to guarantee the continuity of care while preserving the safety of patients, families, and professionals. We also seized the opportunity to improve our model of care.

Background: Optical coherence tomography (OCT) of the retina is a fast and easily accessible tool for the quantification of retinal structural measurements. Multiple studies show that patients with Alzheimer's disease (AD) exhibit thinning in several retinal layers compared to age-matched controls. Subjective cognitive decline (SCD) has been proposed as a risk factor for progression to AD. There is little data about retinal changes in preclinical AD and their correlation with amyloid-β (Aβ) uptake. Aims: We investigated the association of retinal thickness quantified by OCT with Aβ accumulation and conversion to mild cognitive impairment (MCI) over 24 months in individuals with SCD. Methods: One hundred twenty-nine individuals with SCD enrolled in Fundació ACE Healthy Brain Initiative underwent comprehensive neuropsychological testing, OCT scan of the retina and florbetaben (FBB) positron emission tomography (PET) at baseline (v0) and after 24 months (v2). We assessed the association of sixteen retinal thickness measurements at baseline with FBB-PET status (+/-) and global standardize uptake value ratio (SUVR) as a continuous measure at v0 and v2 and their predictive value on clinical status change (conversion to mild cognitive impairment (MCI)) at v2. Results: Mean age of the sample was 64.72 ± 7.27 years; 62.8% were females. Fifteen participants were classified as FBB-PET+ at baseline and 22 at v2. Every 1 μm of increased thickness in the inner nasal macular region conferred 8% and 6% higher probability of presenting a FBB-PET+ status at v0 (OR = 1.08, 95% CI = 1.02-1.14, p = 0.007) and v2 (OR = 1.06, 95% CI = 1.02-1.11, p = 0.004), respectively. Inner nasal macular thickness also positively correlated with global SUVR (at v0: β = 0.23, p = 0.004; at v2: β = 0.26, p = 0.001). No retinal measurements were associated to conversion to MCI over 24 months. Conclusions: Subtle retinal thickness changes in the macular region are already present in SCD and correlate with Aβ uptake. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement no. 796706, and the Instituto de Salud Carlos III (ISCIII) grant PI19/00335 Acción Estratégica en Salud, integrated in the Spanish National R+D+I Plan and financed by ISCIII-Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER-Una manera de hacer Europa") awarded to M.M. Funds were also obtained from donations from “La nit de l’Alzheimer”, a charity dinner initiative that takes place yearly as part of the “Festival Castell de Peralada” (2016-2018). The neuro-ophthalmology exam devices were acquired with a grant EFSD/Lilly Mental Health and Diabetes 2013 Programme of the European Foundation for the Study of Diabetes (EFSD) awarded to the project “Retinal neurodegeneration in type 2 diabetes as biomarker of Alzheimer’s disease” under the leadership of C.H. Funds from Fundació ACE Institut Català de Neurociències Aplicades, Grifols, Life Molecular Imaging, Araclon Biotech, Alkahest, Laboratorio de análisis Echevarne and IrsiCaixa are supporting the FACEHBI study. These sponsors were not involved in the study design, data collection, analysis or interpretation. The sponsors have reviewed the manuscript and have given their approval.

Purpose: This study was conducted to evaluate and compare the effects of different graft materials used in alveolar ridge preservation on dimensional hard tissue changes of the alveolar ridge, assessed using cone-beam computed tomography (CBCT) scans. Methods: A systematic electronic search of MEDLINE and the Cochrane Central Register of Controlled Trials and a manual search were conducted from November 2019 until January 2020. Randomized controlled trials were included if they assessed at least 1 variable related to vertical or horizontal hard tissue changes measured using CBCT scans. After a qualitative analysis of the included studies, subgroups were formed according to the graft material used, and a quantitative analysis was performed for 5 outcome variables: changes in vertical alveolar bone height at 2 points (midbuccal and midpalatal/midlingual) and changes in horizontal (buccolingual) alveolar bone width at 3 different levels from the initial crest height (1, 3, and 5 mm). Results: The search resulted in 1,582 studies, and after an independent 3-stage screening, 16 studies were selected for qualitative analysis and 9 for quantitative analysis. The meta-analysis showed a significantly (P

Background: Examining the association between excess weight or physical fitness and intensity of physical activity (PA) during Physical Education (PE) classes or school recesses and in children could be of great interest and importance, especially for future intervention programs or public policies related to PA. The aim of this study was to explore the association between intensity of PA in PE classes or school recesses and excess weight or global physical fitness in a sample of Spanish schoolchildren. Methods: We performed a cross-sectional study in the Valle de Ricote (Region of Murcia, Spain). A final sample of 350 Spanish schoolchildren between 6 and 13 years of age was included from six different schools. Intensity of PA during PE classes and recesses was assessed by the Physical Activity Questionnaire for Older Children (PAQ-C). To assess physical fitness, the extended ALPHA fitness test battery was used. Body mass index (z-score) was calculated following the age- and sex-specific thresholds of the World Health Organization. Results: Both body mass index (z-score) and Global Fitness Score (z-score) were lower in schoolchildren engaging in high intensity of PA in both PE lessons and school (p < 0.05 for all). Lower odds of having excess weight were found in those who reported high intensity of PA in both PE classes and school recesses (OR = 0.54; CI 95%, 0.30–0.96). In these same participants, higher odds of being in the high Global Fitness Score tertile were found (OR = 1.96; CI 95%, 1.01–3.85). Conclusions: Our study showed that higher intensity of PA in PE classes and school recesses was associated with lower excess weight and higher global physical fitness.

Objective: to assess the degree of adherence to the Mediterranean diet and the practice of physical activity in university Health Sciences students in Castile-La Mancha. Methods: this was a cross-sectional, observational study by means of a dietary and physical activity survey. The sample consisted of 575 university students (77.7 % women). An initial data collection survey was developed using the Google Forms platform (https://www.google.com/forms/about/). Adherence to the Mediterranean diet was assessed with the Mediterranean Diet Adherence Screener (MEDAS) questionnaire and the modified Prevention with Mediterranean Diet (PREDIMED) questionnaire. The Rapid Assessment of Physical Activity Scale (RAPA) questionnaire was used to measure physical activity. Results: we found a 58.3 % adherence to Mediterranean diet among Health Sciences students, with 38.6 % of average adherence, and 5.0 % of poor adherence, with a low consumption of fruits with no gender differences, and a high consumption of red or processed meat and butter or cream with significant differences between women and men. There is also a high consumption of carbonated beverages (more frequent in women). Likewise, a high percentage of students (22.5 %) do practically no physical activity. As for physical exercise, it is always higher in men, with significant differences (p0.05). Conclusion: this study suggests that the sample of university Health Sciences students in Castile-La Mancha shows an acceptable adherence to the Mediterranean diet and insufficient levels of physical activity.Objetivo: valorar el grado de adherencia a la dieta mediterránea y la práctica de actividad física en estudiantes universitarios de Ciencias de la Salud de Castilla-La Mancha. Método: estudio observacional transversal mediante encuesta alimentaria y de actividad física. La muestra contó con 575 estudiantes universitarios (77,7 % de mujeres). Se desarrolló una encuesta de recogida de datos inicial mediante la plataforma Google Forms (https://www.google.com/forms/about/). La adherencia a la dieta mediterránea se valoró con el cuestionario Mediterranean Diet Adherence Screener (MEDAS) y el cuestionario PREvención con DIeta MEDiterránea (PREDIMED), modificado. Para medir la actividad física se utilizó el cuestionario Rapid Assessment of Physical Activity Scale (RAPA), que valora la actividad física desempeñada. Resultados: se encontró en los estudiantes de Ciencias de la Salud una adherencia a la dieta mediterránea del 58,3 %, siendo la adherencia media del 38,6 % y la mala adherencia del 5,0 %, observándose un bajo consumo de frutas sin diferencias de sexo, un alto consumo de carne roja o procesada y de mantequillas o natas, con diferencias significativas entre mujeres y hombres. También hay un consumo alto de bebidas carbonatadas (más frecuente en mujeres). Asimismo, un porcentaje alto de estudiantes (22,5 % del total) no hace prácticamente ninguna actividad física. En cuanto al ejercicio físico, siempre es mayor entre los hombres, con diferencias significativas (p0,05). Conclusión: este estudio sugiere que la muestra de estudiantes universitarios de Ciencias de la Salud de Castilla-La Mancha presenta una aceptable adherencia a la dieta mediterránea y unos niveles de actividad física insuficientes.

Purpose: The aim of this study was to explore the dietary patterns, adherence to Food-Based Dietary Guidelines, and the ultra-processed consumption during the COVID-19 lockdown among a Spanish young population aged 3–17 years.Methods: Parents/legal guardians of preschoolers, children, and adolescents aged 3–17 years were enrolled through social networks. The eating habits were assessed by a Food Propensity Questionnaire applied in the ENALIA (Encuesta Nacional de Alimentación en la población Infantil y Adolescente) Spanish survey, which aims to collect food intake information and other data about eating habits on children and adolescents (0–18 years old). Participants were dichotomized following the Food-Based Dietary Guidelines for the Spanish young population offered by the Spanish Society of Community Nutrition. The ultra-processed food score was determined following the principles established in the NOVA classification.Results: Data from 604 children and adolescents were included. An association between age group and the recommendations of snacks (p = 0.002), fruits (p = 0.010), and diaries (p < 0.001) was found. Adolescents showed a lower mean compliance with these guidelines than children (p = 0.004) and preschoolers (p < 0.001). Similarly, children reported lower Food-Based Dietary Guidelines than preschoolers (p = 0.015). Regarding ultra-processed consumption, it was also observed a higher intake in adolescents than in children (p = 0.037), as well as in preschoolers (p < 0.001).Conclusions: The associations that were found highlight the low proportion of the young population (especially adolescents) meeting the Food-Based Dietary Guidelines and the high consumption of ultra-processed foods during COVID-19 lockdown.

BackgroundTo facilitate population screening and clinical trials of disease-modifying therapies for Alzheimer’s disease, supportive biomarker information is necessary. This study was aimed to investigate the association of plasma amyloid-beta (Aβ) levels with the presence of pathological accumulation of Aβ in the brain measured by amyloid-PET. Both plasma Aβ42/40 ratio alone or combined with an FDG-PET-based biomarker of neurodegeneration were assessed as potential AD biomarkers.MethodsWe included 39 cognitively normal subjects and 20 patients with mild cognitive impairment from the AB255 Study who had undergone PiB-PET scans. Total Aβ40 and Aβ42 levels in plasma (TP42/40) were quantified using ABtest kits. Subjects were dichotomized as Aβ-PET positive or negative, and the ability of TP42/40 to detect Aβ-PET positivity was assessed by logistic regression and receiver operating characteristic analyses. Combination of plasma Aβ biomarkers and FDG-PET was further assessed as an improvement for brain amyloidosis detection and diagnosis classification.ResultsEighteen (30.5%) subjects were Aβ-PET positive. TP42/40 ratio alone identified Aβ-PET status with an area under the curve (AUC) of 0.881 (95% confidence interval [CI] = 0.779–0.982). Discriminating performance of TP42/40 to detect Aβ-PET-positive subjects yielded sensitivity and specificity values at Youden’s cutoff of 77.8% and 87.5%, respectively, with a positive predictive value of 0.732 and negative predictive value of 0.900. All these parameters improved after adjusting the model for significant covariates. Applying TP42/40 as the first screening tool in a sequential diagnostic work-up would reduce the number of Aβ-PET scans by 64%. Combination of both FDG-PET scores and plasma Aβ biomarkers was found to be the most accurate Aβ-PET predictor, with an AUC of 0.965 (95% CI = 0.913–0.100).ConclusionsPlasma TP42/40 ratio showed a relevant and significant potential as a screening tool to identify brain Aβ positivity in preclinical and prodromal stages of Alzheimer’s disease.

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.

Background Poly (lactic-co-glycolic acid) (PLGA) is widely used for the development of delivery systems for drugs and therapeutic biomolecules in tissue engineering applications. Particles of biphasic calcium phosphate can be covered by PLGA to change their manipulating characteristics. Purpose Aim of this study was to investigate the radiological and histomorphometric results of the use of PLGA-coated biphasic calcium phosphate granules in sinus floor elevation and to analyze the underlying molecular processes by immunohistochemical staining. Materials and methods A randomized clinical study was designed to include patients in need of sinus floor elevation. Patients were assigned to receive either PLGA-coated biphasic calcium phosphate particles (group I) or the equivalent but noncoated particles (group II). Cone beam computed tomography (CBCT) scans were performed before and 6 months after the procedure to assess the bone height gain. At the time of implant placement, bone core biopsies were obtained at the site of implant placement. Histological sections were subjected to histomorphometric and immunohistochemical evaluation of differentiation markers (Musashi-1 [MSI1]). Results No statistically significant differences were observed between groups for the radiologic parameters. No differences were observed histologically or histomorphometrically. However, PLGA-coated particles (group I) were more colonized by MSI1-positive osteoblast precursors (P = 0.0001, chi-squared test) and were penetrated by more CD34-positive vascular structures (P = 0.001, chi-squared test) than noncoated particles (group II). Conclusions PLGA-coated particles are associated with more MSI11-positive cells and more extensive microvascularization than noncoated particles.

Producción Científica, Stroke is one of the most common causes of death and disability. Reperfusion therapies are the only treatment available during the acute phase of stroke. Due to recent clinical trials, these therapies may increase their frequency of use by extending the time-window administration, which may lead to an increase in complications such as hemorrhagic transformation, with parenchymal hematoma (PH) being the more severe subtype, associated with higher mortality and disability rates. Our aim was to find genetic risk factors associated with PH, as that could provide molecular targets/pathways for their prevention/treatment and study its genetic correlations to find traits sharing genetic background. We performed a GWAS and meta-analysis, following standard quality controls and association analysis (fastGWAS), adjusting age, NIHSS, and principal components. FUMA was used to annotate, prioritize, visualize, and interpret the meta-analysis results. The total number of patients in the meta-analysis was 2034 (216 cases and 1818 controls). We found rs79770152 having a genome-wide significant association (beta 0.09, p-value 3.90 × 10−8) located in the RP11-362K2.2:RP11-767I20.1 gene and a suggestive variant (rs13297983: beta 0.07, p-value 6.10 × 10−8) located in PCSK5 associated with PH occurrence. The genetic correlation showed a shared genetic background of PH with Alzheimer’s disease and white matter hyperintensities. In addition, genes containing the ten most significant associations have been related to aggregated amyloid-β, tau protein, white matter microstructure, inflammation, and matrix metalloproteinases., Instituto de Salud Carlos III y Fondo Europeo de Desarrollo Regional (FEDER) - ( Projects PI 11/0176 and PI18/01338), Instituto de Salud Carlos III - (Project CM18/00198), Agencia de Gestión de Ayudas Universitarias y de Investigación (AGAUR) y Fondo Social Europeo - (Grant 2020FI_B1 00157), Instituto de Salud Carlos III y Fondo Europeo de Desarrollo Regional (FEDER) - (Project CD20/00043), Instituto de Salud Carlos III - (Projects FI19/00309, CP12/03298, CPII17/00027, CPII19/00020)

(1) Every day, people with functional diversity face different kinds of difficulties that pose a barrier to their social inclusion. These difficulties often go unnoticed by most citizens. Social networks are a powerful tool to sensitize the population. With this objective, different organizations such as associations, federations, foundations, and other institutions have promoted campaigns through the celebration of world days for different types of functional diversity. This research aims to monitor and analyze the impact of these social campaigns in Spain, including Asperger’s syndrome, rare diseases, Down syndrome, autism, hearing and visual impairment, cerebral palsy, dyslexia, ADHD, spina bifida, disability, and dyscalculia world days, between 2015 and 2020. (2) The impact of each campaign on the press, Google, and Twitter has been analyzed using: MyNews, Google Trends, and Trendinalia. (3) The results suggest a close relationship between the impact on the number of pieces of news generated in the press, the searches on Google, and the hashtags in high positions on Twitter. (4) The campaigns with the greatest levels of success are those whose diagnoses involve greater difficulties in adaptive behavior. These results can provide some practical implications for future campaigns.

Background Alzheimer disease (AD) is a progressive neurodegenerative disorder affecting the elderly with a prevalence of 7.1% in women and 3.3% in men. Sex-related patterns have been reported in prognosis, biomarker status, and risk factors. Despite this, the interaction of sex has received limited attention, with AD trials persistently recruiting lower numbers of women than the population distribution and a lack of information on the sex-disaggregated effects of anti-dementia therapies. This is the first study aiming to identify the role of sex in the selection for screening in AD clinical trials. Methods This cross-sectional study provides a comprehensive analysis of screening eligibility according to a set of pre-selection criteria currently applied at Fundació ACE memory clinic for a more efficient trial screening process. A cohort of 6667 women and 2926 men diagnosed with AD dementia (55%) or mild cognitive impairment (45%) was analyzed. We also assessed the frequencies of men and women effectively screened for trial enrolment over a period of 10 years. Additionally, data from AddNeuroMed study was used to explore trends in eligibility based on the education criteria. Results Women showed a significantly lower chance of being eligible for screening than men (OR = 1.26; p < 0.01). This imbalance was confirmed by a lower frequency of women screened for enrolment compared to the study population (63.0% vs. 69.5%). Education was revealed as the key criterion contributing to this unbalance, with men showing over twice the chance of being screened compared with women (OR = 2.25, p < 0.01). Education-based differences were greater in earlier born patients, but the gap narrowed and achieved balance with increasing year of birth. This observation was replicated using data from other European populations included in AddNeuroMed study. Comorbidity was the most limiting criterion with sex differences in frequencies and significant discrimination against the selection of men (OR = 0.86, p < 0.01). Conclusions The large number of low-educated elderly women with AD demands for a sex-focused approach in clinical research. New assessment tools insensitive to education level should be developed to enable a proportional representation of women. Although this gender education gap is mostly inexistent in developed countries, economic or cultural factors may lead to different scenarios in other regions. Overlooking the impact of sex may lead to a handicap in AD research with a direct adverse impact on women’s health.

Smoking is the leading cause of morbidity and mortality worldwide and is clearly involved as a cardiovascular risk factor. Smoking has different effects on the cardiovascular system, such as a decrease in nitric oxide, increased inflammatory response, increased adhesion of pro-atherogenic molecules, lipid disturbances, generation of oxidative stress and endothelial dysfunction as can be shown in different biomarkers modifications. Despite the aids currently available for smoking cessation, many smokers are unwilling or unable to achieve this. So alternative tools with potential harm reduction, such as non-combustion tobacco products, could be an option due to the better results they had shown on cardiovascular risk factors. This has led these devices to be taken into account as a risk-modifying tobacco product according to the FDA.

Background A low amount and extent of Aβ deposition at early stages of Alzheimer’s disease (AD) may limit the use of previously developed pathology-proven composite SUVR cutoffs. This study aims to characterize the population with earliest abnormal Aβ accumulation using 18F-florbetaben PET. Quantitative thresholds for the early (SUVRearly) and established (SUVRestab) Aβ deposition were developed, and the topography of early Aβ deposition was assessed. Subsequently, Aβ accumulation over time, progression from mild cognitive impairment (MCI) to AD dementia, and tau deposition were assessed in subjects with early and established Aβ deposition. Methods The study population consisted of 686 subjects (n = 287 (cognitively normal healthy controls), n = 166 (subjects with subjective cognitive decline (SCD)), n = 129 (subjects with MCI), and n = 101 (subjects with AD dementia)). Three categories in the Aβ-deposition continuum were defined based on the developed SUVR cutoffs: Aβ-negative subjects, subjects with early Aβ deposition (“gray zone”), and subjects with established Aβ pathology. Results SUVR using the whole cerebellum as the reference region and centiloid (CL) cutoffs for early and established amyloid pathology were 1.10 (13.5 CL) and 1.24 (35.7 CL), respectively. Cingulate cortices and precuneus, frontal, and inferior lateral temporal cortices were the regions showing the initial pathological tracer retention. Subjects in the “gray zone” or with established Aβ pathology accumulated more amyloid over time than Aβ-negative subjects. After a 4-year clinical follow-up, none of the Aβ-negative or the gray zone subjects progressed to AD dementia while 91% of the MCI subjects with established Aβ pathology progressed. Tau deposition was infrequent in those subjects without established Aβ pathology. Conclusions This study supports the utility of using two cutoffs for amyloid PET abnormality defining a “gray zone”: a lower cutoff of 13.5 CL indicating emerging Aβ pathology and a higher cutoff of 35.7 CL where amyloid burden levels correspond to established neuropathology findings. These cutoffs define a subset of subjects characterized by pre-AD dementia levels of amyloid burden that precede other biomarkers such as tau deposition or clinical symptoms and accelerated amyloid accumulation. The determination of different amyloid loads, particularly low amyloid levels, is useful in determining who will eventually progress to dementia. Quantitation of amyloid provides a sensitive measure in these low-load cases and may help to identify a group of subjects most likely to benefit from intervention. Trial registration Data used in this manuscript belong to clinical trials registered in ClinicalTrials.gov (NCT00928304, NCT00750282, NCT01138111, NCT02854033) and EudraCT (2014-000798-38).

Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER) Altres ajuts: Generalitat de Catalunya. Programa CERCA Altres ajuts: Instituto de Salud Carlos III (CIBERSAM i CIBERNED) Altres ajuts: Fundació "La Caixa" Altres ajuts: Grífols SA (GR@ACE project) Neuropsychiatric symptoms (NPS) have been recently addressed as risk factors of conversion to Alzheimer's disease (AD) and other dementia types in patients diagnosed with Mild Cognitive Impairment (MCI). Our aim was to determine profiles based on the prominent NPS in MCI patients and to explore the predictive value of these profiles on conversion to specific types of dementia. A total of 2137 MCI patients monitored in a memory clinic were included in the study. Four NPS profiles emerged (classes), which were defined by preeminent symptoms: Irritability, Apathy, Anxiety/Depression and Asymptomatic. Irritability and Apathy were predictors of conversion to dementia (HR = 1.43 and 1.56, respectively). Anxiety/depression class showed no risk effect of conversion when compared to Asymptomatic class. Irritability class appeared as the most discriminant neuropsychiatric condition to identify non-AD converters (i.e., frontotemporal dementia, vascular dementia, Parkinson's disease and dementia with Lewy Bodies). The findings revealed that consistent subgroups of MCI patients could be identified among comorbid basal NPS. The preeminent NPS showed to behave differentially on conversion to dementia, beyond AD. Therefore, NPS should be used as early diagnosis facilitators, and should also guide clinicians to detect patients with different illness trajectories in the progression of MCI.

Background: Studies have reported the association between cardiorespiratory fitness and higher adherence to the Mediterranean diet as well as lower recreational screen time. Similarly, higher screen time has been negatively linked to a lower adherence to the Mediterranean diet. However, the mediator effect of cardiorespiratory fitness on the influence of screen time on adherence to the Mediterranean diet is still unknown. The aim of this study was two-fold: first, to assess the combined association of recreational screen time and cardiorespiratory fitness with adherence to Mediterranean diet among Spanish schoolchildren, and second, to elucidate whether the association between recreational screen time and adherence to the Mediterranean diet is mediated by cardiorespiratory fitness. Methods: A descriptive and cross-sectional study was conducted. A total of 370 schoolchildren aged 6–13 years from six schools in the Region of Murcia (Spain) were included. Results: The mediation analysis showed that once screen time and cardiorespiratory fitness were included together in the model, cardiorespiratory fitness was positively linked to adherence to the Mediterranean diet (p = 0.020) and although screen time remained negatively related to adherence to the Mediterranean diet, this association was slightly attenuated (indirect effect = −0.027, 95% CI = (−0.080, −0.002)). Conclusions: This research supports that cardiorespiratory fitness may reduce the negative association between screen time and Mediterranean dietary patterns.

Background and purpose The role of copy number variation (CNV) variation in stroke susceptibility and outcome has yet to be explored. The Copy Number Variation and Stroke (CaNVAS) Risk and Outcome study addresses this knowledge gap. Methods Over 24,500 well-phenotyped IS cases, including IS subtypes, and over 43,500 controls have been identified, all with readily available genotyping on GWAS and exome arrays, with case measures of stroke outcome. To evaluate CNV-associated stroke risk and stroke outcome it is planned to: 1) perform Risk Discovery using several analytic approaches to identify CNVs that are associated with the risk of IS and its subtypes, across the age-, sex- and ethnicity-spectrums; 2) perform Risk Replication and Extension to determine whether the identified stroke-associated CNVs replicate in other ethnically diverse datasets and use biomarker data (e.g. methylation, proteomic, RNA, miRNA, etc.) to evaluate how the identified CNVs exert their effects on stroke risk, and lastly; 3) perform outcome-based Replication and Extension analyses of recent findings demonstrating an inverse relationship between CNV burden and stroke outcome at 3 months (mRS), and then determine the key CNV drivers responsible for these associations using existing biomarker data. Results The results of an initial CNV evaluation of 50 samples from each participating dataset are presented demonstrating that the existing GWAS and exome chip data are excellent for the planned CNV analyses. Further, some samples will require additional considerations for analysis, however such samples can readily be identified, as demonstrated by a sample demonstrating clonal mosaicism. Conclusion The CaNVAS study will cost-effectively leverage the numerous advantages of using existing case-control data sets, exploring the relationships between CNV and IS and its subtypes, and outcome at 3 months, in both men and women, in those of African and European-Caucasian descent, this, across the entire adult-age spectrum.

To date, very few studies have been focused on the impact of the convergence of neuropsychiatric symptoms (NPS) and APOE ε4 on the conversion to dementia in patients with Mild Cognitive Impairment patients (MCI), and none has been based in a clinical setting. The objective of the study is to determine the predictive value of additive and multiplicative interactions of NPS and APOE ε4 status on the prediction of incident dementia among MCI patients monitored in a Memory Clinic. 1512 patients (aged 60 and older) with prevalent MCI were followed for a mean of 2 years. Neuropsychiatric symptoms were assessed at baseline using the Neuropsychiatric Inventory Questionnaire. Cox proportional hazards models were calculated. Additive interactions for depression, apathy, anxiety, agitation, appetite, or irritability and a positive ε4 carrier status were obtained, significantly increasing the hazard ratios of incident dementia (HR range 1.3-2.03). Synergistic interactions between NPS and APOE ε4 are identified among MCI patients when predicting incident dementia. The combination of the behavioral status and the genetic trait could be considered a useful strategy to identify the most vulnerable MCI patients to dementia conversion in a Memory Clinic.

YouTube es uno de los sitios web más conocidos y de mayor acceso en todo el mundo, por lo que tiene un gran potencial pedagógico. No obstante, la calidad y la veracidad de algunos videos de YouTube son cuestionables. Las dudas sobre la confiabilidad del contenido fáctico es un factor controvertido que debe tenerse en cuenta, especialmente cuando se abordan cuestiones de salud pública. Por ello, el principal objetivo de este trabajo es analizar el contenido de los vídeos en español más vistos en YouTube relacionados con el trastorno del espectro autista (TEA). Para la realización de esta investigación se utilizaron los términos "autismo Y educación", "autismo Y intervención" y "autismo Y cura" (en español). El análisis de los resultados de estas búsquedas indicó que los videos incluidos en la categoría 'cura' son más cortos y menos valorados por los usuarios de Internet. obteniendo las calificaciones más bajas en la "Herramienta de Evaluación de Materiales Educativos para Pacientes" para materiales audiovisuales (PEMAT-A / V), además de presentar terapias que de hecho son más dañinas que los videos en otras categorías. En general, los videos que contienen recomendaciones de terapias que son dañinas son los que han recibido más vistas, junto con los videos que incluyen terapias alternativas no dañinas. Se discuten las implicaciones prácticas de estos hallazgos y recomendaciones para futuras investigaciones. junto con los videos que incluyen terapias alternativas no dañinas. Se discuten las implicaciones prácticas de estos hallazgos y recomendaciones para futuras investigaciones. junto con los videos que incluyen terapias alternativas no dañinas. Se discuten las implicaciones prácticas de estos hallazgos y recomendaciones para futuras investigaciones. YouTube is one of the most well-known and widely accessed websites worldwide, thus having a powerful pedagogical potential. Nonetheless, the quality and the veracity of some YouTube videos are questionable. Doubts regarding the trustworthiness of factual content is a controversial factor that needs to be taken into account, especially when addressing public health issues. For this reason, the main objective of this work is to analyze the content of the most viewed videos in Spanish on YouTube related to autism spectrum disorder (ASD). To carry out this research, the terms 'autism AND education', 'autism AND intervention', and 'autism AND cure' were used (in Spanish). The analysis of these searches results indicated that videos included in the 'cure' category are shorter, and less valued by internet users, obtaining the lowest ratings on the 'Patient Education Materials Assessment Tool' for audiovisual materials (PEMAT-A/V), in addition to present therapies that are in fact more harmful than videos in other categories. In general, videos containing recommendations for therapies that are harmful are the ones that have received most views, along with the videos that include alternative non-harmful therapies. Practical implications of these findings and recommendations for further research are discussed.

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.

Introducción: el objetivo fue analizar los resultados de una intervención motivacional con modificación de los hábitos alimentarios, los estilos de vida y los trastornos emocionales en niños obesos de 6 a 12 años y sus familias. Material y métodos: Estudio de intervención con evaluación pre- y posintervención del programa Familias en Movimiento. Se incluyeron 11 niños (10 niñas y 1 niño) de 6 a 12 años tratados con otros programas para la pérdida de peso sin éxito. Se evaluaron al inicio y al final los parámetros: Índice de Masa Corporal (IMC), los resultados de los cuestionarios: de Dieta Mediterránea y ansiedad en niños y el peso y la ansiedad de los adultos tras la intervención.Resultados: El IMC disminuyó de una mediana de 25,2 (Rango intercuartílico de 23,3–28,0) a 23,9 y (22,9–27,6) tras la intervención, cambio no estadísticamente significativo (p

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.

A textbook constitutes the hegemonic material of the educational institution. It acts as a mediator between the official curriculum and the educational practice. Given its potential influence in the classroom, this study analyzes the treatment of word problems included in the mathematics textbooks published by the publishing houses with the greatest diffusion in Spain at every primary education grade. Three variables were analyzed: their semantic structure, their degree of challenge, and their situational context. The results indicate that most of the problems included in textbooks are characterized by low complexity and variability regarding their semantic structure. They are also characterized by a limited degree of challenge and by being presented in highly standardized situational contexts. Likewise, it is found that there is no evolution in the treatment of these problems with respect to previous studies carried out in the Spanish context. Therefore, it is concluded that the mathematics textbooks currently used in schools are not effective tools to address the process of teaching-learning problem solving.

Introduction: home confinement due to the COVID-19 pandemic can influence the dietary profiles of the population, suddenly subjected to a stressful factor that implies important modifications in life habits. Among others, a restriction of mobility and a change in the way of carrying out work, going from being face-to-face to non-contact (teleworking). Objective: to know the usual dietary pattern prior to confinement, and to assess the evolution of adherence to the Mediterranean diet weekly until its conclusion. Methods: data were collected using a weekly anonymous online questionnaire that monitored adherence to the Mediterranean diet in real time in an initial sample of 490 adults from Spain. Adherence to the Mediterranean diet was assessed using the MEDAS (Mediterranean Diet Adherence Screener) and modified PREDIMED questionnaires. Results: confinement due to the COVID-19 pandemic influenced the eating habits of the participants, so that adherence to the Mediterranean diet increased at the end of the confinement period, which is of special interest, since it was based on a good initial adherence (MEDAS adherence: 10.03 ± 1.9 initial and 10.47 ± 2.1 final; p = 0.016; modified PREDIMED adherence: 9.26 ± 2.0 initial and 9.89 ± 2.1 final; p0.001), without observing clinically relevant changes in body composition as measured by body mass index (BMI) except in women (23.3 kg/m2 ± 2.9 initial and 23.4 kg/m2 ± 2.9 final; p0.001), with a slight increase in this parameter, but maintaining on average the healthy values recommended by the guidelines. Conclusions: in the studied population we observed an improvement in adherence to the Mediterranean diet without observing clinically relevant changes in BMI.Introducción: el confinamiento domiciliario debido a la pandemia de COVID-19 puede influir en los perfiles dietéticos de la población, sometida súbitamente a un factor estresante que implica importantes modificaciones en los hábitos de vida. Entre otros, la restricción de la movilidad y el cambio en la forma de realizar el trabajo, pasando de ser presencial a no presencial (teletrabajo). Objetivo: conocer el patrón dietético habitual previo al confinamiento y valorar la evolución de la adherencia a la dieta mediterránea semanalmente hasta la conclusión del mismo. Métodos: los datos se recopilaron mediante un cuestionario anónimo semanal en línea que monitorizó la adherencia a la dieta mediterránea en tiempo real en una muestra inicial de 490 adultos de España. La adherencia a la dieta mediterránea se valoró mediante los cuestionarios MEDAS (Mediterranean Diet Adherence Screener) y PREDIMED modificado. Resultados: el confinamiento debido a la pandemia de COVID-19 influyó en los hábitos alimenticios de los participantes, de modo que la adherencia a la dieta mediterránea aumentó al concluir el período de confinamiento, lo cual tiene especial interés, ya que se partía de una buena adherencia inicial (adherencia MEDAS: 10,03 ± 1,9 inicial y 10,47 ± 2,1 final; p = 0,016; adherencia PREDIMED modificado: 9,26 ± 2,0 inicial y 9,89 ± 2,1 final; p0,001), sin observarse cambios clínicamente relevantes en la composición corporal valorada por el índice de masa corporal (IMC) excepto en las mujeres (23,3 kg/m2 ± 2,9 inicial y 23,4 kg/m2 ± 2,9 final; p0,001), con un discreto aumento de dicho parámetro pero manteniendo en promedio los valores saludables aconsejados por las guías. Conclusiones: en la población estudiada observamos una mejora de la adherencia a la dieta mediterránea sin observar cambios clínicamente relevantes en el IMC.

To date, very few studies have been focused on the impact of the convergence of neuropsychiatric symptoms (NPS) and APOE ε4 on the conversion to dementia in patients with Mild Cognitive Impairment patients (MCI), and none has been based in a clinical setting. The objective of the study is to determine the predictive value of additive and multiplicative interactions of NPS and APOE ε4 status on the prediction of incident dementia among MCI patients monitored in a Memory Clinic. 1512 patients (aged 60 and older) with prevalent MCI were followed for a mean of 2 years. Neuropsychiatric symptoms were assessed at baseline using the Neuropsychiatric Inventory Questionnaire. Cox proportional hazards models were calculated. Additive interactions for depression, apathy, anxiety, agitation, appetite, or irritability and a positive ε4 carrier status were obtained, significantly increasing the hazard ratios of incident dementia (HR range 1.3–2.03). Synergistic interactions between NPS and APOE ε4 are identified among MCI patients when predicting incident dementia. The combination of the behavioral status and the genetic trait could be considered a useful strategy to identify the most vulnerable MCI patients to dementia conversion in a Memory Clinic.

Some studies have been conducted in order to assess the association between weight status (assessed by body mass index) and socio-demographic factors. Nevertheless, only a few of them have indicated these associations by other anthropometric parameters (e.g., skinfolds). The aim of this study was to determine, compare, and examine the influence of age, sex, type of the schooling, per capita income, area of residence, and immigrant status on obesity parameters in schoolchildren aged 6&ndash, 13 from the Region of Murcia. A cross-sectional study was carried out in six different Primary schools of the Region of Murcia (Spain). A total sample of 370 children (166 girls) aged 6&ndash, 13 (8.7 &plusmn, 1.8) were selected. In order to determine participants&rsquo, body composition, body mass index, waist circumference, waist-to-height ratio, and skinfold measurements were calculated. Higher associations of excess of weight (OR = 1.96, 95%CI = 1.19&ndash, 3.20) and abdominal obesity (OR = 3.12, 95CI% = 1.49&ndash, 6.94) were shown in the case of children from public schools. A greater association of high trunk fat mass was found in children from municipalities with high per capita income (OR = 3.20, 95%CI = 1.05&ndash, 9.77). Therefore, lower association of having an inadequate %BF was found in the participants aged 6&ndash, 9 (OR = 0.38, 95%CI = 0.24&ndash, 0.54), and immigrant students (OR = 2.63, 95%CI = 1.69&ndash, 4.10). Our study suggested that overweight/obesity among schoolchildren in the Region of Murcia is higher than the overall prevalence of Spain. The results of the adjusted analyses showed that age, type of schooling, per capita income, and immigrant status were associated with obesity parameters.

The asymmetric periflexural exanthema of childhood is an underdiagnosed entity of unknown etiology that affects, most commonly, girls around two years of age. Clinically, it affects only one side of the body and it eventually disappears without the need of any specific treatment. We report two cases of this entity. The first case is a 14-month-old female patient with an erythematosus papular eruption that initiates near the axilla and progresses, in a period of seven days, towards the ipsilateral upper limb and hemithorax, with no other alterations. The second case is a 24-month-old female with a pruriginous erythematosus papular exanthema that begins on the left lower extremity and extends throughout the left hemibody. Due to the characteristics of the exanthema and the age range of the patients, they were diagnosed with asymmetric periflexural exanthema. They both received symptomatic treatment with spontaneous resolution of the condition.

Psychotic symptoms, defined as the occurrence of delusions or hallucinations, are frequent in Alzheimer disease (AD with psychosis, AD+P). AD+P affects ∼50% of individuals with AD, identifies a subgroup with poor outcomes, and is associated with a greater degree of cognitive impairment and depressive symptoms, compared to subjects without psychosis (AD-P). Although the estimated heritability of AD+P is 61%, genetic sources of risk are unknown. We report a genome-wide meta-analysis of 12,317 AD subjects, 5,445 AD+P. Results showed common genetic variation accounted for a significant portion of heritability. Two loci, one in ENPP6 (rs9994623, O.R. (95%CI) 1.16 (1.10, 1.22), p=1.26×10−8) and one spanning the 3’-UTR of an alternatively spliced transcript of SUMF1 (rs201109606, O.R. 0.65 (0.56-0.76), p=3.24×10−8), had genome-wide significant associations with AD+P. Gene-based analysis identified a significant association with APOE, due to the APOE risk haplotype ε4. AD+P demonstrated negative genetic correlations with cognitive and educational attainment and positive genetic correlation with depressive symptoms. We previously observed a negative genetic correlation with schizophrenia; instead, we now found a stronger negative correlation with the related phenotype of bipolar disorder. Analysis of polygenic risk scores supported this genetic correlation and documented a positive genetic correlation with risk variation for AD, beyond the effect of ε4. We also document a small set of SNPs likely to affect risk for AD+P and AD or schizophrenia. These findings provide the first unbiased identification of the association of psychosis in AD with common genetic variation and provide insights into its genetic architecture.

Introducción: Analizar las diferentes variables del Índice de Masa Corporal (IMC) en relación con la evolución de la Insuficiencia cardíaca en una zona de salud.Material y métodos: Estudio descriptivo observacional y analítico de los 161 pacientes diagnosticados en la zona de salud entre enero de 2014 y diciembre de 2016. Se analizaron datos demográficos, clínicos, y analíticos. Se calculó el IMC a partir del peso y la talla en la primera visita a la consulta, mediante la fórmula: peso (kg) / cuadrado de la talla (m). Una vez obtenido se evaluó la relación entre el IMC y la evolución en 2 años. Se estudió a 4 subgrupos de pacientes, en función de su IMC, a partir de los criterios definidos por la Organización Mundial de la Salud (OMS) en 1999: bajo peso (IMC < 20,5), peso normal (IMC de 20,5 a < 25,5), sobrepeso (IMC de 25,5 a < 30) y obesidad (IMC ≥ 30).Resultados: 81 participantes eran obesos (50,8%), 33 hombres y 48 mujeres. La edad media de los obesos fue de 80,32 (9,23) años. Un 62,2% tenía diagnosticado algún tipo de cardiopatía, siendo: 29,2% cardiopatía isquémica; 46,6% arritmias cardiacas y 20,5% valvulopatías. El IMC, como variable continua, se asoció de forma significativa con la mortalidad (p < 0,001), la edad (0,002), la enfermedad isquémica (0,001), sexo (0,004), hipertensión (0,002), diabetes (0,003) y dislipemia (0,004). También se vio relación directamente proporcional del IMC con el uso de tratamientos con digoxina, diuréticos de asa y espironolactona. EL IMC también se asoció con el número de ingresos, mayor número de enfermedades crónicas concomitantes y mortalidad. Los pacientes con obesidad obtuvieron peores puntuaciones en el cuestionario de calidad de vida MLWHFQ.Conclusiones: El IMC mostró asociación con la mortalidad, la enfermedad isquémica, el sexo, la hipertensión, diabetes y dislipemia en pacientes con insuficiencia cardiaca.

Rationale: Ischemic stroke is among the leading causes of adult disability. Part of the variability in functional outcome after stroke has been attributed to genetic factors but no locus has been consistently associated with stroke outcome. Objective: Our aim was to identify genetic loci influencing the recovery process using accurate phenotyping to produce the largest GWAS (genome-wide association study) in ischemic stroke recovery to date. Methods and Results: A 12-cohort, 2-phase (discovery-replication and joint) meta-analysis of GWAS included anterior-territory and previously independent ischemic stroke cases. Functional outcome was recorded using 3-month modified Rankin Scale. Analyses were adjusted for confounders such as discharge National Institutes of Health Stroke Scale. A gene-based burden test was performed. The discovery phase (n=1225) was followed by open (n=2482) and stringent joint-analyses (n=1791). Those cohorts with modified Rankin Scale recorded at time points other than 3-month or incomplete data on previous functional status were excluded in the stringent analyses. Novel variants in PATJ (Pals1-associated tight junction) gene were associated with worse functional outcome at 3-month after stroke. The top variant was rs76221407 (G allele, β=0.40, P =1.70×10 −9 ). Conclusions: Our results identify a set of common variants in PATJ gene associated with 3-month functional outcome at genome-wide significance level. Future studies should examine the role of PATJ in stroke recovery and consider stringent phenotyping to enrich the information captured to unveil additional stroke outcome loci.

BackgroundThe Corona Virus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has become a serious infectious disease affecting human health worldwide and rapidly declared a pandemic by WHO. Early, several RT-qPCR were designed by using only the first SARS-CoV-2 genome sequence.ObjectivesA few days later, when additional SARS-CoV-2 genome were retrieved, the kit GPS™ CoVID-19 dtec-RT-qPCR Test was designed to provide a highly specific detection method and commercially available worldwide. The kit was validated following criteria recommended by the UNE/EN ISO 17025:2005 and ISO/IEC 15189:2012.MethodsThe present study approached the in silico specificity of the GPS™ CoVID-19 dtec-RT-qPCR Test and RT-qPCR designs currently published. The empirical validation parameters specificity (inclusivity/exclusivity), quantitative phase analysis (10-106 copies), reliability (repeatability/reproducibility) and sensitivity (detection/quantification limits) were evaluated for a minimum of 10-15 assays. Diagnostic validation was achieved by two independent reference laboratories, the Instituto de Salud Carlos III (ISCIII), (Madrid, Spain) and the Public Health England (PHE; Colindale, London, UK).ResultsThe GPS™ RT-qPCR primers and probe showed the highest number of mismatches with the closet related non-SARS-CoV-2 coronavirus, including some indels. The kits passed all parameters of validation with strict acceptance criteria. Results from reference laboratories 100% correlated with these obtained by suing reference methods and received an evaluation with 100% of diagnostic sensitivity and specificity.ConclusionsThe GPS™ CoVID-19 dtec-RT-qPCR Test, available with full analytical and diagnostic validation, represents a case of efficient transfer of technology being successfully used since the pandemic was declared. The analysis suggested the GPS™ CoVID-19 dtec-RT-qPCR Test is the more exclusive by far.

Background Computerized neuropsychological tests for early detection of Alzheimer’s disease (AD) have attracted increasing interest. Memory for faces and proper names is a complex task because its association is arbitrary. It implicates associative occipito-temporal cerebral regions, which are disrupted in AD. The short form of the Face-Name Associative Memory Exam (FNAME-12), developed to detect preclinical and prodromal AD, asks individuals to learn the names and occupations associated with 12 faces. The current work advances this field by using voice recognition and touchscreen response format. The purpose of this study is to create the first self-administered episodic memory test, FACEmemory®, by adapting the FNAME-12 for tablet use with voice recognition, touchscreen answers, and automatic scoring. The test was minimally supervised by a psychologist to avoid technological problems during execution and scored manually to assess the reliability of the automatic scoring. The aims of the present study were (1) to determine whether FACEmemory® is a sensitive tool for the detection of cognitive impairment, (2) to examine whether performances on FACEmemory® are correlated with those on the S-FNAME (paper-and-pencil version with 16 images), and (3) to determine whether performances on FACEmemory® are related to AD biomarkers in the cerebrospinal fluid (CSF) (Aβ42, p-tau, and Aβ42/p-tau ratio). Methods FACEmemory® was completed by 154 cognitively healthy (CH) individuals and 122 subjects with mild cognitive impairment, of whom 61 were non-amnestic (naMCI) and 61 amnestic (aMCI). A subsample of 65 individuals completed the S-FNAME, and 65 subjects received lumbar punctures. Results Performance on FACEmemory® was progressively worse from CH to the naMCI and aMCI groups. A cutoff of 31.5 in total FACEmemory® obtained 80.5% and 80.3% sensitivity and specificity values, respectively, for discriminating between CH and aMCI. Automatically corrected FACEmemory® scores were highly correlated with the manually corrected ones. FACEmemory® scores and AD CSF biomarker levels were significantly correlated as well, mainly in the aMCI group. Conclusions FACEmemory® may be a promising memory prescreening tool for detecting subtle memory deficits related to AD. Our findings suggest FACEmemory® performance provides a useful gradation of impairment from normal aging to aMCI, and it is related to CSF AD biomarkers.

The use of optical coherence tomography (OCT) has been suggested as a potential biomarker for Alzheimer’s Disease based on previously reported thinning of the retinal nerve fiber layer (RNFL) in Alzheimer’s disease’s (AD) and Mild Cognitive Impairment (MCI). However, other studies have not shown such results. 930 individuals (414 cognitively healthy individuals, 192 probable amnestic MCI and 324 probable AD) attending a memory clinic were consecutively included and underwent spectral domain OCT (Maestro, Topcon) examinations to assess differences in peripapillary RNFL thickness, using a design of high ecological validity. Adjustment by age, education, sex and OCT image quality was performed. We found a non-significant decrease in mean RNFL thickness as follows: control group: 100,20 ± 14,60 µm, MCI group: 98,54 ± 14,43 µm and AD group: 96,61 ± 15,27 µm. The multivariate adjusted analysis revealed no significant differences in mean overall (p = 0.352), temporal (p = 0,119), nasal (p = 0,151), superior (p = 0,435) or inferior (p = 0,825) quadrants between AD, MCI and control groups. These results do not support the usefulness of peripapillary RNFL analysis as a marker of cognitive impairment or in discriminating between cognitive groups. The analysis of other OCT measurements in other retinal areas and layers as biomarkers for AD should be tested further.

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.