Influence of physical fitness and weight status on autonomic cardiac modulation in children.

BACKGROUND: This study provides reference values for cardiovascular modulation at rest, during maximal exercise test and recovery after exercise in Caucasian children according to weight status and cardiorespiratory fitness (CRF) level. Additionally, the current study analyzed several correlations between autonomic cardiovascular modulation, cardiorespiratory performance and cardiometabolic risk. The principal goal of this study was to analyze cardiac function at rest, during maximum exercise, and during the recovery phase in children grouped according to weight status and CRF level. METHODS: One hundred and fifty-two healthy children (78 girls) 10-16 years of age were divided into three groups: soccer and basketball players (SBG), endurance group (EG), and sedentary people with overweight and obesity (OOG). A cardiac RR interval monitor recorded the cardiac data and specific software analyzed the cardiac autonomic response through heart rate (HR) and HR variability. The study analyzed resting HR (RHR), HRpeak, and HR recovery (HRR). RESULTS: OOG showed significant poorer performance in the Léger test lower V̇O2 max and higher values of blood pressure at rest and post-exercise than sport groups. The EG presented the best results in CRF and cardiometabolic risk (CMR) in relation to SBG and OOG. The OOG showed higher percentage of HR values, compatible with an unhealthy cardiovascular autonomic modulation than the sport groups, with significant differences in bradycardia, HR reserve, and HRR 5 min. CONCLUSIONS: Aerobic performance, vagal activity, blood pressure, chronotropic competence, and HRR have significant associations with CMR parameters. IMPACT: The current study presents reference values of autonomic cardiac function in Caucasian children according to weight status and cardiorespiratory fitness level. Aerobic performance, vagal activity, blood pressure, chronotropic competence, and heart rate during the recovery period after exercise have significant associations with cardiometabolic risk parameters. Children with overweight and obesity show signs of autonomic dysfunction reflected as low cardiac vagal activity and poor chronotropic competence.

International physical therapists consensus on clinical descriptors for diagnosing rotator cuff related shoulder pain: A Delphi study.

BACKGROUND: There is a lack of standardized criteria for diagnosing rotator cuff related shoulder pain (RCRSP). OBJECTIVE: To identify the most relevant clinical descriptors for diagnosing RCRSP. METHODS: A Delphi study was conducted through use of an international physical therapists expert panel. A 3-round Delphi survey involving an international panel of physical therapists experts with extensive clinical, teaching, and research experience was conducted. A search query was performed in Web of Science, along with a manual search, to find the experts. The first round was composed of items obtained from a previous pilot Delphi study along with new items proposed by the experts. Participants were asked to rate items across six clinical domains using a five-point Likert scale. An Aiken's Validity Index ≥ 0.7 was considered indicative of group consensus. RESULTS: Fifteen experts participated in the Delphi survey. After the three rounds, consensus was reached on 18 clinical descriptors: 10 items were included in the "subjective examination" domain, 1 item was included in the "patient-reported outcome measures" domain, 3 items in the "diagnostic examination" domain, 2 items in the "physical examination" domain", and 2 items in the "functional tests" domain. No items reached consensus within the "special tests" domain. The reproduction of symptoms in relation to the application of load, the performance of overhead activities, and the need of active and resisted movement assessment were some of the results with greatest consensus. CONCLUSION: In this Delphi study, a total of 18 clinical descriptors across six clinical domains were agreed upon for diagnosing RCRSP.

Endoluminal vacuum therapy in the management of an esophago-pleural fistula as a complication of Boerhaave syndrome in a patient with eosinophilic esophagitis.

BACKGROUND: Boerhaave syndrome is an uncommon condition that represents about 15% of all esophageal perforation. A subset of these patients has eosinophilic esophagitis, a chronic inflammatory disease of the esophagus, that carries a risk of perforation of about 2%. Esophageal perforations can rarely result in the development of an esophago-pleural fistula. Treatment of esophago-pleural fistula represent a challenge due to lack of high quality evidence and scarce reported experience. Endoluminal vacuum-assisted therapy could have a role in the management by using the same principle applied in external wounds which provide wound drainage and tissue granulation. CASE PRESENTATION: We report a unique case of a 24-year-old man with eosinophilic esophagitis complicated with an esophageal rupture who developed an esophago-pleural fistula and was successfully managed with a non-surgical approach using endoluminal vacuum-assisted therapy. To our knowledge this could be the first experience reported in a patient with eosinophilic esophagitis. CONCLUSION: Endoluminal vacuum-assisted therapy might be an effective and novel strategy in patients with eosinophilic esophagitis and esophago-pleural fistula as a consequence of Boerhaave syndrome. Appropriately designed studies are required.

Cardiorespiratory Fitness as Mediator of the Relationship of Recreational Screen Time on Mediterranean Diet Score in Schoolchildren.

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.

Caso clínico: Síndrome de distrés respiratorio del adulto en paciente COVID-19 en ventilación mecánica con aspergilosis pulmonar invasiva / Clinical case: Adult respiratory distress syndrome in COVID-19 patient on mechanical ventilation with invasive pulmonary aspergillosis

The bibliography on the management of the COVID-19 patient in intensive care units is increasing. Research and publication of results help to optimize the management of these patients and the consequent improvement of results. We present the case of a patient admitted to intensive care due to adult respiratory distress syndrome secondary to COVID-19 pneumonia and personal history of liver transplantation the previous year and pulmonary hypertension under treatment. During admission, the patient requires pronation, neuromuscular blockers, and nitric oxide. Invasive aspergillosis is diagnosed and requires percutaneous tracheostomy.

La bibliografía sobre el manejo del paciente COVID-19 en las unidades de cuidados intensivos va en aumento. La investigación y publicación de resultados ayudan a la optimización del manejo de estos pacientes y la mejora consecuente de resultados. Presentamos el caso de un paciente que ingresa en cuidados intensivos (UCI) por síndrome de distrés respiratorio del adulto secundario a neumonía COVID-19 y antecedentes de trasplante hepático el año previo e hipertensión pulmonar en tratamiento. Durante el ingreso, el paciente precisa pronación, relajación neuromuscular y óxido nítrico. Se diagnostica de aspergilosis invasiva y precisa traqueostomía percutánea.

Evolución de los pacientes con enfermedad hepática crítica / Prognosis of patients with critical hepatic disease

INTRODUCTION: The acute liver failure on chronic (ACLF), is an entity, whose recognition is increasing. The ACLF and CLIF OF indexes have been recently presented with the objective of predicting mortality in this kind of patients. MATERIAL AND METHODS: All patients admitted to the Ramón y Cajal University Hospital diagnosed of acute liver failure on chronic during 2016 and 2017 were collected. We collect the scores: SOFA, CLIF, APACHE II, SAPS II and ACLF score in patients admitted to the ICU by comparing them with each other and define which stages have worse prognosis. RESULTS: A total of 46 patients were collected. The study presents an intra ICU mortality of 31% (15/46) and a six-month mortality of 59.6% (28/46). Patients classified as death, present ACLF values ​​at admission (49.5 vs 60 p = 0.001), and at three days (46.66 vs 59.4 p = 0.001) higher than survivors. In the analysis of the ROC curve, the area under the curve in relation to six-month mortality is higher in the ACLF index (0.8) compared to the MELD (0.69) SOFA (0.66) SAPS II (0.69) or APACHE II (0.65). Patients with ACLF indexes above 65 had an intra UCI mortality of 54%, however, mortality at 6 months is 90%. Patients with ACLF values ​​greater than 65 present mean values ​​of lactic acid, leukocytes, INR or bilirubin higher than those under 65 in a statistically significant manner. CONCLUSIONS: The data presented in this study suggest that the ACLF index works as an adequate predictor of intra-ICU mortality and at 6 months.

INTRODUCCIÓN: El fallo hepático agudo sobre crónico es una entidad cuyo reconocimiento va en aumento. Los índices ACLF y CLIF OF, han sido presentados recientemente con el objetivo de predecir la mortalidad en este tipo de enfermos. MATERIAL Y MÉTODOS: Se recogen todos los pacientes ingresados en una unidad de cuidados intensivos (UCI) de un hospital terciario universitario, diagnosticados de fallo hepático agudo sobre crónico durante 2016 y 2017. Recogemos los índices SOFA, CLIF, APACHE II, SAPS II Y ACLF en pacientes ingresados en UCI comparándolos entre sí. Definimos que estadios presentan peor pronóstico. RESULTADOS: Se analizan un total de 46 pacientes. El estudio presenta una mortalidad intra-UCI del 31% (15/46) y una mortalidad a los seis meses de 59,6% (28/46). Los pacientes clasificados como éxitus presentan valores ACLF al ingreso (49,5 vs 60 p = 0,001), a los tres días (46,66 vs 59,4 p = 0,001) superiores a los supervivientes. En el análisis de la curva COR, el área bajo la curva en relación a la mortalidad a los seis meses, es superior en el índice ACLF (0,8) en comparación con el MELD (0,69) SOFA (0,66) SAPS II (0,69) o APACHE II (0,65). Los pacientes con índices ACLF superiores a 65 presentaban una mortalidad intra-UCI del 54% sin embargo, la mortalidad a los 6 meses es del 90%. Los pacientes con valores ACLF superiores a 65 presentan a su vez valores medios de láctico, leucocitos, INR o bilirrubina mayores de forma estadísticamente significativa. CONCLUSIONES: Los datos presentados en este estudio sugieren que el índice ACLF funciona como un adecuado predictor de mortalidad intra-UCI y a los 6 meses.

Meeting the Physical Activity Recommendations and Its Relationship with Obesity-Related Parameters, Physical Fitness, Screen Time, and Mediterranean Diet in Schoolchildren.

The up-to-date scientific evidence suggests that adequate levels of physical activity provide essential health benefits for children and adolescents and help to maintain a healthy body weight. In this sense, children and adolescents should at least accumulate 60 min of moderate-to-vigorous physical activity in a daily basis to achieve these benefits and be considered active. Likewise, some lifestyle-related elements may interact with each other in an antagonistic or synergistic way to modify physical activity status. Thus, a better understanding of how meeting physical activity recommendations influences these potentially modifiable lifestyle factors (obesity-related parameters, physical fitness, dietary habits, or sedentary behaviour) would significantly reinforce the importance of complying with those recommendations from a health perspective and support the establishment of strategies for the promotion of diminishing the lower trends of physical activity among the young population. This study seeks to verify the association of meeting physical activity international recommendations with obesity-related parameters, global physical fitness, screen time, and Mediterranean diet in Spanish schoolchildren aged 8 to 13. A cross-sectional study was performed including 250 schoolchildren (41.2% girls) aged 8-13 (9.7 ± 1.2) from six primary schools in the Region of Murcia (Spain). Results: A higher proportion of children who complying with physical activity recommendations shows normal weight, no abdominal obesity, and low adiposity in comparison to other with different obesity-related parameters categories. Higher values in global physical fitness score were found in those who meet the physical activity international recommendations in both sexes. These higher values were also shown for adherence to the Mediterranean diet in both sexes; not being so in the case of screen time. Notwithstanding, none of these mean differences were statistically significant. To conclude, the proportion of schoolchildren meeting the physical activity recommendations in our study is low. A higher proportion of children who meet with physical activity recommendations present normal weight, no abdominal obesity and low adiposity in comparison to other obesity-related parameters categories in both sexes. Likewise, those considered as active children seem to have higher global physical fitness score and adherence to the Mediterranean diet than children who do not meet the recommendations.

Meeting international screen-time guidelines is associated with healthy dietary patterns in Spanish schoolchildren / El cumplimiento de las recomendaciones internacionales de tiempo de pantalla se asocia a patrones de alimentación saludable en los escolares españoles

OBJECTIVE: the aim of this research was to explore the relationship between dietary pattern habits and compliance with screen-time guidelines in Spanish schoolchildren. MATERIAL AND METHODS: a cross-sectional and associative study was performed in a total of 370 schoolchildren (44.9 % girls) aged 6-13 (8.7 ± 1.8) years. RESULTS: for boys, those who did not meet these guidelines presented lower chances of eating vegetables regularly (OR = 0.50; 95 % CI = 0.28-0.89) or more than once a day (OR = 0.43; 95 % CI = 0.22-0.85). In girls, it was observed that those who did not meet the guidelines presented a lower probability of eating one piece of fruit (OR = 0.43; 95 % CI = 0.19-0.99) as well as a second piece (OR = 0.22; 95 % CI = 0.22-0.81), vegetables more than once a day (OR = 0.39; 95 % CI = 0.19-0.80), fish (at least 2-3 times/week) (OR = 0.40; 95 % CI = 0.20-0.78) and nuts (at least 2 or 3 times per week) (OR = 0.46; 95 % = 0.24-0.87). CONCLUSION: some healthy eating patterns, such as the consumption of fruits and vegetables, appeared to be more prevalent in those children who met the international screen-time guidelines

OBJETIVO: el objetivo de esta investigación fue explorar la relación entre los hábitos de alimentación y el cumplimiento de las recomendaciones de tiempo de pantalla en escolares españoles. MATERIAL Y MÉTODOS: se realizó un estudio transversal y asociativo con un total de 370 escolares (44,9 % niñas) de 6 a 13 años (8,7 ± 1,8). RESULTADOS: en los niños, aquellos que no cumplían con las recomendaciones presentaron menos probabilidades de comer verduras regularmente (OR = 0,50; IC 95 % = 0,28-0,89) y de ingerirlas más de una vez al día (OR = 0,43; IC 95 % = 0,22-0,85). En las niñas se observó que las que no cumplían las recomendaciones presentaban una menor probabilidad de comer una pieza de fruta (OR = 0,43; IC 95 % = 0,19-0,99) así como una segunda pieza (OR = 0,22; IC 95 % = 0,22-0,81), verduras más de una vez al día (OR = 0,39; IC 95 % = 0,19-0,80), pescado (al menos 2-3 veces por semana) (OR = 0,40; IC 95 % = 0,20-0,78) y frutos secos (al menos 2 o 3 veces por semana) (OR = 0,46; IC 95 % = 0,24-0,87). CONCLUSIÓN: algunos patrones de alimentación saludable, como el consumo de frutas y verduras, parecen ser más prevalentes en los niños que cumplen con las recomendaciones internacionales de tiempo de pantalla

Exclusión laboral en los jóvenes de España y México, 2005 a 2017 / Labor exclusion in youth people from Spain and Mexico, 2005 to 2017

Resumen La flexibilidad laboral y la disminución de la participación del Estado han tenido efectos negativos en el bienestar de la población, y más en los jóvenes, porque mantienen empleos inestables e inseguros, con bajos salarios y sin prestaciones sociales. El objetivo de este trabajo fue analizar las variables que determinan el proceso de exclusión laboral de los jóvenes en España y México en el periodo de 2005 a 2017, para comparar su situación. Se construyó un índice, que se denomina índice de exclusión laboral, de ambos países. La metodología utilizada fue el análisis factorial por componentes principales con series de tiempo. De acuerdo a los resultados, se observó que los jóvenes están en riesgo de exclusión laboral en ambos países. En España mantienen trabajos a tiempo parcial involuntarios, mientras que en México presentan condiciones de informalidad laboral aún más severas. En ambos países, para no excluir del mercado laboral a los jóvenes, se les ha incluido en trabajos donde no cuentan con protección social ni certidumbre en el empleo.

Abstract Labor flexibility and the reduction of State participation have had negative effects on the well-being of the population, and more on youth people, because they maintain unstable and insecure jobs, with low salaries and no social benefits. The objective of this work was to analyze the variables that determine the process of labor exclusion of youth people in the countries of Spain and Mexico between 2005 and 2017, in order to compare the situation in both countries. For this purpose, the Labor Exclusion Index was developed. The methodology used was the Principal Component Factor Analysis with time series. According to the results, it was observed that youth people are at risk of labor exclusion in both countries. In Spain, youth people maintain involuntary part-time jobs, while in Mexico, they have even more severe informal labor conditions. In both countries, youth people have been included in jobs where they do not have social security or job certainty in order to avoid excluding them from the labor market.

Joy in Movement: Traditional Sporting Games and Emotional Experience in Elementary Physical Education.

Through games a motivating learning climate is provided, generating mainly positive emotions among the students by the very nature of the game. However, while the early stages are the most important for emotional well-being development, research about scientific knowledge of emotional physical education in children is still scarce. The aims of this study were to analyze the intensity of emotions (positive or negative) produced when players took part in games of different social structure, with or without competition (winner or loser), with or without sport experience and to examine the explanations given by the participants for these emotional experiences. Participants (N = 152) were recruited from two Spanish elementary school. We applied Student's t-test and one-factor ANOVA. Students' subjective comments were classified through content analysis in macro-categories and we used the Chi-square Automatic Interaction Detector (CHAID, implemented in SPSSTM Answer Tree® 13.0). The application of a mixed-methods approach identified statistically significant differences in four variables: (a) the type of emotion, (b) motor domain, (c) type of outcome (winning, losing, and non-competitive), and (d) sport experience. The intensity of positive emotions was higher (M = 3.71, SD = 0.893) than negative emotions (M = 1.18, SD = 0.253, p < 0.001). Furthermore, negative emotions were felt with different intensities (F 3 = 3.82, p = 0.011, ES = 0.071), depending on the motor action domain. Comments referring to negative emotions were more frequent in individual games. Winning was associated significantly (p < 0.05) with the highest intensity ratings of positive emotions, whereas losing produced the highest values for negative emotions. The intensity ratings for positive or negative emotions not were different between non-competitive games and competitive games. The sport experience relativizes the mean of emotional intensity, both positive and negative. The present study brings the value of considering games as a key role to promote a physical education addressed to the education of social-emotional well-being in schoolchildren, as the basis of academic training. Furthermore, the results could benefit teachers as well as coaches have scientific input to organize teaching content, generating the desired motor behaviors together with positive experiences.

Sociodemographic Correlates of Obesity among Spanish Schoolchildren: A Cross-Sectional Study.

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 6-13 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 6-13 (8.7 ± 1.8) were selected. In order to determine participants' 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 = 1.19-3.20) and abdominal obesity (OR = 3.12; 95CI% = 1.49-6.94) 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 = 1.05-9.77). Therefore, lower association of having an inadequate %BF was found in the participants aged 6-9 (OR = 0.38; 95%CI = 0.24-0.54), and immigrant students (OR = 2.63; 95%CI = 1.69-4.10). 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.

Meeting international screen-time guidelines is associated with healthy dietary patterns in Spanish schoolchildren.

INTRODUCTION: Objective: the aim of this research was to explore the relationship between dietary pattern habits and compliance with screen-time guidelines in Spanish schoolchildren. Material and methods: a cross-sectional and associative study was performed in a total of 370 schoolchildren (44.9 % girls) aged 6-13 (8.7 ± 1.8) years. Results: for boys, those who did not meet these guidelines presented lower chances of eating vegetables regularly (OR = 0.50; 95 % CI = 0.28-0.89) or more than once a day (OR = 0.43; 95 % CI = 0.22-0.85). In girls, it was observed that those who did not meet the guidelines presented a lower probability of eating one piece of fruit (OR = 0.43; 95 % CI = 0.19-0.99) as well as a second piece (OR = 0.22; 95 % CI = 0.22-0.81), vegetables more than once a day (OR = 0.39; 95 % CI = 0.19-0.80), fish (at least 2-3 times/week) (OR = 0.40; 95 % CI = 0.20-0.78) and nuts (at least 2 or 3 times per week) (OR = 0.46; 95 % = 0.24-0.87). Conclusion: some healthy eating patterns, such as the consumption of fruits and vegetables, appeared to be more prevalent in those children who met the international screen-time guidelines.

INTRODUCCIÓN: Objetivo: el objetivo de esta investigación fue explorar la relación entre los hábitos de alimentación y el cumplimiento de las recomendaciones de tiempo de pantalla en escolares españoles. Material y métodos: se realizó un estudio transversal y asociativo con un total de 370 escolares (44,9 % niñas) de 6 a 13 años (8,7 ± 1,8). Resultados: en los niños, aquellos que no cumplían con las recomendaciones presentaron menos probabilidades de comer verduras regularmente (OR = 0,50; IC 95 % = 0,28-0,89) y de ingerirlas más de una vez al día (OR = 0,43; IC 95 % = 0,22-0,85). En las niñas se observó que las que no cumplían las recomendaciones presentaban una menor probabilidad de comer una pieza de fruta (OR = 0,43; IC 95 % = 0,19-0,99) así como una segunda pieza (OR = 0,22; IC 95 % = 0,22-0,81), verduras más de una vez al día (OR = 0,39; IC 95 % = 0,19-0,80), pescado (al menos 2-3 veces por semana) (OR = 0,40; IC 95 % = 0,20-0,78) y frutos secos (al menos 2 o 3 veces por semana) (OR = 0,46; IC 95 % = 0,24-0,87). Conclusión: algunos patrones de alimentación saludable, como el consumo de frutas y verduras, parecen ser más prevalentes en los niños que cumplen con las recomendaciones internacionales de tiempo de pantalla.

Clustering Patterns of Physical Fitness, Physical Activity, Sedentary, and Dietary Behavior among School Children.

Background: Some healthy lifestyle behaviors may have a greater impact on childhood obesity in combination, compared to the independent effects of those behaviors in an isolated manner. The present study aimed to identify the different healthy lifestyle patterns of children according to their physical fitness, physical activity (PA) patterns, screen time, and adherence to the Mediterranean Diet, as well as to examine the association between anthropometric indicators and the membership to a certain cluster. Methods: A final sample of 353 Spanish school children (45.9% females) from the Region of Murcia (Spain) was included in this study (aged 6-13). First, we conducted a hierarchical cluster analysis using Ward's method; based on squared Euclidean distances. Second, we used the k-means cluster analysis to get the final cluster solution. Results: Three different clusters were established: Cluster 1 [high cardiorespiratory fitness (CRF), PA, and Mediterranean Diet], Cluster 2 (low CRF, PA, and Mediterranean Diet + high muscular strength), and Cluster 3 (low physical fitness and PA). Cluster 3 had negative values in all the health-related variables analyzed. Regarding the anthropometric parameters analyzed (BMI, tri-ponderal mass index, waist-to-height ratio, and body fat percentage), Cluster 3 presented the highest values in all anthropometric parameters than the other two clusters (p < 0.001), while Cluster 1 showed the lowest values. Conclusions: The study has identified three clusters respect to health-related variables with the higher prevalence in the cluster established as the unhealthiest lifestyle. Also, cluster classification is associated to obesity indicators such as BMI, tri-ponderal mass index, waist-to-height ratio, and body fat percentage.