Methods, strategies, and incentives to increase response to mental health surveys among adolescents: a systematic review.

BACKGROUND: This systematic review aimed to identify effective methods to increase adolescents' response to surveys about mental health and substance use, to improve the quality of survey information. METHODS: We followed a protocol and searched for studies that compared different survey delivery modes to adolescents. Eligible studies reported response rates, mental health score variation per survey mode and participant variations in mental health scores. We searched CENTRAL, PsycINFO, MEDLINE and Scopus in May 2022, and conducted citation searches in June 2022. Two reviewers independently undertook study selection, data extraction, and risk of bias assessments. Following the assessment of heterogeneity, some studies were pooled using meta-analysis. RESULTS: Fifteen studies were identified, reporting six comparisons related to survey methods and strategies. Results indicate that response rates do not differ between survey modes (e.g., web versus paper-and-pencil) delivered in classroom settings. However, web surveys may yield higher response rates outside classroom settings. The largest effects on response rates were achieved using unconditional monetary incentives and obtaining passive parental consent. Survey mode influenced mental health scores in certain comparisons. CONCLUSIONS: Despite the mixed quality of the studies, the low volume for some comparisons and the limit to studies in high income countries, several effective methods and strategies to improve adolescents' response rates to mental health surveys were identified.

Prehabilitation programs for individuals with cancer: a systematic review of randomized-controlled trials.

BACKGROUND: Prehabilitation programs focusing on exercise training as the main component are known as a promising alternative for improving patients' outcomes before cancer surgery. This systematic review determined the benefits and harms of prehabilitation programs compared with usual care for individuals with cancer. METHODS: We searched CENTRAL, MEDLINE, and EMBASE from inception to June 2022, and hand searched clinical trial registries. We included randomized-controlled trials (RCTs) in adults, survivors of any type of cancer, that compared prehabilitation programs that had exercise training as the major component with usual care or other active interventions. Outcome measures were health-related quality of life (HRQL), muscular strength, postoperative complications, average length of stay (ALOS), handgrip strength, and physical activity levels. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias and the certainty of the evidence. RESULTS: Twenty-five RCTs (2682 participants) published between 2010 and 2022 met our inclusion criteria. Colorectal and lung cancers were the most common diagnoses. The studies had methodological concerns regarding outcome measurement, selective reporting, and attrition. Five prehabilitation programs were compared to usual care (rehabilitation): combined training, aerobic training, respiratory muscle training plus aerobic training, respiratory muscle training plus resistance training, and pelvic floor training. The studies provided no clear evidence of an effect between groups. We assessed the overall certainty of the evidence as very low, downgraded due to serious study limitations and imprecision. CONCLUSION: Prehabilitation programs focusing on exercise training may have an effect on adults with cancer, but the evidence is very uncertain. We have very little confidence in the results and the true effect is likely to be substantially different from these. Further research is needed before we can draw a more certain conclusion. SYSTEMATIC REVIEW REGISTRATION: CRD42019125658.

Pulmonary rehabilitation for acute exacerbations of COPD: A systematic review.

INTRODUCTION AND OBJECTIVES: This systematic review summarized the evidence on the effects (benefits and harms) of pulmonary rehabilitation for individuals with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). MATERIAL AND METHODS: We included randomized controlled trials comparing pulmonary rehabilitation to either active interventions or usual care regardless of setting. In March 2022, we searched MEDLINE, Scopus, CENTRAL, CINAHL and Web of Sciences, and trial registries. Record screening, data extraction and risk of bias assessment were undertaken by two reviewers. We assessed the certainty of the evidence using the GRADE approach. RESULTS: This systematic review included 18 studies (n = 1465), involving a combination of mixed settings (8 studies), inpatient settings (8 studies), and outpatient settings (2 studies). The studies were at high risk of performance, detection, and reporting biases. Compared to usual care, pulmonary rehabilitation probably improves AECOPD-related hospital readmissions (relative risk 0.56, 95% CI 0.36 to 0.86; moderate certainty evidence) and cardiovascular submaximal capacity (standardized mean difference 0.73, 95% CI 0.48 to 0.99; moderate certainty evidence). Low certainty evidence suggests that pulmonary rehabilitation may be beneficial on re-exacerbations, dyspnoea, and impact of disease. The evidence regarding the effects of pulmonary rehabilitation on health-related quality of life and mortality is very uncertain (very low certainty evidence). CONCLUSION: Our results indicate that pulmonary rehabilitation may be an effective treatment option for individuals with AECOPD, irrespective of setting. Our certainty in this evidence base was limited due to small studies, heterogeneous rehabilitation programs, numerous methodological weaknesses, and a poor reporting of findings that were inconsistent with each other. Trialists should adhere to the latest reporting standards to strengthen this body of evidence. REGISTRATION: The study protocol was registered in Open Science Framework (https://osf.io/amgbz/).

Using evidence to decision frameworks led to guidelines of better quality and more credible and transparent recommendations.

BACKGROUND AND OBJECTIVES: To determine whether the use of Evidence to Decision (EtD) frameworks is associated to higher quality of both guidelines and individual recommendations. METHODS: We identified guidelines recently published by international organizations that have methodological guidance documents for their development. Pairs of researchers independently extracted information on the use of these frameworks, appraised the quality of the guidelines using the Appraisal of Guidelines, Research and Evaluation II Instrument (AGREE-II), and assessed the clinical credibility and implementability of the recommendations with the Appraisal of Guidelines for REsearch & Evaluation Recommendations Excellence (AGREE-REX) tool. We conducted both descriptive and inferential analyses. RESULTS: We included 66 guidelines from 17 different countries, published in the last 5 years. Thirty guidelines (45%) used an EtD framework to formulate their recommendations. Compared to those that did not use a framework, those using an EtD framework scored higher in all domains of both AGREE-II and AGREE-REX (P < 0.05). Quality scores did not differ between the use of the The Grading of Recommendations Assessment, Development and Evaluation-EtD framework (17 guidelines) or another EtD framework (13 guidelines) (P > 0.05). CONCLUSION: The use of EtD frameworks is associated with guidelines of better quality, and more credible and transparent recommendations. Endorsement of EtD frameworks by guideline developing organizations will likely increase the quality of their guidelines.

Evidence to decision frameworks enabled structured and explicit development of healthcare recommendations.

OBJECTIVE: The aim of this study is to identify and describe the processes suggested for the formulation of healthcare recommendations in healthcare guidelines available in guidance documents. METHODS: We searched international databases in May 2020 to retrieve guidance documents published by organizations dedicated to guideline development. Pairs of researchers independently selected and extracted data about the characteristics of the guidance document, including explicit or implicit recommendation-related criteria and processes considered, as well as the use of evidence to decision (EtD) frameworks. RESULTS: We included 68 guidance documents. Most organizations reported a system for grading the strength of recommendations (88%), half of them being the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Two out of three guidance documents (66%) proposed the use of a framework to guide the EtD process. The GRADE-EtD framework was the most often reported framework (19 organizations, 42%), whereas 20 organizations (44%) proposed their own multicriteria frameworks. Using any EtD framework was related with a more comprehensive set of recommendation-related criteria compared to no framework, especially for criteria like values, equity, and acceptability. CONCLUSION: Although limited, the use of EtD frameworks was associated with the inclusion of relevant recommendation criteria. Among the EtD structured frameworks, the GRADE-EtD framework offers the most comprehensive perspective for evidence-informed decision-making processes.

Patient-important outcomes reported in randomized controlled trials of pharmacologic treatments for COVID-19: a protocol of a META-epidemiological study.

BACKGROUND: The coronavirus disease 19 (covid-19) pandemic has underscored the need to expedite clinical research, which may lead investigators to shift away from measuring patient-important outcomes (PIO), limiting research applicability. We aim to investigate if randomized controlled trials (RCTs) of covid-19 pharmacological therapies include PIOs. METHODS: We will perform a meta-epidemiological study of RCTs that included people at risk for, or with suspected, probable, or confirmed covid-19, examining any pharmacological treatment or blood product aimed at prophylaxis or treatment. We will obtain data from all RCTs identified in a living network metanalysis (NMA). The main data sources are the living WHO covid-19 database up to 1 March 2021 and six additional Chinese databases up to 20 February 2021. Two reviewers independently will review each citation, full-text article, and abstract data. To categorize the outcomes according to their importance to patients, we will adapt a previously defined hierarchy: a) mortality, b) quality of life/ functional status/symptoms, c) morbidity, and d) surrogate outcomes. Outcomes within the category a) and b) will be considered critically important to patients, and outcomes within the category c) will be regarded as important. We will use descriptive statistics to assess the proportion of studies that report each category of outcomes. We will perform univariable and multivariable analysis to explore associations between trial characteristics and the likelihood of reporting PIOs. DISCUSSION: The findings from this meta-epidemiological study will help health care professionals and researchers understand if the current covid-19 trials are effectively assessing and reporting the outcomes that are important to patients. If a deficiency in capturing PIOs is identified, this information may help inform the development of future RCTs in covid-19. SYSTEMATIC REVIEW REGISTRATIONS: Open Science Framework registration: osf.io/6xgjz .

Vitamin D recommendations in clinical guidelines: A systematic review, quality evaluation and analysis of potential predictors.

BACKGROUND: Vitamin D has been widely promoted for bone health through supplementation and fortification of the general adult population. However, there is growing evidence that does not support these strategies. Our aim is to review the quality and recommendations on vitamin D nutritional and clinical practice guidelines and to explore predictive factors for their direction and strength. METHODS: We searched three databases and two guideline repositories from 2010 onwards. We performed a descriptive analysis, a quality appraisal using AGREE II scores (Appraisal of Guidelines Research and Evaluation) and a bivariate analysis evaluating the association between direction and strength of recommendations, AGREE II domains' scores and pre-specified characteristics. RESULTS: We included 34 guidelines, 44.1% recommended, 26.5% suggested and 29.4% did not recommend vitamin D supplementation. Guidelines that scored higher for "editorial independence" and "overall quality score" were less likely to recommend or suggest vitamin D supplementation (median 68.8 vs 35.4; P = .001 and 58.3 vs 37.5; P = .02). Guidance produced by government organisations and those that reported source of funding were associated with higher AGREE II scores. Unclear role of source of funding was associated with recommending or suggesting vitamin D supplementation (P = .034). Editorial independence was an independent predictor for recommending or suggesting vitamin D supplementation (OR 1.09; CI95% 1.02 to 1.16; P = .006). CONCLUSIONS: Policymakers, clinicians and patients should be aware that lower quality guidelines and those reporting conflicts of interest are more likely to promote vitamin D supplementation. Guideline organisations should improve the quality of their recommendations' development and the management of conflicts of interest. Users and editors should be aware of these findings when using and appraising guidelines.

An algorithm provided as initial guidance for reporting registry records and published protocols in systematic reviews.

OBJECTIVE: We aim to synthesize the available guidance with existing practices by Cochrane reviewers to generate an algorithm as a starting point in assisting reviewers reporting of registry records and published protocols (TRRs/PPs) use in systematic reviews of interventions. STUDY DESIGN: We used existing guidance from major review bodies, assessed the current reporting of TRRs/PPs use in a sample of Cochrane reviews, and engaged in critical analysis. Independent reviewers identified and extracted textual excerpts reporting the use of trial registry records and published protocols and codes following a systematic review framework. Based on these elements, and our initial research, we created an algorithm/graphical aid to visualize initial direction. RESULTS: We included 166 Cochrane systematic reviews published between August 2015 and 2016 from 48 review groups. Review authors' terminology (e.g., ongoing, terminated) varied between and within reviews. Reporting practices were diverse and inconsistent. CONCLUSIONS: This is a timely investigation in an era where evidence synthesis informs health and health care decisions. Our proposed algorithm provides initial direction to systematize the reporting of TRR/PP use. We hope that the algorithm generates further discussion to enhance the transparency of TRR/PP reporting and methodological research into the complexities of using protocols in systematic reviews of interventions.

Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis.

BACKGROUND: This study aimed at examining the impact of providing healthcare during health emergencies caused by viral epidemic outbreaks on healthcare workers' (HCWs) mental health; to identify factors associated with worse impact, and; to assess the available evidence base regarding interventions to reduce such impact. METHOD: Rapid systematic review. We searched MEDLINE, Embase, and PsycINFO (inception to August 2020). We pooled data using random-effects meta-analyses to estimate the prevalence of specific mental health problems, and used GRADE to ascertain the certainty of evidence. RESULTS: We included 117 studies. The pooled prevalence was higher for acute stress disorder (40% (95%CI 39 to 41%)), followed by anxiety (30%, (30 to 31%)), burnout (28% (26 to 31%)), depression (24% (24 to 25%)), and post-traumatic stress disorder (13% (13 to 14%)). We identified factors associated with the likelihood of developing those problems, including sociodemographic (younger age and female gender), social (lack of social support, stigmatization), and occupational (working in a high-risk environment, specific occupational roles, and lower levels of specialised training and job experience) factors. Four studies reported interventions for frontline HCW: two educational interventions increased confidence in pandemic self-efficacy and in interpersonal problems solving (very low certainty), whereas one multifaceted intervention improved anxiety, depression, and sleep quality (very low certainty). LIMITATIONS: We only searched three databases, and the initial screening was undertaken by a single reviewer. CONCLUSION: Given the very limited evidence regarding the impact of interventions to tackle mental health problems in HCWs, the risk factors identified represent important targets for future interventions.

Prehabilitation programs for cancer patients: a systematic review of randomized controlled trials (protocol).

BACKGROUND: Around twenty million new cases and ten million of deaths were attributed to cancer in 2018. Physical exercise, as main component of prehabilitation programs, has been associated with clinical improvements in aerobic capacity, muscular strength, gait speed, and fewer postoperative complications. This systematic review aims to determine the benefits and harms of prehabilitation programs, mainly composed of physical exercise, compared with standard care for cancer patients. METHODS/DESIGN: A librarian will systematically search for randomized controlled trials in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), and EMBASE. Two independent reviewers will independently screen the retrieved references, appraise the methodological quality of the included studies, and extract data. If possible, we will pool the data. We will evaluate the completeness of reporting of prehabilitation programs by using the CERT checklist, and the GRADE approach will be used to evaluate the quality of the evidence. DISCUSSION: This systematic review will determine the benefits and harms of prehabilitation programs for cancer patients. We will provide a complete appraisal of the quality of the evidence, our confidence in the results, and completeness of reporting of the exercise interventions evaluated in the prehabilitation programs. Findings from this review will assist health care providers, patients, decision-makers, and international organizations to make informed decisions in this field. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019125658.

The Effect of Exercise Training on Mediators of Inflammation in Breast Cancer Survivors: A Systematic Review with Meta-analysis.

Several sources of evidence indicate that exercise during and after breast cancer could positively modulate the tumor microenvironment. This meta-analysis aimed to determine the effects of exercise training on mediators of inflammation in breast cancer survivors. We searched for randomized controlled trials published from January 1990 to March 2014. An inverse variance method of meta-analysis was performed using a random effects model in the presence of statistical heterogeneity. Eight high-quality trials (n = 478) were included. Exercise improved the serum concentrations of IL6 [weighted mean difference (WMD) = -0.55 pg/mL; 95% confidence interval (CI), -1.02 to -0.09], TNFα (WMD = -0.64 pg/mL; 95% CI, -1.21 to -0.06), IL8 (MD = -0.49 pg/mL; 95% CI, -0.89 to -0.09), and IL2 (WMD = 1.03 pg/mL; 95% CI, 0.40 to 1.67). No significant differences were found in the serum concentrations of C-reactive protein (WMD = -0.15; 95% CI, -0.56 to 0.25) or IL10 (WMD = 0.41; 95% CI, -0.18 to 1.02). Exercise training positively modulates chronic low-grade inflammation in women with breast cancer, which may impact upon carcinogenic mechanisms and the tumor microenvironment. These findings align with the other positive effects of exercise for breast cancer survivors, reinforcing the appropriateness of exercise prescription in this population. Cancer Epidemiol Biomarkers Prev; 25(7); 1009-17. ©2016 AACR.

A cross-sectional study of Colombian University students' self-perceived lifestyle.

BACKGROUND: The Fantastic Lifestyle Questionnaire was designed for enabling staff working in health sciences and physical activity (PA) areas to measure lifestyles (LS) in the general population. The aim of this study was to assess the lifestyle in a sample of university students. METHOD: This was a cross-sectional, descriptive, observational study involving 5,921 subjects' aged 18- to 30-years-old (3,471 females) from three Colombian cities. Was applied "Fantastic" instrument (that consists of 25 closed items on the lifestyle), translated to Spanish in versions of three and five answers. RESULTS: Having a "good LS" was perceived by 57.4% of the females and 58.5% of the males; 14.0% of the females rating their LS as being "excellent" and males 19.3% (p < 0.001); 20.3% of the females and 36.6% of the males stated that they spent more than 20 min/day on PA (involving four or more times per week). Negative correlations between FANTASTIC score and weight (r = -0.113; p < 0.01), body mass index (BMI) (r = -0.152; p < 0.01) and waist circumference (r = -0.178, p < 0.01) were observed regarding females, whilst the correlation concerning males was (r = -0.143, p < 0.05) between Fantastic score and weight, (r = -0.167 for BMI, p < 0.01) and (r = -0.175, p < 0.01 for diastolic blood pressure). In spite of the students being evaluated referring to themselves as having a healthy LS (i.e. giving a self-perceived view of their LS), stated behaviour involving a health risk was observed in the domains concerning nutrition, PA and smoking. CONCLUSION: Specific diffusion, education and intervention action is thus suggested for motivating the adoption of healthy LS.

Ferritin levels in pregnant Colombian women / Niveles de ferritina en mujeres gestantes de Colombia

Objective: Ferritin deficiency is associated with many adverse health outcomes and is highly prevalent worldwide. The present study assesses the prevalence and socio-demographic factors associated with ferritin deficiency in a representative sample of pregnant women in Colombia. Methods: We used data from the cross-sectional, nationally representative survey National Nutritional Survey (ENSIN, 2010). A total of 1,386, (13-49 years old) pregnant women were enrolled. Serum ferritin a concentration was determined by chemiluminescence and sociodemographic date (age, urbanicity geographic region, ethnicity and socioeconomic level-SISBEN), was assessed by computer-assisted personal interview technology. Multivariate analyses using unordered binomial logistic regression models were conducted in the main analysis. Results: The overall prevalence of ferritin deficiency (serum <12μg/L) was 37.2% (95% CI 35.0% to 39.2%). The multivariate logistic regression no shows associated with a probability of serum ferritin deficiencies. Conclusion: A significant prevalence of ferritin deficiency was found in our study population without an association with the studied sociodemographic factors (AU)

Objetivo: La deficiencia ferritina se asocia con resultados adversos para la salud y es altamente prevalente en todo el mundo. El presente estudio evaluó la prevalencia y los factores sociodemográficos asociados con la deficiencia de ferritina en una muestra representativa de mujeres embarazadas de Colombia. Métodos: Estudio descriptivo transversal, secundario de la información obtenida en la Encuesta Nacional de la Situación Nutricional 2010 (ENSIN 2010) en 1.386 mujeres gestantes entre los 13 y 49 años de edad. Los niveles plasmáticos de ferritina se determinaron por quimioluminiscencia, y los factores sociodemográficos evaluados (edad, etnia, puntaje de SISBEN, región y área geográfica) se recogieron por encuesta estructurada. Se establecieron asociaciones mediante la construcción de modelos de regresión binomial y factores asociados. Resultados: Se encontró una prevalencia global de deficiencia de ferritina (<12μg/L) de 37.2% (IC95% 35.0 a 39.2%). En los modelos de regresión binomial no se encontraron factores sociodemográficos asociados a la deficiencia sérica de ferritina. Conclusiones: A pesar de la importante prevalencia de déficit en los niveles séricos de ferritina en las mujeres gestantes evaluadas, no se observaron factores sociodemográficos asociados a esta deficiencia (AU)

Iniciativas escolares y deportivas lideradas desde la Fédération Internationale de Football Association (FIFA): revisión sistemática.

Introducción: Los programas iniciados por la Fédération Internationale de Football Association (FIFA) consisten en la difusión de mensajes relacionados con el cuidado de la salud y como estrategia de prevención de lesiones deportivas entre los niños y jóvenes. El objetivo de esta revisión sistemática fue resumir los resultados de la implementación de los programas "FIFA 11 para la salud" y "FIFA 11+". Métodos: Se realizó una búsqueda sistemática en las bases de datos electrónicos de MEDLINE, EMBASE y Scopus, identificando los estudios que evaluaran la implementación de los programas "FIFA 11 para la salud" y "FIFA 11+", durante los últimos 10 años (1 enero 2003 a 1 diciembre 2013). Resultados: Incluimos 17 estudios. Dos estudios evaluaron la implementación del programa "FIFA 11 para la salud" y encontraron un aumento significativo en el conocimiento de los mensajes de promoción de la salud; 15 estudios evaluaron los efectos del programa "FIFA 11+", reportando una reducción en el riesgo de lesiones deportivas y mejorías en el rendimiento deportivo. Discusión: Los programas "FIFA 11 para la salud" y "FIFA 11+" han demostrado resultados positivos para la salud, en el ámbito escolar y deportivo. Conclusiones: Dichos programas del FIFA representan una oportunidad para crear hábitos protectores y fomentar modos de vida saludables en niños y jóvenes.

Supervised exercise reduces cancer-related fatigue: a systematic review.

QUESTION: Does supervised physical activity reduce cancer-related fatigue? DESIGN: Systematic review with meta-analysis of randomised trials. PARTICIPANTS: People diagnosed with any type of cancer, without restriction to a particular stage of diagnosis or treatment. INTERVENTION: Supervised physical activity interventions (eg, aerobic, resistance and stretching exercise), defined as any planned or structured body movement causing an increase in energy expenditure, designed to maintain or enhance health-related outcomes, and performed with systematic frequency, intensity and duration. OUTCOME MEASURES: The primary outcome measure was fatigue. Secondary outcomes were physical and functional wellbeing assessed using the Functional Assessment of Cancer Therapy Fatigue Scale, European Organisation for Research and Treatment of Cancer Quality of Life QUESTIONnaire, Piper Fatigue Scale, Schwartz Cancer Fatigue Scale and the Multidimensional Fatigue Inventory. Methodological quality, including risk of bias of the studies, was evaluated using the PEDro Scale. RESULTS: Eleven studies involving 1530 participants were included in the review. The assessment of quality showed a mean score of 6.5 (SD 1.1), indicating a low overall risk of bias. The pooled effect on fatigue, calculated as a standardised mean difference (SMD) using a random-effects model, was -1.69 (95% CI -2.99 to -0.39). Beneficial reductions in fatigue were also found with combined aerobic and resistance training with supervision (SMD=-0.41, 95% CI -0.70 to -0.13) and with combined aerobic, resistance and stretching training with supervision (SMD=-0.67, 95% CI -1.17 to -0.17). CONCLUSION: Supervised physical activity interventions reduce cancer-related fatigue. These findings suggest that combined aerobic and resistance exercise regimens with or without stretching should be included as part of rehabilitation programs for people who have been diagnosed with cancer. REGISTRATION: PROSPERO CRD42013005803.

Prevalencia de deficiencia subclínica de vitamina A y factores sociodemográficos asociados en niños de 12-59 meses de edad en Colombia / Prevalence and demographic factors associated with vitamin A deficiency in Colombian children aged 12-59 months

OBJETIVO: Examinar los factores sociodemográficos asociados a la deficiencia subclínica de vitamina A en una muestra representativa de niños colombianos. MATERIALES Y MÉTODOS: Estudio descriptivo transversal, secundario de la información obtenida en la Encuesta Nacional de la Situación Nutricional 2010 (ENSIN 2010) en 4.394 niños entre 12-59 meses. Los niveles plasmáticos de vitamina A se determinaron por cromatografía líquida de alta resolución (HPLC), y los factores sociodemográficos (sexo, edad, grupo étnico, puntaje de SISBEN, región y área geográfica) se recogieron por encuesta estructurada. Se establecieron prevalencias y relaciones mediante la construcción de modelos de regresión y factores asociados. RESULTADOS: Se encontró un rango de niveles de vitamina A de 7,5-93,7μg/dL (media = 26,2μg/dL; IC95% 25,9-26,5μg/dL). El 24,3% de los evaluados presentaron niveles de vitamina A inferiores a 20 μg/dL (deficiencia subclínica). Los niños pertenecientes a la etnia afrodescendiente, los residentes en la zona de Orinoquia y Amazonia, y grupo etario de 12-23 meses de edad, presentaron las mayores deficiencias subclínicas de vitamina A (29,5, 31,1 y 27,6%) respectivamente. Los modelos de regresión muestran que estar entre 12-23 meses de edad (OR 1,32; IC95% 1,011,73), pertenecer al SISBEN nivel 1 (OR 1,66; IC95% 1,18-2,34), residir en la zona de Orinoquia y Amazonia (OR 2,38; IC95% 1,62-3,51) y pertenecer al grupo étnico afrodescendiente (OR 1,35; IC95% 1,05-1,74) se asociaron como factores de presentar deficiencia subclínica de vitamina A. CONCLUSIONES: La población estudiada presenta una alta prevalencia de deficiencia subclínica de vitamina A, por lo que se recomienda intervenciones integrales donde estén involucrados el componente nutricional y educativo

INTRODUCTION: Communication failures may result in inadequate treatment and patient harm, and are among the most common causes of sentinel events. Checklists are part of cycles to improve quality of the care process, promote communication between professionals involved in the different stages, help detect failures and risks, and increase patient safety. The lack of checklists at each stage was identified as a factor contributing to communication failures. OBJECTIVE: To design checklists at different stages of the thyroidectomy care process to improve the communication between the professionals involved. METHOD: Multidisciplinary working team consisting of specialists in otolaryngology, anesthesiology, and endocrinology. The process of thyroidectomy was divided into three stages (preoperative -A-, operative -B- and postoperative -C-). Potential safety incidents and failures at each stage and their contributing factors (causes) were identified by literature review and brainstorming. Checklists for each checkpoint were designed by consensus of the working group. RESULTS: The items correspond to factors contributing to the occurrence of incidents in the perioperative stage of thyroidectomy related to patients, technological equipment, environment, management, and organization. Lists of items should be checked by the appropriate specialist in each stage. CONCLUSIONS: Checklists in thyroid surgery are tools that allow for testing at different checkpoints data related to factors contributing to the occurrence of failures at each stage of the care process

[Muscular fitness and cardiometabolic risk factors among Colombian young adults]. / Fitness muscular y riesgo cardio-metabólico en adultos jóvenes colombianos.

OBJECTIVE: To determine the influence of muscular fitness (MF) on cardiometabolic risk factors in young adult. METHODS: A total of 172 men (age 19.7±2.4 years; weight 65.5±10.7 kg; BMI 22.6±2.8 kg•m(-1)) were invited to participate in the study. They had no indication of cardiometabolic problems, as evaluated by clinical interview. MF was measured by isometric handgrip (dynamometer). The handgrip strength was divided by body mass was used in further analysis. Lower and higher MF values are represented by the first and fourth quartiles, respectively. A lipid-metabolic cardiovascular risk index was derived from the levels of triglycerides, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and glucose. Adiposity index were assessed by measuring, waist circumference (WC), body adiposity index (BAI), body mass index (BMI) and fat mass (%). RESULTS: After adjustment for age, BMI and WC, inverse association was observed between fat mass, WC, cholesterol, HDL-c, LDL-c and MF (p<0.05). In addition, subjects with low handgrip strength/kg body mass(Q1), shower high levels of fat mass, WC, cholesterol, HDL-c and LDL-c (p<0.05 linear). Lasted, a linear relationship was also observed between the MF/kg and the lipid-metabolic index (p<0.05). CONCLUSIONS: In Colombian young adult poorer hand-grip strength/kg body mass were associated with worse metabolic risk factors and adiposity index. Increasing muscle strength could be an appropriate strategy to achieve favorable changes in metabolic risk profile.

Objetivo: Determinar la relación entre el fitness muscular (FM) con marcadores de riesgo cardio-metabólico en adultos jóvenes de Colombia. Métodos: Un total de 172 hombres (edad 19,7±2,4 años; peso 65,5±10,7 kg; IMC 22,6±2,8 kg•m-1) sin enfermedad cardiovascular previa fueron invitados a participar en el estudio. El FM se determinó mediante el test de dinamometría prensil y los resultados fueron divididos en cuartiles según los valores de FM y FM/peso corporal. Se calculó el índice lipídico-metabólico según las concentraciones de triglicéridos, c-LDL, c-HDL y glucosa. La circunferencia de cintura (CC), porcentaje de grasa, índice de adiposidad corporal (IAC) e índice de masa corporal (IMC) fueron usados como indicadores de adiposidad. Resultados: Después de ajustar por edad, IMC y CC, se observaron relaciones inversas entre el porcentaje de grasa, la CC, los niveles colesterol, HDL-c y LDL-c, con los valores de FM y FM/peso corporal (p.

Fitness muscular y riesgo cardio-metabólico en adultos jóvenes colombianos / Muscular fitness and cardiometabolic risk factors among colombian young adults

Objetivo: Determinar la relación entre el fitness muscular(FM) con marcadores de riesgo cardio-metabólico en adultos jóvenes de Colombia. Métodos: Un total de 172 hombres (edad 19,7 ± 2,4 años; peso 65,5 ± 10,7 kg; IMC 22,6 ± 2,8 kg•m-1) sin enfermedad cardiovascular previa fueron invitados a participaren el estudio. El FM se determinó mediante el test de dinamometría prensil y los resultados fueron divididos en cuartiles según los valores de FM y FM/peso corporal. Se calculó el índice lipídico-metabólico según las concentraciones de triglicéridos, c-LDL, c-HDL y glucosa. La circunferencia de cintura (CC), porcentaje de grasa, índice de adiposidad corporal (IAC) e índice de masa corporal(IMC) fueron usados como indicadores de adiposidad. Resultados: Después de ajustar por edad, IMC y CC, se observaron relaciones inversas entre el porcentaje de grasa, la CC, los niveles colesterol, HDL-c y LDL-c, con los valores de FM y FM/peso corporal (p<0,05). Los sujetos del primer cuartil (menor valor de FM/peso corporal),mostraron un incremento en la masa grasa, CC y niveles de colesterol total, HDL-c y LDL-c (p<0,05 lineal).El índice lipídico-metabólico se relacionó inversamente con el FM/peso corporal (p<0,05).Conclusiones: Los sujetos con un menor grado de FM/peso corporal presentan un incremento en el riesgo lipídico-metabólico y en los indicadores de adiposidad. La preservación del Fitness Muscular podría ser una estrategia adecuada para lograr un perfil cardio-metabólico más saludable (AU)

Objective: To determine the influence of muscular fitness(MF) on cardiometabolic risk factors in young adult. Methods: A total of 172 men (age 19.7±2.4 years; weight65.5±10.7 kg; BMI 22.6±2.8 kg•m-1) were invited to participate in the study. They had no indication of cardiometabolic problems, as evaluated by clinical interview. MF was measured by isometric handgrip (dynamometer).The handgrip strength was divided by body mass was used in further analysis. Lower and higher MF values are represented by the first and fourth quartiles, respectively. A lipid-metabolic cardiovascular risk index was derived from the levels of triglycerides, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and glucose. Adiposity index were assessed by measuring, waist circumference (WC), body adiposity index (BAI), body mass index (BMI) and fatmass (%).Results: After adjustment for age, BMI and WC, inverse association was observed between fat mass, WC, cholesterol, HDL-c, LDL-c and MF (p<0.05) . In addition, subjects with low handgrip strength/kg body mass(Q1), shower high levels of fat mass, WC, cholesterol, HDL-c and LDL-c (p<0.05 linear). Lasted, a linear relationship was also observed between the MF/kg and the lipid-metabolic index (p<0.05).Conclusions: In Colombian young adult poorer handgrip strength/kg body mass were associated with worse metabolic risk factors and adiposity index. Increasing muscle strength could be an appropriate strategy to achieve favorable changes in metabolic risk profile (AU)

[Supervised physical activity interventions in the management of cancer-related fatigue: a systematic review]. / Intervenciones con actividad física supervisada en el manejo de la fatiga relacionada con el cáncer: una revisión sistemática.

BACKGROUND: Cancer-related fatigue is the most common and distressing symptom among cancer survivors; physical activity has been proposed as a safe and effective intervention to control it. OBJECTIVE: This study aimed to determine the effectiveness of supervised physical activity interventions for the management of cancer-related fatigue (CRF). METHODOLOGY: Systematic review of randomized controlled trials. Adults (>20 years old) diagnosed with any type of cancer regardless of treatment or diagnosis stage. Physical activity interventions (aerobic and resistance training) supervised by health professionals. CRF was the primary outcome measure, whilst secondary outcomes included depression, the comparison between supervised and non-supervised interventions, physical and functional wellbeing. Risk of bias and methodological quality were evaluated using the PEDro scale. RESULTS: Fourteen studies (n=14) were included (n=1638) with low risk of bias (PEDro mean score=6,5 ± 1). Supervised physical activity significantly improved CRF; similar results were found for resistance training. Further, supervised physical activity was more effective than conventional care for improving CRF among breast cancer. CONCLUSION: Supervised physical activity interventions provide an overall reduction on CRF. These findings suggest that guidelines of aerobic and resistance training should be included in oncologic rehabilitation programs.

Introducción: La fatiga relacionada con el cáncer es el síntoma más prevalente y devastador para pacientes con cáncer; la actividad física ha sido propuesta como una intervención segura y eficaz en su control. Objetivo: Determinar la efectividad de las intervenciones de actividad física supervisada en el manejo de la fatiga relacionada con el cáncer (FRC). Metodología: Revisión sistemática de ensayos clínicos controlados aleatorizados. Pacientes adultos diagnosticados con cualquier tipo de cáncer, sin restricción a una etapa particular de diagnóstico o tratamiento. Intervenciones de actividad física (entrenamiento aeróbico y de resistencia) supervisadas por profesionales de la salud. FRC fue analizada como medida de resultado primario, mientras que las medidas secundarias fueron la depresión, la comparación entre intervenciones supervisadas y no supervisadas, el bienestar físico y funcional. El riesgo de sesgo y la calidad metodológica de los estudios fueron evaluados usando la escala de PEDro. Resultados: Catorce (n=14) estudios con bajo riesgo de sesgo (puntuación media de la escala de PEDro= 6,5±1) fueron incluidos (n=1638). La actividad física supervisada mejoró significativamente la FRC; resultados similares se encontraron para el análisis del entrenamiento de resistencia supervisado. Además, dentro del análisis de subgrupos, la actividad física supervisada fue más efectivo que el cuidado convencional en el manejo de la FRC en las pacientes con cáncer de mama. Conclusión: Las intervenciones con actividad física supervisada proporcionan una disminución global de FRC. Estos hallazgos sugieren que el ejercicio aeróbico y el entrenamiento de resistencia deben ser incluidos en los programas de rehabilitación oncológica.

Anthropometric and physical fitness characterization of male elite karate athletes / Caracterización antropométrica y estado físico de atletas de elite de karate masculino

This study aimed to assess anthropometric and physical fitness characteristics of male elite karate athletes. Our study was carried out on a sample of 19 male Karate Athletes from Colombia (mean age 31.6±8.8 years). Different anthropometric measurements were taken (weight, height, diameters, circumferences, body composition) from which several anthropometric indices were calculated (body mass index, ponderal index, body index adiposity), and the somatotype was then determined. The performance tests carried out were: Astrand-Ryming protocol, vertical jump, anaerobic power and Wingate anaerobic test. The results (mean±SD) showed a body mass (65.4±12.0 kg), height (167.4±9.3 cm), percent body fat (13.6±3.0 %), ponderal index (41.0±1.8) and body adiposity index (25.1±3.6). The somatotype component values according to the Heath-Carter method were (4.0-4.2-2.1) for the endomorphic, mesomorphic, and ectomorphic components respectively. The aerobic capacity average was (44.8±7.1 ml·kg-1·min-1), vertical jump (32.0±8.7 cm) anaerobic power (90.1±22.7 kg·s-1) and anaerobic capacity (5748.7±1477.5 W). These results may provide a profile of elite karate that can be used as training targets for developing athletes. Our findings provide novel insight for both tactical and functional training.

El objetivo del estudio fue evaluar las características antropométricas y del estado físico de los atletas de elite karate maculino. Nuestro estudio se realizó sobre una muestra de 19 atletas karatecas de Colombia (edad media de 31,6±8,8 años). Se tomaron diferentes medidas antropométricas (peso, talla, diámetros, circunferencias, composición corporal) a partir de las cuales se calcularon varios índices antropométricos (índice de masa corporal, índice ponderal, índice de adiposidad corporal), permitiendo determinar el somatotipo. Las pruebas de rendimiento realizadas fueron: el protocolo Astrand-Ryming, salto vertical, potencia anaeróbica y la prueba anaeróbica de Wingate. Se obtuvieron los resultados (Media±DE) de masa corporal (65,4±12,0 kg), altura (167,4±9,3 cm), porcentaje de grasa corporal (13,6±3,0%), índice ponderal (41,0±1,8) e índice de adiposidad corporal (25,1±3,6). Los valores de los componentes del somatotipo, de acuerdo con el método de Heath-Carter, fueron de 4,0­4,2­2,1 para los componentes endomórfico, mesomórfico, y ectomórfico, respectivamente. El promedio para la capacidad aeróbica fue (44,8±7,1 ml·kg1·min-1), del salto vertical (32,0±8,7 cm), de potencia anaeróbica (90,1±22,7 kg·s-1) y de capacidad anaeróbica (5.748,7±1.477,5 W). Estos resultados permiten obtener un perfil del karateca de elite, que puede ser utilizado como blanco de formación para el desarrollo de estos atletas. Los resultados también pueden proporcionar información que busque enfatizar el entrenamiento y desarrollo de tácticas.