Ingurgitación mamaria desde la fisioterapia a través de agentes físicos y técnicas manuales: revisión sistemática con meta-análisis / Breast Engorgement from Physical Therapy using Physical Agents and Manual Techniques: A Systematic Review with Meta-analysis / O ingurgitamento mamário abordado a partir da fisioterapia por meio de agentes físicos e técnicas manuais: revisão sistemática com meta-análise

Objetivo:analizar la evidencia de estudios previos sobre las diferentes alternativas de tratamientos con el uso de agentes físicos y técnicas manuales utilizados en la fisioterapia para la ingurgitación mamaria a nivel internacional. Material y método:estudio de revisión sistemática con meta-análisis según el pro-tocolo prisma. Búsqueda en las bases de datos de Scopus y Medline a través de PubMed, publicados desde el 01 de enero de 2015 hasta el 31 de diciembre de 2021. La estrategia de búsqueda empleó los siguien-tes términos: breastengorgement, treatment, breastfeeding, six-pointengorgementscale, physiotherapy, breastcancer, physicaltherapy. Los 5 estudios elegidos para esta revisión sistemática fueron valorados con la Escala pedro para conocer la calidad metodológica. Resultados:diferencias medias estandarizadas oscilaron entre 0,5959 y 2,7373, la mayoría de las estimaciones positivas. El resultado promedio difirió significativamente de cero (z = 3,5686, p = 0,0004). Según prueba Q, los resultados reales parecen ser heterogéneos (Q (5) = 23,2212, p = 0,0003, tau² = 0,4759, I² = 83,6163%). Intervalo de predicción del 95 % para los resultados reales viene dado por -0,3733 a 2,5931. Un intervalo de predicción del 95 % para los resultados reales viene dado por -3,6762 a 11,5933. Conclusiones: las técnicas estudiadas disminuyen el dolor y la congestión mamaria, sin embargo, se ha visto que la combinación entre ellas puede favorecer aún más la mejora de los mismos. Al aplicarse en las mujeres con ingurgitación generaron beneficios a corto y largo plazo para disminuir el dolor y la ingurgitación mamaria

Objective: To analyze the evidence of previous studies on the different treatment alternatives with the use of physical agents and manual techniques used in physiotherapy for breast engorgement at an international level. Method: Systematic review study with meta-analysis according to the prisma pro-tocol. Search in Scopus and Medline databases through PubMed, published from January 1, 2015 to December 31, 2021. The search strategy employed the following terms: breast engorgement, treatment, breastfeeding, six-point engorgement scale, physiotherapy, breast cancer, Physical therapy. The 5 stu-dies chosen for this systematic review were assessed with the PEDro Scale for methodological quality. Results: Standardized mean differences ranged from 0.5959 to 2.7373, most of the positive estimates. The average result differed significantly from zero (z = 3.5686; p = 0.0004). According to Q test, the actual results appear to be heterogeneous (Q(5) = 23.2212; p = 0.0003; tau² = 0.4759; I² = 83.6163%). The 95% prediction interval for the actual results is given by −0.3733 to 2.5931. A 95% prediction interval for the actual results is given by −3.6762 to 11.5933. Conclusions: The techniques studied decrease breast pain and engorgement; however, it has been seen that the combination between them can further favor their improvement. When applied in women with engorgement, they generated short and long term benefits in reducing pain and breast engorgement

Objetivo: analisar as evidências de estudos anteriores sobre as diferentes alternativas de tratamento com uso de agentes físicos e técnicas manuais utilizadas na fisioterapia para ingurgitamento mamá-rio internacionalmente. Material e método: estudo de revisão sistemática com meta-análise segundo protocolo prisma. Pesquisa nas bases de dados Scopus e Medline por meio do PubMed, publicadas de 1º de janeiro de 2015 a 31 de dezembro de 2021. A estratégia de busca utilizou os seguintes termos: breastingorgement, treatment, breastfeeding, six-pointengorgementscale, physiotherapy, breastcancer, physi-caltherapy. Os 5 estudos escolhidos para esta revisão sistemática foram avaliados com a Escala pedro para determinar a qualidade metodológica. Resultados: as diferenças médias padronizadas variaram de 0,5959 a 2,7373, com a maioria das estimativas positivas. O resultado médio diferiu significativamente de zero (z = 3,5686, p = 0,0004). Segundo o teste Q, os resultados reais parecem ser heterogêneos (Q (5) = 23,2212, p = 0,0003, tau² = 0,4759, I² = 83,6163%). O intervalo de previsão de 95% para resultados reais é dado por -0,3733 a 2,5931. Um intervalo de previsão de 95% para os resultados reais é dado por -3,6762 a 11,5933. Conclusões: as técnicas estudadas reduzem a dor e a congestão mamária, porém, constatou-se que a combinação entre elas pode melhorar ainda mais a sua melhora. Quando aplicados em mulheres 2024com ingurgitamento, geraram benefícios de curto e longo prazo para reduzir a dor e o ingurgitamento mamário.

Gestational Diabetes Mellitus Subtypes Classified by Oral Glucose Tolerance Test and Maternal and Perinatal Outcomes: Results of a Mexican Multicenter Prospective Cohort Study "Cuido Mi Embarazo".

Purpose: This study explores the impact of gestational diabetes mellitus (GDM) subtypes classified by oral glucose tolerance test (OGTT) values on maternal and perinatal outcomes. Patients and Methods: This multicenter prospective cohort study (May 2019-December 2022) included participants from the Mexican multicenter cohort study Cuido mi Embarazo (CME). Women were classified into four groups per 75-g 2-h OGTT: 1) normal glucose tolerance (normal OGTT), 2) GDM-Sensitivity (isolated abnormal fasting or abnormal fasting in combination with 1-h or 2-h abnormal results), 3) GDM-Secretion (isolated abnormal values at 1-h or 2-h or their combination), and 4) GDM-Mixed (three abnormal values). Cesarean delivery, neonates large for gestational age (LGA), and pre-term birth rates were among the outcomes compared. Between-group comparisons were analyzed using either the t-test, chi-square test, or Fisher's exact test. Results: Of 2,056 Mexican pregnant women in the CME cohort, 294 (14.3%) had GDM; 53.7%, 34.4%, and 11.9% were classified as GDM-Sensitivity, GDM-Secretion, and GDM-Mixed subtypes, respectively. Women with GDM were older (p = 0.0001) and more often multiparous (p = 0.119) vs without GDM. Cesarean delivery (63.3%; p = 0.02) and neonate LGA (10.7%; p = 0.078) were higher in the GDM-Mixed group than the overall GDM group (55.6% and 8.4%, respectively). Pre-term birth was more common in the GDM-Sensitivity group than in the overall GDM group (10.2% vs 8.5%, respectively; p=0.022). At 6 months postpartum, prediabetes was more frequent in the GDM-Sensitivity group than in the overall GDM group (31.6% vs 25.5%). Type 2 diabetes was more common in the GDM-Mixed group than in the overall GDM group (10.0% vs 3.3%). Conclusion: GDM subtypes effectively stratified maternal and perinatal risks. GDM-Mixed subtype increased the risk of cesarean delivery, LGA, and type 2 diabetes postpartum. GDM subtypes may help personalize clinical interventions and optimize maternal and perinatal outcomes.

Estado nutricional en estudiantes de medicina de la Universidad San Gregorio de Portoviejo, Ecuador / Nutritional status in medical students of the University San Gregorio of Portoviejo, Ecuador

Fundamentos: Los estudiantes de medicina pueden ser vulnerables al desarrollo de alteraciones en su estado nutricional por las características propias de su formación, que pueden comprometer su estado saludable. El objetivo fue determinar el estado nutricional de los estudiantes de medicina de la Universidad San Gregorio de Portoviejo, Ecuador. Material y métodos: Se realizó un estudio descriptivo de corte transversal en 117 estudiantes de medicina (69 mujeres y 48 hombres) de la Universidad San Gregorio de Portoviejo, Ecuador. Las mediciones realizadas fueron: peso corporal, estatura, circunferencia de cintura, circunferencia de cadera y edad. Luego se calcularon: índice de masa corporal, porcentaje de grasa corporal, índice cintura cadera e índice cintura estatura. Resultados: Se observaron elevados niveles de sobrepeso según el IMC (más del 30%), teniendo la obesidad una prevalencia superior al 10% en ambos sexos. El índice de %GC y la circunferencia de cinturas mostraron niveles de obesidad abdominal superiores que los determinados por el IMC. Así, el %GC arrojo una ligera mayor prevalencia de obesidad en mujeres que en hombres, mientras que alrededor del 15% de los participantes masculinos y femeninos presentó obesidad abdominal. Finalmente, las mujeres presentaron una mayor prevalencia de riesgo cardiovascular alto, y casi el 45,8% de los hombres fueron considerados con un riesgo metabólico elevado. Conclusiones: Se encontraron preocupantes niveles de sobrepeso en ambos sexos. El sexo masculino tuvo mayor riesgo de sufrir síndrome metabólico, mientras que las mujeres presentaron en general mayor riesgo cardiovascular. (AU)

Background: Medical students may be vulnerable to the development of alterations in their nutritional status due to the characteristics of their process. The objective was to identify the nutritional status of medical students at the Universidad San Gregorio de Portoviejo, Ecuador. Material and methods: A descriptive cross-sectional study was carried out in 117 medical students (69 women and 48 men) of the Universidad San Gregorio de Portoviejo, Ecuador. The measurements taken were: body weight, height, waist circumference, hip circumference and age. Results: High levels of overweight were observed according to BMI (more than 30%), with obesity having a prevalence greater than 10% in both sexes. The %BF index and waist circumference showed higher levels of abdominal obesity than those determined by BMI. Thus, the %BF showed a slightly higher prevalence of obesity in women than in men, while around 15% of male and female participants presented abdominal obesity. Finally, women had a higher prevalence of high cardiovascular risk, and almost 45.8% of men were considered to have a high metabolic risk. (AU)

Experimentally-guided in silico design of engineered heart tissues to improve cardiac electrical function after myocardial infarction.

Engineered heart tissues (EHTs) built from human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) showed promising results for cardiac function restoration following myocardial infarction. Nevertheless, human iPSC-CMs have longer action potential and lower cell-to-cell coupling than adult-like CMs. These immature electrophysiological properties favor arrhythmias due to the generation of electrophysiological gradients when hiPSC-CMs are injected in the cardiac tissue. Culturing hiPSC-CMs on three-dimensional (3D) scaffolds can promote their maturation and influence their alignment. However, it is still uncertain how on-scaffold culturing influences the overall electrophysiology of the in vitro and implanted EHTs, as it requires expensive and time consuming experimentation. Here, we computationally investigated the impact of the scaffold design on the EHT electrical depolarization and repolarization before and after engraftment on infarcted tissue. We first acquired and processed electrical recordings from in vitro EHTs, which we used to calibrate the modeling and simulation of in silico EHTs to replicate experimental outcomes. Next, we built in silico EHT models for a range of scaffold pore sizes, shapes (square, rectangular, auxetic, hexagonal) and thicknesses. In this setup, we found that scaffolds made of small (0.2 mm2), elongated (30° half-angle) hexagons led to faster EHT activation and better mimicked the cardiac anisotropy. The scaffold thickness had a marginal role on the not engrafted EHT electrophysiology. Moreover, EHT engraftment on infarcted tissue showed that the EHT conductivity should be at least 5% of that in healthy tissue for bidirectional EHT-myocardium electrical propagation. For conductivities above such threshold, the scaffold made of small elongated hexagons led to the lowest activation time (AT) in the coupled EHT-myocardium. If the EHT conductivity was further increased and the hiPSC-CMs were uniformly oriented parallel to the epicardial cells, the total AT and the repolarization time gradient decreased substantially, thus minimizing the likelihood for arrhythmias after EHT transplantation.

Estado nutricional y actividad física en estudiantes universitarios. Una revisión sistemática

El objetivo del presente trabajo fue sintetizar la evidencia de estudios previos sobre la relación entre los niveles del estado nutricional y la actividad física en estudiantes universitarios. Las estrategias de búsqueda siguieron las directrices de la declaración PRISMA y se basaron en los términos: "Physical activity" and "Nutritional Status" and "University Students". En las siguientes bases de datos de revistas académicas: Web of Science (Core Collection), Scopus, Medline a través de Pubmed y Scielo. La revisión sistemática se realizó con 12 estudios seleccionados. Cinco estudios se realizaron en estudiantes universitarios de Europa para un 42% del total), seis en Latinoamérica para un 50%, y uno en Asia que representa un 8%. La suma de las muestras de los estudios fue de 5071 estudiantes (X= 422,6). En 4 estudios el muestreo fue probabilístico en sus diferentes tipos (33,3%). La mayor parte de los estudios fueron de tipo descriptivos transversales (7 para un 58,2%), 3 estudios de tipo correlacionales (25%), un estudio de tipo analítico y un estudio cuasi experimental (8,4% cada uno). El estado nutricional y la actividad física tuvieron una relación inversamente proporcional. Predominaron los niveles moderados de obesidad y de práctica de actividad física.

We aim to synthesize evidence from previous studies on the relationship between nutritional status levels and physical activity in university students. The search strategies followed the guidelines of the PRISMA statement and were based on the terms: "Physical activity" "Nutritional Status" and "University Students". In the following academic journal databases: Web of Science (Core Collection), Scopus, Medline through Pubmed, and Scielo. The systematic review was carried out with 12 selected studies. Five studies were conducted on university students in Europe (42% of the total), six in Latin America (50%), and one in Asia (8%). The sum of the study samples was 5071 students (X= 422.6). In 4 studies the sampling was probabilistic in its different types (33.3%). Most of the studies were descriptive cross-sectional studies (7 for 58.2%), 3 correlational studies (25%), one analytical study, and one quasi-experimental study (8.4% each). Nutritional status and physical activity had an inversely proportional relationship. Moderate levels of obesity and physical activity were predominant.

MIDO GDM: an innovative artificial intelligence-based prediction model for the development of gestational diabetes in Mexican women.

Given the barriers to early detection of gestational diabetes mellitus (GDM), this study aimed to develop an artificial intelligence (AI)-based prediction model for GDM in pregnant Mexican women. Data were retrieved from 1709 pregnant women who participated in the multicenter prospective cohort study 'Cuido mi embarazo'. A machine-learning-driven method was used to select the best predictive variables for GDM risk: age, family history of type 2 diabetes, previous diagnosis of hypertension, pregestational body mass index, gestational week, parity, birth weight of last child, and random capillary glucose. An artificial neural network approach was then used to build the model, which achieved a high level of accuracy (70.3%) and sensitivity (83.3%) for identifying women at high risk of developing GDM. This AI-based model will be applied throughout Mexico to improve the timing and quality of GDM interventions. Given the ease of obtaining the model variables, this model is expected to be clinically strategic, allowing prioritization of preventative treatment and promising a paradigm shift in prevention and primary healthcare during pregnancy. This AI model uses variables that are easily collected to identify pregnant women at risk of developing GDM with a high level of accuracy and precision.

Ballistic Facial Trauma Reconstruction: Incidence and Practice Patterns in the Civilian Population.

BACKGROUND: Management of nonfatal ballistic facial trauma is well described in the literature for wounds secondary to military combat. However, there is little literature describing such management in civilian practice. We aimed to describe nonmilitary patients with recent nonfatal facial injuries from ballistic trauma using the California Office of Statewide Health Planning and Development patient database. METHODS: A retrospective study was performed using the California Office of Statewide Health Planning and Development Ambulatory Surgery and Inpatient datasets. All adults with the International Classification of Diseases, 10th Revision codes of severe nonfatal facial trauma from firearms requiring emergent surgery during 2016-2018 were included. Outcomes assessed include number and type of facial procedures performed, hospital length of stay, number of admissions, timing of definitive management, and lifetime hospitalization costs. RESULTS: A total of 331 traceable patients were identified over this 3-year period. The average age was 35.4 years (SD, 15.2), and 87% were male. The median index admission length of stay was 8 days (interquartile range, 3-15 days). Subsequent readmission was required for 123 (37.2%) patients with 10% mortality in the index admission. Total median charges per patient for all admissions were $257,804 (interquartile range, $105,601-$531,916). A total of 215 patients (65%) had at least 1 facial repair performed. Of all 331 patients, 64.3% underwent musculoskeletal repair (n = 213), 31.4% underwent digestive system repair (n = 104), and 29.6% underwent respiratory system repair (n = 98). The average number of repairs per patient was 2.52 (SD, 3.38), with 35% not having any of the specified International Classification of Diseases, 10th Revision repair codes. A total of 27% of patients had 1 procedure performed, whereas 38% received 2 or more, for an average of 3.87 (SD, 3.5) repairs over the study duration. DISCUSSION: To our knowledge, this is the first assessment of civilian characteristics of nonfatal ballistic facial trauma in California. Nonfatal facial ballistic trauma results in complex injuries to multiple body systems, requiring long admissions, costly hospital stays, and coordination of care across several surgical specialties. Many patients require a variety of procedures over multiple admissions, highlighting the overall morbidity of these injuries. Future studies will look at how care for these patients differs between various hospitals and geographic regions and whether current civilian management aligns with well-defined military reconstructive protocols for facial ballistic injuries.

Diagnostic Accuracy of Capillary Blood Glucometer Testing for Gestational Diabetes.

Purpose: Few pregnant women in low-resource settings are screened for gestational diabetes mellitus (GDM) using the gold standard oral glucose tolerance test (OGTT). This study compared capillary blood glucose testing with 2-h plasma glucose measurements obtained using the 75-g OGTT to screen for GDM at primary healthcare clinics in Mexico. Patients and Methods: Pregnant women who participated in a previous prospective multicenter longitudinal cohort study and who had not been previously diagnosed with diabetes were included. Participants were evaluated using the plasmatic 2-h 75-g OGTT with simultaneous capillary blood glucose measurements using a glucometer. The study endpoint was the comparability of the glucometer results to the gold standard OGTT when collected simultaneously. Sensitivity, specificity, and area under the curve of the glucose measurements obtained for capillary blood compared with venous plasma (gold standard) were calculated to determine diagnostic accuracy. Results: The study included 947 pregnant women who had simultaneous glucose measurements available (blood capillary [glucometer] and venous blood OGTT). Overall, capillary blood glucose testing was very sensitive (89.47%); the specificity was 66.58% and the area under the curve (95% confidence interval) was 0.78 (0.74-0.81). The sensitivity, specificity and area under the curve of each capillary measurement were: 89.47%, 66.58% and 0.78 (0.74-0.82) for the fasting measurement, 91.53%, 93.24% and 0.92 (0.88-0.96) for the one-hour measurement, and 89.80%, 93.32%, 0.91 (0.87-0.95) for the second-hour measurement, respectively. No adverse events were reported. Conclusion: Capillary OGTT is a valid alternative to the gold standard OGTT for screening of GDM in low-resource situations or in situations where there are other limitations to performing the OGTT as part of primary healthcare services.

MIDO COVID: A digital public health strategy designed to tackle chronic disease and the COVID-19 pandemic in Mexico.

Screening, prevention, and management of non-communicable diseases (NCDs, including obesity, hypertension, and type 2 diabetes) is the core function of Integrated Measurement for Early Detection (MIDO), a digital strategy developed by the Carlos Slim Foundation in Mexico. An extension of this strategy, MIDO COVID, was developed to address the need for an integrated plan in primary health care during the COVID-19 pandemic. MIDO COVID facilitates planning, surveillance, testing, and clinical management of SARS-CoV-2 infections and the major NCDs and their pre-disease states, to streamline the continuum of care. MIDO COVID screening was applied in 1063 Carso Group workplaces in 190 municipalities of the 32 Mexican states. Staff were trained to screen healthy workers for NCDs using a questionnaire, anthropomorphic measurements, and blood work; healthy individuals returning to work also received a SARS-CoV-2 antibody test. Between June 26 and December 31, 2020, 58,277 asymptomatic individuals underwent screening. The prevalence of obesity, hypertension, and type 2 diabetes was 32.1%, 25.7%, and 9.7% respectively. Only 2.2%, 8.8%, and 4.5% of individuals, respectively, were previously aware of their condition. Pre-obesity was identified in 38.6%, pre-hypertension in 17.4%, and prediabetes in 7.5% of the population. Risk of SARS-CoV-2 infection was highest for individuals with multiple NCDs. Many Mexicans are unaware of their health status and potentially increased risk of COVID-19 and serious complications. As a universal strategy implemented regardless of social factors, MIDO COVID promotes equity in access to health care prevention and early stage detection of NCDs; the information gained may help inform decisionmakers regarding prioritising vulnerable populations for immunisation.

Fabrication of human myocardium using multidimensional modelling of engineered tissues.

Biofabrication of human tissues has seen a meteoric growth triggered by recent technical advancements such as human induced pluripotent stem cells (hiPSCs) and additive manufacturing. However, generation of cardiac tissue is still hampered by lack of adequate mechanical properties and crucially by the often unpredictable post-fabrication evolution of biological components. In this study we employ melt electrowriting (MEW) and hiPSC-derived cardiac cells to generate fibre-reinforced human cardiac minitissues. These are thoroughly characterized in order to build computational models and simulations able to predict their post-fabrication evolution. Our results show that MEW-based human minitissues display advanced maturation 28 post-generation, with a significant increase in the expression of cardiac genes such as MYL2, GJA5, SCN5A and the MYH7/MYH6 and MYL2/MYL7 ratios. Human iPSC-cardiomyocytes are significantly more aligned within the MEW-based 3D tissues, as compared to conventional 2D controls, and also display greater expression of C×43. These are also correlated with a more mature functionality in the form of faster conduction velocity. We used these data to develop simulations capable of accurately reproducing the experimental performance. In-depth gauging of the structural disposition (cellular alignment) and intercellular connectivity (C×43) allowed us to develop an improved computational model able to predict the relationship between cardiac cell alignment and functional performance. This study lays down the path for advancing in the development ofin silicotools to predict cardiac biofabricated tissue evolution after generation, and maps the route towards more accurate and biomimetic tissue manufacture.

Effects of Physical Exercise on Burnout Syndrome in University Students.

INTRODUCTION: Burnout syndrome has a negative impact on university students' health worldwide. Global prevalence of each dimension of the syndrome is estimated at 55.4% for emotional exhaustion, 31.6% for cynicism and 30.9% for academic inefficacy. OBJECTIVE: Evaluate the efficacy of physical exercise in reducing burnout levels in university students. METHODS: We carried out an investigation in students from the Technical University of Ambato, Ecuador. Students were in different career tracks, randomly selected, and were assigned to three different groups with pre-test and post-test measurements: two intervention groups (aerobic and strength exercise) and one control group (no exercise). The evaluation instrument was the Maslach Burnout Inventory-Student Survey, whose dimensions are exhaustion, cynicism and academic inefficacy. We also evaluated heart rate variability. RESULTS: The aerobic exercise group reduced cynicism by 21.1% (d = 0.252), inefficacy 13.1% (d = 0.397) and exhaustion by 31.0% (d = 0.532). The strength exercise group reduced cynicism by 27.4% (d = 0.315), inefficacy by 21.7% (d = 0.704) and exhaustion by 19.6% (d = 0.299). In the control group, exhaustion and inefficacy increased by 10.1% (d = 0.128) and 4.4% (d = 0.129) respectively; instead, cynicism was reduced by 7.3% (d = 0.062).The aerobic exercise group had the greatest increase in heart rate variability (at 16.8%), followed by the strength group (16.6%) and the control group (5.2%). CONCLUSIONS: Physical exercise (both aerobic and strength) was effective in reducing burnout levels in university students.

Integrated Measurement for Early Detection (MIDO) as a digital strategy for timely assessment of non-communicable disease profiles and factors associated with unawareness and control: a retrospective observational study in primary healthcare facilities in Mexico.

OBJECTIVES: The Carlos Slim Foundation implemented the Integrated Measurement for Early Detection (MIDO), a screening strategy for non-communicable diseases (NCDs) in Mexico as part of CASALUD, a portfolio of digital health services focusing on healthcare delivery and prevention/management of NCDs. We investigated the disease profile of the screened population and evaluated MIDO's contribution to the continuum of care of the main NCDs. DESIGN: Using data from MIDO and the chronic diseases information system, we quantified the proportion of the population screened and diagnosed with NCDs, and measured care linkage/retention and level of control achieved. We analysed comorbidity patterns and estimated prevalence of predisease stages. Finally, we estimated characteristics associated with unawareness and control of NCDs, and examined efficacy of the CASALUD model in improving NCD control. SETTING: Public primary health centres in 27/32 Mexican states. PARTICIPANTS: Individuals aged ≥20 years lacking healthcare access. RESULTS: From 2014 to 2018, 743 000 individuals were screened using MIDO. A predisease or disease condition was detected in ≥70% of the population who were unaware of their NCD status. The screening identified 38 417 new cases of type 2 diabetes, 53 133 new cases of hypertension and 208 627 individuals with obesity. Dyslipidaemia was found in 77.3% of individuals with available blood samples. Comorbidities were highly prevalent, especially in people with obesity. Only 5.47% (n=17 774) of individuals were linked with their corresponding primary health centre. Factors associated with unawareness of and uncontrolled NCDs were sex, age, and social determinants, for example, rural/urban environment, access to healthcare service, and education level. Patients with type 2 diabetes treated at clinics under the CASALUD model were more likely to achieve disease control (OR: 1.32, 95% CI: 1.09 to 1.61). CONCLUSION: Patient-centred screening strategies such as MIDO are urgently needed to improve screening, access, retention and control for patients with NCDs.

Prevalence of burnout syndrome in university students: A systematic review / Prevalencia del síndrome de burnout en estudiantes universitarios: Una revisión sistemática

Abstract Introdution Burnout syndrome is a social and health problem in college students. Objective To synthesize evidence from previous studies on the prevalence of burnout syndrome in university students in their three-dimensional approach. Method The search strategies followed the PRISMA guidelines and were based on the following descriptive terms: "burnout," "studies," "prevalence," "students." Pubmed, Web of Science Core Collection, PsicINFO, and Scielo were consulted. An evaluation of the quality of the information was carried out applying the STROBE positioning guidelines. Results We found 1,406 studies that were reduced to 46 studies for final analysis using the STROBE statement, eventually leaving 20 studies. One study (5%) was conducted in North America, five (25%) in Asia, nine (45%) in Latin America, and five (25%) in Europe. Of the 20 studies evaluated in the systematic review, those that had the best overall evaluation in the STROBE analysis were selected for discussion, corresponding to 10 (out of 75% of STROBE). Overall prevalence of each dimension of the syndrome was estimated at 55.4% for emotional exhaustion, 31.6% for cynicism, and 30.9% for academic efficacy. Discussion and conclusion Moderate levels of burnout syndrome prevail in the different populations of university students of different careers worldwide. In only a few studies is the prevalence low and this could be due to multiple evaluative variables.

Resumen Introducción El síndrome de burnout es un problema social y de salud en los estudiantes universitarios. Objetivo Sintetizar las pruebas de estudios anteriores sobre la prevalencia del síndrome de burnout en estudiantes universitarios en su enfoque tridimensional. Método Las estrategias de búsqueda siguieron las pautas de PRISMA y se basaron en los siguientes términos descriptivos: "burnout", "estudios", "prevalencia", "estudiantes". Se consultaron Pubmed, Web of Science Core Collection, PsicINFO y Scielo. Se llevó a cabo una evaluación de la calidad de la información aplicando las directrices de posicionamiento de STROBE. Resultados Se encontraron 1,406 estudios que se redujeron a 46 estudios para el análisis final utilizando la declaración STROBE, con lo que quedaron finalmente 20 estudios. Un estudio (5%) se llevó a cabo en América del Norte, cinco (25%) en Asia, nueve (45%) en América Latina y cinco (25%) en Europa. De los 20 estudios evaluados en la revisión sistemática, se seleccionaron para su discusión aquellos que tuvieron la mejor evaluación general en el análisis de la STROBE, correspondientes a 10 (de un 75% de la STROBE). La prevalencia general de cada dimensión del síndrome se estimó en un 55.4% para el agotamiento emocional, un 31.6% para el cinismo y un 30.9% para la eficacia académica. Discusión y conclusión Los niveles moderados del síndrome de burnout prevalecen en las diferentes poblaciones de estudiantes universitarios de distintas carreras en todo el mundo. En sólo unos pocos estudios la prevalencia es baja y esto podría deberse a múltiples variables evaluativas.

Ejercicios físicos en los niveles de Síndrome de Burnout y la Variabilidad de la Frecuencia Cardíaca de estudiantes universitarios: un estudio de intervención / Physical exercise on Burnout Syndrome levels and Heart Rate Variability in university students: an intervention study

RESUMEN: Los programas de intervención para prevenir o tratar el Síndrome de Burnout son esenciales para mejorar la salud de los estudiantes. Pero la mayoría de las investigaciones realizadas son intervenciones psicológicas y cognitivas.Objetivo: Determinar los efectos de los ejercicios físicos en los niveles de Síndrome de Burnout y la Variabilidad de la Frecuencia Cardíaca en estudiantes universitarios.Métodos: Estudio experimental con pre-test y post-test, con 2 grupos de intervención y un grupo de control. La muestra fue probabilística y estratificada con participación proporcional. Instrumentos utilizados: Maslach Burnout Inventory Students Survey (MBI-SS) y Variabilidad de la Frecuencia Cardíaca (HRV): cálculo de la media RR, SDNN y RMSSD. Para el ejercicio físico, se aplicaron ejercicios aeróbicos y de fuerza durante 3 sesiones semanales de una hora, en días alternos, durante 16 semanas.Resultados: El grupo de aeróbicos con Agotamiento MBI-SS fue mayor, reduciendo sus niveles en un 26,4% (d=0,532), en Cinismo (-21,06, d=0,252) y en Eficacia (-13,11, 0,397). Grupo de fuerza en Cinismo (-27,38, d=0,315), en Eficacia (-21,69, d=0,704), Agotamiento (-19,55, d=0,299). El grupo de control Agotamiento aumentó en un 10,26% (d=0,128). En la HVR, con el grupo aeróbico el SDNN tuvo el mayor cambio porcentual, con un aumento del 24,82 %, sobre la media RR y RMSSD (14,40 % y 16,45 %). En el grupo de fuerza y en el grupo de control (21,77%, 14,24%, 12,60%; y 12,59%, 4,97% y 4,99% respectivamente). Hubo un cambio en el RR medio en los grupos aeróbico y de fuerza (d = 1,281 y 1,328).Conclusiones: Efecto de reducción del síndrome de burnout y efecto contrario de incremento de valores del HRV. (AU)

ABSTRACT: Intervention programs to prevent or treat Burnout Syndrome are essential to improve the health of students. But most of the research that has been done is psychological and cognitive interventions.Objective: To determine the effects of physical exercises on Burnout Syndrome levels and Heart Rate Variability in university students.Methods: An experimental study was carried out with pre-test and post-test, with 2 intervention groups and a control group. The sample was probabilistic and stratified with proportional participation. Study variables and instruments were included: Maslach Burnout Inventory Students Survey (MBI-SS) and Heart Rate Variability (HRV): calculation of the average RR, SDNN and RMSSD. For physical exercise, aerobic and strength exercises were applied during 3 weekly sessions of one hour, on alternate days, for 16 weeks.Results: The group of aerobics with MBI-SS exhaustion was higher, reducing its levels by 26.4% (d=0.532), in Cynicism (-21.06, d=0.252) and Efficiency (-13.11, 0.397). Force group in Cynicism (-27.38, d=0.315), in Efficiency (-21.69, d=0.704), Exhaustion (-19.55, d=0.299). The Exhaustion control group increased by 10.26% (d=0.128). In HVR, with the aerobic group, NDL had the greatest percentage change, increasing 24,82 %, over the average RR and RMSSD (14,40 % and 16,45 %). In the force group and in the control group (21.77%, 14.24%, 12.60%; and 12.59%, 4.97% and 4.99% respectively) there was a change in the mean RR in the aerobic and strength groups (d = 1.281 and 1.328).Conclusions: Effect of reduction of burnout syndrome and opposite effect of increase of HRV values. (AU)

Embedded Bio-Mimetic System for Functional Electrical Stimulation Controlled by Event-Driven sEMG.

The analysis of the surface ElectroMyoGraphic (sEMG) signal for controlling the Functional Electrical Stimulation (FES) therapy is being widely accepted as an active rehabilitation technique for the restoration of neuro-muscular disorders. Portability and real-time functionalities are major concerns, and, among others, two correlated challenges are the development of an embedded system and the implementation of lightweight signal processing approaches. In this respect, the event-driven nature of the Average Threshold Crossing (ATC) technique, considering its high correlation with the muscle force and the sparsity of its representation, could be an optimal solution. In this paper we present an embedded ATC-FES control system equipped with a multi-platform software featuring an easy-to-use Graphical User Interface (GUI). The system has been first characterized and validated by analyzing CPU and memory usage in different operating conditions, as well as measuring the system latency (fulfilling the real-time requirements with a 140 ms FES definition process). We also confirmed system effectiveness, testing it on 11 healthy subjects: The similarity between the voluntary movement and the stimulate one has been evaluated, computing the cross-correlation coefficient between the angular signals acquired during the limbs motion. We obtained high correlation values of 0.87 ± 0.07 and 0.93 ± 0.02 for the elbow flexion and knee extension exercises, respectively, proving good stimulation application in real therapy-scenarios.

Supply-side interventions to improve health: Findings from the Salud Mesoamérica Initiative.

BACKGROUND: Results-based aid (RBA) is increasingly used to incentivize action in health. In Mesoamerica, the region consisting of southern Mexico and Central America, the RBA project known as the Salud Mesoamérica Initiative (SMI) was designed to target disparities in maternal and child health, focusing on the poorest 20% of the population across the region. METHODS AND FINDINGS: Data were first collected in 365 intervention health facilities to establish a baseline of indicators. For the first follow-up measure, 18 to 24 months later, 368 facilities were evaluated in these same areas. At both stages, we measured a near-identical set of supply-side performance indicators in line with country-specific priorities in maternal and child health. All countries showed progress in performance indicators, although with different levels. El Salvador, Honduras, Nicaragua, and Panama reached their 18-month targets, while the State of Chiapas in Mexico, Guatemala, and Belize did not. A second follow-up measurement in Chiapas and Guatemala showed continued progress, as they achieved previously missed targets nine to 12 months later, after implementing a performance improvement plan. CONCLUSIONS: Our findings show an initial success in the supply-side indicators of SMI. Our data suggest that the RBA approach can be a motivator to improve availability of drugs and services in poor areas. Moreover, our innovative monitoring and evaluation framework will allow health officials with limited resources to identify and target areas of greatest need.

Actividad física y salud en docentes. Una revisión / Physical activity and health in teachers. A review

Los docentes de las universidades en la mayoría de los casos tienen estilos de vida sedentarios producto de su propio trabajo. Por tanto, se realizó un estudio de revisión documental y bibliográfica de artículos científicos publicados entre enero de 1999 y febrero de 2016 con el objetivo de actualizar los conocimientos existentes sobre la actividad física relacionada con la salud de docentes a nivel internacional. Las bases de datos consultadas fueron Medline, Scopus y Scielo. La búsqueda se realizó mediante PubMed y fue clasificada por 2 objetivos de búsqueda. Se usaron las siguientes palabras claves: actividad física, ejercicio físico, docentes; en idioma español e inglés (physical activity, physical exercise, teachers). Se seleccionaron aquellos estudios de aplicación de la actividad física en docentes de cualquier tipo de enseñanza, a nivel internacional. Se encontraron 8 estudios, todos de aplicación, en los diferentes niveles de experimentación (pre-, cuasi- y experimental) en los que se demostró los beneficios de la actividad física en poblaciones de docentes y futuros docentes (AU)

Most university teachers have sedentary lifestyles, a product of the job itself. Scientific articles published between January 1999 and February 2016 were reviewed in terms of bibliography and documentary evidence, with a view to updating existing knowledge of physical activity and its effect on the health of teachers, internationally. The databases searched were Medline, Scopus and Scielo. The search was run using PubMed, and classified by two search objectives. The following keywords were used in English and Spanish: physical activity, physical exercise and teachers (actividad física, ejercicio físico, docentes). Studies on the physical activity of any kind of teacher, internationally, was selected. Eight studies were found, all applied at different levels of experimentation (pre, quasi, and experimental), which demonstrated the benefits of physical activity in populations of current and future teachers (AU)

Online continuing medical education as a key link for successful noncommunicable disease self-management: the CASALUD™ Model.

PURPOSE: The purpose of this study is to evaluate how the benefits of online continuing medical education (CME) provided to health care professionals traveled along a patient "educational chain". In this study, the educational chain begins with the influence that CME can have on the quality of health care, with subsequent influence on patient knowledge, disease self-management, and disease biomarkers. METHODS: A total of 422 patients with at least one noncommunicable disease (NCD) treated in eight different Mexican public health clinics were followed over 3 years. All clinics were participants in the CASALUD Model, an NCD care model for primary care, where all clinic staff were offered CME. Data were collected through a questionnaire on health care, patient disease knowledge, and self-management behaviors; blood samples and anthropometric measurements were collected to measure patient disease biomarkers. RESULTS: Between 2013 and 2015, the indexes measuring quality of health care, patient health knowledge, and diabetes self-management activities rose moderately but significantly (from 0.54 to 0.64, 0.80 to 0.84, and 0.62 to 0.67, respectively). Performing self-care activities - including owning and using a glucometer and belonging to a disease support group - saw the highest increase (from 0.65 to 0.75). A1C levels increased between 2013 and 2015 from 7.95 to 8.41% (63-68 mmol/mol) (P<0.001), and blood pressure decreased between 2014 and 2015 from 143.7/76.8 to 137.5/74.4 (systolic/diastolic reported in mmHg) (P<0.001). The mean levels of other disease biomarkers remained statistically unchanged, despite the improvements seen in the previous "links" of the educational chain. CONCLUSION: Online CME can effect certain changes in the educational chain linking quality of health care, patient knowledge, and self-management behaviors. However, in order to assure adequate NCD control, the entire health care system must be improved in tandem. Online CME programs, such as CASALUD's, are feasible strategies for impacting changes in disease self-management at a clinic level throughout a country.

A Policy Analysis on the Proactive Prevention of Chronic Disease: Learnings from the Initial Implementation of Integrated Measurement for Early Detection (MIDO).

Mexico, like many low- and middle-income countries (LMICs), faces an epidemic of chronic non-communicable diseases (NCDs), specifically diabetes, hypertension, obesity, and lipid disorders. Many people with these NCDs may not be aware that they have a disease, pointing to the need for broader screening programs. The traditional prevention policy in Mexico was based on screening with a paper-based risk factor questionnaire. However, this was used to screen patients already seeking healthcare services at facilities, and screening goals were set as a function of the number of questionnaires applied, not number of individuals screened. Due to this, Fundación Carlos Slim developed Medición Integrada para la Detección Oportuna (MIDOTM), or Integrated Measurement for Early Detection, an NCD screening and proactive prevention policy. This document is a policy analysis based on early learnings from the initial implementation of MIDO in eight primary healthcare centers in two central Mexican states. MIDO was found to expand screening programs beyond clinic walls, systematize community screening strategies, emphasize the detection of pre-disease phases, incorporate lifestyle counseling, and propose screening goals based on population targets. In collaboration with the Mexican Ministry of Health, MIDO has successfully screened over 500 000 individuals-about 40% of whom would not have been screened under previous policies. Of these more than 500 000 screened individuals, 13.4% had pre-diabetes (fasting glucose between 100 and 125 mg/dL), and 5.8% had undiagnosed diabetes (defined as fasting glucose above 126 mg/dL or random glucose above 200 mg/dL). However, there is still room for improvement in linking positive results from screening with disease confirmation and with patient incorporation into disease management. The experience of implementing MIDO in Mexico suggests that primary and secondary prevention programs in other parts of the world should consider the need for population-based screening targets, a greater focus on pre-disease stages, and the streamlining of the transition between screening, confirmation of diagnosis, and incorporation of patients into the healthcare system.

Alimentación saludable en docentes / A healthy diet in professors

Introducción: en la actualidad, los docentes tienen estilos de vida sedentarios producto a su propio trabajo y esto les provoca en muchos casos enfermedades asociadas. Objetivo: actualizar los conocimientos existentes sobre la alimentación saludable de docentes a nivel internacional. Métodos: revisión documental y bibliográfica de artículos científicos publicados hasta abril de 2016. Las bases de datos consultadas fueron Medline, Scopus y Scielo. Las búsquedas que se han realizado mediante PubMed y clasificadas por dos objetivos de búsqueda. Se usaron las siguientes palabras claves: alimentación, docentes, salud; en idioma español e inglés. Se seleccionaron aquellos estudios de donde se reflejara programas, intervenciones y revisiones sobre la alimentación saludable en docentes o futuros docentes de cualquier tipo de enseñanza a nivel internacional. Conclusiones: la aplicación correcta de programas de alimentación saludable es beneficiosa de forma general en los docentes y futuros docentes(AU)

Introduction: Nowadays, teachers have sedentary lifestyles due to their own work, which causes them, in many cases, associated diseases. Objective: To update the existing knowledge on healthy diets of teachers at the international level. Methods: Document and bibliography review of scientific articles published until April 2016. The databases consulted were Medline, Scopus and Scielo. The searches used PubMed and were classified by two search goals. The following key words were used: food, teachers, health, both in Spanish and English. These studies were selected to reflect programs, interventions and reviews on healthy diet in teachers or future teachers of any kind of schooling at an international level. Conclusions: The correct application of healthy diet programs is generally beneficial for teachers and future teachers(AU)