[Choice of Family and Community Medicine in the MIR 2002-2023: An objective approach shows that it is as highly valued as hospital specialties]. / Elección de Medicina Familiar y Comunitaria en el MIR 2002-2023: un enfoque objetivo muestra que es una especialidad tan valorada como las hospitalarias.

INTRODUCTION: Currently there is a shortage of general practitioners (GP), and this is expected to increase in the coming years. Despite this need, it is a specialty that is supposedly little demanded, leaving specialized training places unfilled in recent years. The purpose of this study is to present new parameters to more objectively measure the demand and the relationship between supply and demand. METHODS: A database was used with the results of the places assigned in the MIR calls from 2002 to 2023. The calculated parameters were quoting index (CI), quote order, the order of top demand and the order of total demand of the GP specialty. The software R version 4.3.02 was used for statistical analysis. RESULTS: The specialty quotation and top demand have remained constant during the study period, while there has been a slight and progressive worsening of the total demand. Nevertheless, the total demand for Family Medicine in the last call for MIR exam was higher than that for specialties such as urology, neurology, ENT, endocrinology, oncology, intensive care medicine or neurosurgery, among others. CONCLUSIONS: In contrast to the subjective perception of the worsening attractiveness Family Medicine in the last MIR calls, using objective parameters, we found that the attractiveness of the specialty, measured as quotation (supply/demand ratio) and demand, has remained stable (with a slight worsening of total demand).

La ecografía, técnica diagnóstica en esteatosis hepática no alcohólica / Ecography, diagnostic technique in non-alcoholic hepatic esteatosis

OBJETIVO: Analizar le ecografia como prueba diagnostica de la esteatosis hepática no alcohólica. MÉTODO: Estudio observacional, descriptivo y analítico, de sección transversal. Durante 12 meses se seleccionaron 100 pacientes, con 2 o más factores de riesgo cardiovascular, con nula o baja ingesta de alcohol, que acudían a consulta de Atención Primaria. Determinaciones efectuadas. Variables demográficas y bioquímicas: Edad. Género. Ingesta de alcohol. Historia de diabetes, hipertensión arterial sistémica. Peso, talla, índice de masa corporal (IMC). Medición de presión arterial. Niveles de glucosa basal, hemoglobina glicosilada. Colesterol total, colesterol HDL, colesterol LDL, Triglicéridos, AST, ALT, bilirrubinas y fosfatasa alcalina. También se recogieron antecedentes personales y familiares de diabetes, HTA, dislipemia, tratamiento farmacológico, cifras de otros parámetros analíticos y perímetro abdominal. Evaluación hepática por ultrasonografía. Una vez cumplían los criterios de selección eran citados para la realización de la ecografía de abdomen completo, previa información del propósito de la técnica a efectuar y aportando el consentimiento informado firmado. La ecografía se realizaba con el paciente en ayunas y a ser posible con vejiga repleccionada, para poder efectuar la técnica en las mejores condiciones de preparación del paciente, con el fin de disminuir los artefactos ecográficos y poder valorar todas las estructuras abdominales correctamente. Analisis Estadístico con programa SPSS 23. Las variables cualitativas se exponen como valor exacto y en porcentaje, las cuantitativas como media y desviación estándar (DE). La comparación entre medias se realizó a través de la prueba t de Student para grupos independientes o la U de Mann-Whitney si las condiciones de normalidad (aplicación del test de Kolmogorov- Smirnoff o de Shapiro Willks) no se cumplían. En las variables cualitativas, la prueba de Ji al cuadrado. RESULTADOS: Han participado 100 pacientes: 44 hombres y 56 mujeres, con una edad media de 61,84. El 71% de los sujetos tienen obesidad. El 23 % de los sujetos no tiene esteatosis, y en el 58 % es de grado leve y moderado en ambos géneros (p< 0,003). El 19 % tiene esteatosis grado 3. Los factores de riesgo más prevalentes de los pacientes estudiados son obesidad, que la presentan el 78 % de ellos, hipercolesterolemia el 73 %, DM el 62 % e HTA el 59 %. CONCLUSIONES: La ecografía es la modalidad de elección para la determinación cualitativa de esteatosis, pero es una prueba subjetiva y dependiente del operador: sólo detecta infiltración grasa de moderada a grave

OBJECTIVE: To analyze the ultrasound as a diagnostic test for non-alcoholic liver steatosis. METHOD: Observational, descriptive and analytical study, of cross section. For 12 months, 100 patients were selected, with 2 or more cardiovascular risk factors, with no or low alcohol intake, who attended Primary Care. Determinations made: Demographic and biochemical variables: Age. Gender. Alcohol intake. History of diabetes, systemic arterial hypertension. Weight, height, body mass index (BMI). Blood pressure measurement Basal glucose levels, glycosylated hemoglobin. Total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, AST, ALT, bilirubins and alkaline phosphatase. Personal and family history of diabetes, HBP, dyslipidemia, drug treatment, figures of other analytical parameters and abdominal perimeter were also collected. Hepatic evaluation by ultrasonography: Once they met the selection criteria, they were cited for the realization of the ultrasound of the entire abdomen, prior information on the purpose of the technique to be performed and providing the signed informed consent. The ultrasound was performed with the patient on an empty stomach and, if possible, with a bladder replenished, in order to perform the technique in the best conditions of preparation of the patient, in order to reduce the ultrasound devices and to assess all the abdominal structures correctly. Statistical Analysis with SPSS program 23. The qualitative variables are shown as exact value and in percentage, the quantitative variables as mean and standard deviation (SD). The comparison between means was made through the Student t test for independent groups or the Mann-Whitney U test if the normal conditions (application of the Kolmogorov-Smirnoff or Shapiro Willks test) were not met. In qualitative variables, the chi-square test. RESULTS: 100 patients participated: 44 men and 56 women, with a mean age of 61.84. 71% of subjects are obese. 23% of the subjects do not have steatosis, and in 58% it is mild and moderate in both genders (p <0.003). 19% have grade 3 steatosis. The most prevalent risk factors of the patients studied are obesity, which is presented by 78% of them, hypercholesterolemia 73%, DM 62% and HT 59%. CONCLUSIONS: Ultrasound is the modality of choice for the qualitative determination of steatosis, but it is a subjective and operator-dependent test: it only detects moderate to severe fat infiltration

Influencia de una intervención comunitaria en obesidad y estilos de vida de escolares en el ámbito rural / Influence of a community intervention of obesity and the lifestyle of schools in the rural area

INTRODUCCIÓN: La prevalencia de sobrepeso y obesidad en la población escolar se está incrementando en los últimos años, y es de vital importancia su control dada la relación que existe entre la obesidad y la morbimortalidad de causa cardiovascular y otras causas. Con este estudio se pretendía conocer la prevalencia de sobrepeso y obesidad entre los escolares de un centro rural de Castilla la Mancha y conocer sus hábitos alimentarios e intentar influir favorablemente en estos mediante actividades comunitarias en colegio. MATERIAL Y MÉTODOS: Se trata de un estudio transversal descriptivo realizado en un centro escolar del ámbito rural en Castilla la Mancha. En un primer momento se explotaron los datos de los percentiles de IMC de las historias clínicas de los escolares que se clasificaron en las categorías de sobrepeso y obesidad con las tablas de referencia de la OMS. Posteriormente se realizó una encuesta a los padres de los escolares vía online sobre el tipo de alimentación que realizaban sus hijos, nivel de actividad física y tiempo de realización de actividades de ocio sedentario. Por ultimo se realizaron 3 encuestas visuales sobre los alimentos que llevaban para almorzar al colegio, la primera antes de la intervención con los niños, la segunda después de la intervención de estos y la tercera después de la intervención con los padres. Los cálculos estadísticos se realizaron con el paquete estadístico SPSS versión 20. RESULTADOS: La mayoría de los escolares se encontraban en normopeso (84,9%), la prevalencia de sobrepeso fue del 3,8% y la de obesidad del 11,3%. Los niños consumían diariamente en un 93% pan blanco, el 24% cereales azucarados, 40%% verduras, 58% frutas, 31% de carnes blancas, 26% huevos, 41% leche entera, 48% queso y 44% yogur. En contra se aprecia un alto consumo diario de carne roja un 27% , 24 % comida rápida, y el 17 % de zumos industriales. Consumen refrescos azucarados al menos semanalmente el 44%. En lo referente al ejercicio físico la mayoría va a l colegio andando o en automóvil en igual porcentaje, el 87% hace deporte extraescolar, del ellos el 78% de 2-6 veces a la semana. El tiempo que consumen viendo televisión o con videojuegos varia de menos de 1 hora a 2 horas entre semana y los fines de semana el 52% dedican 2 horas a estas actividades. Los alimentos que con mayor frecuencia llevaban a centro para almorzar fueron embutido, queso, pan y yogur, y no vario con las intervenciones realizadas en niños y padres. CONCLUSIONES: La prevalencia de sobrepeso y obesidad en los escolares de medio rural fue menor que en otros estudios realizados en España. La alimentación se ajustaba bastante a la pirámide recomendada por la SENC pero aún queda un largo camino por mejorar los objetivos fijados. No se apreciaron modificaciones en los alimentos del almuerzo escolar tras las intervenciones realizadas en centro escolar los sanitarios tanto con escolares como con los padres

INTRODUCTION: The prevalence of overweight and obesity in the school population is increasing in recent years, and its control is vital given the relationship between obesity and the morbidity and mortality of cardiovascular causes and other causes. This study aimed to know the prevalence of overweight and obesity among schoolchildren in a rural center of Castilla la Mancha and learn their eating habits and try to influence them favorably through community activities in school. MATERIAL AND METHODS: This is a descriptive cross-sectional study carried out in a rural school in Castilla la Mancha. Initially, the BMI percentile data of the medical records of schoolchildren that were classified in the overweight and obesity categories were exploited with the WHO reference tables. Subsequently, a survey was carried out on the parents of schoolchildren via online about the type of feeding their children made, level of physical activity and time of sedentary leisure activities. Finally, 3 visual surveys were carried out on the food they took for lunch at school, the first before the intervention with the children, the second after their intervention and the third after the intervention with the parents. Statistical calculations were performed with the statistical package SPSS version 20. RESULTS: The majority of schoolchildren were in normal weight (84.9%), the prevalence of overweight was 3.8% and that of obesity was 11.3%. Children consumed 93% white bread, 24% sugary cereals, 40 %% vegetables, 58% fruits, 31% white meats, 26% eggs, 41% whole milk, 48% cheese and 44% yogurt daily. Against it, there is a high daily consumption of red meat, 27%, 24% fast food, and 17% of industrial juices. They consume sugary sodas at least 44% weekly. With regard to physical exercise, the majority go to school on foot or by car in the same percentage, 87% do extracurricular sports, 78% of them 2-6 times a week. The time they spend watching television or video games varies from less than 1 hour to 2 hours during the week and on weekends 52% spend 2 hours on these activities. The foods that were most often taken to the center for lunch were sausage, cheese, bread and yogurt, and did not vary with interventions performed on children and parents. CONCLUSIONS: The prevalence of overweight and obesity in rural schoolchildren was lower than in other studies carried out in Spain. The food was quite adjusted to the pyramid recommended by the SENC but there is still a long way to improve the objectives set. There were no changes in the school lunch foods after the interventions carried out in the school by health workers with both schoolchildren and parents

Cannabinoids: from pot to lab.

Cannabis is becoming increasingly present in our society. In recent years, the line between the natural (cannabis) and the synthetic (synthetic cannabinoids), the recreational (cannabis) and the medical (pharmaceutical cannabinoids and medical cannabis) has been crossed. In this paper we review some of the novel aspects of cannabis and cannabinoids in relation to their legal situation, changes in their composition and forms of cannabis use, the concept of medical cannabis, and synthetic cannabinoids as new psychoactive substances (NPS). We have also analyzed serious adverse reactions and intoxications associated with the use of synthetic cannabinoids, as well as the latest developments in the research of pharmaceutical cannabinoids.

Nutritional composition and fatty acids profile in cocoa beans and chocolates with different geographical origin and processing conditions.

Nutritional composition and fatty acids (FA) profile were determined in cocoa and chocolates of different geographical origin and subject to different processing conditions. Cocoa butter was the major nutrient in cocoa beans and carbohydrates were the most important in chocolates. Cocoa composition and FA profile varied depending on geographical origin whilst in chocolates only carbohydrates and fat content varied significantly due to the effect of origin and no significant effect was observed for processing conditions. Both for cocoa and chocolates differences in FA profile were mainly explained as an effect of the geographical origin, and were not due to processing conditions in chocolate. For cocoa, differences in FA profile were found in C12:0, C14:0, C16:0, C16:1, C17:0, C17:1 and C18:0 whilst for chocolates only differences were found in C16:0, C18:0, C18:1 and C18:2. For all samples, C16:0, C18:0, C18:1 and C18:2 were quantitatively the most important FA. Ecuadorian chocolate showed a healthier FA profile having higher amounts of unsaturated FA and lower amounts of saturated FA than Ghanaian chocolate.

Influence of label information on dark chocolate acceptability.

The aim of the present work was to study how the information on product labels influences consumer expectations and their acceptance and purchase intention of dark chocolate. Six samples of dark chocolate, varying in brand (premium and store brand) and in type of product (regular dark chocolate, single cocoa origin dark chocolate and high percentage of cocoa dark chocolate), were evaluated by 109 consumers who scored their liking and purchase intention under three conditions: blind (only tasting the products), expected (observing product label information) and informed (tasting the products together with provision of the label information). In the expected condition, consumer liking was mainly affected by the brand. In the blind condition, differences in liking were due to the type of product; the samples with a high percentage of cocoa were those less preferred by consumers. Under the informed condition, liking of dark chocolates varied depending on both brand and type of product. Premium brand chocolates generated high consumer expectations of chocolate acceptability, which were fulfilled by the sensory characteristics of the products. Store brand chocolates created lower expectations, but when they were tasted they were as acceptable as premium chocolates. Claims of a high percentage of cocoa and single cocoa origin on labels did not generate higher expectations than regular dark chocolates.

Glutamate supply positively affects serum release of triiodothyronine and insulin across time without increases of glucose during the onset of puberty in female goats.

The current study evaluated the effect of glutamate supply on the onset of puberty and possible links to changes in serum concentrations of insulin [INS], glucose [GLU] and triiodothyronine [T(3)]. The study was conducted from June to November in prepuberal female goats (n=18; 3 mo. old, 7/8 Saanen-Alpine, 1/8 Criollo, 26° north) randomly assigned to two experimental groups: (i) excitatory amino acids group (group AA, n=10; 16.52±1.04 kg LW, 3.4±0.12 body condition score [BCS], receiving an intravenous infusion of 7 mg kg(-1) live weight [LW] of l-glutamate, twice a week, and (ii) control group (group CC, n=8; 16.1±1.04 kg LW, 3.1±0.12 BCS) receiving saline. Blood samples were obtained twice a week, for assessing progesterone [P(4)], as well as in a monthly basis to evaluate INS and T(3) by RIA. Mean final LW and BCS were 23.2±0.72 kg, 3.53±0.10 units, without differences between groups. The AA group depicted an earlier onset of puberty (6.9±0.3 compared to 7.5±0.4 mo.; P<0.05) and an increased ovarian activity (70±0.28% compared to 25±0.26%; P<0.05). Neither serum INS concentrations nor serum glucose concentrations differed between treatments (1.2±0.06 ng mL(-1) and 89.6±1.8 mg 100 mL(-1); P>0.05, respectively). Serum T(3) concentrations, however, were greater in AA goats (1.55±0.03 compared to 1.39±0.04 ng mL(-1)). In addition, a treatment x time interaction occurred (P<0.05) across the experimental period for both T(3) and INS, with increases by the last third of the experimental period, time at which the onset of puberty occurred in both experimental groups. No differences (P>0.05) for glucose concentrations across time occurred between treatments. Results indicate that, in prepuberal goats, glutamate acts as a cue for sexual maturation in a glucose-independent pathway, while both T(3) and INS seem to act as metabolic modulators for the establishment of puberty in goats. Actions of INS and T(3) are mediated directly on hypothalamic centers regulating the pulsatile release of GnRH or indirectly by peripheral cues reflecting INS-T(3) actions on somatic development remains to be determined.

[Nutrient content and health effects of nuts]. / Composición nutritiva y efectos sobre la salud de los frutos secos.

Nuts are foods with a high energy density, due in part to its small water content. They also present a low saturated fat content (<7%) but a high unsaturated fat contribution (40-60%). They represent one of the richest sources of dietary fiber, which is basically of the insoluble type. The effects of nut intake on health have been widely studied. Several prospective epidemiological studies performed on large cohorts have consistently shown that regular consumption of small amounts of nuts is negatively related to the risk of cardiovascular disease and to the risk of cardiovascular or all-cause mortality. From these studies can be concluded that regular consumption of small amounts of nuts leads to a 30-50% reduction in the risk of cardiovascular disease. Additionally, intervention studies have shown a positive effect of nut intake on lipid profile with significant reductions in total and LDL cholesterol levels and small or null effects on the HDL fraction. More recently, some studies have focused on the effect of nuts on body weight. At present, no evidences support a detrimental effect of nut consumption on body weight. On the contrary some weight loss studies suggest a beneficial effect of nut intake on body weight regulation.

Composición nutritiva y efectos sobre la salud de los frutos secos / Nutrient content and health effects of nuts

Los frutos secos son alimentos caracterizados por una alta densidad energética debida en parte a su escaso contenido hídrico. Además, presentan un bajo contenido en grasa saturada (<7 por ciento) y un elevado aporte de grasa insaturada (40-60 por ciento). Constituyen también una de las fuentes más ricas de fibra dietética, fundamentalmente insoluble. Se ha estudiado ampliamente cuales son los efectos que la ingestión de frutos secos tiene sobre la salud. Diversos estudios epidemiológicos prospectivos realizados sobre amplias cohortes han mostrado consistentemente una relación negativa entre el consumo regular de pequeñas cantidades de frutos secos y el riesgo de enfermedad cardiovascular o el riesgo de mortalidad de origen cardiovascular y de mortalidad por todas las causas. El análisis de estos estudios refleja que el consumo regular de pequeñas cantidades de frutos secos reduce el riesgo de enfermedad cardiovascular en un 30-50 por ciento. Los estudios de intervención demuestran que la toma regular de suplementos de frutos secos mejora el perfil lipídico, reduciendo significativamente los niveles de colesterol total y colesterol LDL con escaso o nulo efecto sobre las HDL. El efecto de los frutos secos sobre el peso corporal ha sido también recientemente estudiado. Hasta el momento no existen evidencias de un aumento de peso corporal asociado al consumo de estos alimentos y, sin embargo, algunos estudios de pérdida ponderal sugieren un posible efecto beneficioso en la regulación del peso corporal