Exploring nursing student self-esteem change and its predictors: cohort study and its methodological challenges.

OBJECTIVE: Considering methodological difficulties and inconsistent results of previous studies on it, the objective was to describe the change in nursing student self-esteem over time and its predictors, using a sound theoretical framework and relevant tools to measure and analyse the data. METHOD: Cohort study. Self-esteem and related factors were assessed in nursing students in a 4-year bachelor's program at the beginning of each academic year from 2017 to 2019 and at the end of the academic year in May 2020, using he revised version of Self-liking/Self-competence scale of Tafarodi and Swann. Univariate and multivariate analyses were performed via generalized linear mixed modelling. RESULTS: Self-esteem was moderate at the beginning of the program: 50.40 (9.10). It increased slightly over time: 51.15 (9.11) at T1; 51.64 (0.49) at T2; and 51.39 (10.79) at T3 (p = .002). Baseline variables that predicted self-esteem change were gender, secondary school graduation level, state anxiety, intent to continue, and self-efficacy. Assessing and improving those last variables via a strong career plan could boost student achievement and increase retention during and after training. CONCLUSION: Nursing student self-esteem can be assessed using a bidimensional model, with a two-factor scale like Tafarodi & Swann's self-liking/self-competence scale. Generalized linear mixed model is a useful way to correlate large sets of longitudinal data.

Core data set para la generación de datos de la vida real en esclerosis múltiple: adaptación de una iniciativa global para América Latina / Core data set for real world data in multiple sclerosis: customization for latin america from a global task force recommendation

Introducción: Los objetivos primarios del core data set son reducir la heterogeneidad y promover la armonización entre las fuentes de datos en la esclerosis múltiple (EM), reduciendo así el tiempo necesario para ejecutar esfuerzos en la recolección de datos de vida real. Recientemente, un grupo liderado por la Multiple Sclerosis Data Alliance ha desarrollado un core data set para la recolección de datos del mundo real en EM a nivel global. Nuestro objetivo ha sido adaptar y consensuar este conjunto de datos globales a las necesidades de América Latina para que pueda ser implementado por los registros ya desarrollados y en proceso de desarrollo en la región. Material y métodos. Se conformó un grupo de trabajo regionalmente y se adaptó el core data set creado globalmente (proceso de traducción al español, incorporación de variables regionales y consenso sobre variables que se iban a utilizar). El consenso se obtuvo a través de la metodología Delphi remoto de ronda de cuestionarios y discusión a distancia de las variables del core data set. Resultados: Veinticinco profesionales de América Latina llevaron adelante el proceso de adaptación entre noviembre de 2022 y julio de 2023. Se estableció un acuerdo sobre un core data set de nueve categorías y 45 variables, versión 2023, con la sugerencia de implementarlo en registros desarrollados o en vías de desarrollo y cohortes de EM en la región. Conclusión: El core data set busca armonizar las variables recolectadas por los registros y las cohortes de EM en América Latina con el fin de facilitar dicha recolección y permitir una colaboración entre fuentes. Su implementación facilitará la recolección de datos de vida real y la colaboración en la región.(AU)

Introduction: The primary objective of the core data set is to reduce heterogeneity and promote harmonization among data sources in EM, thereby reducing the time needed to execute real life data collection efforts. Recently, a group led by the Multiple Sclerosis Data Alliance has developed a core data set for collecting real-world data on multiple sclerosis (MS) globally. Our objective was to adapt this global data set to the needs of Latin America, so that it can be implemented by the registries already developed and in the process of development in the region. Material and methods: A working group was formed regionally, the core data set created globally was adapted (translation process into Spanish, incorporation of regional variables and consensus on variables to be used). Consensus was obtained through the remote Delphi methodology of a round of questionnaires and remote discussion of the core data set variables. Results: A total of 25 professionals from Latin America carried out the adaptation process between November 2022 and July 2023. Agreement was established on a core data set of nine categories and 45 variables, version 2023 to suggest its implementation in developed or developing registries, and MS cohorts in the region. Conclusion: The core data set seeks to harmonize the variables collected by registries and cohorts in MS in Latin America in order to facilitate said collection and allow collaboration between sources. Its implementation will facilitate real life data collection and collaboration in the region.(AU)

Salud cardiovascular en España basada en el Life's Essential 8 y su asociación con mortalidad general y cardiovascular: la cohorte ENRICA / Cardiovascular health in Spain based on the Life's Essential 8 and its association with all-cause and cardiovascular mortality: the ENRICA cohort

Introducción y objetivos: La American Heart Association ha desarrollado el índice Life's Essential 8 (LE8) para promover la prevención de la enfermedad cardiovascular (ECV). Este estudio examinó la distribución del LE8 en la población adulta española y su asociación con la mortalidad general y por ECV.MétodosSe analizaron datos de 11.616 personas de edad≥ años (el 50,5% mujeres) del estudio ENRICA, reclutadas en 2008-2010 y seguidas hasta 2020-2022. El LE8 incluye 8 parámetros (dieta, actividad física, exposición a la nicotina, sueño, índice de masa corporal, lípidos y glucosa en sangre y presión arterial) y se puntúa de 0 a 100. La asociación entre LE8 y mortalidad se resumió mediante hazardratio obtenidas de modelos de Cox.ResultadosEl 13,2% de los participantes (del 6,1 al 16,9% según la comunidad autónoma) mostraron mala salud cardiovascular (LE8≤49). Tras una mediana de 12,9 años de seguimiento, ocurrieron 908 muertes totales y, durante una mediana de 11,8 años de seguimiento, 207 muertes por ECV. Tras ajustar por los principales factores de confusión y comparados con el cuartil más bajo (menos saludable) de LE8, los HR (IC 95%) de mortalidad general en el segundo, el tercer y el cuarto cuartil fueron, respectivamente, 0,68 (0,56-0,83), 0,63 (0,51-0,78) y 0,53 (0,39-0,72). Los resultados correspondientes a la mortalidad cardiovascular, considerando riesgos competitivos de muerte, fueron 0,62 (0,39-0,97), 0,55 (0,32-0,93) y 0,38 (0,16-0,89).ConclusionesUna proporción sustancial de los españoles mostraron mala salud cardiovascular. Una mayor puntación de LE8, desde el segundo cuartil, se asocia con menores mortalidad general y cardiovascular. (AU)

Introduction and objectives: The American Heart Association has recently developed the Life's Essential 8 (LE8) score to encourage prevention of cardiovascular disease (CVD). This study assessed the distribution of LE8 in the Spanish adult population and its association with all-cause and CVD death.MethodsWe used data from 11 616 individuals aged 18 years and older (50.5% women) from the ENRICA study, recruited between 2008 and 2010 and followed up until 2020 to 2022. The LE8 score includes 8 metrics (diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids and glucose, and blood pressure) and ranges from 0 to 100. The association of LE8 score with mortality was summarized with hazard ratios (HR), obtained from Cox regression.ResultsIn total, 13.2% of participants (range, 6.1%-16.9% across regions) had low cardiovascular health (LE8≤49). During a median follow-up of 12.9 years, 908 total deaths occurred, and, during a median follow-up of 11.8 years, 207 CVD deaths were ascertained. After adjustment for the main potential confounders and compared with being in the least healthy (lowest) quartile of LE8, the HR (95%CI) of all-cause mortality for the second, third and fourth quartiles were 0.68 (0.56-0.83), 0.63 (0.51-0.78), and 0.53 (0.39-0.72), respectively. The corresponding figures for CVD mortality, after accounting for competing mortality risks, were 0.62 (0.39-0.97), 0.55 (0.32-0.93), and 0.38 (0.16-0.89).ConclusionsA substantial proportion of the Spanish population showed low cardiovascular health. A higher LE8 score, starting from the second quartile, was associated with lower all-cause and CVD mortality. (AU)

Caracterización de las complicaciones intrahospitalarias de los estados hiperglucémicos en pacientes adultos internados en el Hospital Nacional de Itauguá, Paraguay, en 2015-2022

Introducción: las complicaciones más graves de la diabetes mellitus son la cetoacidosis diabética y el estado hiperglucémico hiperosmolar, muchas veces se observan alteraciones clínicas y laboratoriales que abarcan los dos espectros y que denominamos estado mixto, representan cerca del 50% de las hospitalizaciones en el servicio de urgencias en pacientes diabéticos. Objetivo: determinar las complicaciones intrahospitalarias y los desenlaces de los estados hiperglucémicos en pacientes adultos internados en el Hospital Nacional, Itauguá, Paraguay, en el periodo 2015-2022. Metodología: se aplicó un diseño de cohortes retrospectivas. Se seleccionaron pacientes con diagnósticos de diabetes mellitus tipo 1 y tipo 2, mayores de 18 años, de ambos sexos, agrupados en tres cohortes que corresponden a cada una de las descompensaciones agudas de la diabetes mellitus. La muestra estuvo conformada por 180 pacientes distribuidos en tres grupos de cohortes con 60 pacientes cada una. Resultados: 51% correspondió al sexo masculino. Se halló mayor desarrollo de eventos cardiovasculares, infecciones intrahospitalarias, requerimiento de cuidados intensivos y mortalidad en la cohorte con estado hiperosmolar. Conclusión: la cohorte con estado hiperosmolar hiperglucémico se caracterizó por la mayor cantidad de complicaciones.

Introduction: The most serious complications of diabetes mellitus are diabetic ketoacidosis and the hyperosmolar hyperglycemic state. Clinical and laboratory alterations are often observed that cover both spectrums and which we call a mixed state. They represent close to 50% of hospitalizations in the service. of emergencies in diabetic patients. Objective: To determine in-hospital complications and outcomes of hyperglycemic states in adult patients admitted to the Hospital Nacional, Itauguá, Paraguay, in the period 2015-2022. Methodology: A retrospective cohort design was applied. Male and female patients with diagnoses of type 1 and type 2 diabetes mellitus, who were over 18 years of age, were selected and grouped into three cohorts that corresponded to each of the acute decompensations of diabetes mellitus. The sample was made up of 180 patients distributed into three cohort groups with 60 patients each. Results: Fifty one percent were male. A greater development of cardiovascular events, hospital-acquired infections, intensive care requirements and mortality were found in the cohort with hyperosmolar state. Conclusion: the cohort with hyperglycemic hyperosmolar state was characterized by the highest number of complications.

Efeito da idade-período-coorte na mortalidade por câncer do colo do útero no Centro-Oeste do Brasil, 1980-2019 / Age-period-cohort effect on cervical cancer mortality in the Center-West of Brazil, 1980-2019 / Efecto edad-período-cohorte en la mortalidad por cáncer de cuello uterino en el Centro-Oeste de Brasil, 1980-2019

Objetivos: analisar o efeito da idade-período-coorte nas taxas de mortalidade por câncer do colo do útero no Centro-Oeste do Brasil. Métodos: estudo ecológico de séries temporais, de 1980 a 2019, cujas fontes de dados foram o Sistema de Informação sobre Mortalidade e as estimativas populacionais do Instituto Brasileiro de Geografia e Estatística. Modelos de efeito idade-período-corte com distribuição de Poisson foram usados. Resultados: observaram-se 19.260 óbitos, correspondente à taxa de mortalidade padronizada média de 17,23/100 mil mulheres. O efeito da idade indicou aumento progressivo das taxas com o avançar da idade. O efeito do período evidenciou redução do risco de morte no Distrito Federal (2015-2019), Mato Grosso do Sul (2010-2014) e Mato Grosso (2010-2019), além de aumento em Goiás (2015-2019). O efeito da coorte revelou aumento do risco de morte para as nascidas antes de 1950-1954 e redução nas gerações a partir de 1955-1959. Conclusão: há evidências de efeito da idade-período-coorte na mortalidade por câncer do colo do útero no Centro-Oeste brasileiro, o que demanda fortalecimento de ações para sua prevenção e controle voltadas para mulheres de coortes e idades sob maior risco de morrer por essa causa.

Objectives: to analyze the effect of age-period-cohort on cervical cancer mortality rates in the Center-West of Brazil. Methods: ecological time series study from 1980 to 2019, utilizing data from the Mortality Information System and population estimates from the Brazilian Institute of Geography and Statistics. Age-period-cohort effect models with Poisson distribution were employed. Results: 19,260 deaths were observed, corresponding to an average standardized mortality rate of 17.23/100,000 women. The age effect indicated a progressive increase in rates as age advanced. The period effect showed a reduction in the risk of death in the Federal District (2015-2019), Mato Grosso do Sul (2010-2014), and Mato Grosso (2010-2019), as well as an increase in Goiás (2015-2019). The cohort effect showed an increase in the risk of death for those born before 1950-1954 and a reduction in the generations from 1955-1959 onwards. Conclusion: there is evidence of an age-period-cohort effect on mortality from cervical cancer in the Brazilian Center-West, which calls for the strengthening of actions for its prevention and control aimed at women of cohorts and ages at greater risk of dying from this cause.

Objetivos: análisis del efecto de la edad-período-cohorte en las tasas de mortalidad por cáncer de cuello uterino en el centro-oeste de Brasil. Métodos:estudio de series temporales ecológicas, de 1980 a 2019, cuyas fuentes de datos fueron el Sistema de Información de Mortalidad y las estimaciones de población del Instituto Brasileño de Geografía y Estadística. Se utilizaron modelos de efecto edad-período-corte con distribución de Poisson. Resultados: se registraron 19.260 fallecimientos, lo que corresponde a una tasa media de mortalidad estandarizada de 17,23/100.000 mujeres. El efecto edad indicó un aumento progresivo de las tasas con el avance de la edad. El efecto período mostró una reducción del riesgo de muerte en el Distrito Federal (2015-2019), Mato Grosso do Sul (2010-2014) y Mato Grosso (2010-2019), así como un aumento en Goiás (2015-2019). El efecto cohorte mostró un aumento del riesgo de muerte para los nacidos antes de 1950-1954 y una reducción en las generaciones a partir de 1955-1959. Conclusión: hay evidencias de un efecto edad-período-cohorte en la mortalidad por cáncer de cuello uterino en el Centro-Oeste brasileño, lo que exige el refuerzo de las acciones para su prevención y control dirigidas a las mujeres de cohortes y edades con mayor riesgo de morir por esta causa.

Aseguramiento y control de la calidad de los datos en un estudio de cohorte en Colombia

Introducción: La calidad de los datos facilita garantizar la fiabilidad de los estudios observacionales. Objetivo: Describir el aseguramiento y el control de calidad para mantener la fiabilidad y la validez del dato en un estudio de cohorte. Métodos: Presentar el manejo de datos implementado dentro de un seguimiento de enfermos renales crónicos cuya exposición fue un programa de protección renal comparado con el tratamiento convencional y su asociación con desenlaces clínicos. Se evaluó el cambio en la frecuencia de errores después de implementar el plan y la reproducibilidad del ingreso de registros a las bases de datos. Resultados: Se documentó una disminución progresiva en los errores cometidos en la captación de datos. El valor de Kappa entre los recolectores de la información para las variables clínicas más importantes fue 0,960 para la depuración de creatinina 150 mg/dL; 0,730 para la alteración del sedimento urinario; 0,956 para la asignación de estadio al ingreso. Los coeficientes de correlación intraclase para la identificación de las cifras de presión arterial sistólica fue 0,996; para la de presión arterial diastólica 0,993 y para los niveles de creatinina sérica al diagnóstico 0,995. Discusión: La calidad de los datos comienza con el reconocimiento de los retos y dificultades que implica su responsable captación, de ahí el aporte de la estandarización de los procesos y el personal que los lleve a cabo en forma idónea. Estudios evidencian que muchos procesos de mejora surgen en el desarrollo de la investigación sin protocolos preestablecidos. Conclusión: La reducción en la proporción y el tipo de error durante el proceso de captación de datos se debe a su identificación temprana y la corrección de instructivos, del instrumento de control de diligenciamiento y de la capacitación continua del personal. El análisis mostró una buena concordancia interevaluador.

Introduction: Data quality makes it easier to ensure that observational studies are reliable. Objective: To describe assurance and quality control to maintain data reliability and validity in a cohort study. Methodology: We present the data management strategies implemented in a study that followed patients of chronic kidney disease who were in a renal protection program and compared them with those undergoing conventional treatment to observe its association with clinical outcomes. We assessed the changes in error frequency after implementing the plan along with the reproducibility of the strategies for entering records into the databases. Results: We documented a progressive decrease of data collection errors. The Kappa values among data collectors for the most important variables were: 0.960 for creatinine clearance 150 mg/dl; 0.730 for urinary sediment alteration and 0.956 for stage allocation upon admission. The intraclass correlation coefficient for the identification of systolic blood pressure was 0.996; for diastolic blood pressure, the coefficient was 0.993 and for serum creatinine levels at diagnosis, the value was 0.995. Discussion: Data quality begins with the recognition of the challenges and difficulties involved in responsible data collection, hence the contribution of standardized processes and personnel to carry them out in a suitable manner. Studies show that many improvement processes arise in the development of research without pre-established protocols. Conclusion: The reduction in error ratio and type during the data collection process are the result of the early identification of erroneously entered or missing data, the correction of the guidelines for completing forms as well as of the instruments for detecting errors and continuous training of the staff. The analysis showed good inter-rater reliability.

Estudios observacionales analíticos / Analytical observational studies

Los estudios epidemiológicos observacionales y analíticos son aquellos que permiten estudiar relaciones causales y asociaciones entre variables sin que el investigador asigne o introduzca en la muestra el factor de estudio. Es decir, el investigador se limita a observar cómo una exposición da lugar a un desenlace. Existen diferentes tipos de estudios observacionales, algunos prospectivos y otros retrospectivos. En el presente artículo veremos algunos de los diseños más habituales, como el estudio de cohortes y el estudio de casos y controles.(AU)

Observational and analytical epidemiological studies are those that allow the study of causal relationships and associations between variables, without the researcher assigning or introducing the study factor into the sample. That is, the researcher limits himself to observing how an exposure gives rise to an outcome. There are different types of observational studies, some prospective and others retrospective. In this article we will see some of the most common designs, such as the cohort study and the case-control study.(AU)

[Peritoneal dialysis impact on quality of life in elderly]. / Impacto de la diálisis peritoneal en la calidad de vida de adultos mayores.

Background: Nowadays elderly live longer but with more diseases and geriatric syndromes which can deteriorate their quality of life (QoL). Peritoneal dialysis (PD) is a renal replacement therapy which seeks to prolong an improve QoL; however, this is uncertain in elderly. Therefore, comparing QoL before and after starting dialysis in this population may let us know if there is a benefit at this level. Objective: Identify the QoL that patients have before and after PD. Material and methods: Longitudinal, comparative, prospective cohort, before and after study. Elderly with End Stage Renal Disease in whom hospitalization for PD was indicated. QoL was measured the instrument KDQOL SF 1.3. before and after 2 months of PD. Statistical Analysis: T paired test was performed with the basal value of QoL and after. Risks with 95% confidence intervals and X2 were obtained between the basal characteristics and the dependent variable of QoL. Results: 21 patients. After 2 months the QoL had an increment in comparison to basal QoL, but with no statistical significance (63.47 [SD 16.63] Vs 56.83 [16.01], P= 0.22. In the 7th decade PD increased QoL by 13.01 points (P= 0.04). Conclusions: PD increases QoL in the 7th decade.

Introducción: en la actualidad, los adultos mayores (AM) viven más años, pero con más enfermedades y síndromes geriátricos, lo cual puede deteriorar su calidad de vida (CV). La diálisis peritoneal (DP) es una terapia de sustitución renal que se pretende mejorar la esperanza y la CV, aunque esto es incierto en los AM. Por lo tanto, comparar la CV antes y después de iniciar la DP en esta población permite saber si existe un beneficio a ese nivel. Objetivo: identificar la CV con la que cuentan los AM antes y después de DP. Material y métodos: cohorte prospectiva, comparativa, tipo antes y después en AM con enfermedad renal terminal quienes se hospitalizaron para iniciar DP. La CV de determinó con el instrumento KDQOL SF 1.3, antes y dos meses después de la DP. El análisis estadístico consistió en t pareada entre el puntaje de CV basal y después. Entre las características basales y la variable CV se obtuvieron riesgos con intervalos de confianza al 95%, así como Chi cuadrada. Se tomó como significativa una p bilateral de ≤ 0.05. Resultados: 21 pacientes. Luego de 2 meses iniciada la DP, el valor promedio de la CV mostró un incremento en comparación con la CV basal, aunque no logra significancia estadística (63.47 [DE: 16.63] frente a 56.83 [DE: 16.01], p = 0.22. En la séptima década de la vida, la DP produjo un incremento de 13.01 puntos en la CV (p = 0.04). Conclusiones: la DP mejora la CV en AM de la séptima década de la vida.

Fenofibrate normalizes alkaline phosphatase and improves long-term outcomes in patients with advanced primary biliary cholangitis refractory to ursodeoxycholic acid / El fenofibrato normaliza la fosfatasa alcalina y mejora los resultados a largo plazo en pacientes con colangitis biliar primaria avanzada refractaria al ácido ursodesoxicólico

Background: Although patients with advanced liver disease have been included in studies evaluating fibrates for the treatment of primary biliary cholangitis (PBC), the frequency of biochemical responses and adverse effects for this group of patients was not reported separately and comprehensively. Aims: to evaluate the efficacy and safety of additional fenofibrate therapy in patients with advanced and ursodeoxycholic acid (UDCA)-refractory PBC. Methods: Patients were analyzed retrospectively to determine the clinical therapeutic effects of UDCA with additional fenofibrate therapy versus continued UDCA monotherapy. The liver transplantation (LT)-free survival and the alkaline phosphatase (ALP) normalization rates were estimated using Cox regression analyses and Kaplan–Meier plots with inverse probability of treatment weighting (IPTW). Results: A total of 118 patients were included: 54 received UDCA alone and 64 received UDCA in combination with fenofibrate therapy. In the fenofibrate and UDCA groups, 37% and 11% of patients with advanced and UDCA-refractory PBC, respectively, achieved ALP normalization (P=0.001). Additional fenofibrate therapy improved both LT-free survival and ALP normalization rate after IPTW (hazard ratio [HR]: 0.23, 95% confidence interval [CI]: 0.07–0.75, P=0.015; and HR: 11.66, 95% CI: 5.02–27.06, P=0.001, respectively). These effects were supported by parallel changes in the rates of liver decompensation and histologic progression, and the United Kingdom (UK)-PBC and Globe risk scores. (AU)

Antecedentes: Aunque los pacientes con enfermedad hepática avanzada se han incluido en los estudios que evalúan los fibratos para el tratamiento de la colangitis biliar primaria, la frecuencia de las respuestas bioquímicas y los efectos adversos para este grupo de pacientes no se informó por separado y de forma exhaustiva. Objetivos: Evaluar la eficacia y la seguridad del tratamiento adicional con fenofibrato en pacientes con colangitis biliar primaria avanzada y refractaria al ácido ursodesoxicólico. Métodos: Se analizaron los pacientes de forma retrospectiva para determinar los efectos terapéuticos clínicos del ácido ursodesoxicólico con terapia adicional de fenofibrato frente a la monoterapia continuada con ácido ursodesoxicólico. La supervivencia sin trasplante de hígado y las tasas de normalización de la fosfatasa alcalina se estimaron mediante análisis de regresión de Cox y gráficos de Kaplan-Meier con ponderación de la probabilidad inversa del tratamiento. Resultados: Se incluyeron un total de 118 pacientes: 54 recibieron ácido ursodesoxicólico solo y 64 recibieron ácido ursodesoxicólico en combinación con el tratamiento con fenofibrato. En los grupos de fenofibrato y ácido ursodesoxicólico, 37 y 11% de los pacientes con colangitis biliar primaria avanzada y refractaria al ácido ursodesoxicólico, respectivamente, lograron la normalización de la fosfatasa alcalina (p=0,001). El tratamiento adicional con fenofibrato mejoró tanto la supervivencia libre de trasplante de hígado como la tasa de normalización de la fosfatasa alcalina tras la ponderación de la probabilidad inversa del tratamiento (cociente de riesgos: 0,23, intervalo de confianza del 95% [IC 95%]: 0,07-0,75, p=0,015; y cociente de riesgos: 11,66, IC 95%: 5,02–27,06, p=0,001, respectivamente). (AU)

Cardiovascular health in Spain based on the Life's Essential 8 and its association with all-cause and cardiovascular mortality: the ENRICA cohort.

INTRODUCTION AND OBJECTIVES: The American Heart Association has recently developed the Life's Essential 8 (LE8) score to encourage prevention of cardiovascular disease (CVD). This study assessed the distribution of LE8 in the Spanish adult population and its association with all-cause and CVD death. METHODS: We used data from 11 616 individuals aged 18 years and older (50.5% women) from the ENRICA study, recruited between 2008 and 2010 and followed up until 2020 to 2022. The LE8 score includes 8 metrics (diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids and glucose, and blood pressure) and ranges from 0 to 100. The association of LE8 score with mortality was summarized with hazard ratios (HR), obtained from Cox regression. RESULTS: In total, 13.2% of participants (range, 6.1%-16.9% across regions) had low cardiovascular health (LE8 ≤ 49). During a median follow-up of 12.9 years, 908 total deaths occurred, and, during a median follow-up of 11.8 years, 207 CVD deaths were ascertained. After adjustment for the main potential confounders and compared with being in the least healthy (lowest) quartile of LE8, the HR (95%CI) of all-cause mortality for the second, third and fourth quartiles were 0.68 (0.56-0.83), 0.63 (0.51-0.78), and 0.53 (0.39-0.72), respectively. The corresponding figures for CVD mortality, after accounting for competing mortality risks, were 0.62 (0.39-0.97), 0.55 (0.32-0.93), and 0.38 (0.16-0.89). CONCLUSIONS: A substantial proportion of the Spanish population showed low cardiovascular health. A higher LE8 score, starting from the second quartile, was associated with lower all-cause and CVD mortality.

Monitoring health and health behaviors among adolescents in Central Catalonia: DESKcohort protocol / Monitorización de la salud y los comportamientos de salud entre los adolescentes de la Cataluña Central: Protocolo DESKcohort

El objetivo de este estudio prospectivo de cohortes (proyecto DESKcohort) es describir y monitorizar la salud, los comportamientos de salud y sus factores asociados en los adolescentes de entre 12 y 19 años escolarizados en centros de Educación Secundaria Obligatoria o secundaria posobligatoria de la Cataluña Central, considerando los determinantes sociales de la salud. La encuesta DESKcohort se realiza bianualmente, entre los meses de octubre y junio, y el proyecto lleva 3 años en marcha. Se ha entrevistado a 7319 y 9265 adolescentes en los cursos 2019/20 y 2021/22, respectivamente. Respondieron un cuestionario creado por un comité de expertos, que incluía las siguientes variables: sociodemográficas, salud física y mental, alimentación, actividad física, ocio y movilidad, consumo de sustancias, relaciones interpersonales, sexualidad, uso de pantallas y entretenimiento digital, y juegos de azar. Los resultados son presentados a los centros educativos, las diputaciones, los municipios y las entidades sanitarias y del tercer sector para planificar, implementar y evaluar acciones de prevención y promoción de la salud que aborden las necesidades identificadas.(AU)

The objective of the prospective cohort study (the DESKcohort project) is to describe and monitor health, health behaviors, and their related factors among 12 and 19-year-old adolescents schooled at centers of Compulsory Secondary Education or post-compulsory secondary education in Central Catalonia, considering social determinants of health. The DESKcohort survey is administered biannually between the months of October and June, and the project has been running for three years. We have interviewed 7319 and 9265 adolescents in the academic years 2019/20 and 2021/22, respectively. They responded a questionnaire created by a committee of experts, that included the following variables: sociodemographic factors, physical and mental health, food, physical activity, leisure and mobility, substance use, interpersonal relationships, sexuality, screen use and digital entertainment, and gambling. The results are presented to educational centers, county councils, municipalities, and health and third sector entities to plan, implement, and evaluate prevention and health promotion actions that address the identified needs.(AU)

Risk Factors for Type 2 Diabetes in the Multiethnic Cohort.

OBJECTIVES: In this report, we investigated the association between established risk factors and type 2 diabetes (T2D) across 5 distinct ethnic groups and explored differences according to T2D definition within the Multiethnic Cohort (MEC) Study. METHODS: Using the full MEC, with participants in Hawaii and Los Angeles (N=172,230), we applied Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). All participants completed questionnaires asking about demographics, anthropometrics, lifestyle factors, and regular diet. T2D status was determined from self-reported diagnosis/medication and Medicare claims. We assessed the associations between well-established risk factors and T2D in the full cohort, after stratification by ethnic group, according to the T2D definition, and in a biorepository subset. Effect modification by ethnicity was evaluated using Wald's tests. RESULTS: Overall, 46,500 (27%) participants had an incident T2D diagnosis after a mean follow-up of 17.1±6.9 years. All predictors were significantly associated with T2D: overweight (HR=1.74), obesity (HR=2.90), red meat intake (HR=1.15), short (HR=1.04) and long (HR=1.08) sleep duration, and smoking (HR=1.26) predicted a significantly higher T2D incidence, whereas coffee (HR=0.90) and alcohol (HR=0.78) consumption, physical activity (HR=0.89), and diet quality (HR=0.96) were associated with lower T2D incidence. The strength of these associations was similar across ethnic groups with noteworthy disparities for overweight/obesity, physical activity, alcohol intake, coffee consumption, and diet quality. CONCLUSIONS: These findings confirm the importance of known risk factors for T2D across ethnic groups, but small differences were detected that may contribute to disparate incidence rates in some ethnic groups, especially for obesity and physical activity.

Monitoring health and health behaviors among adolescents in Central Catalonia: DESKcohort protocol.

The objective of the prospective cohort study (the DESKcohort project) is to describe and monitor health, health behaviors, and their related factors among 12 and 19-year-old adolescents schooled at centers of Compulsory Secondary Education or post-compulsory secondary education in Central Catalonia, considering social determinants of health. The DESKcohort survey is administered biannually between the months of October and June, and the project has been running for three years. We have interviewed 7319 and 9265 adolescents in the academic years 2019/20 and 2021/22, respectively. They responded a questionnaire created by a committee of experts, that included the following variables: sociodemographic factors, physical and mental health, food, physical activity, leisure and mobility, substance use, interpersonal relationships, sexuality, screen use and digital entertainment, and gambling. The results are presented to educational centers, county councils, municipalities, and health and third sector entities to plan, implement, and evaluate prevention and health promotion actions that address the identified needs.

Prueba de volumen en el quirófano: subestudio planificado del estudio observacional Fluid Day / Fluid challenges in operating room: A planned sub study of the Fluid Day observational study

Antecedentes: La administración intraoperatoria de fluidos es una intervención ubicua en los pacientes quirúrgicos. Pero la administración inadecuada de fluidos puede llevar a malos resultados postoperatorios. La prueba de volumen (PV), dentro o fuera de la denominada fluidoterapia guiada por objetivos, permite probar el sistema cardiovascular y la necesidad de administración adicional de fluidos. Nuestro objetivo primario fue evaluar el modo en que el anestesiólogo realiza la PV en el quirófano en términos de tipo, volumen, variables utilizadas para impulsar la PV, y comparar la proporción de pacientes que recibieron administración adicional de fluidos basada en la respuesta a la PV. Métodos: Se trata de un subestudio planificado de un estudio observacional realizado en 131 centros en España, en pacientes sometidos a cirugía. Resultados: En el estudio se incluyeron y analizaron 396 pacientes. La cantidad media [rango intercuartílico] de fluidos administrados durante la PV fue de 250ml (200-400). La principal indicación de la PV fue el descenso de la presión arterial sistólica en 246 casos (62,2%). La segunda indicación fue el descenso de la presión arterial media (54,4%). Se utilizó el gasto cardiaco en 30 pacientes (7,58%), y la variación del volumen sistólico en 29 de entre 385 casos (7,32%). La respuesta a la PV inicial no tuvo impacto a la hora de prescribir administración adicional de fluidos. Conclusiones: La indicación y la evaluación actuales de la PV en los pacientes quirúrgicos son altamente variables. La predicción de la receptividad a los fluidos no se utiliza rutinariamente, evaluándose a menudo las variables no adecuadas para valorar la respuesta hemodinámica a la PV, pudiendo causar efectos perjudiciales.(AU)

Background: Intraoperative fluid administration is a ubiquitous intervention in surgical patients. But inadequate fluid administration may lead to poor postoperative outcomes. Fluid challenges (FCs), in or outside the so-called goal-directed fluid therapy, allows testing the cardiovascular system and the need for further fluid administration. Our primary aim was to evaluate how anesthesiologists conduct FCs in the operating room in terms of type, volume, variables used to trigger a FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC. Methods: This was a planned substudy of an observational study conducted in 131 centers in Spain in patients undergoing surgery. Results: A total of 396 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during a FC was 250mL (200-400). The main indication for FC was a decrease in systolic arterial pressure in 246 cases (62.2%). The second was a decrease in mean arterial pressure (54.4%). Cardiac output was used in 30 patients (7.58%), while stroke volume variation in 29 of 385 cases (7.32%). The response to the initial FC did not have an impact when prescribing further fluid administration. Conclusions: The current indication and evaluation of FC in surgical patients is highly variable. Prediction of fluid responsiveness is not routinely used, and inappropriate variables are frequently evaluated for assessing the hemodynamic response to FC, which may result in deleterious effects.(AU)

Fluid challenges in operating room: A planned sub study of the Fluid Day observational study.

BACKGROUND: Intraoperative fluid administration is a ubiquitous intervention in surgical patients. But inadequate fluid administration may lead to poor postoperative outcomes. Fluid challenges (FCs), in or outside the so-called goal-directed fluid therapy, allows testing the cardiovascular system and the need for further fluid administration. Our primary aim was to evaluate how anesthesiologists conduct FCs in the operating room in terms of type, volume, variables used to trigger a FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC. METHODS: This was a planned substudy of an observational study conducted in 131 centres in Spain in patients undergoing surgery. RESULTS: A total of 396 patients were enrolled and analysed in the study. The median [interquartile range] amount of fluid given during a FC was 250ml (200-400). The main indication for FC was a decrease in systolic arterial pressure in 246 cases (62.2%). The second was a decrease in mean arterial pressure (54.4%). Cardiac output was used in 30 patients (7.58%), while stroke volume variation in 29 of 385 cases (7.32%). The response to the initial FC did not have an impact when prescribing further fluid administration. CONCLUSIONS: The current indication and evaluation of FC in surgical patients is highly variable. Prediction of fluid responsiveness is not routinely used, and inappropriate variables are frequently evaluated for assessing the hemodynamic response to FC, which may result in deleterious effects.

Comparación de la mortalidad en pacientes en quimioterapia o inmunoterapia durante y antes de la pandemia de COVID-19. Estudio multicéntrico de cohortes emparejadas en Argentina / Comparison of mortality in patients on chemotherapy or immunotherapy during and before COVID-19 pandemic. Multicenter matched cohort study in Argentina

RESUMEN Objetivos. Comparar la mortalidad por todas las causas de pacientes oncológicos no vacunados que recibieron quimioterapia o inmunoterapia durante la pandemia, con aquellos tratados antes de la pandemia. Materiales y métodos. Realizamos un estudio de cohortes en cuatro hospitales terciarios en Argentina. Pacientes ambulatorios con una neoplasia sólida de cualquier estadio en tratamiento citotóxico o inmune intravenoso fueron elegibles. La cohorte pandémica se enroló durante la fase inicial del brote y se comparó con una cohorte de un período anterior a la pandemia utilizando emparejamiento por puntuación de propensión (PSM, por sus siglas en inglés). Los sujetos se emparejaron por edad, sexo, seguro de salud, factores de riesgo para complicaciones graves por COVID-19, estado funcional, tipo de cáncer y tratamiento, línea de tratamiento e índice de masa corporal. La mortalidad por todas las causas se estimó en ambas cohortes después de seis meses de seguimiento. Resultados. 169 pacientes fueron reclutados entre abril y agosto de 2020 para la cohorte pandémica y 377 para la cohorte prepandémica en el mismo período de 2019, 168 pacientes fueron emparejados. Luego de la PSM, la mortalidad por todas las causas fue del 17,9% en la cohorte pandémica y del 18,5% en la cohorte prepandémica, Riesgo Relativo: 0,97 (intervalo de confianza al 95 %: 0,61-1,52; p=0,888). En la cohorte pandémica, 30/168 pacientes fallecieron, ninguno por infección por COVID-19. Conclusiones. No hemos observado un aumento de mortalidad en pacientes ambulatorios no vacunados en tratamiento oncológico endovenoso activo durante la pandemia por COVID-19.

ABSTRACT Objectives. To compare all-cause mortality of unvaccinated oncology patients who received chemotherapy or immunotherapy during the pandemic with those treated before the pandemic. Materials and methods. We conducted a cohort study in four tertiary hospitals in Argentina. Outpatients with a solid neoplasm of any stage under-going cytotoxic or intravenous immunotherapy were eligible. The pandemic cohort was enrolled during the initial phase of the outbreak and compared with a pre-pandemic cohort using propensity score matching (PSM). Subjects were matched for age, sex, health insurance, risk factors for severe COVID-19 complications, performance status, cancer type and treatment, line of treatment, and body mass index. All-cause mortality was estimated for both cohorts after 6 months of follow-up. Results. A total of 169 patients were recruited between April and August 2020 for the pandemic cohort and 377 for the pre-pandemic cohort in the same months of 2019; 168 patients were matched. After PSM, all-cause mortality was 17.9% in the pandemic cohort and 18.5% in the pre-pandemic cohort; the Relative Risk was 0.97 (95 % confidence interval: 0.61-1.52; p=0.888). In the pandemic cohort, 30/168 patients died, but none from COVID-19. Conclusions. Our findings show that the mortality rate of unvaccinated ambulatory patients on active intravenous oncology treatment during the COVID-19 pandemic did not increase.

ITC EUREST-PLUS Spain: protocol of a prospective longitudinal study of smokers in Spain.

OBJECTIVE: The ITC EUREST-PLUS Spain Survey is a longitudinal study of a representative sample of Spanish adult (≥18 years old) smokers. This protocol describes the methods of the 2021 follow-up survey. METHOD: The ITC EUREST-PLUS Survey, a prospective cohort study of a representative sample of smokers in six European countries, was conducted in 2016 (baseline) and 2018 (waves 1 and 2). The 2021 ITC EUREST-PLUS Spain Survey is a continuation of the Spanish cohort with a new interview in 2021 (wave 3). Lost participants were replaced with new smokers recruited using the same multi-stage sampling design. This latest follow-up aims to examine current patterns and transitions of tobacco use and to evaluate the impact of new tobacco-related policies. COMMENTS: The ITC EUREST-PLUS Spain Survey will provide recent information about the impact of tobacco control policies on smoking behaviour.

Sleep patterns in childhood: a longitudinal assessment from the Generation XXI birth cohort.

OBJECTIVE: To describe sleep-wake patterns in young children, based on sleep characteristics in early infancy and preschool ages, identifying their main sociodemographic characteristics, and to assess the association between different sleep characteristics at both ages. METHOD: We included 1092 children from the Generation XXI birth cohort, evaluated at six months and four years of age, by face-to-face interviews. Sleep patterns were constructed through latent class analysis and structured equation modeling, including data on wake-up time and bedtime, afternoon naps, locale of nighttime sleep and night awakenings. To estimate the association between sociodemographic characteristics and sleep patterns, odds ratios and 95% confidence intervals were computed using logistic regression. RESULTS: Two sleep patterns were identified through latent class analysis: pattern 1 was characterized by earlier bedtime and wake-up times, while pattern 2 was defined by later times. When compared with pattern 1, pattern 2 was more frequent among children whose mothers had changed from partnered to not partnered until preschool age and those who did not stay at the kindergarten, and was less common among those with siblings. Through structured equation modeling, an aggregating factor was identified at preschool age, which was mainly correlated with bedtime and wake-up time. A positive association between sleep characteristics evaluated in early infancy and in preschool ages was observed. CONCLUSIONS: Sleep patterns and circadian sleep preferences seem to be developed early in life, which highlight the importance of promoting an adequate sleep hygiene from infancy, assuming its impact on sleep quality during the life course.

Adesão dos enfermeiros à avaliação de risco de lesão por pressão com escala munro / Nurses' adherence to the munro scale pressure injury risk assessment / Adherencia de los enfermeros a la evaluación del riesgo de lesión por presión según la escala munro

RESUMO: Objetivo: medir a taxa de adesão ao registro eletrônico da escala Munro no perioperatório. Método: estudo de coorte retrospectivo baseado na análise de prontuários no ano de 2022, em hospital privado, filantrópico de grande porte no município de São Paulo -BR. Os dados de preenchimento foram extraídos em um relatório em Excel e analisados quanto ao preenchimento da escala. Resultados: 22.743 registros de escala Munro foram analisados, correspondendo a 11.892 prontuários eletrônicos. A taxa de adesão foi de 98,45% na fase pré-operatória, 61,73% na intraoperatória e 90,14% na pós-operatória, sendo a taxa média de 83,44%. As falhas de registro estavam relacionadas à ausência ou preenchimento parcial de itens da escala e execução da fase intra ou pós-operatória sem avaliação da fase anterior. Conclusão: este estudo contribui para a prática profissional, mostrando a necessidade de intervenções educativas e melhorias de processos no intraoperatório para aumentar a adesão à avaliação de risco.

ABSTRACT Objective: To measure the rate of adherence to the electronic recording of the Munro scale in the perioperative period. Method: Retrospective cohort study based on the analysis of medical records in 2022 in a large private philanthropic hospital in the city of São Paulo -BR. The completion data was extracted into an Excel report and analyzed for compliance with the scale. Results: 22,743 Munro scale records were analyzed, corresponding to 11,892 electronic medical records. The adherence rate was 98.45% in the preoperative phase, 61.73% in the intraoperative phase, and 90.14% in the postoperative phase, with an average rate of 83.44%. Failures to record were related to the absence or partial completion of items on the scale and carrying out the intraor post-operative phase without evaluating the previous phase. Conclusion: This study contributes to professional practice by showing the need for educational interventions and improvements in intraoperative processes to increase adherence to risk assessment.

RESUMEN Objetivo: Medir la tasa de adherencia al registro electrónico de la escala Munro en el periodo perioperatorio. Método: Estudio de cohorte retrospectivo basado en el análisis de historias clínicas en el año 2022, en un gran hospital privado filantrópico de la ciudad de São Paulo -BR. Los datos de cumplimentación se extrajeron en un informe de Excel y se analizaron en función de si se había cumplimentado la escala. Resultados: Se analizaron 22.743 registros de la escala Munro, correspondientes a 11.892 historias clínicas electrónicas. La tasa de adherencia fue del 98,45% en la fase preoperatoria, del 61,73% en la intraoperatoria y del 90,14% en la postoperatoria, con una tasa media del 83,44%. Los fallos en el registro estaban relacionados con la ausencia o cumplimentación parcial de los ítems de la escala y con la realización de la fase intra o postoperatoria sin evaluar la fase anterior. Conclusión: Este estudio contribuye a la práctica profesional al mostrar la necesidad de intervenciones educativas y mejoras en los procesos intraoperatorios para aumentar el cumplimiento de la evaluación de riesgos.

Fenofibrate normalizes alkaline phosphatase and improves long-term outcomes in patients with advanced primary biliary cholangitis refractory to ursodeoxycholic acid.

BACKGROUND: Although patients with advanced liver disease have been included in studies evaluating fibrates for the treatment of primary biliary cholangitis (PBC), the frequency of biochemical responses and adverse effects for this group of patients was not reported separately and comprehensively. AIMS: to evaluate the efficacy and safety of additional fenofibrate therapy in patients with advanced and ursodeoxycholic acid (UDCA)-refractory PBC. METHODS: Patients were analyzed retrospectively to determine the clinical therapeutic effects of UDCA with additional fenofibrate therapy versus continued UDCA monotherapy. The liver transplantation (LT)-free survival and the alkaline phosphatase (ALP) normalization rates were estimated using Cox regression analyses and Kaplan-Meier plots with inverse probability of treatment weighting (IPTW). RESULTS: A total of 118 patients were included: 54 received UDCA alone and 64 received UDCA in combination with fenofibrate therapy. In the fenofibrate and UDCA groups, 37% and 11% of patients with advanced and UDCA-refractory PBC, respectively, achieved ALP normalization (P=0.001). Additional fenofibrate therapy improved both LT-free survival and ALP normalization rate after IPTW (hazard ratio [HR]: 0.23, 95% confidence interval [CI]: 0.07-0.75, P=0.015; and HR: 11.66, 95% CI: 5.02-27.06, P=0.001, respectively). These effects were supported by parallel changes in the rates of liver decompensation and histologic progression, and the United Kingdom (UK)-PBC and Globe risk scores. During the follow-up period, serum levels of ALP and aminotransferase decreased significantly, while total bilirubin, albumin, platelet, serum creatinine, and estimated glomerular filtration rate remained stable in fenofibrate-treated participants. No fenofibrate-related significant adverse events were observed in our cohort. CONCLUSIONS: Additional fenofibrate therapy significantly improved LT-free survival and ALP normalization in patients with advanced and UDCA-refractory PBC. Furthermore, adding-on fenofibrate therapy appeared to be safe and well tolerated in this population.