Markov modeling for cost-effectiveness using federated health data network.

OBJECTIVE: To introduce 2 R-packages that facilitate conducting health economics research on OMOP-based data networks, aiming to standardize and improve the reproducibility, transparency, and transferability of health economic models. MATERIALS AND METHODS: We developed the software tools and demonstrated their utility by replicating a UK-based heart failure data analysis across 5 different international databases from Estonia, Spain, Serbia, and the United States. RESULTS: We examined treatment trajectories of 47 163 patients. The overall incremental cost-effectiveness ratio (ICER) for telemonitoring relative to standard of care was 57 472 €/QALY. Country-specific ICERs were 60 312 €/QALY in Estonia, 58 096 €/QALY in Spain, 40 372 €/QALY in Serbia, and 90 893 €/QALY in the US, which surpassed the established willingness-to-pay thresholds. DISCUSSION: Currently, the cost-effectiveness analysis lacks standard tools, is performed in ad-hoc manner, and relies heavily on published information that might not be specific for local circumstances. Published results often exhibit a narrow focus, central to a single site, and provide only partial decision criteria, limiting their generalizability and comprehensive utility. CONCLUSION: We created 2 R-packages to pioneer cost-effectiveness analysis in OMOP CDM data networks. The first manages state definitions and database interaction, while the second focuses on Markov model learning and profile synthesis. We demonstrated their utility in a multisite heart failure study, comparing telemonitoring and standard care, finding telemonitoring not cost-effective.

Network analysis of physical activity and depressive and affective symptoms during COVID-19 home confinement.

INTRODUCTION: The aim of this study was to analyze the network structure of physical activity, frequency, depressive, and affective symptoms in people under home isolation due to COVID-19. METHOD: A longitudinal study was conducted in two phases (beginning (March 19, 2020) and end of home confinement (April 8, 2020)). The sample consisted of 579 participants from Spain (250 men and 329 women) aged 16 to 92 years (overall sample: M = 47.06, SD = 14.52). A network analysis was performed. RESULTS: Four clusters emerged (PA, depressive symptoms, positive affect, and negative affect). A higher frequency of physical activity was related to better-sustained attention, increased alertness, and enthusiasm. In addition, feelings of guilt and shame were mitigated, and confinement distress and irritability were reduced. Physical activity also mitigated fatigue in women, whereas feelings of unhappiness were reduced in men. CONCLUSION: Physical activity seems to be an effective option for mitigating the negative effects of the COVID-19 pandemic. Public health policymakers should develop programs to promote physical activity in order to be able to cope with confinement or similar scenarios in the future.

Factors Influencing the Likelihood of Alcohol and Tobacco Use in Adolescent Athletes: Type of Sport, Age, and Action Tendencies in Sport.

This article proposes a new approach to understand substance use among adolescent athletes. Thus, this article describes an investigation of the likelihood of alcohol and tobacco use in adolescent athletes considering the type of sport, age, gender, and their action tendencies. A total of 552 athletes with an age range of 12-16 years were engaged in medium-high-contact sports (n = 291) and non-contact sports (n = 261). They completed the Children's Action Tendency Scale, the Sport Children's Action Tendency Scale, and the Personal and Social Responsibility Questionnaire. The results showed that 16-year-old athletes were the most likely to drink alcohol and to smoke tobacco (p < 0.001). Likewise, it was found that practicing a medium-high-contact sport was a risk factor for alcohol and tobacco use (p < 0.01). The more aggressive athletes were more likely to have smoked tobacco during the last month (p = 0.019) and also to drink more alcohol that the less aggressive ones (p < 0.001). Finally, the athletes who showed more submissiveness were less likely to have drunk alcohol in the last year and the last month (p < 0.001). These findings show the predictive value of new factors associated with alcohol and tobacco use among adolescent athletes. Preventive measures should be targeted, since a new link between the action tendencies in sport and substance use has been found.

Impact of Teachers' Autonomy Support in Students' Basic Psychological Needs, Intrinsic Motivation and Moderate-to-Vigorous Physical Activity.

The students' active participation in physical education does not always guarantee the fulfilment of the international guidelines on moderate-to-vigorous physical activity (MVPA). The goal of the study was to examine the effects of the teacher autonomy support on the MVPA, basic psychological needs, and intrinsic motivation of primary education students. A three-phase, crossed research design was used in four groups of primary education (grades three, four, five, and six). Eighty-three students (40 boys; 43 girls) completed three physical education sessions with three levels of teacher autonomy support: low, intermediate, and high. They wore WGT3x accelerometers and answered a questionnaire. Results showed significant differences in MVPA, autonomy, competence, and intrinsic motivation (p < 0.001) between sessions one (controlling), two (intermediate-supportive autonomy), and three (full-supportive autonomy). In session three, the students' MVPA increased to 73.70%. In conclusion, teacher's autonomy-supportive environment can be modified to increase the students' intrinsic motivation, basic physiological needs, and MVPA to reach the minimum international standards.

Postoperative limb alignment in total knee replacement. Conventional versus navigated versus robotic techniques.

BACKGROUND: Our objective was to compare the coronal mechanical axis after total knee replacement (TKR) obtained in three groups of patients subjected to conventional, navigated, and robotic surgery. METHODS: Retrospective analysis. RESULTS: 124 knees were included (36 conventional, 41 navigated, 47 robotic). No statistically significant differences were found between the postOp tibiofemoral angle of the conventional, navigated and robotic groups (p = 0.396). A repeated-measure analysis of preOp-to-postOp also found no significant differences (p = 0.387). There were no differences in the proportion of outliers (3-degree) found (p = 0.211). Nevertheless, a higher proportion of patients in the robotic group improved their mechanical alignment, as compared with conventional surgery (p = 0.023), although no differences were found when comparing with navigation (p = 0.121). CONCLUSIONS: No statistically significant differences were found with respect to the postOp alignment achieved. However, statistically significant differences were detected between robotic and conventional surgery when considering the percentage of patients with improved limb alignment.

Psychometric properties of the Clarke questionnaire for hypoglycemia awareness in the Spanish population with type 2 diabetes.

OBJECTIVES: The Clarke questionnaire, validated in Spanish language, assesses hypoglycemia awareness in patients with type 1 diabetes. This study aimed to analyze its psychometric properties in patients with type 2 diabetes (T2DM). METHODS: This was a questionnaire validation study. Patients with T2DM and treated with insulin, sulfonylureas or glinides were consecutively recruited from six endocrinology consultations and six primary care centers. The internal structure of the 8-item Clarke questionnaire was analyzed by exploratory (training sample) and confirmatory (testing sample) factor analysis; the internal consistency using Omega's McDonald coefficient; and goodness of fit with comparative fit index (CFI, cutoff >0.9), Goodness of Fit Index (GFI, cutoff >0.9), and root mean-square error of approximation (RMSEA, cutoff <0.09), as well as unidimensionality indicators. RESULTS: The 265 participants (56.8% men) had a mean age of 67.8 years. Confirmatory factor analysis for one dimension obtained poor indicators: fit test (p < 0.001); CFI = 0.748; RMSEA = 0.122 and SRMR = 0.134. Exploratory factor analysis showed 2 or 3 dimensions with poor adjustment indicators. Omega's McDonald was 0.739. CONCLUSIONS: The Spanish version of the Clarke questionnaire was not valid or reliable for assessing hypoglycemia awareness in people with T2DM in Spanish population.

Self-made material in physical education: Teacher perceptions of the use of an emerging pedagogical model before and during the COVID-19 pandemic.

The COVID-19 pandemic caused drastic changes in education, which had to adapt to changing scenarios (online, face-to-face, hybrid teaching). Within physical education (PE), strategies such as 'do not use or share equipment' were proposed to avoid infections. These strategies fit with an emerging pedagogical model called the Self-made Material Model (SMM), which involves students creating their own PE equipment. The objectives of the present study were: (a) to analyse PE teachers' beliefs about the use of self-made material in their classes, (b) to evaluate teachers' perceptions of the impact of the use of self-made material in PE lessons during the pandemic and (c) to examine gender/age differences. A quantitative, snowball research design was followed. The Self-made Material Questionnaire ( Méndez-Giménez and Fernández-Río, 2011) comprising two scales (41 items) was adapted: Teachers' beliefs about the use of self-made material scale and Teachers' perceptions of the impact of self-made material usage during the pandemic scale. In total, 1093 in-service teachers (443 women, 40.5%; M = 41.39, SD = 9.54) from 13 Ibero-American countries participated. Descriptive statistics were calculated, Student's T test was conducted for comparisons by gender and one-way analysis of variance (ANOVA) was run for comparisons by age ranges. Overall, the scores were high, emphasising the potential to promote recycling and students' creativity and respect for the material. Women scored higher in items such as promoting interdisciplinarity, equality, attention to disability and education in values. In total, 833 (76.21%) teachers used self-made material during the pandemic and reported high levels of satisfaction, expectations of use, usefulness and profitability. No gender differences were found. In the COVID-19 era, the SMM is playing a relevant role as a meaningful framework and a helpful teaching methodology in different educational scenarios.

Validation of the Cooperative Learning Scale and Cooperation Global Factor Using Bifactor Structural Equation Modelling / La validación de la escala de aprendizaje colaborativo y del factor de cooperación global usando el modelo bifactorial de ecuaciones estructurales

Cooperative learning has been found to be more productive in academic, personal, and social variables than individualistic or competitive settings, but there is a lack of adequate assessment instruments. The goals of the study were two: a) adapt and validate the existing Cooperative Learning Scale Spanish version for English-speaking secondary education contexts and b) obtain a cooperation global factor. A total of 778 secondary education students, within the 11-15 age range, enrolled in five different schools in Wales (year seven = 301, year eight = 276, year nine = 201) participated in the study. The original instrument, designed and validated for Spanish contexts, underwent a process of double debugging: a) experts trial and b) pilot study. The Cooperative Learning Scale English version included five factors with three items each: interpersonal skills, group processing, positive interdependence, promotive interaction, and individual accountability. Novel bifactor exploratory structural equation modelling (B-ESEM) was used. Results showed well-defined factors corresponding to a-priori expectations and a G-factor, a cooperation global factor.

Se ha comprobado que el aprendizaje cooperativo es más productivo que el individualista o el competitivo en variables académicas, personales y sociales, pero hay una carencia de instrumentos de evaluación adecuados. Los objetivos del estudio fueron dos: a) validar la Escala de Aprendizaje Cooperativo de cinco factores para contextos ingleses y b) obtener un factor de cooperación global. Participó un total de 778 estudiantes de secundaria, de entre 11 y 15 años de edad, matriculados en cinco centros educativos de Gales (1º ESO = 301, 2º ESO = 276, 3º ESO = 201). El instrumento original, diseñado y validado para el contexto español, sufrió un proceso de doble depuración: a) juicio de expertos y b) estudio piloto. La versión inglesa, Cooperative Learning Scale, incluía cinco factores de tres ítems cada uno: habilidades interpersonales, procesamiento grupal, interdependencia positiva, interacción promotora y responsabilidad individual. Se utilizó un modelo novedoso bifactor exploratorio de ecuaciones estructurales (B-SEM). Los resultados mostraron factores bien definidos que se correspondían con las expectativas, así como un factor-G, de cooperación global.

A Cross-Sectional Study to Measure Physical Activity with Accelerometry in ADHD Children according to Presentations.

(1) Background: Attention deficit hyperactivity disorder (ADHD) is a common mental disorder affecting 5-7% of school-aged children. Previous studies have looked at the effects of physical activity interventions on the symptoms of ADHD, although few have compared the motor behavior of children with ADHD versus those without. This exploratory study provides detailed information on the patterns and intensity of physical activity and sedentary behavior in children with ADHD as measured by Actigraph GT3X accelerometry, as well as the differences in physical activity in the different presentations of ADHD; (2) Methods: A cross-sectional design was used with a sample of 75 children, aged 6 to 12 years, with and without ADHD. The ADHD group had a previous diagnosis, determined by clinical assessment based on DSM-5 criteria; (3) Results: Physical activity levels were higher in children with ADHD compared to children without ADHD, but there was no difference in sedentary time between groups during weekdays or weekends. Physical activity decreased with age, with significant differences in the ADHD group, who exhibited more minutes of moderate Physical activity in 6-7 year-olds than 10-11 year-olds during weekdays and weekends; (4) Conclusions: Sedentary time increased by age in children without ADHD, and there was a decrease in moderate-intensity physical activity time in children with ADHD by age.

Intra-individual changes in 3x2 achievement goals, friendship goals, motivational regulations and consequences in physical education / Cambios intraindividuales en las metas de logro 3x2, metas de amistad, regulaciones motivacionales y consecuencias en educación física

Abstract Introduction: This research examines intraindividual changes in 3x2 achievement goals in physical education classes during one semester, as well as the relationship of these changes with those in other motivational and outcome variables. Method: A total of 334 (178 boys and 156 girls) high school students (M = 13.12, SD = 1.05) completed five questionnaires in two different school years. Results: The results of the true intraindividual change model (TIC) provided unequivocal support for the separation of task-based and self-based goals, as well as the structures based on both valences of approach and avoidance. They also showed different intraindividual change patterns in the 3x2 achievement goals, indicating a progression in the stability of the goals depending on their definition. Intraindividual variability in achievement goals is directly related to intraindividual variability in dependent variables, with the task-approach goals TIC being the most adaptive. Conclusions: These goals should be prioritized.

Resumen Introducción: Este artículo examina el cambio intraindividual de las metas de logro 3x2 en las clases de educación física durante un semestre, así como la relación de estos cambios con los producidos en otras variables motivacionales y de resultado. Método: Un total de 334 (178 varones y 156 mujeres) estudiantes de educación secundaria (M = 13.12, DT = 1.05) completaron un cuestionario en dos cursos escolares diferentes. Resultados: Los resultados de la aplicación del modelado del verdadero cambio intraindividual (TIC) proporcionaron un claro apoyo a la separación de las metas basadas en la tarea y en el yo, así como a las estructuras basadas en ambas valencias de aproximación y evitación. También mostraron patrones de cambio intraindividual diferentes en las metas de logro 3x2 que parecen indicar una progresión en la estabilidad de las metas en función de su definición. Se observa que la variabilidad intraindividual en las metas de logro está directamente relacionada con la variabilidad intra individual en otras variables dependientes, siendo el TIC de las metas de aproximación-tarea el más adaptativo. Conclusiones: Se reafirman los beneficios de promover las metas de aproximación-tarea por encima del resto

Locally linear embedding and plantar pressure-time graph selection in heel pain classification: An observational, case-control study.

Plantar heel pain mainly manifests during the gait cycle when the whole foot is in contact with the floor, which corresponds to the second rocker of the gait. This moment can be studied through the analysis of pressure-time graphs obtained using plantar pressure plate systems. However, these graphs are complex, and a dimensionality reduction method, such as locally linear embedding (LLE), greatly assists in their comprehension. This observational, case-control pilot study included 45 subjects divided into case (n = 21) and control (n = 24) groups, depending on the presence/absence of plantar heel pain. The second rocker pressure-time graphs of the 45 subjects were obtained using the Footwork Pro® plantar pressure plate system. These graphs were analyzed and defined as the dynamic simultaneity surfaces (DSSs). This complex structure was composed of four dimensions: the dynamic simultaneity time (DST), slope upward grade (α), slope downward grade (ß), and height (h), and were reduced into one dimension and classified into pathological and non-pathological subjects using the LLE method. All 45 DSSs were successfully reduced and classified to distinguish between the case (plantar heel pain) and control (non-plantar heel pain) subjects. This study is the first to use the LLE method for gait analysis. This method serves as a novel and promising tool for the study and classification of pathological and non-pathological gait cycles. This method opens the door for future research and analysis, with significant potential to assess diagnosis, treatment follow-up, and injury prevention in physical medicine consultations.

Physical activity and prevention of depressive symptoms in the spanish population during confinement due to covid-19 / Actividad Física y Prevención de Síntomas Depresivos en Población Española durante el Confinamiento por COVID-19

BACKGROUND: In March 2020, the Spanish government established an official lockdown across the country in response to the COVID-19 pandemic and confined the population to their homes, restricting their mobility. The objectives of the study are twofold: a) to examine dose-response relationships between physical activity (PA) components (volume, intensity, frequency, duration) and depressive symptoms of the population during confinement, and b) to identify the optimal levels of PA to mitigate notable depressive symptoms (NDS). METHODS: 4,811 (2,952 women) Spanish citizens, age range 16-92 years, completed an online questionnaire (snowball sampling) to measure their levels of depressive symptoms, PA, and various anthropometric and sociometric variables. Volume (METs-min/week), frequency (days/week), and duration (hours) were examined using logistic regressions with restricted cubic splines. RESULTS: The PA components were inversely associated with NDS. Performing at least 477 METs-min/week was associated with a 33% decrease in probability of NDS, and reaching 3,000 METs-min/week was associated with the lowest risk of NDS (47%). As for frequency, with 10 times/week the probability of NDS was 56% lower. At 10 hours of weekly practice, the probability of NDS was 39% lower. CONCLUSIONS: A range and optimal amount of PA is suggested to reduce the appearance of SDN during confinement

ANTECEDENTES: en marzo de 2020 el gobierno español decretó el estado de alarma debido a la pandemia por COVID-19 y confinó a la población. Los objetivos son dos: a) examinar las relaciones dosis-respuesta entre los componentes de actividad física (AF: volumen, intensidad, frecuencia y duración) y los síntomas depresivos de la población durante el confinamiento, y b) identificar los niveles óptimos de AF para mitigar los síntomas depresivos notables (SDN). MÉTODO: 4.811 (2.952 mujeres) ciudadanos de España, de 16 a 92 años respondieron a un cuestionario on line (muestreo de bola de nieve) para medir sus niveles de síntomas depresivos, AF, y variables antropométricas y sociométricas. El volumen (METs-min/sem), la frecuencia (días/sem) y la duración (horas) se examinaron mediante regresiones logísticas con splines cúbicas restringidas. RESULTADOS: los componentes de AF se asociaron inversamente con las probabilidades de SDN. La realización de 477 METs-min/sem se asoció con una disminución del 33% en las probabilidades de SDN, y alcanzar 3.000 METs-min/sem se asoció con el menor riesgo de SDN (47%). En cuanto a frecuencia, con 10 días/sem las probabilidades de SDN fueron un 56% más bajas. A las 10 horas de práctica semanal, las probabilidades de SDN fueron un 39% más bajas. CONCLUSIONES: se sugiere un rango y cantidad óptima de AF para reducir la aparición de SDN en confinamiento

COVID-19 and home confinement: data on physical activity / COVID-19 y confinamiento en casa: datos de actividad física

In March 14th 2020, the Spanish Government declared the "State of Emergency" due to the pandemic caused by the COVID-19 and all the population was forced to "shelter-at-home" for two weeks. Citizens had less than 24 hours to prepare for the self-quarantine. The goal of the present was to assess Spanish citizens' physical activity practice at the end of the first week of the home quarantine. A total of 1858 Spanish citizens, 674 males and 1184 females (M = 40.18, SD = 15.84 years) agreed to participate. The study is descriptive in nature, based on an on-line questionnaire conducted seven days after the mandatory shelter-at-home health order issued by the Spanish Government. It included The International Physical Activity Questionnai-re, Anthropometric parameters, Sociometric and COVID-19 information. Global results showed that the vast majority of the confined population was below the World Health Organization recommendations on Vigorous Physical Activity, Moderate Physical Activity or a combination. Physical activity practice was dependent on personal factors such as gender, age or weight, but also on contextual factors such as living with a dependent person or the type of house (square meters, having a balcony or a backyard). Insufficient physical activity has been considered a prominent risk factor for non-communicable diseases, mental health and, consequently, quality of life. Mandatory shelter-at home orders like the ones issued due to COVID-19 could be repeated in the future. National authorities should consider the findings from the present study to prevent citizens from putting their health at jeopardy while in confinement

El 14 de marzo de 2020, el gobierno español decretó el "estado de emergencia" debido a la pandemia provocada por la COVID-19 y la población fue forzada a confinarse en sus casas durante dos semanas. Los ciudadanos tuvieron menos de 24 horas para prepararse. El objetivo del estudio fue evaluar la práctica de actividad física de los españoles al final de la primera semana de la cuarentena en el hogar. Un total de 1858 ciudadanos españoles, 674 varones y 1184 mujeres (M = 40.18, SD = 15.84 años) accedieron a participar. El estudio siguió un diseño descriptivo, basado en un cuestionario on-line distribuido siete días después de decretarse por el Gobierno de España la orden de confinamiento de la población. Incluía el International Physical Activity Questionnaire, medidas antropométricas, sociométricas e información relacionada con el COVID-19. Los resultados globales mostraron que la amplia mayoría de la población confinada estaba por debajo de las recomendaciones de la Organización Mundial de la Salud de Actividad Física Vigorosa, Actividad Física Moderada o una combinación. La práctica de actividad física dependió de factores personales como el género, la edad o el peso, pero también de factores contextuales como convivir con una persona dependiente o el tipo de casa (metros cuadrados, disponer de un balcón o de un patio). Una insuficiente cantidad de actividad física ha sido considerada como un factor de riesgo importante para el desarrollo de enfermedades no-comunicables, para la salud mental y, consecuentemente, para la calidad de vida y los ciudadanos españoles confinados tenían niveles por debajo de los recomendados. Órdenes de confinamiento como las que se han decretado a raíz del COVID-19 podrían repetirse en el futuro. Las autoridades nacionales deberían tener en cuenta los resultados del presente estudio para prevenir que los ciudadanos pongan en riesgo su salud durante el confinamiento

Effects of Sleep on the Academic Performance of Children with Attention Deficit and Hyperactivity Disorder.

Attention deficit and hyperactivity disorder (ADHD) is commonly associated with disordered or disturbed sleep and the association of sleep problems with ADHD is complex and multidirectional. The purpose of this study was to analyze the relationship between sleep and academic performance, comparing children with ADHD and a control group without ADHD. Academic performance in Spanish, mathematics, and a foreign language (English) was evaluated. Different presentations of ADHD were considered as well as the potential difference between weekday and weekend sleep habits. The sample consisted of 75 children aged 6-12 in primary education. Accelerometry was used to study sleep, and school grades were used to gather information about academic performance. The results showed that ADHD influenced the amount of sleep during weekends, the time getting up at the weekends, weekday sleep efficiency, as well as academic performance. Given the effects that were seen in the variables linked to the weekend, it is necessary to consider a longitudinal design with which to determine if there is a cause and effect relationship.

Physical Activity and Prevention of Depressive Symptoms in the Spanish Population during Confinement due to COVID-19.

BACKGROUND: In March 2020, the Spanish government established an official lockdown across the country in response to the COVID-19 pandemic and confined the population to their homes, restricting their mobility. The objectives of the study are twofold: a) to examine dose-response relationships between physical activity (PA) components (volume, intensity, frequency, duration) and depressive symptoms of the population during confinement, and b) to identify the optimal levels of PA to mitigate notable depressive symptoms (NDS). METHODS: 4,811 (2,952 women) Spanish citizens, age range 16-92 years, completed an online questionnaire (snowball sampling) to measure their levels of depressive symptoms, PA, and various anthropometric and sociometric variables. Volume (METs-min/week), frequency (days/week), and duration (hours) were examined using logistic regressions with restricted cubic splines. RESULTS: The PA components were inversely associated with NDS. Performing at least 477 METs-min/week was associated with a 33% decrease in probability of NDS, and reaching 3,000 METs-min/week was associated with the lowest risk of NDS (47%). As for frequency, with 10 times/week the probability of NDS was 56% lower. At 10 hours of weekly practice, the probability of NDS was 39% lower. CONCLUSIONS: A range and optimal amount of PA is suggested to reduce the appearance of SDN during confinement.

A longitudinal study on depressive symptoms and physical activity during the Spanish lockdown / Estudio longitudinal de los síntomas depresivos y la actividad física durante el confinamiento en España

Background/Objective: The aim was to evaluate the evolution of depressive symptoms and to explore the influence of physical activity (PA) practice during the home confinement due to the COVID-19 outbreak in Spain. Method: Information was collected from 595 confined participants who reported personal and contextual information, depressive symptoms and PA levels at four time points. Results: The changes in depressive symptoms were analyzed using a linear mixed model with cubic splines. Results showed a significant increase, with a significant rise between T1 and T2 (OR = 2.38, 95% CI = 1.83-3.10). It continued growing until T4 (OR = 2.93, 95% CI = 1.97-4.38). A negative relationship was observed between the increase in depressive symptoms and moderate-to-vigorous physical activity (MVPA) levels, with a significant slope up to 4 hours of MVPA per week (OR = 0.51, 95% CI = 0.29-0.90) that tended to increase until 16 hours per week of MVPA (OR = 0.41, 95% CI = 0.20-0.87). Conclusions: Results from a partition model showed that moderate intensity of PA could be enough to prevent an increase of depressive symptoms during home isolation. (AU)

Antecedentes/Objetivo: El objetivo fue evaluar la evolución de los síntomas depresivos y explorar la influencia de la práctica de actividad física (AF) durante la fase de confinamiento domiciliario de la población española como consecuencia de la enfermedad del coronavirus 2019 (COVID-19). Método: Participaron 595 personas confinadas que informaron de su situación personal, los síntomas depresivos y la AF en cuatro momentos de medida. Resultados: Los cambios en los síntomas depresivos analizados con splines cúbicos a partir de modelos lineales mixtos, mostraron un incremento significativo, con una subida importante entre el T1 y el T2 (OR=2,38, 95% CI=1,83-3,10), para luego seguir incrementándose de manera más lenta hasta el T4 (OR=2,93, 95% CI=1,97-4,38). Se observó una relación inversa entre el incremento de los síntomas depresivos y los niveles de actividad física moderada-vigorosa (AFMV) semanal, con una pendiente importante hasta las cuatro horas de AFMV a la semana (OR=0,51, 95% CI=0,29-0,90) que tiende a disminuir hasta las 16 horas/semana AFMV (OR=0,41, 95% CI=0,20-0,87). Conclusiones: Se probó un modelo de partición que mostró que la AF de intensidad moderada podría ser suficiente para prevenir un incremento de los síntomas depresivos en situación de confinamiento. (AU)

A longitudinal study on depressive symptoms and physical activity during the Spanish lockdown.

Background/Objective: The aim was to evaluate the evolution of depressive symptoms and to explore the influence of physical activity (PA) practice during the home confinement due to the COVID-19 outbreak in Spain. Method: Information was collected from 595 confined participants who reported personal and contextual information, depressive symptoms and PA levels at four time points. Results: The changes in depressive symptoms were analyzed using a linear mixed model with cubic splines. Results showed a significant increase, with a significant rise between T1 and T2 (OR = 2.38, 95% CI = 1.83-3.10). It continued growing until T4 (OR = 2.93, 95% CI = 1.97-4.38). A negative relationship was observed between the increase in depressive symptoms and moderate-to-vigorous physical activity (MVPA) levels, with a significant slope up to 4 hours of MVPA per week (OR = 0.51, 95% CI = 0.29-0.90) that tended to increase until 16 hours per week of MVPA (OR = 0.41, 95% CI = 0.20-0.87). Conclusions: Results from a partition model showed that moderate intensity of PA could be enough to prevent an increase of depressive symptoms during home isolation.

Antecedentes/Objetivo: El objetivo fue evaluar la evolución de los síntomas depresivos y explorar la influencia de la práctica de actividad física (AF) durante la fase de confinamiento domiciliario de la población española como consecuencia de la enfermedad del coronavirus 2019 (COVID-19). Método: Participaron 595 personas confinadas que informaron de su situación personal, los síntomas depresivos y la AF en cuatro momentos de medida. Resultados: Los cambios en los síntomas depresivos analizados con splines cúbicos a partir de modelos lineales mixtos, mostraron un incremento significativo, con una subida importante entre el T1 y el T2 (OR = 2,38, 95% CI = 1,83-3,10), para luego seguir incrementándose de manera más lenta hasta el T4 (OR = 2,93, 95% CI = 1,97-4,38). Se observó una relación inversa entre el incremento de los síntomas depresivos y los niveles de actividad física moderada-vigorosa (AFMV) semanal, con una pendiente importante hasta las cuatro horas de AFMV a la semana (OR = 0,51, 95% CI = 0,29-0,90) que tiende a disminuir hasta las 16 horas/semana AFMV (OR = 0,41, 95% CI = 0,20-0,87). Conclusiones: Se probó un modelo de partición que mostró que la AF de intensidad moderada podría ser suficiente para prevenir un incremento de los síntomas depresivos en situación de confinamiento.

Renal function and attributable risk of death and cardiovascular hospitalization in participants with diabetes from a registry-based cohort.

AIMS: To estimate the attributable risk of renal function on all-cause mortality and cardiovascular hospitalization in patients with diabetes. METHODS: A prospective cohort study in 19,469 adults with diabetes, free of cardiovascular disease, attending primary care in Spain (2008-2011). The estimated glomerular filtration rate (eGFR) and other variables were collected and patients were followed to the first hospitalization for coronary or stroke event, or death, until the end of 2012. The cumulative incidence of the study endpoints by eGFR categories was graphically displayed and adjusted population attributable risks (PARs) for low eGFR was calculated. RESULTS: Mean follow-up was 3.2 years and 506 deaths and 1720 hospitalizations were recorded. The cumulative risk for the individual events increased as eGFR levels decreased. The PAR associated with having an eGFR of 60mL/min/1.73m2 or less was 11.4% (95% CI 4.8-18.3) for all-cause mortality, 9.2% (95% CI 5.3-13.4) for coronary heart disease, and 2.6% (95% CI -1.8 to 7.4) for stroke. CONCLUSIONS: Reduced eGFR levels were associated with a larger proportion of avoidable deaths and cardiovascular hospitalizations in people with diabetes compared to previously reported results in people with other cardiovascular risk factors.

Analysis of LDL and HDL size and number by nuclear magnetic resonance in a healthy working population: The LipoLab Study.

BACKGROUND AND AIM: Atherosclerosis is the underlying process in cardiovascular disease (CVD), the first cause of death in developed countries. We aimed to identify people with no known CVD and normal values of LDL-C and HDL-C, but with alterations in the number and size of lipoprotein particles (as measured by nuclear magnetic resonance [NMR]) and to analyse their sociodemographic, clinical and biochemical characteristics. METHODS: Cross-sectional study in occupational risks prevention centre in Castellón (Spain) in 2017 and 2018, in consecutively recruited adults (18-65 years) with no known CVD. Sociodemographic, clinical and biochemical variables were collected. Lipid profiles were analysed (Liposcale test), along with the concentration, size and number of the main types of lipoprotein particles, determined by 2D diffusion-ordered NMR spectroscopy. Using contingency tables, we analysed the characteristics of people with normal LDL and HDL cholesterol but abnormal levels of LDL and HDL particles. The magnitude of association between explanatory variables and abnormal levels of each kind of lipoprotein was assessed with multivariable logistic regression models. RESULTS: Of the 400 total participants (31.3% women; age 46.4 ± 4.3 years), 169 had normal LDL and HDL cholesterol. Abnormal lipoprotein particle values depended on the subtype: prevalence of abnormal LDL levels ranged from 8.3% to 36.7%; and of HDL, from 28.4% to 42.6%. High systolic blood pressure and total cholesterol were significantly associated with abnormal LDL levels. Male sex and high systolic blood pressure were associated with abnormalities in HDL. CONCLUSIONS: An extended lipids profile, obtained by NMR, enables the identification of people with normal HDL-C and LDL-C levels who present abnormal levels of LDL-P and/or HDL-P. Higher total cholesterol, systolic blood pressure, BMI and male sex were significantly associated with these abnormal values.

Resilience and physical activity in people under home isolation due to COVID-19: A preliminary evaluation.

BACKGROUND: The recent shelter-in-place order issued by the Spanish government (due to the outbreak of the COVID-19) forced the Spanish population to self-isolate at home. The psychological and social effects of this new situation are unknown. Therefore, this study aimed to examine the impact of such scenario on citizens' resilience, as well as the connections between resilience, physical activity (PA), gender, weight and body mass index (BMI) before and after confinement, and COVID-19-related information. METHODS: A total of 1795 people answered an online questionnaire conducted on March 21st, , 2020, seven days after the mandatory shelter-in-place health order was issued. RESULTS: Results showed that individuals who regularly engaged in Vigorous PA during the first week of confinement reported higher resilience in terms of higher locus of control, higher self-efficacy, and higher optimism. Moreover, inter-personal resilience differences were observed based on gender, age groups, BMI, weight, and people living with dependent persons or under health risk conditions. CONCLUSION: To the best of our knowledge, these findings are the first quantitative evidence pointing towards a link between engagement in Vigorous PA and resilience within the COVID-19 restrictions in Spain. These findings may have important implications for general population during the course of this pandemic, or future ones.