Buccopharyngeal route administered high polyphenolic olive oil and COVID-19: A pilot clinical trial.

INTRODUCTION: Waning immunity after vaccination justifies the need for additional effective COVID-19 treatments. Immunomodulation of local immune response at the oropharyngeal mucosa could hypothetically activate mucosal immunity, which can prevent SARS-CoV-2 main immune evasion mechanisms in early stages of the disease and send an effective warning to other components of immune system. Olive polyphenols are biologically active compounds with immunomodulatory activity. There are previous studies based on immunomodulation with olive polyphenols and respiratory infections using an enteral route, which point to potential effects on time to resolution of symptoms. The investigators sought to determine whether participants following immunomodulation with tiny quantities of high polyphenolic olive oil administered through an oromucosal route could have a better outcome in COVID-19. SUMMARY: This pilot clinical trial investigated the effect of buccopharyngeal administered high polyphenolic olive oil on COVID-19 incidence, duration, and severity. IMPORTANCE: Waning immunity after vaccination justifies the need of further research for additional effective treatments for COVID-19. OBJECTIVE: Immunomodulation of local immune response at the buccopharyngeal mucosa could hypothetically activate mucosal immunity, which would in turn difficult SARS-CoV-2 immune evasion mechanisms in early stages of the disease and send an effective warning to other components of immune system. Olive polyphenols are biologically active compounds with immunomodulatory activity. There are previous studies based on immunomodulation with olive polyphenols and respiratory infections, using an enteral route, which suggest potential shortening of time to resolution of symptoms. The investigators sought to determine whether participants following immunomodulation with tiny quantities of high polyphenolic olive oil administered through an oromucosal route could have a better outcome in COVID-19. DESIGN, SETTING, AND PARTICIPANTS: Double blind, randomized pilot clinical trial conducted at a single site, Talavera de la Reina, Spain. Potential study participants were identified by simple random sampling from the epidemiological database of contact patients recently diagnosed of COVID-19 during the study period. A total of 88 adult participants were enrolled and 84 completed the 3-month study, conducted between July 1, 2021 and August 31, 2022. INTERVENTION: Participants were randomized to receive oromucosal administered high polyphenolic olive oil, 2 mL twice a day for 3 months or no treatment. MAIN OUTCOME AND MEASURES: Primary outcomes were incidence, duration, and severity of COVID-19 after intervention. RESULTS: There were no differences in incidence between both groups but there were significant differences in duration, the median time to resolution of symptoms was 3 days in the high polyphenolic olive oil group compared with 7 days in the no-treatment group. Although time to resolution is directly related to severity, this study did not find any differences in severity. CONCLUSION AND RELEVANCE: Among full-vaccinated adults recent infected with COVID-19, a daily intake of tiny quantities of oromucosal administered high polyphenolic olive oil before infection significantly improved the time to symptom resolution. This finding strongly support the appropriateness of further deep research on the use of oromucosal administered high polyphenolic olive oil as an effective immune strategy against COVID-19.

Postoperative Diet with an Oligomeric Hyperproteic Normocaloric Supplement versus a Supplement with Immunonutrients in Colorectal Cancer Surgery: Results of a Multicenter, Double-Blind, Randomized Clinical Trial.

(1) Background: For normo-nourished colorectal cancer patients, the need for immunonutrients after elective surgery is not known. (2) Methods: Multicenter, randomized, double-blind, phase III clinical trial comparing the postoperative diet with 200 mL oligomeric hyperproteic normocaloric (OHN; experimental arm) supplement vs. 200 mL immunonutritional (IN) (active comparator) supplement twice a day for five days in 151 normo-nourished adult colorectal-resection patients following the multimodal rehabilitation ERAS protocol. The proportions of patients with complications (primary outcome) and those who were readmitted, hospitalized for <7 days, had surgical site infections, or died due to surgical complications (secondary outcome) were compared between the two groups until postoperative day 30. Tolerance to both types of supplement and blood parameters was also assessed until day 5. (3) Results: Mean age was 69.2 and 84 (58.7%) were men. Complications were reported in 41 (28.7%) patients and the incidence did not differ between groups (18 (25%) vs. 23 (32.4%) patients with OHN and IN supplement, respectively; p = 0.328). No significant differences were found for the rest of the variables. (4) Conclusions: IN supplement may not be necessary for the postoperative recovery of colorectal cancer patients under the ERAS regimen and with normal nutritional status at the time of surgery.

The role of prenatal exposure to antidepressants, anxiolytic, and hypnotics and its underlying illness on the risk of miscarriage using BIFAP database.

PURPOSE: Despite the notable increase on the prescription of antidepressants and anxiolytics during pregnancy, recommendation on maintaining the treatment during prenatal period is still controversial. We aimed to separately assess the role of effects of the antidepressants and anxiolytic and the underlying illness, controlled by potential confounding associated with miscarriage onset. METHODS: We used data from a validated pregnant cohort aged 15-49 years from 2002 to 2016 using BIFAP database. All confirmed miscarriages were used to perform a nested control analysis using conditional logistic regression. Women were classified according to use of each drug of interest into four mutually exclusive groups: nonusers, users only during prepregnancy, continuers, and initiators during first trimester. Adjusted odds ratios (aORs) for major confounders during pregnancy such as number of visits to primary care practitioners visits, obesity, smoking, HTA, diabetes with 95% confidence intervals were calculated. RESULTS: Compared with nonusers, antidepressants continuers had the highest increased risk of miscarriage aOR (95%) of 1.29 (1.13-1.46), being continuers of paroxetine and fluoxetine the antidepressants with the strongest association. Likewise, continuers of anxiolytics and initiators showed an increased risk of 1.19 (1.04-1.37) and 1.30 (1.13-1.50). When separating the effect between the condition itself or the treatment, women exposed during first trimester, regardless treatment duration and/or the underlying illness, had the highest risk 1.27 (1.08-1.51) for antidepressants and 1.25 (1.13-1.39) for anxiolytics. CONCLUSIONS: Our analysis showed an association between prenatal exposure to antidepressants and anxiolytics and miscarriage onset after controlling by potential confounding adjusting for confounders and the underlying illness. This association was not supported for hypnotic medications. Further studies are warranted to evaluate the risk of miscarriage among subpopulation of pregnant women requiring these medications.

A Validation Study on the Frequency and Natural History of Miscarriages Using the Spanish Primary Care Database BIFAP.

(1) Background: There is a major gap of knowledge towards the natural history of miscarriages in electronic medical records. We aimed to calculate the frequency of miscarriages using data from BIFAP database. (2) Methods: We identified all pregnancy losses and carried out a multistep validation exercise. Potential cases with positive predictive values (PPV) of miscarriage confirmation <85% or those confirming other pregnancy loss were excluded. Kaplan-Meier figures and incidence rates (IRs) of miscarriage with 95% confidence intervals (CIs) expressed by 1000 person-weeks were calculated. Stratifying analysis by age, specific high-risk groups, and drug exposure within the pre-pregnancy period were performed restricted to women with recording last menstrual period (LMP). (3) Results: Women with confirmed miscarriage (N = 18,070), tended to be older, with higher frequency of comorbidities and drug utilization. Restricting to women with LPM recorded, IR of miscarriage was 10.89 (CI 95% 10.68-11.10) per 1000 women-weeks, with a median follow-up of 10 weeks (IQR: 8-12). The IR according to age was: 2.71 (CI 95% 2.59-2.84) in those aged <30 years compared to 9.11 (CI 95% 8.55-9.70) in women aged ≥40 years. Advanced maternal age (Hazard Ratio (HR, 95% confidence interval) CI 95%: 3.34 (3.08-3.62)), use of antihypertensives (1.49 (1.21-1.84), and use of drugs classified as D or X during pregnancy (1.17 (1.07-1.29)) showed to be positive predictors associated with increased risk of miscarriages. (4) Conclusion: BIFAP database can be used to identify women suffering from miscarriages, which will serve to further study risk factors associated with miscarriages with special attention to drug utilization.

Hypothalamic Crh/Avp, Plasmatic Glucose and Lactate Remain Unchanged During Habituation to Forced Exercise.

It has been demonstrated that physical activity contributes to a healthier life. However, there is a knowledge gap regarding the neural mechanisms producing these effects. One of the keystones to deal with this problem is to use training programs with equal loads of physical activity. However, irregular motor and stress responses have been found in murine exercise models. Habituation to forced exercise facilitates a complete response to a training program in all rodents, reaching the same load of physical activity among animals. Here, it was evaluated if glucose and lactate - which are stress biomarkers - are increased during the habituation to exercise. Sprague-Dawley rats received an 8-days habituation protocol with progressive increments of time and speed of running. Then, experimental and control (non-habituated) rats were subjected to an incremental test. Blood samples were obtained to determine plasmatic glucose and lactate levels before, immediately after and 30 min after each session of training. Crh and Avp mRNA expression was determined by two-step qPCR. Our results revealed that glucose and lactate levels are not increased during the habituation period and tend to decrease toward the end of the protocol. Also, Crh and Avp were not chronically activated by the habituation program. Lactate and glucose, determined after the incremental test, were higher in control rats without previous contact with the wheel, compared with habituated and wheel control rats. These results suggest that the implementation of an adaptive phase prior to forced exercise programs might avoid non-specific stress responses.

Sports facilities, socio-economic context and overweight among the childhood population in two southern European cities: a cross sectional study.

BACKGROUND: To evaluate relationship between socio-economic environment and overweight in Madrid and Barcelona, adjusting for possible confounding factors. METHODS: We obtained three indicators which reflected socio-economic context, namely, unemployment rate, percentage of population with tertiary education, and percentage with a second home. The design is a cross sectional study. The association with overweight was estimated using odds ratios by multilevel logistic regression. The statistical analysis, data synthesis, or model creation was performed from the 2017. In all, 707 children from 21 districts of Madrid and 474 children from 10 districts of Barcelona were analysed. RESULTS: In Madrid, standardised ORs for personal and family characteristics were 1.17, 1.53 and 1.57 by reference to unemployment rate and percentages of population with a university education and second home. After adjustment, only the OR obtained with unemployment rate decreased, specifically by 58%. In Barcelona, the following ORs were obtained: 1.80 with unemployment rate; 1.80 with population having a university education; and 1.86 with population having a second home. After being standardised, these ORs decreased by 14% in the case of unemployment rate, 10% in the case of population with a university education, and 9% in the case of population with a second home. CONCLUSIONS: Overweight displayed a risk gradient in Madrid and Barcelona alike. This risk of overweight is not accounted for by physical inactivity and could, in part, be due to the availability of sports facilities.

Cardiovascular Disease, Digestive Diseases, Traffic Accidents, and Suicides: Leading Causes of Death Responsible for Excess Mortality in Farmers in Spain.

OBJECTIVE: The aim of this study was to compare mortality from the leading causes of death in farmers and in all other workers. METHODS: Mortality by cause of death was calculated from a longitudinal study in which 9.5 million men were followed up for 10 years. We estimated the contribution of the causes of death to the difference in all-cause mortality. RESULTS: Most of the excess in all-cause mortality in farmers was due to cardiovascular diseases, digestive diseases, and external causes, which contributed 22.3%, 17.2%, and 53.3% to the difference in all-cause mortality, respectively. Traffic accidents and suicide were the main contributors to the excess mortality from external causes. CONCLUSION: Farmers are a vulnerable group in terms of health, thus there is a need to identify the factors that influence excess mortality from cardiovascular diseases, digestive diseases, traffic accidents, and suicide.

Macroeconomic fluctuations, changes in lifestyles and mortality from diabetes: a quasiexperimental study.

BACKGROUND: To evaluate trends in diabetes-related health behaviours and mortality from diabetes and other chronic diseases in the Spanish population before, during and after the 2008 economic crisis. METHODS: Annual population measurements were obtained from national surveys and administrative registries for 2004-2016. Using segmented regression analysis, we calculated the annual percentage change (APC) in 2004-2007, 2008-2010, 2011-2013 and 2014-2016 in risk behaviours (smoking, alcohol consumption, obesity and meals away from home), in healthy behaviours (fruit and vegetable intake and physical activity) and in mortality rates from diabetes, cardiovascular disease and cancer. RESULTS: In general, during the economic crisis (2008-2013), the Spanish population reduced risk behaviours and improved healthy behaviours as compared with the trend observed before and afterwards. Diabetes mortality decreased more during the crisis than before or afterwards. The APC in each time interval was -3.3, -3.7, -4.4 and -2.6 in all-age mortality and -2.9, -5.2, -6.7 and -1.3 in premature mortality (less than 75 years). Only in older people (≥75 years) diabetes mortality showed similar decline before and during the crisis. Mortality from cardiovascular disease also declined more during the crisis, except for all-age mortality and older people in the second part of the crisis, whereas the downward trend in cancer mortality was smaller during the crisis years. CONCLUSIONS: During the 6 years of the economic crisis in Spain, the favourable changes in health behaviours were accompanied by an important reduction in diabetes mortality in the population.

Socio-economic environment, area facilities and obesity and physical inactivity among children.

BACKGROUND: To evaluate whether the relationship between socio-economic environment and obesity and physical inactivity in children can be explained by household socio-economic position and area facilities. METHODS: Two indicators of the socio-economic context of neighbourhood of residence based on wealth and deprivation were estimated in a sample of 727 children and adolescents residents in Madrid (Spain). Multilevel logit models were used to calculate the relationship between each indicator and obesity and physical inactivity. RESULTS: After adjusting for household socio-economic position, obesity prevalence was 3.79 times higher among subjects living in deprived areas than among those living in non-deprived areas (CI: 1.95-7.34), and 2.38 higher among subjects living in less wealthy areas than in those living in wealthier areas (CI: 0.85-6.65). Adjustment for the availability of retail shops in subjects' neighbourhood of residence failed to change the magnitude of the association. Neither neighbourhood socio-economic context nor availability of sports facilities was related to physical inactivity. CONCLUSION: In the city of Madrid, socio-economic context of neighbourhood of residence shows an inverse relationship with obesity but not with physical inactivity among children. The relationship observed with obesity is not explained by the availability of area facilities.

Low mortality in the poorest areas of Spain: adults residing in provinces with lower per capita income have the lowest mortality.

The objective of this study is to ascertain whether income inequality and per capita income of area of residence show a relationship with mortality in Spain. Data are from a nation-wide prospective study with a 7-year mortality follow-up covering all persons living in Spain's 50 provinces in 2001. In total 28,944,854 subjects aged 25 years or over at baseline were studied. Rate ratio for total mortality and cause-specific mortality, according to provincial income inequality and per capita income in two age groups, 25-64 years (adult population) and 65 years and over (elderly population). Provincial income inequality was not related to total mortality or cause-specific mortality. Total mortality rate ratios among residents of the poorest versus the richest provinces were 0.89 (95% CI 0.95-0.93) in men and 0.91 (0.87-0.96) in women, among the adult population; and 1.02 (0.97-1.08) in men and 1.08 (1.02-1.16) in women, among the elderly population. With the exception of cardiovascular-disease mortality for which no association with per capita income was observed, adult residents of the poorest provinces registered the lowest mortality rate ratio for other causes of death. Elderly residents of the poorest provinces registered the highest mortality rate ratio for cardiovascular disease and the lowest mortality rate ratio for cancer and external causes. Aside from cardiovascular-disease mortality, the lowest mortality for most causes of death was registered by residents of the poorest provinces. Nevertheless, these findings need to be confirmed by similar studies using smaller areas as the unit of analysis.

Risk behaviors and sports facilities do not explain socioeconomic differences in childhood obesity: a cross-sectional study.

BACKGROUND: To assess whether the relationship between neighborhood socioeconomic context of residence and childhood obesity is explained by family socioeconomic position, risk behaviors and availability of sports facilities. METHODS: Based on the income and educational level of residents in the neighborhoods of the city of Madrid, two indicators of socioeconomic context were calculated using the information about income and education and grouped into quartiles. In a sample of 727 children aged 6-15 years, the relationship of these indicators with overweight and obesity was studied using multilevel logit models. RESULTS: With respect to children and adolescents living in neighborhoods having higher per capita incomes or higher population percentages with university education those living in neighborhoods having lower per capita incomes or lower population percentages with university education had age- and sex-adjusted odds ratios (ORs) of overweight that were 1.84 (95% CI, 1.03-3.29) and 1.68 (0.95-2.94) times higher, respectively. After adjustment for family socioeconomic position, unhealthy diet and physical inactivity, these ORs fell to 1.80 (0.99-3.29) and 1.56 (0.87-2.79), respectively. In the case of obesity, the age- and sex-adjusted ORs in these quartiles of both indicators of socioeconomic context were 3.35 (1.06-10.60) and 3.29 (1.03-10.52), respectively, rising to 3.77 (1.12-12.70) and 3.42 (1.00-11.68) after adjustment for the remaining variables. The highest OR was observed in the third quartile, except in the case of the relationship between per capita income and obesity. No relationship between the number of sport facilities per 1,000 population and physical inactivity was observed. CONCLUSION: The socioeconomic context is associated with obesity but not with overweight children in Madrid. The relationship is not explained by family socioeconomic position, risk behaviors and availability of sports facilities.

Patrón socioeconómico en la alimentación no saludable en niños y adolescentes en España / Socioeconomic pattern in unhealthy diet in children and adolescents in Spain

OBJETIVO: Investigar la posible asociación de patrones alimentarios relacionados con la obesidad y la posición socioeconómica en la población infantil y adolescente española. DISEÑO: Estudio descriptivo transversal. Participantes: Los datos proceden de la Encuesta Nacional de Salud de 2007, realizada a una muestra representativa española de 0 a 15 años. En este estudio se han analizado 6.143 sujetos de 5 a 15 años. Mediciones principales: Se ha estimado la prevalencia de omisión de desayuno, la prevalencia de bajo consumo de fruta y verdura y la prevalencia de alto consumo de comida rápida, snacks y bebidas azucaradas. Los indicadores de posición socioeconómica han sido el nivel de estudios y la clase social de la persona que aportaba más ingresos económicos al hogar. En cada consumo de alimentos se han estimado las diferencias socioeconómicas mediante la razón de prevalencia, tomando como referencia la categoría socioeconómica más alta. RESULTADOS: Tanto en la infancia como en la adolescencia la magnitud de la razón de prevalencia muestra un gradiente socioeconómico inverso en todos los consumos de alimentos investigados: la menor y la mayor razón de prevalencia se observa en los sujetos de familias de posición socioeconómica más alta y más baja, respectivamente. CONCLUSIÓN: En la población infantil y adolescente española la alimentación no saludable relacionada con la obesidad muestra un patrón socioeconómico claro

OBJECTIVE: To investigate the possible association of dietary patterns associated with obesity and socioeconomic status in Spanish children and adolescents. DESIGN: Cross-sectional study. Participants: Data were drawn from the 2007 National Health Survey, conducted on a representative sample of Spanish 0-15 years. In this study we have analyzed 6143 subjects from 5 to15 years. Main measurements: It has been estimated prevalence of breakfast skipping, the prevalence of low consumption of fruit and vegetable and the prevalence of high fast food, snacks and sugary drinks consumption. Socioeconomic status indicators were educational level and social class of primary household earner. In each type of food consumption socioeconomic differences were estimated by prevalence ratio using the higher socioeconomic status as reference category. RESULTS: Both in childhood and adolescence, the magnitude of the prevalence ratio shows an inverse socioeconomic gradient in all foods consumption investigated: the lowest and highest prevalence ratios have been observed in subjects from families of higher socioeconomic status and lower, respectively. CONCLUSION: Unhealthy food related with obesity show a clear socioeconomic pattern in Spanish children and adolescents

[Socioeconomic pattern in unhealthy diet in children and adolescents in Spain]. / Patrón socioeconómico en la alimentación no saludable en niños y adolescentes en España.

OBJECTIVE: To investigate the possible association of dietary patterns associated with obesity and socioeconomic status in Spanish children and adolescents. DESIGN: Cross-sectional study. PARTICIPANTS: Data were drawn from the 2007 National Health Survey, conducted on a representative sample of Spanish 0-15 years. In this study we have analyzed 6143 subjects from 5 to 15 years. MAIN MEASUREMENTS: It has been estimated prevalence of breakfast skipping, the prevalence of low consumption of fruit and vegetable and the prevalence of high fast food, snacks and sugary drinks consumption. Socioeconomic status indicators were educational level and social class of primary household earner. In each type of food consumption socioeconomic differences were estimated by prevalence ratio using the higher socioeconomic status as reference category. RESULTS: Both in childhood and adolescence, the magnitude of the prevalence ratio shows an inverse socioeconomic gradient in all foods consumption investigated: the lowest and highest prevalence ratios have been observed in subjects from families of higher socioeconomic status and lower, respectively. CONCLUSION: Unhealthy food related with obesity show a clear socioeconomic pattern in Spanish children and adolescents.

Decreasing income inequality and emergence of the association between income and premature mortality: Spain, 1970-2010.

This study evaluates the relationship between income and mortality in Spain over a long period of declining in income inequality. The ratio between income in the richest and poorest provinces was 2.74 in 1970 and 2.10 in 2010. Pearson correlation coefficients for the association between provincial income and the measures of mortality were estimated, as well as absolute and relative differences between the mortality rates of the poorest and richest provinces. The correlation coefficient between income and infant mortality decreased from -0.59 in 1970 to -0.17 in 2010, and lost significance from 1995 onwards. The coefficient for premature all-cause mortality increased from -0.04 in 1970 to -0.40 in 2010, and acquired significance beginning in 2005. The coefficient also increased in mortality from cardiovascular, respiratory and digestive diseases. No association was found between provincial income and cancer mortality or mortality from injuries. The findings on premature mortality do not support the theory that decreasing income inequality will lead to reduced inequalities in mortality.

Area-based socioeconomic environment, obesity risk behaviours, area facilities and childhood overweight and obesity: socioeconomic environment and childhood overweight.

OBJECTIVE: The objective of this study is to evaluate whether the relation between area-based socioeconomic environment and childhood obesity can be explained by household socioeconomic position, obesity-related risk behaviours and area facilities. METHODS: Two indicators of socioeconomic environment based on wealth and deprivation were estimated in a sample of 4529 Spanish children and adolescents in 2006. Multilevel logit models were used to calculate the relation between each indicator and obesity. RESULTS: After adjusting for socioeconomic position and risk behaviours, no relation was observed between wealth and overweight; however, obesity prevalence was 1.45 times higher in subjects living in areas with lower wealth than in those living in areas with higher wealth. After adjusting for these variables, the prevalence of overweight and obesity in subjects living in deprived areas was, respectively, 1.26 and 1.63 higher than in those living in non-deprived areas. There was a graded association between number of sports facilities and prevalence of physical inactivity, but no relation was found between the price of fruits and vegetables and frequency of consumption. CONCLUSION: The relation of socioeconomic environment with childhood obesity could not be explained by household socioeconomic position or obesity-related risk behaviours. Availability of sport facilities may mediate this relation.

The role of political and welfare state characteristics in infant mortality: a comparative study in wealthy countries since the late 19th century.

BACKGROUND: A close examination of the literature suggests that the consistent relation between political and welfare state characteristics and infant mortality in the second half of the 20th century in wealthy countries may not be causal. METHODS: The evolution of infant mortality since the late 19th century was studied in 17 wealthy countries classified according to political traditions, family policy model and period of infant mortality transition. The relation of public health expenditure and income inequality to infant mortality from 1980 to 2005 was also evaluated. RESULTS: The Social Democratic and Scandinavian countries, and those with the earliest transition in infant mortality, had the lowest infant mortality rates until the early 21st century, whereas the late democracies, the Southern European countries, and those in which the transition in infant mortality took place later, had the highest rates until the late 20th century. By the early 21st century, the differences in infant mortality were negligible. Three of the four Scandinavian countries were the first to achieve infant mortality transition, whereas the Southern European countries were the last. The relation between public health expenditure and infant mortality varied depending on the time period in which the analysis was made, and increased income inequality was associated with higher infant mortality. CONCLUSIONS: The relation between political and welfare state characteristics and infant mortality in previous studies probably reflects the historical moment in which the transition in infant mortality took place in each country. Methodological limitations do not allow inference of causality in the associations found between welfare state characteristics and infant mortality.