The emotional and cognitive impact of the unexpected death in the simulation lab / Impacto emocional y cognitivo de la muerte inesperada en el laboratorio de simulación

INTRODUCTION: The impact of animal death on surgeons during training in laparoscopic techniques is unknown. METHODS: Emotions and cognitive load were assessed depending on animal survival. RESULTS: Those exposed to animal death (n=14) had higher levels of sadness (1.3) and anxiety (2.4), and lower levels of happiness (6.1) on a one-to-ten scale, compared to the 56 that were non-exposed (1.0/2.0/7.5). Mean cognitive load was 68.21±12.865 in the exposed and 64.74±14.632 in the non-exposed (p > 0.05). CONCLUSIONS: Emotions and cognitive load among surgeons training in laparoscopic techniques were similar, regardless animal survival after the surgical procedure

INTRODUCCIÓN: Se desconoce el impacto de la muerte animal en los cirujanos durante el entrenamiento en técnicas laparoscópicas. MÉTODOS: Se evaluaron emociones y carga cognitiva dependiendo de la exposición a la muerte del animal. RESULTADOS: Los 14 expuestos tuvieron niveles de tristeza (1,3) y ansiedad (2,4) más altos, y de felicidad más bajos (6,1), que los 56 no expuestos (1,0/2,0/7,5). La carga cognitiva fue 68,21±12,865 en los expuestos y 64,74±14,632 en los no expuestos. (p > 0,05). CONCLUSIONES: Emociones y carga cognitiva de cirujanos durante el entrenamiento en técnicas laparoscópicas fueron similares independientemente de la supervivencia del animal

Ergonomic evaluation and performance of a new handle for laparoscopic tools in surgery.

This paper presents a new handle for instruments used in laparoscopic surgery. This new handle has been designed to provide the best ergonomic and usability features required in this kind of surgical interventions. The main novelty of this handle is that the opening and closing motion of the end-effector is operated with the thumb using a lever located on the top of the handle. This enables the surgeon to reach the patient's organs without adopting extremely awkward postures. In order to demonstrate its advantages, the handle has been tested and compared with another commercial handle in terms of efficiency, effectiveness, and satisfaction. To this end, volunteers have been selected for participation in the experimental evaluation, which comprised two types of surveys: objective and subjective. Electromyography and goniometric studies provide objective parameters for evaluation. Questionnaires are used for the subjective assessment. Outstanding results include the lower level of pain reported by the individuals working with the new handle, as well as the reduction in the hyperflexion of the wrist. Compared with the conventional handle, electromyography reveals that no muscle load is increased when working with the new handle. The results of the subjective survey show that volunteers expressed a significant preference for the new handle, demonstrating an improvement in the ergonomic characteristics.

Factors associated with grip strength among adolescents: An observational study.

STUDY DESIGN: Cross-sectional. INTRODUCTION: The muscle strength has been studied in different populations in relation with individual and other factors. PURPOSE OF THE STUDY: The purpose of this study was to determine values of grip strength in adolescents and to examine its association with sex, age, weight, height, nutritional status, handedness, and academic performance. METHODS: A total of 452 adolescents (246 men and 206 women) aged 12 to 17 years were included in the study. Grip strength was measured using a Takei dynamometer. RESULTS: Boys were significantly stronger than girls with both the dominant hand (33.1 kgf vs 25.0 kgf; mean difference = 8.1 kgf; P < .001) and the nondominant hand (30.9 kgf vs 23.1 kgf; mean difference = 7.8 kgf; P < .001), and there was a significant increase in strength values as the age rises in both sexes (P < .001). The dominant hand was stronger than the nondominant one (29.4 kgf vs 27.3 kgf; mean difference = 2.1 kgf; P < .001), except for left-handed subjects who were significantly stronger than right-handed ones in their nondominant hand. Furthermore, strength was positively associated with nutritional status and negatively associated with academic performance in men. CONCLUSIONS: Sex, age, handedness, nutritional status, and academic performance have a significant influence on the grip strength values. There seems to be a sexual dimorphism in the relationship between strength and both nutritional status and academic performance.

Prevalence and factors associated with overweight and obesity among Spanish students attending special education schools.

BACKGROUND: Some studies suggest that children and adolescents with intellectual disability (ID) are at elevated risk of obesity. The objective was to determine the prevalence of and factors associated with overweight and obesity among students attending special education schools in Cantabria, Spain. METHODS: Cross-sectional design. A sample of n = 220 students with intellectual disability attending seven special education schools was selected using convenience sampling. Body mass index was classified into four categories according to the International Obesity Task Force (IOTF) criteria: underweight; normal weight; overweight; obesity. RESULTS: The prevalence of overweight/obesity was 40.9% (95% CI: 34.6-47.5). Obesity was more frequent among females (26.0%) than males (9.8%), with an OR = 3.23 (95% CI: 1.53-6.85). Participants with Down syndrome showed an increased risk of obesity compared to other conditions (p = .005). CONCLUSIONS: The prevalence of overweight/obesity among children, adolescents and young adults with intellectual disability was remarkably high, with females in general and students of both sexes with Down syndrome at particularly high risk.

Using infrared imaging for assessment of muscular activity in the forearm of surgeons in the performance of laparoscopic tasks.

Surgeons working in laparoscopic surgery are subjected to hard working conditions because of the poor ergonomic characteristics of the workplace. The improvement in the working conditions requires the use of reliable techniques for the assessment of muscular activity. In this article infrared imaging is used and compared with electromyography for the evaluation of muscle activity in the performance of laparoscopic surgical tasks. Electromyography has been widely used for the evaluation of the electrical activity produced by the muscles in the performance of surgery. On the contrary, infrared imaging is an innovative technique that has not been sufficiently explored. An experimental evaluation was carried out using a thermography camera and recording the infrared images from volunteers in different tests. Pearson's correlation was obtained between the electromyography and thermographic measurements in two stages: Endurance Stage (best value: ρ = 0.8401 with p < 0.01) and Surgical Task (best value: ρ = 0.8309 with p < 0.01). The article demonstrates that infrared imaging is a valuable technique for the evaluation of muscle activity in laparoscopic surgery, and it can be compared with electromyography. The main advantages of infrared imaging are that it allows remote measurement and provides activity information in the whole area of interest. However, drawbacks such as delayed response of the infrared imaging due to thermal conductivity of the skin should be considered. Electromyography only provides information in the location of the electrodes, but it is a real-time response. For these reasons, the techniques complement each other.

La simulación como modelo de enseñanza en cirugía / Simulation as a surgical teaching model

La enseñanza de la cirugía se ha visto afectada por múltiples factores a lo largo de estos últimos años, como son la reducción de la jornada laboral, la optimización del uso del quirófano o la seguridad del paciente. La metodología de enseñanza tradicional no logra minimizar el impacto de estos factores en la formación de los cirujanos. La simulación como modelo de enseñanza minimiza dicho impacto y es más eficaz que los métodos docentes tradicionales para integrar los conocimientos y las habilidades clínico-quirúrgicas complejas. La simulación complementa la asistencia clínica al paciente con la formación, creando un entorno de aprendizaje seguro en el que no se ve afectada la seguridad del paciente ni se generan conflictos éticos ni legales. Las metodologías de aprendizaje que utilizan la simulación permiten individualizar la enseñanza adaptándola a las necesidades de aprendizaje de cada alumno. Además, permiten entrenar todo tipo de habilidades técnicas, cognitivas o de comportamiento (AU)

Teaching of surgery has been affected by many factors over the last years, such as the reduction of working hours, the optimization of the use of the operating room or patient safety. Traditional teaching methodology fails to reduce the impact of these factors on surgeons training. Simulation as a teaching model minimizes such impact, and is more effective than traditional teaching methods for integrating knowledge and clinical-surgical skills. Simulation complements clinical assistance with training, creating a safe learning environment where patient safety is not affected, and ethical or legal conflicts are avoided. Simulation uses learning methodologies that allow teaching individualization, adapting it to the learning needs of each student. It also allows training of all kinds of technical, cognitive or behavioural skills (AU)

Simulation as a surgical teaching model. / La simulación como modelo de enseñanza en cirugía.

Teaching of surgery has been affected by many factors over the last years, such as the reduction of working hours, the optimization of the use of the operating room or patient safety. Traditional teaching methodology fails to reduce the impact of these factors on surgeons training. Simulation as a teaching model minimizes such impact, and is more effective than traditional teaching methods for integrating knowledge and clinical-surgical skills. Simulation complements clinical assistance with training, creating a safe learning environment where patient safety is not affected, and ethical or legal conflicts are avoided. Simulation uses learning methodologies that allow teaching individualization, adapting it to the learning needs of each student. It also allows training of all kinds of technical, cognitive or behavioural skills.

A study of the prevalence of musculoskeletal disorders in surgeons performing minimally invasive surgery.

INTRODUCTION: Minimally invasive surgery (MIS) has shown significant benefits for patients and healthcare systems. However, due to the poor ergonomic adaptation of operating rooms and surgical instruments, most surgeons suffer from pain caused by musculoskeletal disorders (MSDs). METHODS: A descriptive survey on MIS surgeons working in different surgical specialties has been carried out in Hospital Valdecilla (Spain). The aim is to determine the prevalence of MSDs using a personal interview and the standardized Nordic questionnaire. The study determines the prevalence of MSDs in different parts of the body and their relationship with epidemiological and labor variables. A questionnaire was filled out by 129 surgeons. RESULTS: 90% of surgeons reported MSDs. The higher prevalence appears in the most experienced surgeons. The most affected zones are the lower back (54%), neck (51%), upper back (44%), lower extremities (42%), right shoulder (29%) and right hand (28%). CONCLUSIONS: The prevalence of MSDs is higher in MIS surgeons than in any other occupational group. The most vulnerable group is experienced surgeons and there is a potential risk that symptoms will be increased in the future. Muscle strength is revealed as a protective factor against MSDs.

Adherencia a la Dieta Mediterránea de los adolescentes de Cantabria / Adherence to the Mediterranean Diet of adolescents in Cantabria

Fundamentos: A pesar de los múltiples beneficios atribuidos a la Dieta Mediterránea (DM), diversos estudios han señalado una disminución en su seguimiento. Describir el grado de adherencia a la DM que presentan los adolescentes escolarizados en la Comunidad Autónoma de Cantabria. Métodos: Estudio transversal que analiza una muestra de 1829 adolescentes, de entre 10 y 17 años, escolarizados en 37 centros de enseñanza públicos y concertados, mediante el test KidMed. Resultados: El 6% de los adolescentes mantiene una dieta de muy baja adhesión, el 42% una adhesión media y el 52 % goza de una alta adhesión a la dieta mediterránea. El porcentaje de mujeres que presenta una alta adhesión a la dieta mediterránea es más elevado que el de los varones (54% vs50%). No se observan diferencias estadísticamente significativas en el grado de adherencia a la Dieta Mediterránea entre sexos. La alta adherencia a la Dieta Mediterránea disminuye notablemente a medida que la edad aumenta, principalmente en el paso de 10 y 11 años (57,7%)al tramo de 12 a 15 años (46,7%).Conclusiones: La mitad de los adolescentes mantienen una alta adherencia a la DM, que disminuye con el aumento de la edad, siendo especialmente significativa en el paso de los adolescentes de 10 y 11 años a los jóvenes de 12 a 15 años

Background: Despite the multiple benefits attributed to the Mediterranean Diet (DM), several studies have indicated a decrease in its follow-up. To describe the Adherence to DM, among primary and secondary education adolescents from Cantabria. Methods: A cross-sectional study was carried out, analysing a sample of 1,829 adolescents: 924 (50,5%) were women and 905 (49,5%) were men, aged 10 to 17, attending 37 different primary and secondary education centres, by means of KidMed questionnaire. Results:6% of adolescents maintain a very low adherence to Mediterranean Diet, 42% shows an average adherence, and 52% keep a high adherence. The percentage of women with a high adherence to Mediterranean Diet is higher than men (54 % vs 50 %). There arenot noticeably significant statistical differences of the Adherence to a Mediterranean Diet regarding gender. The high adherence to Mediterranean Diet decreases with age, especially from 10 -11 years to 12-15 years. Conclusions: Half of adolescents keep a high adherence to a Mediterranean Diet. Nevertheless, a major age related decline this high adherence, especially when the adolescents pass from 10-11 years old to 12-15 years old

Learning curve patterns generated by a training method for laparoscopic small bowel anastomosis.

BACKGROUND: The identification of developmental curve patterns generated by a simulation-based educational method and the variables that can accelerate the learning process will result in cost-effective training. This study describes the learning curves of a simulation-based instructional design (ID) that uses ex vivo animal models to teach laparoscopic latero-lateral small bowel anastomosis. METHODS: Twenty general surgery residents were evaluated on their performance of laparoscopic latero-lateral jejuno-jejunal anastomoses (JJA) and gastro-jejunal anastomoses (GJA), using swine small bowel and stomach on an endotrainer. The ID included the following steps: (1) provision of references and videos demonstrating the surgical technique, (2) creation of an engaging context for learning, (3) critical review of the literature and video on the procedures, (4) demonstration of the critical steps, (5) hands-on practice, (6) in-action instructor's feedback, (7) quality assessment, (8) debriefing at the end of the session, and (9) deliberate and repetitive practice. Time was recorded from the beginning to the completion of the procedure, along with the presence or absence of anastomotic leaks. RESULTS: The participants needed to perform 23.8 ± 6.96 GJA (12-35) and 24.2 ± 6.96 JJA (9-43) to attain proficiency. The starting point of the learning curve was higher for the GJA than for the JJA, although the slope and plateau were parallel. Further, four types of learning curves were identified: (1) exponential, (2) rapid, (3) slow, and (4) no tendency. The type of pattern could be predicted after procedure number 8. CONCLUSIONS: These findings may help to identify the learning curve of a trainee early in the developmental process, estimate the number of sessions required to reach a performance goal, determine a trainee's readiness to practice the procedure on patients, and identify the subjects who lack the innate technical abilities. It may help motivated individuals to become reflective and self-regulated learners. Moreover, the standardization of the ID may help to measure the effectiveness of learning strategies and make comparisons with other educational strategies.

Efecto de la simulación quirúrgica en la implementación clínica de procedimientos colorrectales laparoscópicos / Effects of surgical simulation on the implementation of laparoscopic colorectal procedures

INTRODUCCIÓN: La cirugía laparoscópica avanzada necesita complementar el aprendizaje fuera del quirófano. La simulación clínica con animales o cadáveres favorece este aprendizaje. OBJETIVO: Mostrar el grado de impacto en la práctica quirúrgica diaria en los cirujanos que realizaron un curso clínico-experimental de cirugía colorrectal laparoscópica. MATERIAL Y MÉTODO: Entre marzo de 2007 y marzo de 2012, realizamos 30 cursos de 4 días de duración, durante 35 h (18 en quirófano, 12 en animales de experimentación y 4 en seminarios), en los que participaron 163 cirujanos. En mayo de 2012, vía online, se les remitió una encuesta con la finalidad de evaluar el impacto que este curso podía haber tenido en su práctica diaria de cirugía colorrectal laparoscópica. RESULTADOS: El número de encuestas contestadas fue de 70 (47%), que correspondían a cirujanos de 60 hospitales diferentes. El periodo medio tras el curso fue de 11,5 meses (2-60). El 75% de los cirujanos iniciaron o aumentaron el número de cirugías que realizan después del curso, siendo este aumento menor de 5 casos/mes en el 56% y mayor de 10 casos/mes en el 19%. El 38% iniciaron esta vía de abordaje. CONCLUSIONES: El 75% de los cirujanos encuestados aumentaron la implementación clínica de una técnica quirúrgica compleja como es la cirugía colorrectal por vía laparoscópica, después de realizar un curso de entrenamiento apoyado en simulación clínica

INTRODUCTION: Advanced laparoscopic surgery requires supplementary training outside the operating room. Clinical simulation with animal models or cadavers facilitates this learning. OBJECTIVE: We measured the impact on clinical practice of a laparoscopic colorectal resection training program based on surgical simulation. MATERIAL AND METHODS: Between March 2007 and March 2012, 163 surgeons participated in 30 courses that lasted 4 days, of 35 hours (18 h in the operating room, 12 h in animal models, and 4 h in seminars). In May 2012, participants were asked via an on-line survey about the degree of implementation of the techniques in their day-to-day work. RESULTS: Seventy surgeons (47%) from 60 different hospitals answered the survey. Average time elapsed after the course was 11.5 months (2-60 months). A total of 75% initiated or increased the number of surgeries performed after the training. The increase in practice was > 10 cases/month in 19%, and < 5 cases/month in 56% of surgeons. 38% of participants initiated this surgical approach. CONCLUSIONS: Seventy five percent of the surveyed surgeons increased the clinical implementation of a complicated surgical technique, such as laparoscopic colorectal surgery, after attending a training course based on clinical simulation

Design and evaluation of a new ergonomic handle for instruments in minimally invasive surgery.

BACKGROUND: Laparoscopic surgery techniques have been demonstrated to provide massive benefits to patients. However, surgeons are subjected to hardworking conditions because of the poor ergonomic design of the instruments. In this article, a new ergonomic handle design is presented. This handle is designed using ergonomic principles, trying to provide both more intuitive manipulation of the instrument and a shape that reduces the high-pressure zones in the contact with the surgeon's hand. MATERIALS AND METHODS: The ergonomic characteristics of the new handle were evaluated using objective and subjective studies. The experimental evaluation was performed using 28 volunteers by means of the comparison of the new handle with the ring-handle (RH) concept in an instrument available on the market. The volunteers' muscle activation and motions of the hand, wrist, and arm were studied while they performed different tasks. The data measured in the experiment include electromyography and goniometry values. RESULTS: The results obtained from the subjective analysis reveal that most volunteers (64%) preferred the new prototype to the RH, reporting less pain and less difficulty to complete the tasks. The results from the objective study reveal that the hyperflexion of the wrist required for the manipulation of the instrument is strongly reduced. CONCLUSIONS: The new ergonomic handle not only provides important ergonomic advantages but also improves the efficiency when completing the tasks. Compared with RH instruments, the new prototype reduced the high-pressure areas and the extreme motions of the wrist.

[Effects of surgical simulation on the implementation of laparoscopic colorectal procedures]. / Efecto de la simulación quirúrgica en la implementación clínica de procedimientos colorrectales laparoscópicos.

INTRODUCTION: Advanced laparoscopic surgery requires supplementary training outside the operating room. Clinical simulation with animal models or cadavers facilitates this learning. OBJECTIVE: We measured the impact on clinical practice of a laparoscopic colorectal resection training program based on surgical simulation. MATERIAL AND METHODS: Between March 2007 and March 2012, 163 surgeons participated in 30 courses that lasted 4 days, of 35 hours (18 h in the operating room, 12h in animal models, and 4h in seminars). In May 2012, participants were asked via an on-line survey about the degree of implementation of the techniques in their day-to-day work. RESULTS: Seventy surgeons (47%) from 60 different hospitals answered the survey. Average time elapsed after the course was 11.5 months (2-60 months). A total of 75% initiated or increased the number of surgeries performed after the training. The increase in practice was>10 cases/month in 19%, and<5 cases/month in 56% of surgeons. 38% of participants initiated this surgical approach. CONCLUSIONS: Seventy five percent of the surveyed surgeons increased the clinical implementation of a complicated surgical technique, such as laparoscopic colorectal surgery, after attending a training course based on clinical simulation.

Evaluación del entrenamiento de residentes en cirugía laparoscópica en el laboratorio basado en un modelo de anastomosis digestivas / Assessment of resident training in laparoscopic surgery based on a digestive system anastomosis model in the laboratory

IntroducciónLa complejidad de la cirugía laparoscópica hace necesario un entrenamiento específico fuera del quirófano para acortar la curva de aprendizaje y reducir la morbilidad. El objetivo del estudio es analizar la progresión en habilidades laparoscópicas tras un programa de entrenamiento en laboratorio.Material y métodosEstudio prospectivo de un programa de entrenamiento de residentes de 4 semanas anuales (20 h semanales) basado en anastomosis en endotrainer, realizado entre 2004 y 2007. Los parámetros principales fueron tiempo y número de anastomosis necesarias hasta llegar a una correcta ejecución. Una vez completada, la anastomosis se revisó conjuntamente mediante un residente y un monitor. Se registraron tiempo de ejecución y fallos anastomóticos (sutura floja, eversión de bordes y fuga).ResultadosDoce residentes realizaron 189 anastomosis yeyunoyeyunales (AYY) (media: 15,8) y 197 anastomosis gastroyeyunales (AGY) (media: 16,4). El tiempo medio de las AYY fue de 72,7min y el de las AGY fue de 87,2min. Se observó una gran reducción en el tiempo de ejecución desde el comienzo al final del programa. El porcentaje de anastomosis incorrectas disminuyó en función del tiempo de entrenamiento: el 26,6; el 21,8; el 17,1; el 17; el 16,1 y el 10,5% después de 20; 40; 60; 80; 100 y 120h, respectivamente. Considerando la reducción, tanto en tiempo de ejecución como en el índice de anastomosis incorrectas, después de 70h de entrenamiento la curva de aprendizaje alcanzaba una meseta.ConclusionesEl entrenamiento en endotrainer basado en anastomosis intestinales (tanto AYY o AGY) constituye un método útil de entrenamiento laparoscópico. Después de un entrenamiento de 70h se aprecia poca progresión (AU)

BackgroundThe complexity of laparoscopic surgery makes specific training out of the operating rooms necessary to shorten learning curves and to minimise morbidity rates. Our aim was to analyse the increase in laparoscopic skills after completion of a laboratory training program.Material and methodsProspective study of surgical resident training based on anastomosis performance on an “endotrainer”. The program consisted of 4 weeks per year (20h per week) between 2004 and 2007. The outcome measures were the time and number of anastomosis necessary to perform a proper anastomosis. Upon completion, the anastomosis was checked by both trainee and evaluator and quality was assessed. Time and technical failures (loose suture, edge eversion, leakage) were recorded.ResultsTwelve surgical residents were trained. They performed 189 jejuno-jejunal anastomoses (JJA), mean 15.8 per resident and 197 gastro-jejunal anastomoses (GJA), mean 16.4 per resident. The performance mean time was 72.7min for JJA and 87.2 for GJA. There was a marked reduction in time from the beginning to completion of training. The percentage of flawed anastomosis decreased with training: 26.6%, 21.8%, 17.1%, 17%, 16.1% and 10.5% after 20, 40, 60, 80, 100 and 120h, respectively. Bearing in mind reduction in both performance time and flawed anastomosis rate, it appears that after 70h of training the learning curve reaches a plateau zone.ConclusionsIntestinal anastomosis (either JJA or GJA) performed in “endotrainer” is a suitable model for laparoscopic training, without the need of live animals. After a training period of 70 hours, the improvement seems of little benefit (AU)

[Assessment of resident training in laparoscopic surgery based on a digestive system anastomosis model in the laboratory]. / Evaluación del entrenamiento de residentes en cirugía laparoscópica en el laboratorio basado en un modelo de anastomosis digestivas.

BACKGROUND: The complexity of laparoscopic surgery makes specific training out of the operating rooms necessary to shorten learning curves and to minimise morbidity rates. Our aim was to analyse the increase in laparoscopic skills after completion of a laboratory training program. MATERIAL AND METHODS: Prospective study of surgical resident training based on anastomosis performance on an "endotrainer". The program consisted of 4 weeks per year (20h per week) between 2004 and 2007. The outcome measures were the time and number of anastomosis necessary to perform a proper anastomosis. Upon completion, the anastomosis was checked by both trainee and evaluator and quality was assessed. Time and technical failures (loose suture, edge eversion, leakage) were recorded. RESULTS: Twelve surgical residents were trained. They performed 189 jejuno-jejunal anastomoses (JJA), mean 15.8 per resident and 197 gastro-jejunal anastomoses (GJA), mean 16.4 per resident. The performance mean time was 72.7 min for JJA and 87.2 for GJA. There was a marked reduction in time from the beginning to completion of training. The percentage of flawed anastomosis decreased with training: 26.6%, 21.8%, 17.1%, 17%, 16.1% and 10.5% after 20, 40, 60, 80, 100 and 120 h, respectively. Bearing in mind reduction in both performance time and flawed anastomosis rate, it appears that after 70 h of training the learning curve reaches a plateau zone. CONCLUSIONS: Intestinal anastomosis (either JJA or GJA) performed in "endotrainer" is a suitable model for laparoscopic training, without the need of live animals. After a training period of 70 hours, the improvement seems of little benefit.

Design and evaluation of a treatment programme for Spanish adolescents with overweight and obesity. The EVASYON Study.

BACKGROUND: The prevalence of overweight and obesity (OW/OB) among adolescents worldwide has increased since the 60 s. Spain has reached one of the highest OW/OB prevalence rates among adolescents from European countries. The aim of this methodological paper is to describe the design and evaluation in the EVASYON study (Development, implementation and evaluation of the efficacy of a therapeutic programme for adolescents with OW/OB: integral education on nutrition and physical activity). METHODS/DESIGN: The EVASYON was planned by a multidisciplinary team to treat OW/OB in Spanish adolescents. The EVASYON is a multi-centre study conducted in 5 hospitals in 5 Spanish cities (Granada, Madrid, Pamplona, Santander and Zaragoza) and two hundred and four OW/OB Spanish adolescents were recruited for this intervention. The treatment was implemented for approximately one-year follow-up. The adolescents were treated in groups of a maximum of 10 subjects; each group had 20 visits during the treatment period in two phases: intensive during the first 2 months (1st to 9th visits), and extensive during the last 11 months (10th to 20th visits). In order to assess the efficacy of the treatment, 8 dimensions were measured: diet; physical activity and fitness; eating behaviour; body composition; haematological profile; metabolic profile; minerals and vitamins; immuno-inflammatory markers. Moreover, genetic polymorphisms were also determined. DISCUSSION: The treatment programme developed in the EVASYON study was designed as a national pilot study to be implemented as an effective treatment for adolescents with OW/OB into the Spanish Health Care Service.

The effect of early menarche on later body composition and fat distribution in female adolescents: role of birth weight.

BACKGROUND: To examine the effect of early menarche (EM) on adolescent body composition and fat distribution, and to explore the possible contribution of birth weight (BW) to this relationship. METHODS: From the cross-sectional AVENA study, 788 girls (aged 13-18.5 years) were selected. Post-menarcheal body composition was estimated by anthropometric methods. RESULTS: BW Z-score was associated with age at menarche (beta = 0.496, p < 0.001). EM (age of menarche <12 years) adolescents were shorter, had a higher body mass index (BMI), fat free mass index (FFMI), fat mass index (FMI) and waist circumference (all p < 0.01). BW was associated with height (p < 0.001), BMI Z-score (p < 0.01), FFMI (p < 0.01) and FMI (p < 0.05). These relationships did not change when the analysis was controlled for age of menarche. Height and FFM were lower in EM (p < 0.01), but these effects seem to be due to the BW (p < 0.01). CONCLUSION: EM was strongly associated with unhealthy body composition in female adolescents, but these relationships seem to be due to the programming effect of BW.

Oncoplastic techniques extend breast-conserving surgery to patients with neoadjuvant chemotherapy response unfit for conventional techniques.

BACKGROUND: Oncoplastic surgery is extending the role of breast-conserving surgery in an increasing number of patients who are unsuitable for conventional breast-conserving techniques. The aim of this retrospective study was to analyze the surgical approach, oncoplastic surgery guided by bracketing, used in the treatment of patients who required a wide breast tissue excision after neoadjuvant chemotherapy. The parameters evaluated were as follows: margin status, rate of re-excision for positive margin, early ipsilateral recurrence, and cosmetic outcomes. METHODS: A total of 23 patients were treated with an oncoplastic breast-conserving surgery one-stage procedure using volume-replacement (20) and volume-displacement techniques (3). We reviewed medical records, mammograms and magnetic resonance images. Cosmetic assessment was carried out by a mixed panel made up of three women: a general practitioner, a resident general surgeon and a nurse. RESULTS: All margins were negative and none of the patients had to have a re-excision for positive margins. One ipsilateral local recurrence was observed after a 32-month follow-up period. Cosmetic outcome was good, with an overall score of 8 out of 10. CONCLUSIONS: Oncoplastic techniques extend breast-conserving surgery to patients with neoadjuvant chemotherapy response unfit for conventional techniques. The surgical approach combining oncoplastic techniques with bracketing allows breast-conserving surgery to be performed in these patients.

Interplay between weight loss and gut microbiota composition in overweight adolescents.

The aim of this study was to determine the influence of an obesity treatment program on the gut microbiota and body weight of overweight adolescents. Thirty-six adolescents (13-15 years), classified as overweight according to the International Obesity Task Force BMI criteria, were submitted to a calorie-restricted diet (10-40%) and increased physical activity (15-23 kcal/kg body weight/week) program over 10 weeks. Gut bacterial groups were analyzed by quantitative real-time PCR before and after the intervention. A group of subjects (n=23) experienced >4.0 kg weight loss and showed significant BMI (P=0.030) and BMI z-score (P=0.035) reductions after the intervention, while the other group (n=13) showed <2.0 kg weight loss. No significant differences in dietary intake were found between both groups. In the whole adolescent population, the intervention led to increased Bacteroides fragilis group (P=0.001) and Lactobacillus group (P=0.030) counts, and to decreased Clostridium coccoides group (P=0.028), Bifidobacterium longum (P=0.031), and Bifidobacterium adolescentis (P=0.044) counts. In the high weight-loss group, B. fragilis group and Lactobacillus group counts also increased (P=0.001 and P=0.007, respectively), whereas C. coccoides group and B. longum counts decreased (P=0.001 and P=0.044, respectively) after the intervention. Total bacteria, B. fragilis group and Clostridium leptum group, and Bifidobacterium catenulatum group counts were significantly higher (P<0.001-0.036) while levels of C. coccoides group, Lactobacillus group, Bifidobacterium, Bifidobacterium breve, and Bifidobacterium bifidum were significantly lower (P<0.001-0.008) in the high weight-loss group than in the low weight-loss group before and after the intervention. These findings indicate that calorie restriction and physical activity have an impact on gut microbiota composition related to body weight loss, which also seem to be influenced by the individual's microbiota.