The Effect of Pulmonary Rehabilitation on Cardiovascular Risk, Oxidative Stress and Systemic Inflammation in Patients with COPD.

PURPOSE: Chronic obstructive pulmonary disease (COPD) is a leading cause of death, and cardiovascular (CV) comorbidities play a role. Evidence of the pulmonary rehabilitation (PR) effect in reducing the CV risk (CVR) in COPD patients is limited. In this study, we aimed to determine the impact of an 8-week PR program (PRP) on the CVR of the overall population and to compare the impact on the exacerbator versus non-exacerbator patients. PATIENTS AND METHODS: This was a prospective study that included adults who had post-bronchodilator forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) (FEV1/FVC) ratio <70% and FEV1 <80% predicted, had quit smoking for at least 1 year and had a history of tobacco consumption greater than 10 packs/year, and were clinically stable in the last 8 weeks. Pre- and post-PRP assessments included respiratory function evaluation, laboratory tests, and exercise capacity assessment (6-minute walking test [6MWT]). CVR was assessed using different risk prediction models. RESULTS: A total of 50 patients (28 exacerbators and 22 non-exacerbators) completed the PRP (median age: 64.5 years, men: 72%; arterial hypertension: 70%, dyslipidemia: 30%, diabetes: 20%; CV disease (CVD): 24%. After the PRP, exacerbator patients showed a significant decrease in the CVR calculated by the COPDCoRi model (p<0.001); patients with ≥30-meter increase on the 6MWT showed statistically significant lower levels of glucose (p=0.004), HbA1c (p=0.004) and BODE index score (p=0.026) compared to patients with <30-meter increase. CONCLUSIONS: PR reduced certain modifiable CVR factors and CVD risk, especially in exacerbator patients.

Differences in cardiovascular risk and health-related quality of life in COPD patients according to clinical phenotype.

Chronic obstructive pulmonary disease (COPD) has a high prevalence and a major impact on health-related quality of life (HRQL). COPD exacerbations are an important cause of morbidity and mortality, affecting cardiovascular risk, and are associated with poorer health status. The aim of this study was to assess the association between cardiovascular risk (CVR) and HRQL, according to exacerbator or non-exacerbator phenotype. We undertook a cross-sectional, observational, descriptive study of 107 patients with COPD. Patients with two or more moderate exacerbations or one severe exacerbation in the previous year were considered as exacerbators. The CVR was calculated with the Framingham scale and SCORE (Systematic Coronary Risk Evaluation) and the HRQL was assessed with the generic questionnaire Short Form-36 Health Survey (SF-36), the St George Respiratory Questionnaire (SGRQ) and the COPD Assessment Test (CAT). Statistical analysis was done with SPSS version 26.0 for Windows. The SF-36 and the SGRQ showed lower values for the exacerbator phenotype, indicating a poorer quality of life. The CAT questionnaire showed values above 10 for the exacerbator phenotype, and lower values in the non-exacerbator group. After categorizing the sample according to their median age (65 years), we found a greater deterioration in HRQL in patients under 65 years of age according to the SF-36, the SGRQ and the CAT. We also detected differences in HRQL between non-exacerbator patients with a high CVR according to the Framingham (≥ 20%) and SCORE (≥ 5%) scales compared to those without this risk. A tendency towards worse HRQL was observed in non-exacerbator patients with a high CVR, which was statistically significant for the SGRQ impact domain on the SCORE scale. The CAT also showed a worse quality of life in non-exacerbator patients with a high CVR, which was significant in the Framingham model (Framingham high risk 8.41 vs non-high risk 6.05, p < 0.01). These differences were not observed in exacerbator patients. Our findings confirm that a high CVR influences HRQL in patients with COPD, especially in non-exacerbator patients with a high CVR, measured according to the SGRQ and the CAT.

Cardiovascular health and target end-organ damage and comorbidities in hypertensive patients from a Spanish primary care urban population / Salud cardiovascular y daño a órganos diana y comorbilidades en pacientes hipertensos procedentes de una población urbana de atención primaria en España

We hypothesized that a poorer cardiovascular health status is related to a higher risk of hypertension-mediated organ-damage (HMOD) or hypertension-related comorbidities (HRC). We assessed the relationship between cardiovascular health metrics (CVHM) and HMOD-HRC in 243 hypertensive patients from primary care center followed for two years. We recorded the baseline CVHM score (Life's Simple 7) plus clinical data, including prevalent and incident HMOD-HRC, hospitalization and mortality. The prevalence of ideal CVHM scores was very low in both men and women. The patients with healthier CVHM scores were younger, and had a lower prevalence of diabetes, cardiovascular disease and chronic kidney disease. We recorded 264 cases of HMOD-HRC (225 at baseline and 39 during follow-up). Nine patients died and 64 had any-cause hospitalization during follow-up. A lower prevalence of HMOD-HRC and unfavorable outcomes was observed as the number of ideal CVHM increased (P<0.05). Multivariate logistic regression adjusted for confounders showed a lower CVHM score (0–1) was associated with increased odds of HMOD-HRC (4.04, 95% CI 1.26–12.94; P=0.019) and composite endpoint (HMOD-HRC, death or all-cause hospitalization) (3.43, 95% CI 1.19–9.92; P=0.023). Individual components were less predictive than the cumulative CVHM score. Few hypertensive patients in this urban population had ideal CVHM scores. An inverse relationship between scores and outcomes (HMOD-HRC, death or hospitalizations) was observed. Interventions to increase this score may improve prognosis among community-based hypertensive patients (AU)

Nuestra hipótesis fue que un estado de peor salud cardiovascular está relacionado con un mayor riesgo de daño orgánico provocado por la hipertensión (DOP HTA) o de comorbilidades relacionadas con la hipertensión (CRHTA). Evaluamos la relación entre las métricas de la salud cardiovascular (MSCV) y el DOP HTA-CRHTA en 243 pacientes hipertensos procedentes de un centro de atención primaria, a quienes se realizó un seguimiento durante 2 años. Registramos la puntuación basal de MSCV (Life's Simple 7) y los datos clínicos, incluyendo DOP HTA-CRHTA prevalente e incidental, hospitalización y mortalidad. La prevalencia de puntuaciones MSCV ideales fue muy baja tanto en hombres como en mujeres. Los pacientes con puntuaciones MSCV más saludables fueron más jóvenes y tuvieron una menor prevalencia de diabetes, cardiopatías y enfermedad renal crónica. Registramos 264 casos de DOP HTA-CRHTA (225 al inicio y 39 durante el seguimiento). Nueve pacientes fallecieron y 64 fueron hospitalizados por cualquier causa durante el seguimiento. Se observó una menor prevalencia de DOP HTA-CRHTA y resultados no favorables a medida que aumentaba el MSCV ideal (p<0,05). La regresión logística multivariante ajustada a los factores de confusión reflejó una menor puntuación MSCV (0-1) asociada a un incremento de la odds ratio de DOP HTA-CRHTA (4,04, IC 95% 1,26-12,94; p=0,019) y un resultado compuesto (DOP HTA-CRHTA, muerte u hospitalización por cualquier causa) (3,43, IC 95% 1,19-9,92; p=0,023). Los componentes individuales fueron menos predictivos que la puntuación MSCV acumulada. Pocos pacientes hipertensos de esta población urbana tuvieron puntuaciones MSCV ideales. Se observó una relación inversa entre las puntuaciones y los resultados (DOP HTA-CRHTA, muerte u hospitalizaciones). Las intervenciones para incrementar esta puntuación pueden mejorar el pronóstico entre los pacientes hipertensos con base comunitaria (AU)

Cardiovascular health and target end-organ damage and comorbidities in hypertensive patients from a Spanish primary care urban population.

We hypothesized that a poorer cardiovascular health status is related to a higher risk of hypertension-mediated organ-damage (HMOD) or hypertension-related comorbidities (HRC). We assessed the relationship between cardiovascular health metrics (CVHM) and HMOD-HRC in 243 hypertensive patients from primary care center followed for two years. We recorded the baseline CVHM score (Life's Simple 7) plus clinical data, including prevalent and incident HMOD-HRC, hospitalization and mortality. The prevalence of ideal CVHM scores was very low in both men and women. The patients with healthier CVHM scores were younger, and had a lower prevalence of diabetes, cardiovascular disease and chronic kidney disease. We recorded 264 cases of HMOD-HRC (225 at baseline and 39 during follow-up). Nine patients died and 64 had any-cause hospitalization during follow-up. A lower prevalence of HMOD-HRC and unfavorable outcomes was observed as the number of ideal CVHM increased (P<0.05). Multivariate logistic regression adjusted for confounders showed a lower CVHM score (0-1) was associated with increased odds of HMOD-HRC (4.04, 95% CI 1.26-12.94; P=0.019) and composite endpoint (HMOD-HRC, death or all-cause hospitalization) (3.43, 95% CI 1.19-9.92; P=0.023). Individual components were less predictive than the cumulative CVHM score. Few hypertensive patients in this urban population had ideal CVHM scores. An inverse relationship between scores and outcomes (HMOD-HRC, death or hospitalizations) was observed. Interventions to increase this score may improve prognosis among community-based hypertensive patients.

Cyberbullying and Psychopathological Behaviors in Spanish Secondary Education Students.

Cyberbullying is considered a serious health problem that mainly affect adolescents, with different characteristics depending on the role in which they are directly involved. The objective of our research was to analyze the sociodemographic characteristics and psychopathological behaviors among the roles of those involved in cyberbullying (victims, aggressors, bystanders and aggressive victims). The study participants were 280 students aged between 12 and 17 years (61.8% female) from the Region of Murcia, Spain. The Cyberbullying Screening of Bullying among Peers, the Clinical Analysis Questionnaire and a sociodemographic survey were used. Hierarchical regression analysis was used. This study showed that the roles of those directly involved in cyberbullying correlate with psychopathological behaviors. It is a priority to promote prevention programs aimed at improving cyberbullying among students.

Programs to improve body image in adolescents: A systematic review / Programas para mejorar la imagen corporal en adolescentes: una revisión sistemática

Abstract Objective: To examine the intervention programs that have been conducted on body image in adolescents. Materials and methods: The PRISMA statement was used in this review. The search for studies was conducted in PubMed, Web of Science, MEDLINE-ProQuest, and EBSCO databases from January 1, 2017, to January 25, 2022. Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project. Results: Eight studies were included, most of which had a strong methodological quality. The results obtained after the implementation of the programs reflected favorable changes in body image and body satisfaction for adolescents between 11 and 18 years old, only for five studies. Additionally, five studies maintained the same changes at follow-up. Conclusions: Findings from this review allow us to conclude that intervention programs are a safe and effective way to influence adolescent body image.

Resumen Objetivo: Examinar los programas de intervención que se han realizado sobre imagen corporal en adolescentes. Materiales y métodos: En esta revisión se utilizó la declaración PRISMA. La búsqueda de los estudios se realizó en las bases de datos PubMed, Web of Science, MEDLINE-ProQuest y EBSCO, a partir del 1 enero de 2017 hasta el 25 de enero de 2022. La calidad metodológica se evaluó a través de la Quality Assessment Tool for Quantitative Studies, desarrollada por el Effective Public Health Practice Project. Resultados: Se incluyeron ocho estudios, de los cuales la mayoría tuvo una calidad metodológica fuerte. Los resultados obtenidos después de la implementación de los programas reflejaron cambios favorables en la imagen corporal y en satisfacción corporal para los adolescentes de entre 11 y 18 años, solo para cinco estudios. Adicionalmente, cinco estudios mantuvieron en el seguimiento los mismos cambios. Conclusiones: Los hallazgos de esta revisión nos permiten concluir que los programas de intervención, constituyen una forma segura y eficaz de incidir en la imagen corporal de los adolescentes.

Eosinophilic Granulomatosis With Polyangiitis Presentation After Nandrolone Withdrawal.

A 41-year-old man was admitted to the Emergency Department with bilateral numbness in lower extremities and left femoral palsy. He also reported constitutional symptoms, vomiting and non-bloody diarrhoea for the last several months. He had a previous history of eosinophilic asthma with erratic follow-up. During admission, eosinophil count was 66% of white blood cells. Sural nerve biopsy revealed vasculitis with eosinophilic infiltration. Further evaluations consisted of colonoscopy and nasal endoscopy that confirmed eosinophil infiltrates on colonic ulcers and nasal polypi. The patient was started on systemic corticosteroids and cyclophosphamide. Among his personal records, he had been taking nandrolone decanoate without medical prescription, and had withdrawn a few years before the first asthma exacerbation.

Association between Cardiovascular Health, C-Reactive Protein, and Comorbidities in Spanish Urban-Dwelling Overweight/Obese Hypertensive Patients.

The relationship between poorer cardiovascular health metrics (CVHM) plus low-grade inflammation (LGI) and hypertension-mediated organ damage (HMOD) and hypertension-related comorbidities (HRC) in hypertensive populations with an overweight/obese (Ow/Ob) hypertension-related phenotype is understudied. We examined the relationship between the CVHM score and the presence of LGI and Ow/Ob hypertension-associated phenotype morbidities and mortality in 243 hypertensive patients from an urban primary care center. We recorded the baseline CVHM score plus clinical data, including hs-C-reactive protein (CRP) and prevalent and incident HMOD-HRC and death. A total of 26 (10.7%) had a body mass index (BMI) < 25 kg/m2, 95 (31.1%) were overweight (BMI 25-29.9 kg/m2), and 122 (50.2%) were obese (BMI ≥ 30 kg/m2). There were 264 cases of HMOD-HRC and 9 deaths. Higher hs-CRP levels were observed as BMI increased. Linear regression analysis showed a significant correlation between BMI and hs-CRP, adjusted for confounders. Additionally, individuals with a higher hs-CRP tertile had a significant increase in BMI. Significantly lower log hs-CRP levels were found as the number of ideal CVHM scores rose. Multivariate binary logistic regression found the risk of HMOD-HRC increased significantly as the ideal CVHM scores decreased, and hs-CRP levels also correlated with HMOD-HRC in the whole cohort and in the Ow and Ob subpopulations. These findings highlight the need for early intervention targeting ideal CVHMs among hypertensive individuals with an Ow/Ob phenotype in order to attenuate the inflammatory state and prevent cardiovascular disease.

Time-Dependent Changes of Klotho and FGF-23 Levels after Kidney Transplantation: Role of Cold Ischemia Time, Renal Function and Graft Inflammation.

We investigated the evolution of serum klotho (s-Kl) and FGF-23 during the first two years post-kidney transplantation (KT), considering the cold ischemia time (CIT), glomerular filtration rate (GFR) and graft subclinical inflammation (SCI). We undertook a prospective, cohort, multicenter study of consecutive patients between April 2018 and January 2021 (with follow-up at 24 months). Subgroups were analyzed according to the median CIT (<14 vs. ≥14 h), the median GFR (≤40 vs. >40 mL/min/1.73 m2) and the presence of SCI at month 3. A total of 147 patients were included. s-Kl and fibroblast growth factor-23 (FGF-23) levels were measured at baseline and at months 3, 12 and 24. Graft biopsies (n = 96) were performed at month 3. All patients had low s-Kl levels at month 3. Patients with CIT < 14 h exhibited a significant increase in s-Kl at month 24. In patients with CIT ≥ 14 h, s-Kl at month 3 fell and lower s-Kl levels were seen at month 24. Patients with a GFR > 40 had a lesser decrease in s-Kl at month 3. FGF-23 fell significantly at months 3 and 12 in both GFR groups, a reduction maintained during follow-up. There were significant inter-group differences in s-Kl from months 3 to 24. CIT, GFR at 3 months and SCI were significantly associated with s-KI at month 3. A reduction in s-Kl at month 3 post-KT could be explained by longer CIT and delayed graft function as well as by impaired graft function. Early SCI may regulate s-Kl increase post-KT.

Alfabetización en medios para promover la satisfacción corporal y la alimentación saludable en adolescentes / Media literacy to promote body satisfaction and healthy eating in adolescents

Resumen Este estudio evaluó la eficacia de un programa de alfabetización en medios (AM) para promover la satisfacción corporal y la alimentación saludable en adolescentes de 12 a 15 años de edad. Es un estudio cuantitativo, cuasiexperimental y longitudinal, con preprueba y postprueba. Participaron 30 mujeres adolescentes de 12-15 años de edad, asignadas aleatoriamente a una de dos condiciones: programa de AM (n = 16) y grupo control en lista de espera (n = 14). Las participantes completaron, en preprueba y postprueba, el Cuestionario de Actitudes hacia la Apariencia Física (SATAQ-3), el Cuestionario de Evitación de la Imagen Corporal (BIAQ) y el Cuestionario de Comportamiento Alimentario (CCA). Hubo una disminución en las puntuaciones obtenidas por el grupo con intervención. Las participantes reportaron comparar menos su cuerpo con relación al cuerpo de las personas que son atléticas (F = 4.17, p = .05), las participantes también consideraron, al finalizar la intervención, que las personas famosas no son una fuente importante de información sobre la moda y sobre cómo ser atractiva (F = 6.87, p = .01). Los programas de AM son herramientas socioeducativas útiles para prevenir la insatisfacción corporal y los comportamientos alimentarios de riesgo, así como para promover conductas saludables.

Abstract This study evaluated the effectiveness of a media literacy (ML) program to promote body satisfaction and healthy eating in adolescents from 12 to 15 years old. The study is quantitative, quasi-experimental and longitudinal study, with pre-test and final post-test. Participated 30 female adolescents aged from 12 to 15 years old, randomly assigned to one of two conditions: ML program (n = 16) and control group on the waiting list (n = 14), who answered the Attitudes to the Physical Appearance Questionnaire (SATAQ-3), the Body Image Avoidance Questionnaire (BIAQ) and the Eating Behavior Questionnaire (CCA). The participants reported comparing their body less with respect to the body of people who are athletic (F = 4.17, p = .05), the participants also considered, at the end of the intervention, that famous people are not an important source of information about fashion and how to be attractive (F = 6.87, p = .01). ML programs are useful socio-educational tools to prevent problems such as dissatisfaction with body image and risky eating behaviors, or to promote healthy behaviors.

Predicción de la resiliencia docente mediante redes neuronales artificiales:influencia del burnout y del estrés por COVID-19 / Predicting teacher resilience by using artificial neural networks: influence of burnout and stress by COVID-19

Antecedentes: La resiliencia en el profesorado permite afrontar situaciones difíciles y reponerse a la adversidad existiendo diferencias de género al respecto. Asimismo, la inteligencia artificial y las técnicas asociadas a ella han resultado ser de gran utilidad para predecir variables educativas y estudiar la interconexión entre ellas tras la COVID-19. Dicho esto, el objetivo general de esta investigación fue predecir los niveles de resiliencia en las profesoras y profesores de Secundaria a través del diseño de una red neuronal artificial (RNA). Método: Se administró la Escala Breve de Afrontamiento Resiliente, el Inventario de Burnout de Maslach y el Cuestionario de Estrés frente a la COVID-19 a 401 docentes de secundaria (70.6% mujeres) de centros educativos del sureste español, con una edad media de 44.36 años (DT= 9.38). Resultados: Se hallaron diferencias en la configuración de los modelos predictivos de la resiliencia entre profesoras y profesores contribuyendo las variables independientes en diferente grado en función del género. Conclusiones: Se pone de manifiesto la utilidad de las RNA en el ámbito educativo y la necesidad de diseñar programas más ajustados.(AU)

Background:Resilience in teachers allows them to face difficult situations to recover from adversity and there are gender differences. Likewise, artificial intelligence and the techniques associated with it have proven to be very useful in predicting educational variables and studying the interconnection between them after COVID-19. That said, the general objective of this research was to predict the levels of resilience in second-ary school teachers through the design of an artificial neural network (ANN). Method: The Brief Resilient Coping Scale, the Maslach Burnout In-ventory and the COVID-19 Stress Questionnaire were administered to 401 secondary school teachers (70.6% female) from schools in southeastern Spain, with a mean age of 44.36 years (SD = 9.38). Results:Differences were found in the configuration of the predictive models of resilience be-tween male and female teachers, with the independent variables contrib-uting to different degrees depending on gender. Conclusions:It is highlighted the usefulness of ANNs in the educational setting and the need to design more adjusted programs.(AU)

Quantum reference frames for an indefinite metric.

The current theories of quantum physics and general relativity on their own do not allow us to study situations in which the gravitational source is quantum. Here, we propose a strategy to determine the dynamics of objects in the presence of mass configurations in superposition, and hence an indefinite spacetime metric, using quantum reference frame (QRF) transformations. Specifically, we show that, as long as the mass configurations in the different branches are related via relative-distance-preserving transformations, one can use an extension of the current framework of QRFs to change to a frame in which the mass configuration becomes definite. Assuming covariance of dynamical laws under quantum coordinate transformations, this allows to use known physics to determine the dynamics. We apply this procedure to find the motion of a probe particle and the behavior of clocks near the mass configuration, and thus find the time dilation caused by a gravitating object in superposition. Comparison with other models shows that semi-classical gravity and gravitational collapse models do not obey the covariance of dynamical laws under quantum coordinate transformations.

Cov-caldas: A new COVID-19 chest X-Ray dataset from state of Caldas-Colombia.

The emergence of COVID-19 as a global pandemic forced researchers worldwide in various disciplines to investigate and propose efficient strategies and/or technologies to prevent COVID-19 from further spreading. One of the main challenges to be overcome is the fast and efficient detection of COVID-19 using deep learning approaches and medical images such as Chest Computed Tomography (CT) and Chest X-ray images. In order to contribute to this challenge, a new dataset was collected in collaboration with "S.E.S Hospital Universitario de Caldas" ( https://hospitaldecaldas.com/ ) from Colombia and organized following the Medical Imaging Data Structure (MIDS) format. The dataset contains 7,307 chest X-ray images divided into 3,077 and 4,230 COVID-19 positive and negative images. Images were subjected to a selection and anonymization process to allow the scientific community to use them freely. Finally, different convolutional neural networks were used to perform technical validation. This dataset contributes to the scientific community by tackling significant limitations regarding data quality and availability for the detection of COVID-19.

Treatment of early borderline lesions in low immunological risk kidney transplant patients: a Spanish multicenter, randomized, controlled parallel-group study protocol: the TRAINING study.

BACKGROUND: Subclinical inflammation, including borderline lesions (BL), is very common (30-40%) after kidney transplantation (KT), even in low immunological risk patients, and can lead to interstitial fibrosis/tubular atrophy (IFTA) and worsening of renal function with graft loss. Few controlled studies have analyzed the therapeutic benefit of treating these BL on renal function and graft histology. Furthermore, these studies have only used bolus steroids, which may be insufficient to slow the progression of these lesions. Klotho, a transmembrane protein produced mainly in the kidney with antifibrotic properties, plays a crucial role in the senescence-inflammation binomial of kidney tissue. Systemic and local inflammation decrease renal tissue expression and soluble levels of α-klotho. It is therefore important to determine whether treatment of BL prevents a decrease in α-klotho levels, progression of IFTA, and loss of kidney function. METHODS: The TRAINING study will randomize 80 patients with low immunological risk who will receive their first KT. The aim of the study is to determine whether the treatment of early BL (3rd month post-KT) with polyclonal rabbit antithymocyte globulin (Grafalon®) (6 mg/kg/day) prevents or decreases the progression of IFTA and the worsening of graft function compared to conventional therapy after two years post-KT, as well as to analyze whether treatment of BL with Grafalon® can modify the expression and levels of klotho, as well as the pro-inflammatory cytokines that regulate its expression. DISCUSSION: This phase IV investigator-driven, randomized, placebo-controlled clinical trial will examine the efficacy and safety of Grafalon® treatment in low-immunological-risk KT patients with early BL. TRIAL REGISTRATION: clinicaltrials.gov : NCT04936282. Registered June 23, 2021, https://clinicaltrials.gov/ct2/show/NCT04936282?term=NCT04936282&draw=2&rank=1 . Protocol Version 2 of 21 January 2022. SPONSOR: Canary Isles Institute for Health Research Foundation, Canary Isles (FIISC). mgomez@fciisc.org .

Abnormal ankle-brachial index, cardiovascular risk factors and healthy lifestyle factors in hypertensive patients: prospective cohort study from a primary care urban population.

BACKGROUND: Peripheral arterial disease (PAD) and arterial stiffness (AS) may be hypertension-mediated vascular lesions. Both are determined by an abnormal ankle-brachial index (ABI) and are predictors of cardiovascular disease (CVD) and mortality. We assessed the relationship in urban hypertensive patients between an abnormal ABI and an ideal cardiovascular health (CVH) score, plus other healthy factors, with unfavourable outcomes. METHODS: We studied 243 hypertensive patients from a primary care urban population, followed for two years. Clinical data, comorbid conditions, including hypertension-mediated organ damage (HMOD) and hypertension-related comorbidities (HRC), hospitalizations and mortality were also recorded. RESULTS: A low prevalence of ideal CVH was observed in urban hypertensive patients. The ABI ≤ 0.9 group (n = 16) showed a higher proportion of prior CVD other than PAD, mortality and hospitalizations than the ABI > 1.4 group (n = 41), and a poorer lipid, metabolic and renal profile. An inverse relationship between CVH score and ABI ≤ 0.9 and unfavourable outcomes (HMOD, HRC, death or hospitalization) was observed. Chronic kidney disease (CKD) and diabetes were independently associated with an ABI ≤ 0.9. Age, sex, diabetes, CKD, ABI ≤ 0.9 and ideal cholesterol were also associated with outcomes, but not other CVH metrics. CONCLUSIONS: Besides a low prevalence of ideal CVH, an inverse relationship between CVH score and ABI ≤ 0.9 and unfavourable outcomes was observed in hypertensive patients from an urban population. Stronger efforts to promote ideal CVH may improve outcomes in this particular population.

Cardio-renal benefits of sacubitril/valsartan in patients with advanced chronic kidney disease: experience in daily clinical practice.

BACKGROUND: The association between cardiac complications, such as heart failure (HF), and chronic kidney disease (CKD) is well known. In this study, we examined the effectiveness and safety of treatment with neprilysin inhibition in patients with advanced chronic kidney disease (stage 3b-4). METHODS: This single-centre, longitudinal, retrospective study of 31 months duration involved consecutive patients with CKD and HF with a reduced ejection fraction (HFrEF) who started treatment with sacubitril/valsartan. Glomerular filtration rate (GFR), cardiovascular risk factors, proteinuria, potassium, echocardiographic parameters and admissions for heart failure were analysed. RESULTS: The study comprised 25 patients with a median age of 73.2 ± 5.9 years. The most frequent aetiology of heart failure was ischemic heart disease. The median GFR was 29.4 ± 8.3 ml/min/1.73 m2 and the left ventricular ejection fraction (LVEF) 36.4 ± 8.9%. The GFR improved after initiating the treatment (F = 3.396, p = 0.019), as did the LVEF at one year of follow-up (p = 0.018). The number of visits to the emergency department for heart failure was also reduced. No patients needed to start renal replacement therapy. CONCLUSIONS: This study shows that sacubitril/valsartan may play a beneficial role in patients who have advanced CKD and HFrEF, with a satisfactory safety profile.

Introduction to the Special Issue on Cyberbullying and Cybervictimization.

Nowadays, the Internet is commonly used by students for both social activities and the academic field [...].

Content validity of a psychological e-health program of self-control and motivation for adults with excess weight.

Excess weight requires multidisciplinary treatment, including psychology in face-to-face and e-health interventions. The need to analyse interventions' content validity has become evident. The objective is to assess content validity of a psychological e-health program of self-control and motivation for adults with excess weight. Six health professionals (a nutritionist, a personal trainer, physician and three psychologists) evaluated the content validity of the program. The results showed that the item-level content validity index (I-CVI) was 1 (the maximum value) for 11 of the 22 activities that comprise the program. This index fluctuated between 0.83 and 0.85 for the other activities, and the scale-level content validity index was greater than 0.90 for the four modules. In terms of relevance, effectiveness and appropriateness, 90%, 65% and 60% of the activities, respectively, obtained the maximum possible I-CVI, while the index was acceptable for the remainder of the activities. This is the first study about content validity of a psychological program for adults with excess weight in Mexico and it supported that the content program was suitable, and it may be used as a part of multidisciplinary treatments. This study also highlights the importance of involving an expert review in the development of intervention programs. This intervention program may be useful in the context of a multidisciplinary intervention; however, it is important to conduct studies to evaluate its efficacy.

Self-Esteem at University: Proposal of an Artificial Neural Network Based on Resilience, Stress, and Sociodemographic Variables.

Artificial intelligence (AI) is a useful predictive tool for a wide variety of fields of knowledge. Despite this, the educational field is still an environment that lacks a variety of studies that use this type of predictive tools. In parallel, it is postulated that the levels of self-esteem in the university environment may be related to the strategies implemented to solve problems. For these reasons, the aim of this study was to analyze the levels of self-esteem presented by teaching staff and students at university (N = 290, 73.1% female) and to design an algorithm capable of predicting these levels on the basis of their coping strategies, resilience, and sociodemographic variables. For this purpose, the Rosenberg Self-Esteem Scale (RSES), the Perceived Stress Scale (PSS), and the Brief Resilience Scale were administered. The results showed a relevant role of resilience and stress perceived in predicting participants' self-esteem levels. The findings highlight the usefulness of artificial neural networks for predicting psychological variables in education.