The effects of obesity on longitudinal ventricular and atrial strain in a rural population of Spanish children and adolescents, evaluated by a new strain software.

BACKGROUND AND OBJECTIVES: Research on the relationship between body mass index (BMI) and strain values in children and adolescents is limited. Our aim was to analyse the relationship between BMI and strain values of both ventricles and left atrium in children and adolescents. METHODS: Both ventricles and left atrial strain values were compared among different BMI categories in children and adolescents from a town in the South of Spain. RESULTS: Of the 198 subjects, aged 6-17 years, 53% were of normal weight, 26% were overweight and 21% had obesity. Lower absolute values of left ventricular global longitudinal strain (25.9 ± 2.0% vs. 26.9 ± 2.2%, p = 0.002) and right ventricular free wall longitudinal strain (29.5 ± 4.2% vs. 30.8 ± 4.5%, p = 0.04) were found in subjects with obesity and overweight versus subjects with normal weight. A lower right ventricular four-chamber longitudinal strain was also observed in males with obesity and overweight (24.8 ± 3.3% vs. 26.4 ± 3.6%, p = 0.03). Statistically significant negative correlations of BMI were found for all ventricular, but not atrial, strain values in univariate analysis. This association turned non-significant for right ventricular four-chamber longitudinal strain in multivariate analysis. CONCLUSIONS: Utilizing this new strain software, children and adolescents with high BMI were associated with significantly lower values for left and right ventricular free wall longitudinal strain, without impact in left atrial strain.

A Mediterranean-Diet-Based Nutritional Intervention for Children with Prediabetes in a Rural Town: A Pilot Randomized Controlled Trial.

Prediabetes is a pathological condition in which the blood glucose concentration is higher than normal concentrations but lower than those considered necessary for a type 2 diabetes mellitus diagnosis. Various authors have indicated that the Mediterranean Diet is one of the dietary patterns with the most healthy outcomes, reducing high levels of HbA1c, triglycerides, BMI, and other anthropometric parameters. The main objective of this study was to determine the efficacy of the nutritional intervention for children with prediabetes, including the effectiveness of this nutritional education regarding anthropometric parameters. A randomized pilot trial with two groups, an experimental group (EG) and a control group (CG), using intervention in dietary habits with nutritional reinforcement was carried out on 29 children with prediabetes from a rural area. The nutritional intervention was analyzed through astrophotometric and glycemic measurements and validated surveys. Results: The results indicated improvement in eating habits, adherence to the Mediterranean diet, anthropometric measurements, mainly body mass index and perimeters, and analytical parameters, with a significant decrease in glycated hemoglobin in the EG compared to the CG (p < 0.001). Although the results showed that both groups' anthropometric parameters improved, a more significant decrease was observed in the experimental group compared to the control.

The Assessment of Myocardial Longitudinal Strain in a Paediatric Spanish Population Using a New Software Analysis.

BACKGROUND: Two-dimensional speckle-tracking echocardiography (2DSTE) has been present for years. However, it is underutilized due to the expertise and time requirements for its analysis. Our aims were to provide strain values in a paediatric Spanish population and to assess the feasibility and reproducibility of a new strain software analysis in our environment. METHODS: A cross-sectional study of 156 healthy children aged 6 to 17 years. Longitudinal strain (LS) analysis of the left ventricle, right ventricle, and left atrium was performed. Feasibility and reproducibility were assessed. The associations of clinical and echocardiographic variables with strain values were investigated by multivariate analysis. RESULTS: Mean age was 11 ± 3 years (50% female). Feasibility of LS measurement ranged from 94.2% for left ventricle global LS (LVGLS) to 98.1% for other chamber strain parameters. Strain values were 26.7 ± 2.3% for LVGLS; 30.5 ± 4.4% and 26.9 ± 4% for right ventricle free wall LS (RVFWLS) and four chambers view LS (RV4CLS) respectively; and 57.8 ± 10.5%, 44.9 ± 9.5%, and 12.9 ± 5.5% for left atrium LS reservoir phase (LALSr), conduct phase (LALScd) and contraction phase (LALSct), also respectively. Body surface area (BSA) and age presented a negative correlation with strain values. Higher values were found in females than in males, except for LALScd. Excellent intra- and inter-observer reproducibility were found for right and left ventricular strain measurement, with intraclass correlation coefficients (ICC) ranging from 0.88 to 0.98, respectively. In conclusion, we described strain values in a healthy Spanish paediatric population. LS assessment by this new strain analysis software by semi-automatic manner was highly feasible and reproducible.

Narrativas de cambio para la prevención del consumo de cannabis: CANNBIANDO, los relatos de Paula y de Alex / Narratives of change for prevention of cannabis use; CANNBIANDO, the stories of Paula and Alex

Este trabajo trata de describir el proceso de elaboración de una herramienta narrativa (storytelling) basada en las teorías sobre persuasión narrativa y el modelo transteórico de Prochaska y DiClemente (1982), con el propósito de que pueda ser utilizado por los profesionales de la educación, la salud y la intervención social para prevenir el consumo de cannabis entre adolescentes entre 12 y 18 años de forma universal y selectiva. El proceso de creación de esta herramienta audiovisual siguió las siguientes fases: a) identificar perfiles psicosociales de riesgo del consumo de cannabis desde una revisión de la literatura científica y entrevistas a profesionales; b) análisis de historias de vida de adolescentes consumidores de cannabis; c) creación de dos historias en función del género; d) validación de la herramienta a partir de grupos focales; y e) diseño de una propuesta de intervención para los profesionales. En conclusión, presentamos el proceso de creación de una herramienta narrativa junto con una propuesta de intervención basadas en la evidencia científica, vital y profesional, que pretende ser de utilidad para los profesionales dedicados al campo de la prevención del consumo al cannabis entre los adolescentes.

This paper tries to describe the process of elaboration of a narrative tool (storytelling) based on theories about narrative persuasion and the transtheoretical model of Prochaska and DiClemente (1982), with the purpose that it can be used by education, health and social intervention professionals to prevent cannabis use among adolescents between 12 and 18 years of age universally and selectively. The creation process of this audiovisual tool involved the following phases: a) identify psychosocial risk profiles of cannabis use from a review of the scientific literature and interviews with professionals; b) analysis of life stories of adolescent cannabis users; c) creation of two stories based on gender; d) validation of the tool from focus groups; and e) design of an intervention proposal for professionals. In conclusion, we present the process of creating a narrative tool together with an intervention proposal based on scientific, vital and professional evidence, which aims to be useful for professionals dedicated to the field of prevention of cannabis use among adolescents

Prevalencia de infección por SARS-CoV-2 durante la primera oleada de la pandemia entre personal sanitario y no sanitario del Hospital General de Segovia, Castilla y León / Prevalence of SARS-CoV-2 infection during the first wave of the pandemic among health and non-health personnel of the General Hospital of Segovia, Castilla y León

Introducción. Los trabajadores sanitarios y no sanitarios(TSyNS) de un hospital están más expuestos al contagio porSARS-CoV-2 que la población general. Estudiamos la prevalencia de esta infección en los trabajadores del hospital de Segovia tras la primera ola.Material y métodos. Estudio monocéntrico, observacional, transversal, realizado entre el 29 de abril y el 14 de mayode 2020. Se diagnosticó la infección mediante test de inmunocromatografía capilar para anticuerpos IgG y/o IgM, o PCR. Seestudiaron variables laborales, de salud, y de exposición.Resultados. Participaron en el estudio 1.335 TSyNS de untotal 1.667 (80,1%), un 79,3% mujeres, con una edad media de47,3 años, y de 47,1 para los hombres. La prevalencia de infectados fue del 21,95%, el 24,7% asintomáticos. La edad presentó una OR significativa de 1,02/año. La exposición extralaboralaumentó la prevalencia un 16,8%. El uso continuado del Equipo de Protección Individual (EPI) y la administración de nebulizaciones presentaron una OR de 0,54 y 0,46 respectivamente.Los síntomas asociados a mayor prevalencia fueron anosmia(OR 9,31), ageusia (OR 3,05), y fiebre (OR 1,94). Hasta la fecha,el 75% de los TSyTNS infectados lo hicieron en la primera ola.Conclusiones. La prevalencia es mayor entre los TSyNSque en la población general. La edad se asocia a una mayorprevalencia de infección. Casi un 25% de los infectados fueasintomático. El uso de EPI de forma continuada se asoció amenor prevalencia. Los síntomas con mayor asociación fueronfiebre, anosmia, y ageusia. (AU)

Introduction. Health and non-health workers (H&NH-W)in a hospital are more exposed to SARS-CoV-2 infection thanthe general population. We studied the prevalence of this infection in these workers of Segovia´s Hospital after the firstepidemic wave.Material and methods. Monocentric, observational,cross-sectional study, carried out between April 29 and May14, 2020. The infection was diagnosed by capillary immunochromatography test for IgG and / or IgM antibodies, or PCR.Work, health, and exposure variables were studied.Results. A total of 1,335 H&NH-W participated in thestudy out of a total of 1,667 (80.1%), 79.3% women, with amean age of 47.3 years, and 47.1 for men. The prevalence ofinfected was 21.95%, 24.7% asymptomatic. Age presented asignificant OR of 1.02/year. Exposure outside of work increasedthe prevalence by 16.8%. The continued use of Personal Protective Equipment (PPE) and the administration of nebulizations presented an OR of 0.54 and 0.46 respectively. The symptoms associated with the highest prevalence were anosmia(OR 9.31), ageusia (OR 3.05), and fever (OR 1.94). Today, about75% of H&NH-W were infected in the first wave.Conclusions. The prevalence is higher among healthcareworkers than the population they serve. Age is associated witha higher prevalence of infection. Almost a quarter of thoseinfected were asymptomatic. The continuous use of PPE wasassociated with a lower prevalence, for that the administrationof nebulisations could be safe. The symptoms with the greatestassociation were fever, anosmia, and ageusia (AU)

Role of obesity and blood pressure in epicardial adipose tissue thickness in children.

BACKGROUND: Elevated body mass index (BMI) has been associated with cardiac changes, such as higher epicardial adipose tissue (EAT) thickness. This fat has been identified as a predictive factor of cardiovascular diseases during adulthood. However, few studies have tested the association of multiple cardiovascular risk factors (high weight or blood pressure) with EAT in adolescents and children. Therefore, the main objective of this current research was to determine the impact of BMI, overweight, obesity, and blood pressure on EAT thickness in children. METHODS: A descriptive cross-sectional study focused on elementary and high school students aged 6-16 years was carried out by utilizing diverse measurements and instruments, such as echocardiography. RESULTS: EAT thickness (N = 228) was linked to sex (more predominant in boys 2.3 ± 0.6; p = 0.044), obesity (2.3 ± 0.6; p < 0.001), and hypertension (2.6 ± 0.6; p = 0.036). The logistic regression indicated that age, sex, and BMI seemed to be more relevant factors in EAT thickness in children (adjusted R square = 0.22; p < 0.001). CONCLUSIONS: This paper examined the associations of sex, age, and cardiovascular risk factors (arthrometric measures and blood pressure) with EAT thickness, indicating that it is necessary to assess whether the findings are associated with future events. IMPACT: Excessive weight gain and blood pressure in the early stages of life have been associated with adipose tissue. This increase in weight and blood pressure has been attributed to alterations in the epicardial adipose tissue linked to anthropometric markers in adults, but no related study has been implemented in Spanish children. This study revealed how higher epicardial adipose tissue is linked to body mass index, other anthropometric parameters, and blood pressure in Spanish children. These measurements are related to high epicardial adipose tissue thickness, which in early stages does not imply pathology but increases the risk of developing cardiovascular diseases.

Relationship between overweight and obesity and cardiac dimensions and function in a paediatric population.

Obesity in adults is associated with left ventricular hypertrophy, dilatation, and myocardial fibrosis, as well as heart failure and coronary heart disease. These associations have been studied to a lesser extent in the paediatric population. This study aims to investigate the relationship between obesity and cardiac structure and function in the paediatric population. In a southern Spanish village, we selected all inhabitants aged 6-17 years stratifying by age, gender, and educational centres. We performed a complete transthoracic echocardiogram evaluating all the cardiac morphological and functional parameters commonly measured in an echocardiographic study. There were 212 children and adolescents included. Of them, 48.1% were males. The mean age was 10.9 ± 3.0 years. A total of 106 (50%) were normal weight, 57 (26.9%) overweight, and 49 (23.1%) obese. Sex and age were similar in all three groups. Overweight and obesity were associated with larger left ventricular end-diastolic and end-systolic volumes (p < 0.0005), greater left ventricular mass (p < 0.0005), and smaller ejection fraction (p < 0.0005). They were also associated with larger atrial, aortic, and right ventricular size. Lateral and mean E/e' ratios were higher (p = 0.007 and p = 0.01 respectively). Body mass index was independently associated with all cavity size variables as well as left ventricular ejection fraction. CONCLUSION: Childhood obesity is independently associated with larger heart chambers, greater left ventricle mass, and smaller left ventricle ejection fraction. WHAT IS KNOWN: • Childhood obesity is related to the development of cardiovascular risk factors and is considered an epidemic of the twenty-first century; its prevalence is rising. WHAT IS NEW: • Childhood overweight and obesity lead to changes in cardiac structure and function which, although not considered clinically pathological, are significant and a result of obesity, and which behave as unfavourable incipient alterations at an early age.

Family and School Relationship during COVID-19 Pandemic: A Systematic Review.

Education systems worldwide have been affected by a sudden interruption in classroom learning because the coronavirus pandemic forced both the closure of all schools in March 2020 and the beginning of distance learning from home, thus compelling families, schools, and students to work together in a more coordinated fashion. The present systematic review was carried out following PRISMA guidelines. The main objective was to present critical information on the relationship between the family and the school in the face of the imposed distance learning scenario caused by COVID-19. A total of 25 articles dealing with the relationships established during the pandemic of any of the three agents involved (family, students, and school) were analysed. The results showed that the relationships between the three groups involved must be improved to some extent to meet the needs that have arisen as a result of distance learning. In conclusion, the educational scenario during the pandemic has been one of the most significant challenges experienced in the recent history of education.

Efficiency in the governance of the Covid-19 pandemic: political and territorial factors.

BACKGROUND: The pandemic generated by Covid-19 has changed the way of life of citizens around the world in a short time, affecting all areas of society directly or indirectly, which is facing a global health crisis with different national responses implemented by governments. Several months into the pandemic, the first after-effects of Covid-19 are beginning to be felt by citizens, who are questioning the management carried out so far. In order to improve the performance of governmental decisions to reduce the impact of the pandemic during the coming months, we calculated the levels of efficiency in the management of health resources. In addition, we identify some country characteristics that may condition efficient management. RESULTS: We obtained significant differences according to the geographical location of the country, with European and American countries being less efficient than Asian and African countries. Likewise, we can affirm that greater freedom of expression, a higher median age and an unstable economy and labor market reduce efficiency. However, female leadership of the government and greater compliance with the rule of law offer more efficient management, as do countries that derive more revenues from tourism. CONCLUSIONS: These results provide an opportunity for political leaders to reflect on their management during these months of the pandemic in order to identify mistakes and improve the implementation of effective measures. It has been shown that using more resources does not mean managing better; therefore, policymakers need to pay special attention to the use of resources, taking into account the budgetary constraints of the public sector.

Which region and which sector leads the circular economy? CEBIX, a multivariant index based on business actions.

The circular economy encompasses a sustainable economic model based on a production, consumption, distribution and maintenance process that reuses as much as possible. In this research, the two-step composite Circular Economy Business Index was created, based on 17 environmental practices that companies have implemented to reduce the generation of waste and emissions and to increase the reuse and efficiency of materials and energy, among other actions. The use of a sample of 26,783 companies from 49 countries and 10 sectors for the period 2014-2019 allowed the aggregation of these initiatives at the country and industry levels. In this sense, our results show less progress in the circular transformation worldwide and can be used in the design of policies aimed at promoting changes in production and consumption systems in specific geographic or industrial contexts.

A Sustainable Approach to the Metabolic Syndrome in Children and Its Economic Burden.

The prevalence of obesity continues to grow, resulting in metabolic syndrome and increasing economic burden for health systems. The objectives were to measure the ability of the NIM-MetS test, previously used in the adults, for the early and sustainable detection of the Metabolic Syndrome (MetS) in children and adolescents. Moreover, to determine the economic burden of the children with MetS. Furthermore, finally, to use and implement the NIM-MetS test, via a self-created online software, as a new method to determine the risk of MetS in children. The method used was an observational study using different instruments (NIM-MetS test, International Diabetes Federation (IDF), or Cook) and measures (body mass index). Additionally, the economic burden was estimated via a research strategy in different databases, e.g., PubMed, to identify previous papers. The results (N = 265 children, age from 10-12) showed that 23.1% had obesity and 7.2% hypertension. The prevalence of MetS using the NIM-Mets was 5.7, and the cost of these children was approximate 618,253,99 euros. Finally, a model was obtained and later implemented in a web platform via simulation. The NIM-MetS obtained is a non-invasive method for the diagnosis of risk of MetS in children.

Estudio de la obesidad en una población infantil rural y su relación con variables antropométricas / Study of obesity in a rural children population and its relationship with anthropometric variables

Objetivos: Conocer la prevalencia de obesidad en escolares de educación primaria y secundaria, y evaluar la precisión diagnóstica de variables antropométricas para su detección. Diseño: Estudio transversal. Año 2014. Emplazamiento: Área rural de Córdoba. Participantes: Población estudiantil. Se llevó a cabo un muestreo estratificado por edad, género y centros educativos. Un total de 323 alumnos de 6 a 16 años fueron estudiados, cuyos padres habían firmado el consentimiento informado. Mediciones principales: Se determinó la prevalencia de obesidad y se recogieron variables predictoras sociodemográficas, antropométricas, de condición física y alimentación. Se realizó una regresión logística binaria determinando los valores de odds ratio (OR) crudas y ajustadas, se confeccionaron curvas ROC y se determinaron valores de corte, calculando la sensibilidad, la especificidad y el índice de Youden. Resultados: La prevalencia de sobrepeso y obesidad fue del 26,2 y 22,3%, respectivamente. Solo un 15,2% de los escolares realizó dieta mediterránea óptima. El índice cintura-altura (ICT) fue la variable predictiva con mayor OR ajustada (7,1 [4,3-11,6]) y mayor área bajo la curva (0,954 [0,928-0,979]); a partir de un valor de corte global para discriminar obesidad de 0,507, consiguió una sensibilidad del 90% y una especificidad del 87,2%. Conclusiones: La alta prevalencia de obesidad, la media-baja adherencia a la dieta mediterránea y la baja condición física hacen de esta población un objetivo prioritario de actuación para la prevención de futuros eventos cardiovasculares. El ICT ha sido el mejor predictor antropométrico de obesidad, recomendándose su uso para el diagnóstico de obesidad en población infantil en detrimento del índice de masa corporal

Goals: To know the prevalence of obesity in primary and secondary school students, and to evaluate the diagnostic accuracy of anthropometric variables for its detection. Design: Cross-sectional study. Location: Rural area of Córdoba. In the year 2014. Participants: Student population. A stratified sampling was performed according to age, gender and educational centers. A total of 323 students from 6 to 16 years were included in the study, all parents had signed informed consent. Main measurements: The prevalence of obesity was determined and sociodemographic, anthropometric, physical condition and dietary predictor variables were collected. A binary logistic regression was performed determining crude and adjusted Odds Ratio (OR) values, ROC curves were obtained and cut-off values were determined, calculating the sensitivity, specificity and Youden index. Results: The prevalence of overweight and obesity was 26.2% and 22.3%, respectively. Only 15.2% of school children had an optimal Mediterranean diet. The waist-height ratio (WtHR) was the predictive variable with the highest adjusted OR 7.1 (4.3-11.6) and the largest area under the curve 0.954 (0.928-0.979), from a global cut-off value to discriminate obesity of 0.507. This gave a sensitivity of 90% and specificity of 87.2%. Conclusions: The high prevalence of obesity, the low-medium adherence to the Mediterranean diet and the low physical fitness make this population a priority target for the prevention of future cardiovascular events. The WtHR has been the best anthropometric predictor of obesity, recommending its use for the diagnosis of obesity in children at the expense of body mass index

El sobrecrecimiento bacteriano de intestino delgado es una entidad frecuente tras gastrectomía, pero con escasa relevancia en el estado nutricional / Small intestinal bacterial overgrowth is common after gastrectomy but with little impact on nutritional status

Antecedentes: La evidencia disponible que evalúa el impacto de la presencia de sobrecrecimiento bacteriano de intestino delgado (SIBO) después de una gastrectomía es escasa. Objetivos: Evaluar la frecuencia de SIBO tras gastrectomía y su asociación con malnutrición. Describir las líneas antibióticas necesarias para su corrección y si mejora el estado nutricional. Material y métodos: Estudio de cohortes prospectivo en el ámbito de la Agencia Sanitaria Costa del Sol desde 2012 hasta 2015. Se realizó test del aliento en hidrógeno y en metano espirado con sobrecarga oral de glucosa. Recogida de variables demográficas y valoración nutricional, basal y al mes del tratamiento eficaz del SIBO. Se evaluaron las pautas antibióticas y el número de tratamientos. Resultados: Se analizaron 60 pacientes gastrectomizados, 58,3%varones. Se realizó un subanálisis de la curva a los 45min para minimizar los posibles falsos positivos con una frecuencia de SIBO del 61,6%. En presencia de SIBO, se observó una tendencia no significativa a presentar un menor IMC. Tras el tratamiento con rifaximina, el SIBO permaneció positivo en el 94,6% y tras metronidazol, en el 85,7%. El multifracaso de la terapia antibiótica fue de 67,6%. No hay cambios estadísticamente significativos en parámetros nutricionales después del tratamiento. Conclusiones: El SIBO está presente en el 61,6% de los pacientes gastrectomizados, sin que se demuestre asociación con el deterioro nutricional. Rifaximina y metronidazol son escasamente efectivos en la erradicación del SIBO. Cuando este se consigue, el efecto sobre la malnutrición es escaso, pudiendo correlacionarse con otros factores

Background: Available evidence assessing the impact of small intestinal bacterial overgrowth (SIBO) following gastrectomy is limited. Objectives: To evaluate the prevalence of SIBO after gastrectomy and its association with malnutrition. To describe the antibiotic treatment required to correct it and if nutritional status improves. Material and methods: A prospective cohort study was performed at the Agencia Sanitaria Costa del Sol (Costa del Sol Health Agency) from 2012 to 2015. A hydrogen-methane breath test with oral glucose overload was performed. Demographic variables and nutritional parameters were collected at baseline and one month after effective treatment of SIBO. The antibiotic regimens and the number of treatment lines used were assessed. Results: Sixty gastrectomy patients were analysed, 58.3% of which were male. A sub-analysis of the curve was performed at 45min to minimise possible false positives, and SIBO was identified in 61.6% of cases. SIBO patients tended to have a lower BMI, although this trend was not statistically significant. After treatment with rifaximin, 94.6% of patients were still positive for SIBO, which fell to 85.7% after metronidazole. The rate of total antibiotic treatment failure was 67.6%. No statistically significant changes were found in nutritional parameters after treatment. Conclusions: SIBO was identified in 61.6% of patients after gastrectomy. No correlation was found with any malnutrition parameter. Rifaximin and metronidazole were found to be largely ineffective in eradicating SIBO. When treatment was effective, the impact on malnutrition was negligible and may have been associated with other factors

[Study of obesity in a rural children population and its relationship with anthropometric variables]. / Estudio de la obesidad en una población infantil rural y su relación con variables antropométricas.

GOALS: To know the prevalence of obesity in primary and secondary school students, and to evaluate the diagnostic accuracy of anthropometric variables for its detection. DESIGN: Cross-sectional study. LOCATION: Rural area of Córdoba. In the year 2014. PARTICIPANTS: Student population. A stratified sampling was performed according to age, gender and educational centers. A total of 323 students from 6 to 16 years were included in the study, all parents had signed informed consent. MAIN MEASUREMENTS: The prevalence of obesity was determined and sociodemographic, anthropometric, physical condition and dietary predictor variables were collected. A binary logistic regression was performed determining crude and adjusted Odds Ratio (OR) values, ROC curves were obtained and cut-off values were determined, calculating the sensitivity, specificity and Youden index. RESULTS: The prevalence of overweight and obesity was 26.2% and 22.3%, respectively. Only 15.2% of school children had an optimal Mediterranean diet. The waist-height ratio (WtHR) was the predictive variable with the highest adjusted OR 7.1 (4.3-11.6) and the largest area under the curve 0.954 (0.928-0.979), from a global cut-off value to discriminate obesity of 0.507. This gave a sensitivity of 90% and specificity of 87.2%. CONCLUSIONS: The high prevalence of obesity, the low-medium adherence to the Mediterranean diet and the low physical fitness make this population a priority target for the prevention of future cardiovascular events. The WtHR has been the best anthropometric predictor of obesity, recommending its use for the diagnosis of obesity in children at the expense of body mass index.

Small intestinal bacterial overgrowth is common after gastrectomy but with little impact on nutritional status. / El sobrecrecimiento bacteriano de intestino delgado es una entidad frecuente tras gastrectomía, pero con escasa relevancia en el estado nutricional.

BACKGROUND: Available evidence assessing the impact of small intestinal bacterial overgrowth (SIBO) following gastrectomy is limited. OBJECTIVES: To evaluate the prevalence of SIBO after gastrectomy and its association with malnutrition. To describe the antibiotic treatment required to correct it and if nutritional status improves. MATERIAL AND METHODS: A prospective cohort study was performed at the Agencia Sanitaria Costa del Sol (Costa del Sol Health Agency) from 2012 to 2015. A hydrogen-methane breath test with oral glucose overload was performed. Demographic variables and nutritional parameters were collected at baseline and one month after effective treatment of SIBO. The antibiotic regimens and the number of treatment lines used were assessed. RESULTS: Sixty gastrectomy patients were analysed, 58.3% of which were male. A sub-analysis of the curve was performed at 45min to minimise possible false positives, and SIBO was identified in 61.6% of cases. SIBO patients tended to have a lower BMI, although this trend was not statistically significant. After treatment with rifaximin, 94.6% of patients were still positive for SIBO, which fell to 85.7% after metronidazole. The rate of total antibiotic treatment failure was 67.6%. No statistically significant changes were found in nutritional parameters after treatment. CONCLUSIONS: SIBO was identified in 61.6% of patients after gastrectomy. No correlation was found with any malnutrition parameter. Rifaximin and metronidazole were found to be largely ineffective in eradicating SIBO. When treatment was effective, the impact on malnutrition was negligible and may have been associated with other factors.

Industry mimetic isomorphism and sustainable development based on the X-STATIS and HJ-biplot methods.

Based on both neo-institutional theory and comparative institutional analysis, this paper studies the role that mimetic forces play in the patterns and evolution of behavior concerning company sustainability. The panel data is composed of 6600 observations of 600 international large listed companies belonging to 39 different activity sectors for the period 2004-2014. Through employing the multivariate statistical methods HJ-biplot and X-STATIS, which provide a useful visualization of a complex data structure in a low-dimensional space, it can be observed that mimetic forces indicate that firms operating in high-impact sectors-sectors that operate under greater pressure from interest groups-face greater social and environmental risks and have higher corporate social responsibility (CSR) scores than companies from other sectors. The adoption or development of CSR practices depends largely on the type of industry in which the company operates, as stakeholder engagement in different industry sectors has different areas of concern. Therefore, companies operating in more polluting sectors, such as mining, paper, chemicals, or oil, give higher priority to environmental protection and defense of human rights, while other, less polluting companies involved in the communication sector are concerned to a greater extent by social issues, such as business ethics or the rights of their employees. Finally, this paper evidences that firms operating in similar contexts, in industries that face analogous risks and challenges, probably develop common policies and regulations with the aim of mitigating the pressures applied by their major stakeholder groups.

Ulcerative colitis with gastric and duodenal involvement.

Ulcerative colitis is one of the forms of presentation of the inflammatory bowel disease. UC yypically affects the large bowel but in the last few years more cases with proximal involvement have been described (diffuse gastritis, focally enhanced gastritis and duodenitis). We present the case of gastric and duodenitis involvement in the context of a moderate-severe ulcerative pancolitis which showed a good evolution and resolution of symptoms with corticoid treatment.

Sociopolitical and economic elements to explain the environmental performance of countries.

The present research explains environmental performance using an ecological composite index as the dependent variable and focusing on two national dimensions: sociopolitical characteristics and economics. Environmental performance is measured using the Composite Index of Environmental Performance (CIEP) indicator proposed by García-Sánchez et al. (2015). The first model performs a factor analysis to aggregate the variables according to each analyzed dimension. In the second model, the estimation is run using only single variables. Both models are estimated using generalized least square estimation (GLS) using panel data from 152 countries and 6 years. The results show that sociopolitical factors and international trade have a positive effect on environmental performance. When the variables are separately analyzed, democracy and social policy have a positive effect on environmental performance while transport, infrastructure, consumption of goods, and tourism have a negative effect. Further observation is that the trade-off between importing and exporting countries overshadows the pollution caused by production. It was also observed that infrastructure has a negative coefficient for developing countries and positive for developed countries. The best performances are in the democratic and richer countries that are located in Europe, while the worst environmental performance is by the nondemocratic and the poorest countries, which are on the African continent.