Anthropometric Measurements, Metabolic Profile and Physical Fitness in a Sample of Spanish Women with Type 2 Diabetes.

BACKGROUND: Exercise training has proven to be effective for treatment of metabolic diseases, such as type 2 diabetes mellitus. The aims of this study were to compare anthropometric measurements, metabolic profile and physical fitness between active and sedentary women with type 2 diabetes, and to analyse relationships between anthropometry and metabolic profile and components of physical fitness (balance, flexibility, strength and endurance). METHODS: Cross-sectional research on 28 women with type 2 diabetes. Amount of daily physical activity, BMI, waist circumference, HbA1c, fibrinogen, hs-CRP, tiptoe dynamic balance, static balance, finger floor distance, abdominal, upper and lower limb strength and walking cardiovascular endurance were recorded. RESULTS: Age: 58.5 ± 7.8. Overall, 16 subjects were physically active and 12 were sedentary. Active subjects had lower BMI (p = 0.033) and better cardiovascular endurance (p = 0.025). BMI and waist circumference were not influenced by any physical fitness component. HbA1c, fibrinogen and hs-CRP were related with worse dynamic balance (p = 0.036, 0.006 and 0.031, respectively). CONCLUSIONS: Active women had lower BMI and showed a better performance in cardiovascular endurance. Tiptoe dynamic balance impairments were related to worse glycaemic control, hypercoagulation and inflammatory state.

[Multidisciplinary nutritional consensus on assessment and nutritional dietary treatment in patients with chronic kidney disease and SARS-CoV-2 infection]. / Consenso multidisciplinar sobre la valoración y el tratamiento nutricional y dietético en pacientes con enfermedad renal crónica e infección por SARS-CoV-2. Consenso de nutrición en enfermedad renal crónica e infección por SARS-CoV-2.

The presence of malnutrition in patients with chronic kidney disease (CKD) is high, it can be made worse by SARS-CoV-2 infection.The nutritional assessment should be adapted to minimize the infection, recommending monitoring: weight loss percentage, body mass index (BMI), loss of appetite, analytical parameters and functional capacity using the dynamometer. As well as the sarcopenia assessment using the SCARF scale, and the possibility of using the GLIM criteria in those patients who have been tested positive by MUST.It is important to adapt the nutritional recommendations in the caloric and protein intake, to the CKD stage and to the SARS-CoV-2 infection stage. In patients with hypercatabolism, to prioritize preserving the nutritional status (35 kcal/kg weight/day, proteins up to 1.5 g/kg/day). The rest of the nutrients will be adapted to CKD stage and the analytical values.In the post-infection stage, a complete nutritional assessment is recommended, including sarcopenia. The energy and protein requirements in this phase will be adapted to the nutritional status, with special attention to the loss of muscle mass.Dietary recommendations need to be tailored to side effects of SARS-CoV-2 infection: anorexia, dysphagia, dysgeusia, and diarrhea.Anorexia and hypercatabolism makes it difficult to meet the requirements through diet, therefore the use of oral nutritional supplements is recommended as well as the enteral or parenteral nutrition in severe phases.

Consenso multidisciplinar sobre la valoración y el tratamiento nutricional y dietético en pacientes con enfermedad renal crónica e infección por SARS-CoV-2. Consenso de nutrición en enfermedad renal crónica e infección por SARS-CoV-2 / Multidisciplinary nutritional consensus on assessment and nutritional dietary treatment in patients with chronic kidney disease and SARS-CoV-2 infection

La presencia de malnutrición en pacientes con enfermedad renal crónica (ERC) es elevada, puede agravarse por la infección por SARS-CoV-2. La valoración nutricional se debe adaptar para minimizar contagios, recomendando monitorizar: porcentaje de pérdida de peso, índice de masa corporal (IMC), pérdida de apetito, parámetros analíticos y capacidad funcional mediante dinamometría. Así como valorar la sarcopenia mediante la escala SCARF, y la posibilidad de utilizar los criterios GLIM en aquellos pacientes que el cribado MUST ha dado positivo. Es importante adaptar las recomendaciones nutricionales en ingesta calórica y proteica, al estadio de la ERC y a la fase de infección por SARS-CoV-2. En pacientes hipercatabólicos priorizar preservar estado nutricional (35kcal/kg peso/día, proteínas hasta 1,5g/kg/día). El resto de nutrientes se adaptarán a estadio de ERC y valores analíticos. En la etapa postinfección, se recomienda realizar valoración nutricional completa, incluyendo sarcopenia. Los requerimientos energéticos y proteicos en esta fase se adaptarán a la afectación del estado nutricional, con especial atención a la pérdida de masa muscular. Es necesario adaptar las recomendaciones dietéticas a efectos secundarios de la infección por SARS-CoV-2: anorexia, disfagia, disgeusiay diarrea. La anorexia y el hipercatabolismo dificulta el cumplimiento de los requerimientos a través de la alimentación, por lo que se recomienda la utilización de soporte nutricional oral y en las fases severas la nutrición enteral o la parenteral. (AU)

The presence of malnutrition in patients with chronic kidney disease (CKD) is high, it can be made worse by SARS-CoV-2 infection. The nutritional assessment should be adapted to minimize the infection, recommending monitoring: weight loss percentage, body mass index (BMI), loss of appetite, analytical parameters and functional capacity using the dynamometer. As well as the sarcopenia assessment using the SCARF scale, and the possibility of using the GLIM criteria in those patients who have been tested positive by MUST. It is important to adapt the nutritional recommendations in the caloric and protein intake, to the CKD stage and to the SARS-CoV-2 infection stage. In patients with hypercatabolism, to prioritize preserving the nutritional status (35kcal/kg weight/day, proteins up to 1.5g/kg/day). The rest of the nutrients will be adapted to CKD stage and the analytical values. In the post-infection stage, a complete nutritional assessment is recommended, including sarcopenia. The energy and protein requirements in this phase will be adapted to the nutritional status, with special attention to the loss of muscle mass. Dietary recommendations need to be tailored to side effects of SARS-CoV-2 infection: anorexia, dysphagia, dysgeusia, and diarrhea. Anorexia and hypercatabolism makes it difficult to meet the requirements through diet, therefore the use of oral nutritional supplements is recommended as well as the enteral or parenteral nutrition in severe phases. (AU)

Multidisciplinary nutritional consensus on assessment and nutritional dietary treatment in patients with chronic kidney disease and SARS-CoV-2 infection.

The presence of malnutrition in patients with Chronic Kidney Disease (CKD) is high, it can be made worse by SARS-CoV2 infection. The nutritional assessment should be adapted to minimize the infection, recommending monitoring: weight loss percentage, body mass index (BMI), loss of appetite, analytical parameters and functional capacity using the dynamometer. As well as the sarcopenia assessment using the SCARF scale, and the possibility of using the GLIM criteria in those patients who have been tested positive by MUST. It is important to adapt the nutritional recommendations in the caloric and protein intake, to the CKD stage and to the SARS-CoV2 infection stage. In patients with hypercatabolism, to prioritize preserving the nutritional status (35 kcal/kg weight/day, proteins up to 1.5 g/kg/day). The rest of the nutrients will be adapted to CKD stage and the analytical values. In the post-infection stage, a complete nutritional assessment is recommended, including sarcopenia. The energy and protein requirements in this phase will be adapted to the nutritional status, with special attention to the loss of muscle mass. Dietary recommendations need to be tailored to side effects of SARS-CoV-2 infection: anorexia, dysphagia, dysgeusia, and diarrhea. Anorexia and hypercatabolism makes it difficult to meet the requirements through diet, therefore the use of oral nutritional supplements is recommended as well as the enteral or parenteral nutrition in severe phases.

Relationship between knee alignment in asymptomatic subjects and flexibility of the main muscles that are functionally related to the knee.

Objective To assess the relationship between static frontal knee alignment in asymptomatic subjects and flexibility of the main muscles functionally related to the knee. Methods A descriptive cross-sectional study was performed in 33 healthy adults (19-31 years). The frontal knee angle (valgus/varus angle) was measured by photogrammetry and it was measured in the lateral side. Therefore, high values were assigned for genu varum and low values for genu valgum. Iliopsoas, gluteus maximus and medius, rectus femoris, biceps femoris, vastus of the quadriceps, and gastrocnemius muscles were stretched. Muscles were classified as normal, reflex hypomobile, or structural hypomobile. Results Women had significantly greater valgus than did men (right angle, women: 174.41°/men: 177.41°; left angle, women: 174.20°/men: 178.70°). The right frontal plane knee angle was higher in women with structural hypomobile vastus. The left frontal plane knee angle was higher in women with structural hypomobile iliopsoas. No relationships were found in men. Conclusions A tighter vastus of the quadriceps and tighter iliopsoas are related to greater genu varum in adult women. Stretching the vastus of the quadriceps and iliopsoas when there is a tendency for excess varus in the knee, to prevent overuse injury or early osteoarthritis, might be clinically relevant.

Impacto de un programa cuerpo-mente basado en ejercicios de fisioterapia y técnicas psicológicas en el bienestar psíquico de una población de pacientes diabéticos tipo 2 / Impact of a Body Mind Program Base on Physiotherapeutic Exercises and Psychological Techniques in the Psychic Welfare of a Diabetics Patients Type 2

RESUMEN En los pacientes con diabetes tipo 2, el riesgo de sufrir algún tipo de malestar psicológico con síntomas de depresión y ansiedad, es aproximadamente el doble que en población normal. Cuando son síntomas relacionados con condiciones concomitantes, físicas y psicológicas deben ser tratados. El objetivo de este trabajo, fue examinar los efectos de un programa de ejercicios de fisioterapia y técnicas psicológicas, en el bienestar psíquico de una población diabética. El programa de 12 semanas se aplicó en 25 pacientes y se evaluaron: dolor, tensión arterial, antropometría, analítica sanguínea y bienestar psíquico (cuestionario de Goldberg de 28 ítems: GHQ-28). A pesar de la edad (84 % < de 65 años), solo el 12 % trabajaban, debido a su situación clínica de alto riesgo cardiovascular, presencia de comorbilidades (96 %) y dolor asociado. Todo ello afectaba negativamente el bienestar psíquico de los pacientes que puntuaron alto en el GHQ: disfunción social (14.8 ± 2.2), síntomas somáticos (13.5 ± 3.6), ansiedad e insomnio (11.9 ± 3.4) y depresión severa (9.2 ± 4.4). La situación clínica determinó el diseño del programa, que mostró gran eficacia terapéutica para el dolor y el aumento del bienestar psicológico, con gran repercusión en la puntuación total del GHQ, en los síntomas somáticos y en la disfunción social, aunque en la ansiedad e insomnio y la depresión los cambios fueron menores. En síntesis, el programa mejoró el bienestar físico y psíquico de la muestra, lo que aumenta la evidencia sobre la opción de incluir fisioterapia y psicología para tratar las circunstancias que causan malestar psíquico en la diabetes.

ABSTRACT Diabetic patients are around twice as likely to suffer from anxiety and depression symptoms as the general population. When these symptoms are related to concurrent conditions they should be treated. The objective of this study has been to examine the effects of a physical therapy exercises and psychological techniques program, in mental wellness of a diabetic population. The twelve weeks program was applied in 25 patients. Pain, arterial pressure, anthropometry, blood samples and mental wellness (with 28 items Goldberg questionnaire: GHQ-28) were evaluated. Though they were relatively young (84 % < than 65 years), only 12 % were working, due to the high cardiovascular risk clinical situation, the existence of comorbidities (96 %) and the associated pain. These facts negatively affected the mental wellness of the people, so they scored high in GHQ questionnaire: social dysfunction (14.8 ± 2.2), somatic symptoms (13.5 ± 3.6), anxiety and insomnia (11.9 ± 3.4) and severe depression (9.2 ± 4.4). The clinical situation determined the design of the program, which showed good treatment effects for pain and general mental wellness, with high effect sizes, in GHQ total score, in somatic symptoms and in social dysfunction, though in anxiety and insomnia and severe depression the effect size was small. In conclusion, the program improved physical and psychological wellness of our patients. The evidence for inclusion of physical therapy and psychology techniques in the management of concurrent conditions in diabetes, source of mental discomfort, had been reinforced.

Adherence to Mediterranean Diet Pattern among Spanish Adults Attending a Medical Centre: Nondiabetic Subjects and Type 1 and 2 Diabetic Patients.

OBJECTIVE: To identify adherence to Mediterranean diet among two groups of Spanish adults: diabetic patients and nondiabetic subjects. METHODS: Adherence to Mediterranean diet was measured by a 14-item screener (scale: 0-14; ≤5: low, 6-9: moderate, and ≥10: high) in 351 volunteers. RESULTS: Mean age was 50.97 ± 12.58 in nondiabetics (n = 154) and 59.50 ± 13.34 in diabetics (n = 197). The whole sample scored 8.77 ± 1.82. Score was 9.19 ± 1.84 in nondiabetic females (n = 58) and 8.15 ± 1.79 in diabetic females (n = 85) (p = 0.003), due to lower consumption of olive oil (p = 0.005) and nuts (p = 0.000). Type 2 diabetic males (n = 79; 8.76 ± 1.88) consumed less olive oil than healthy males (n = 28; 9.36 ± 1.59) (p = 0.046). Up to 30-year-old nondiabetics scored lower than more than 60-year-old nondiabetics (8.40 ± 1.5 versus 9.74 ± 2.03; p = 0.047). The youngest ate less olive oil (p = 0.002) and more pastries (p = 0.007). CONCLUSIONS: The sample presented moderate adherence to Mediterranean diet in all subgroups. Scientific evidence about the benefits of Mediterranean diet, olive oil, and nuts supports the recommendation to increase consumption of olive oil and nuts in diabetic women and of daily olive oil in type 2 diabetic men, reducing consumption of red meat, butter, and pastries, and to promote Mediterranean diet among the youngest of the sample studied.

Optimizing physical therapy for ankylosing spondylitis: a case study in a young football player.

[Purpose] Ankylosing spondylitis is prevalent in men. Modern and expert consensus documents include physical therapy among the strategies for the treatment of ankylosing spondylitis. This study aimed to describe the physical therapy approach in an athlete with ankylosing spondylitis. [Subject and Methods] The patient, refractory to treatment with anti-inflammatory medication, showed pelvic and lumbar pain and joint, muscle, and functional disorders, which were treated with orthopedic joint mobilization, dry needling, exercise, and whole-body hyperthermia. [Results] After the treatment, pain relief, normal joint mobility, improved muscle function, and return to activities of daily living and competitive sporting activities were recorded. [Conclusion] The literature provides evidence for the use of joint mobilization techniques; however, no previous studies have used the same techniques and methods. There is no previous evidence for the use of dry needling in this pathology. Exercise therapy has a higher level of evidence, and guidelines with scientific support were followed. This research confirms the effectiveness of hyperthermia for arthritis. The early stage of ankylosing spondylitis, and the young age, good overall condition, and cooperative attitude of the patient led to positive outcomes. In conclusion, a favorable response that promoted the remission of the disease was observed.

Analysis of a sample of type 2 diabetic patients with obesity or overweight and at cardiovascular risk: a cross sectional study in Spain.

BACKGROUND: The multifactorial control of diabetes relies on interventions that provide patients with the best knowledge and resources available. The objective of this research was to analyze the clinical characteristics of a sample of people with type 2 diabetes at high cardiovascular risk, and establish possible links between disease control, family history and lifestyle, to improve the quality of interventions. Family history, lifestyle habits, blood pressure, anthropometric data and laboratory tests were analyzed in this descriptive and comparative cross-sectional study. RESULTS: All patients had a pathological body mass index (BMI), and in those patients with a family history of diabetes, the disease was more serious and onset was earlier. Overall, 70.9% were taking drugs for arterial blood pressure management, with mean values within recommended limits; 87.1% were taking antihyperlipidemic drugs and had mean values for blood lipids within reference range; 93.5% were receiving oral antidiabetic drugs and/or insulin and had blood glucose and glycosylated hemoglobin (HbA1c) values higher than recommended limit; and 87% were taking antiplatelet drugs and had fibrinogen and ultrasensitive C-reactive protein higher than the normal range. High HbA1c values were found in a high proportion of our sample who were not following a tailored diet (84.2%), and better BMIs were associated with moderate physical activity. Coexistence of somatic disorders (97.4% of the sample with musculoskeletal diseases) could lead to the lack of physical activity. CONCLUSIONS: This sample of patients with type 2 diabetes and at high cardiovascular risk, had acceptable metabolic control, facilitated by drug therapy. Family history of diabetes was associated with earlier disease onset and worse disease progression. Patients who were not following a tailored diet had worse HbA1c values compared with those who were. Individuals who practiced moderate physical activity in line with international recommendations for weight maintenance had the best BMI values, but the high prevalence of comorbidities could adversely affect exercise habits. Appropriate use of medication, dietary advice, and tailored physiotherapy physical activity suitable for people with comorbidities should be included in multifactorial treatment strategies for these patients, particularly in the presence of a family history of diabetes.

A descriptive study of health status and health related quality of life in selected outpatients with type 2 diabetes, pathological body mass index and cardiovascular risk in Spain.

BACKGROUND: Ottawa Charter defined health as a resource for everyday life and as an important dimension of health related quality of life (HRqol). Diabetes and obesity have repeatedly been shown as diseases that diminish health status and HRqol. The aim of this study was to measure health status and HRqol in a Spanish sample of obese patients with type 2 diabetes at cardiovascular risk and analyze behavioural, biological and social determinants of health. METHODS: Outpatients from external specialized clinic in Endocrinology were evaluated. MEASUREMENTS: sex, age, family history, employment status, comorbidities, pain, lifestyle habits, anthropometrics, blood pressure, blood analysis and HRqol with COOP/WONCA questionnaire (7 dimensions). STATISTICS: univariate, bivariate, multivariate and comparative analysis. RESULTS: Mean age was 59.1 ± 7.6 [95%IC: 56.6-61.6], 74% were women and 63.2% were physically active. WONCA values were; summary index (SI): 18.7 ± 4 [95%IC: 17.3-20] (maximum 35); physical fitness: 3.3 ± 1, feelings: 2.3 ± 1.1, social activities: 1.5 ± 1, daily activities: 2.1 ± 1.2, change in health: 2.7 ± 0.9, overall health: 3.6 ± 0.7 and pain: 3.5 ± 1.2 (maximum 5). High fibrinogen values (339.3 ± 85.8 [95%IC: 309.8-368.8]) negatively influenced pain visual analogic scale (p = 0.029). Physically active patients (63.2%) had better values in daily activities dimension (p = 0.025). More than the half of the sample (51.5%) reported a good quality of sleep, but the pain worsened it (p = 0.040). High BMI values (34.8 ± 5.8 [95%IC: 32.9-36.7]) harmed the COOP-WONCA SI (p = 0.009). High glycated hemoglobin (HbA1c) values (6.8 ± 1.3 [95%IC: 6.3-7.2]) had a negative impact on COOP-WONCA SI (p = 0.018). Nor tailored diet (15.8%) or being employed (18.4%) influenced the HRqol. The regression that best models COOP-WONCA SI was adjusted for BMI and HbA1c. SI = 3.509 + 0.335BMI +0.330HbA1c. CONCLUSIONS: HRqol was worse than in general population, but better than in previous studies of diabetes patients, without differences by sex or age, though feelings, daily activities and pain dimensions scored worse than in these studies. Higher levels of HbA1c, obesity and procoagulative state had a negative impact in these last dimensions. Pain impaired quality of sleep and physical activity had a positive impact in daily activities. BMI and HbA1c modeled the HRqol.

Mejora de la alimentación en una población con riesgo cardiovascular tras un programa de educación nutricional / Improvement of food practices in a population with cardiovascular risk factors after a nutrition education program

Fundamentos: Conseguir la mejora en el estado clínico y patrón alimentario de una población con riesgo cardiovascular (según ATP III) después de un Programa de educación nutricional (PEN). Métodos: Estudio de intervención antes-después de un solo grupo. Muestra de 32 pacientes (87,5% mujeres) y 57,43 años de edad media. La intervención (PEN) duró 6 semanas. La valoración recogió datos demográficos y clínicos, cuestionario de frecuencia de consumo de alimentos, nivel de adherencia al programa y nivel de asimilación de conocimientos, al inicio, los dos y los cinco meses. Resultados: - Tras la intervención se produce un aumento en la carne de ave (p=0,043 ), de pescado blanco (p=0,033) y azul (p=0,013). - Los pacientes que consumen más fruta tienden a estar más delgados al inicio (-0,461 p=0,008) y una mayor ingesta de pescado se correlaciona con menor obesidad abdominal al final (-0,417 p=0,034). - Se observa una disminución del criterio ATP III colesterol HDL del 37,6% al 12,5% (p=0,031). - Se registra una disminución en la proporción de personas con síndrome metabólico del 68,8% al 31,3% (p=0,022). Conclusiones: El PEN generó una mejora de la alimentación, una disminución de los factores de riesgo cardiovascular y el número de personas con síndrome metabólico (AU)

Background: To assess changes in clinical status and nutrition pattern of a population of patients with cardiovascular risk (ATP III criteria) after a nutrition education program. Methods: Intervention study, pre-post test design, with no control group. Sample of 32 patients (87,5% women) with cardiovascular risk; the average age was 57,43 years. Six week intervention with assessment undertaken through demographic and clinical data, food frequency questionnaire, control of attendance and participation and evaluation test at baseline and after two and five months of intervention. Results: - A significant increase in the consumption of poultry (p=0.043) and fat (p=0.013) and white fish (p=0.033) was observed. Patients who consumed more fruit tend to be thinner in the first assessment (-0.461 p=0.008) and at the end of the study the consumption of fish was lower in individuals with abdominal obesity (-0.417 p=0.034). In the post-test a decrease in the ATP III cholesterol HDL criterion, from 37.6% to 12.5%, (p=0.031) was observed. There was also a decrease in the proportion of people with metabolic syndrome from 68.8% to 31.3% (p=0.022). Conclusions: The Nutrition education program had a positive impact in food practices. After the intervention a decrease in cardiovascular risk factors was observed, as well as people with diagnosis of metabolic syndrome (AU)

Descriptive study of stress and satisfaction at work in the Saragossa university services and administration staff.

BACKGROUND: The notion of stress in connection with the work environment became an important topic during the 1970's, when the first studies on the subject were published and the term of work stress was first coined. In 1974, Freudenberger proposed the term burnout to refer to the condition of physical and emotional exhaustion, as well as the associated negative attitudes, resulting from the intense interaction in working with people. The aim of our study is to examine burnout and job satisfaction in Saragossa University Services and Administration Staff (SAS) and detect the main factors which could contribute to too much stress, because job stress has emerged as a major psychosocial influence on mental health, associated with burnout. METHODS: 24 people from the Services and Administration Staff in the University of Saragossa participated in the study. The research was carried out during the implementation of a module on Stress Management organised by the University of Saragossa and commissioned to the Unit for Research in Physical Therapy (University School of Health Sciences) from that University. This research is an exploratory research to improve the stress management program. A personal interview was carried out and additionally, participants were given the Maslach Burnout Inventory and the Scale of Satisfaction at Work of Warr, Cook & Wall. RESULTS: However using small sample this is worth to state that participants present most of them low burnout levels in the burnout scale. Only in one person high exhaustion level was reflected, even though other seven showed mean levels; in the professional self-esteem section, most of them showed high self-esteem, with two cases of low self-esteem and five with mean level.With regard to satisfaction people participating in the study show mean levels in intrinsic as much as in extrinsic factors and general satisfaction. CONCLUSIONS: Services and Administration Staff from the University of Saragossa shows low burnout levels linked with high professional self-esteem and low emotional exhaustion and depersonalization.It has been found also medium levels in work satisfaction probably related with the continuous quality improvement efforts in the academics environment to create protective factors in decreasing levels of job stress.These results show that not only personality or temperament have an influence on burnout and stress, also the job conditions are related with these diseases. These aspects should be taken into account in the design of stress prevention programme at work.