Effect of Intradialytic Oral Nutritional Supplementation with or without Exercise Improves Muscle Mass Quality and Physical Function in Hemodialysis Patients: A Pilot Study.

BACKGROUND: Oral nutritional supplementation (ONS) with or without exercise (EX) could improve muscle mass (MM) in chronic kidney disease. METHODS: Patients were randomized into two groups: (1) ONS and (2) ONS + EX. Thigh muscle area (cm2) and intramuscular lipid content via attenuation were evaluated at baseline and 6 months with computed tomography (CT) to measure MM quantity and quality. Physical function was measured by six-minute walk test (6 MWT), gait speed, handgrip strength (HGS), and Time Up and Go test (TUG) at baseline and 3 and 6 months. RESULTS: The ONS group (n= 14) showed statistically significant improvement in gait speed and HGS; ONS + EX group (n = 10) showed differences in gait speed, in 6 MWT, and HGS. In the ANOVA (3 times × 2 groups), no differences were observed between groups. Greater effect sizes in favor to ONS + EX group were observed in the 6 MWT (d = 1.02) and TUG test (d = 0.63). Muscle quality at six months revealed a significant trend in favor of the EX-group (p = 0.054). CONCLUSIONS: Both groups had improved physical function, and greater effect sizes were seen in the ONS + EX group for the 6 MWT and TUG test. Neither MM quantity or quality was improved in either group.

Effect of Oral Nutritional Supplementation With and Without Exercise on Nutritional Status and Physical Function of Adult Hemodialysis Patients: A Parallel Controlled Clinical Trial (AVANTE-HEMO Study).

OBJECTIVE: Protein energy wasting affects the nutritional status (NS) and physical function (PF) of dialysis patients. Among the different anabolic strategies to improve NS and PF, oral nutritional supplementation (ONS) and resistance exercise (RE) or aerobic exercise (AE) have been shown to be effective. Nevertheless, the combination of both anabolic strategies has not been completely evaluated. The aim of this study is to assess the effect of exercise combined with ONS versus ONS without exercise during hemodialysis sessions on PF and NS indicators. METHODS: Young hemodialysis patients (29 ± 9.3 years) with predominantly unknown causes of renal disease (80%) were divided into the following 3 groups during a period of 12 weeks: (1) ONS (n = 15), (2) ONS + RE (n = 15), and (3) ONS + AE (n = 15). Anthropometric, biochemical, PF, and quality of life measurements were recorded at baseline and after 3 months. Repeated measures analysis of variance and effect sizes (Cohen's d) were used to assess the effect of exercise and nutrition (ISRCTN registry 10251828). RESULTS: At the completion of the study, the ONS and ONS + RE groups exhibited statistically significant increases in body weight, body mass index, and in the percentage of fat mass (P < .05); the greatest effect sizes were observed in the ONS + RE group (d = 0.30 for body weight, d = 0.63 for body mass index, and d = 0.90 for the percentage of fat mass). Groups with RE and AE had statistically significant increases and large effect sizes in the six-minute walk test (RE: d = 0.94, P = .02; AE: d = 1.11, P = .03), sit-to-stand test (RE: d = 0.81, P = .041; AE: d = 1.20, P = .002), timed up and go test (RE: d = 1.04, P = .036; AE: d = 1.6, P = .000), and muscle strength (RE: d = 1.01, P = .000; AE: d = 0.60, P = .003). Regarding quality of life, the ONS + RE group had more areas of improvement at the end of the study, followed by the ONS + AE group. No statistically significant differences were found in the repeated measures ANOVA. CONCLUSIONS: The combination of exercise with ONS had larger effects on PF than on ONS alone. Further studies to examine the impact of exercise on the effect of oral nutritional supplementation in dialysis patients are indicated.

Mortality in Patients With Chronic Renal Disease Without Health Insurance in Mexico: Opportunities for a National Renal Health Policy.

INTRODUCTION: Despite a systematic increase in the coverage of patients with end-stage renal disease (ESRD) who have received dialytic therapies and transplantation over the past 2 decades, the Mexican health system currently still does not have a program to provide full coverage of ESRD. Our aim was to analyze mortality in patients with ESRD without health insurance. METHODS: This was a prospective cohort study of 850 patients with advanced chronic kidney disease (CKD). Risk factors associated with death were calculated using a Cox's proportional hazards model. We used the statistical package SPSS version 22.0 for data analysis. RESULTS: The mean age of patients was 44.8 ± 17.2 years old. At the time of hospital admission, 87.6% of the population did not have a social security program to cover the cost of renal replacement treatment, and 91.3% of families had an income below US$300 per month. During the 3 years of the study, 28.8% of the cohort patients were enrolled in 1 of Mexico's social security programs. The 3-year mortality rate was of 56.7% among patients without access to health insurance, in contrast to 38.2% of patients who had access to a social security program that provided access to renal replacement therapy (P < 0.001). Risk factor analysis revealed that not having health insurance increased mortality (risk ratio: 2.64, 95% confidence intervals: 1.84-3.79; P = 0.001). CONCLUSION: Mexico needs a coordinated National Kidney Health and Treatment Program. A program of this nature should provide the basis for an appropriate educational and intervention strategy for early detection, prevention, and treatment of patients with advanced chronic kidney disease.

Avances metodológicos para la determinación del origen de enfermedades laborales relacionadas con el estrés: la experiencia colombiana / Methodological advances in the determination of the origin of stress-related occupational diseases: the Colombian experience

Contexto: La inclusión de las enfermedades generadas por el estrés en el trabajo en la legislación colombiana planteó la necesidad de disponer de herramientas que faciliten la valoración de los casos de forma estandarizada. Objetivo: Diseñar un método homogéneo y válido para el análisis, evaluación y establecimiento de relaciones causales entre exposiciones psicosociales en el trabajo y la presentación de enfermedades en la población trabajadora. Método: La metodología bajo la cual opera el protocolo está compuesta por siete etapas consecutivas que se extienden de la verificación del diagnóstico a la valoración de factores de riesgo tanto psicosociales como no psicosociales, los cuales se califican en una matriz de valoración que permite estimar el peso relativo de cada uno de ellos. Resultados: El protocolo se validó con un conjunto de casos de enfermedades presuntamente relacionadas con estrés en el trabajo. Se calcularon los indicadores de sensibilidad y especificidad generales, así como particulares para cada una de las enfermedades incluidas en el protocolo. Conclusiones: Esta herramienta fue asumida por el Ministerio de Trabajo de Colombia como de uso obligatorio por los equipos de calificadores de las diferentes instancias de la seguridad social. Luego de diez años de utilización, se analizó su pertinencia y funcionalidad, y se inició el proceso de actualización de la evidencia científica que la respalda.

Background: The inclusion of stress-related diseases in the Colombian legislation raised the need for tools that facilitate the assessment of cases in a standardized manner. Objective: To design a homogeneous and valid method for analysis, evaluation and establishment of causal relationships between psychosocial exposures at work and occurrence of diseases among the working population. Method: The protocol comprises seven consecutive steps from the verification of the diagnosis to assessment of psychosocial and non-psychosocial risk factors, which are scored on a valuation matrix that allows estimating the relative weight of each of them. Results: The protocol was validated with a set of cases of diseases possibly related with stress at work. General sensitivity and specificity indicators were calculated, as well as the ones particular for each disease included in the protocol. Conclusions: The Labor Ministry of Colombia established the protocol described here as mandatory reference for assessment teams at the various social security levels. Its relevance and applicability were assessed after ten years of use, and the process to update its supporting evidence was started.

[Basic questionnaire and methodological criteria for Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean]. / Cuestionario básico y criterios metodológicos para las Encuestas sobre Condiciones de Trabajo, Empleo y Salud en América Latina y el Caribe.

This article aimed to present a basic questionnaire and minimum methodological criteria for consideration in future Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean. A virtual and face-to-face consensus process was conducted with participation by a group of international experts who used the surveys available up until 2013 as the point of departure for defining the proposal. The final questionnaire included 77 questions grouped in six dimensions: socio-demographic characteristics of workers and companies; employment conditions; working conditions; health status; resources and preventive activities; and family characteristics. The minimum methodological criteria feature the interviewee's home as the place for the interview and aspects related to the quality of the fieldwork. These results can help improve the comparability of future surveys in Latin America and the Caribbean, which would in turn help improve information on workers' heath in the region.

Cuestionario básico y criterios metodológicos para las Encuestas sobre Condiciones de Trabajo, Empleo y Salud en América Latina y el Caribe / Basic questionnaire and methodological criteria for Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean / Questionário básico e critérios metodológicos para as Pesquisas sobre Condições de Trabalho, Emprego e Saúde na América Latina e Caribe

Resumen: El objetivo de este trabajo es presentar un cuestionario básico y criterios metodológicos mínimos, para ser considerados en futuras Encuestas sobre Condiciones de Trabajo, Empleo y Salud (ECTES) en América Latina y el Caribe. Para ello, se llevó a cabo un proceso de consenso, tanto virtual como presencial, con la participación de un grupo internacional de expertos que, para definir la propuesta, partieron de las encuestas disponibles en la región hasta 2013. El cuestionario final incluyó 77 preguntas agrupadas en seis dimensiones: características sociodemográficas del trabajador y la empresa; condiciones de empleo; condiciones de trabajo; estado de salud; recursos y actividades preventivas; y características familiares. Entre los criterios metodológicos mínimos destacan el domicilio de la persona entrevistada como lugar de la entrevista y los relacionados con la calidad del trabajo de campo. Estos resultados pueden ayudar a mejorar la comparabilidad de las futuras ECTES en América Latina y el Caribe, lo que contribuiría a mejorar la información en salud laboral en la región.

Abstract: This article aimed to present a basic questionnaire and minimum methodological criteria for consideration in future Surveys on Working Conditions, Employment, and Health in Latin America and the Caribbean. A virtual and face-to-face consensus process was conducted with participation by a group of international experts who used the surveys available up until 2013 as the point of departure for defining the proposal. The final questionnaire included 77 questions grouped in six dimensions: socio-demographic characteristics of workers and companies; employment conditions; working conditions; health status; resources and preventive activities; and family characteristics. The minimum methodological criteria feature the interviewee's home as the place for the interview and aspects related to the quality of the fieldwork. These results can help improve the comparability of future surveys in Latin America and the Caribbean, which would in turn help improve information on workers' heath in the region.

Resumo: O objetivo deste trabalho é apresentar um questionário básico e critérios metodológicos mínimos, para serem considerados em futuras pesquisas sobre Condições de Trabalho, Emprego e Saúde (ECTES) na América Latina e Caribe. Para tal, foi realizado um processo de consenso, tanto virtual como presencial, com a participação de um grupo internacional de expertos que, para definir a proposta, partiram das pesquisas disponíveis na região até 2013. O questionário final incluiu 77 perguntas agrupadas em seis dimensões: características sociodemográficas do trabalhador e a empresa; condições de emprego; condições de trabalho; estado de saúde; recursos e atividades preventivas; assim como características familiares. Entre os critérios metodológicos mínimos destacam-se o domicílio da pessoa entrevistada como lugar da entrevista e os relacionados com a qualidade do trabalho de campo. Estes resultados podem ajudar a melhorar a comparabilidade das futuras ECTES na América Latina e Caribe, o que contribuiria para melhorar a informação sobre saúde do trabalhador na região.

Validation of new psychosocial factors questionnaires: a Colombian national study.

BACKGROUND: The study of workers' health problems possibly associated with stressful conditions requires valid and reliable tools for monitoring risk factors. The present study validates two questionnaires to assess psychosocial risk factors for stress-related illnesses within a sample of Colombian workers. METHODS: The validation process was based on a representative sample survey of 2,360 Colombian employees, aged 18-70 years. Worker response rate was 90%; 46% of the responders were women. Internal consistency was calculated, construct validity was tested with factor analysis and concurrent validity was tested with Spearman correlations. RESULTS: The questionnaires demonstrated adequate reliability (0.88-0.95). Factor analysis confirmed the dimensions proposed in the measurement model. Concurrent validity resulted in significant correlations with stress and health symptoms. CONCLUSIONS: "Work and Non-work Psychosocial Factors Questionnaires" were found to be valid and reliable for the assessment of workers' psychosocial factors, and they provide information for research and intervention.

Design of psychosocial factors questionnaires: a systematic measurement approach.

BACKGROUND: Evaluation of psychosocial factors requires instruments that measure dynamic complexities. This study explains the design of a set of questionnaires to evaluate work and non-work psychosocial risk factors for stress-related illnesses. METHODS: The measurement model was based on a review of literature. Content validity was performed by experts and cognitive interviews. Pilot testing was carried out with a convenience sample of 132 workers. Cronbach's alpha evaluated internal consistency and concurrent validity was estimated by Spearman correlation coefficients. RESULTS: Three questionnaires were constructed to evaluate exposure to work and non-work risk factors. Content validity improved the questionnaires coherence with the measurement model. Internal consistency was adequate (α = 0.85-0.95). Concurrent validity resulted in moderate correlations of psychosocial factors with stress symptoms. CONCLUSIONS: Questionnaires' content reflected a wide spectrum of psychosocial factors sources. Cognitive interviews improved understanding of questions and dimensions. The structure of the measurement model was confirmed.

Concentraciones Sanguíneas de Calcio, Fósforo y Magnesio en Mautas Mestizas (Taurus-Indicus) Suplementadas Estratégicamente durante el periodo Peripuberal / Blood Levels of Calcium, Phosphorus, and Magnesium in Crossbred Heifers (Taurus-Indicus) Strategically Fed During Peripuberty Period

Con el objetivo de examinar las concentraciones sanguíneas de calcio, fósforo y magnesio durante el período peripuberal en mautas bajo pastoreo y suplemententadas con dos estrategias alimenticias (Alimento balanceado comercial y un suplemento con Gliricidia sepium), se realizó un experimento con 24 animales mestizos doble propósito, distribuidos en forma aleatorizada en 3 grupos de 8 animales cada uno, los cuales constituyeron los tratamientos a saber: T1: consumo de gramíneas a pastoreo (CGP); T2: CGP + el consumo de alimento balanceado comercial y T3: CGP + el consumo de un suplemento alimenticio que contenía harina de hojas de Gliricidia sepium (GS). Se recolectaron muestras de suero sanguíneo, 2 semanas antes y 2 semanas después de la pubertad para determinar la concentración de calcio, fósforo y magnesio. Los datos fueron analizados a través de un análisis de varianza del sistema de análisis estadístico (SAS) empleando el procedimiento GLM. Las concentraciones sanguíneas de P y Mg observados en las semanas 2 (6,27 y 2,53 mg/dL, respectivamente), 3 (6,41 y 2,55 mg/dL, respectivamente), 4 (6,31 y 2,60 mg/dL, respectivamente) y 5 (6,39 y 2,49 mg/dL, respectivamente) superan (P < 0,01) a los mostrados en las semanas 1 (5,07 y 1,30 mg/dL, respectivamente). Particularmente el Ca sérico durante las semanas 3 (11,60 mg/dL), 4 (11,43 mg/dL) y 5 (11,72 mg/dL) fue superior (P < 0,01) que las semanas 1 (9,68 mg/dL) y 2 (10,80 mg/dL). Las mautas de T2 y T3, presentaron concentraciones sanguíneas de Ca, P y Mg, superiores (P < 0,01) a las observadas en T1. En atención a los resultados de la presente investigación, los niveles sanguíneos de Ca, P y Mg, se incrementaron una semana antes de la pubertad, siendo esto niveles mantenidos hasta la última semana del periodo peripuberal. El alimento balanceado comercial y el suplemento alimenticio con GS, fueron efectivos en aumentar las concentraciones sanguíneas de Ca, P y Mg.

With the objective of examining serum concentrations of calcium, phosphorus and magnesium during the peripuberal period in grazing heifers feeding two supplemental strategies (balanced commercial food and Gliricidia sepium), An experiment was carried out with 24 dual purpose crossbred heifers, distributed in 3 randomized groups (8 animals each): T1: gramineous grazing (CGP); T2: CGP + commercial balanced food and T3: CGP + nutritional supplement that contained flour of leaves of Gliricidia sepium (GS). Serum samples were taken, 2 weeks before and 2 weeks after the puberty to determine the concentration of calcium, phosphorus and magnesium. The data was analyzed by an analysis of variance of the statistical analysis system (SAS) using the procedure GLM. The serum concentrations of P and Mg observed in the weeks 2 (6.27 and 2.53 mg/dL, respectively), 3 (6.41 and 2.55 mg/dL, respectively), 4 (6.31 and 2.60 mg/dL, respectively) and 5 (6.39 and 2.49 mg/dL, respectively) were higher (P < 0.01) to those shown in the weeks 1 (5.07 and 1.30 mg/dL, respectively). Particularly the serum Ca during the weeks 3 (11.60 mg/dL), 4 (11.43 mg/dL) and 5 (11.72 mg/dL) it was superior (P < 0.01) that the weeks 1 (9.68 mg/dL) and 2 (10.80 mg/dL). Heifers of T2 and T3, showed higher serum concentrations of Ca, P and Mg presented (P < 0.01) compared to those observed in T1. In attention to the results of the present investigation, the serum levels of Ca, P and Mg, were increased one week before the puberty, being this levels maintained until the last week of the peripuberal period. The commercial balanced food and the nutritious supplement with GS, were effective in increasing the serum concentrations of Ca, P and Mg.

Respuesta al crecimiento y concentraciones sanguíneas de calcio, fósforo, magnesio y potasio, en novillos mestizos (taurus-indicus)suplementados con una mezcla mineral completa / Growth response and mineral blood levels of calcium, phosphorus, magnesium and potassium in crossbred steers (taurus-indicus) with complete mineral supplementation

16 novillos mestizos fueron utilizados para evaluar el efecto de un suplemento mineral completo (SMC) sobre la ganancia diaria (GDP) y total de peso (GTP), concentraciones sanguíneas de Ca, P, Mg, K, hemoglobina (Hb) y porcentaje de hematocrito (Htc). Los animales se estabularon durante 140 días y distribuidos en 4 tratamientos: T1, suplemento basal (63 por ciento de maíz amarillo molido, 30 por ciento de harina de soya, 5 por ciento de melaza de caña y 3 por ciento de urea) + heno; T2, suplemento basal (SB) + heno + 50 g/animal/día de SMC; T3, dieta basal + heno + 100 g/animal/día de SMC; T4, SB + heno + 150 g/animal/día de SMC. Cada 14 días fueron pesados los animales y se tomaron muestras sanguíneas al inicio, a los 60 días y al final para determinar Ca, Mg, P, K, hemoglobina (Hb) y el hematocrito (Hct). Los datos se analizaron por el procedimiento GLM del SAS. La GDP refirió valores superiores (P<0,05) para los tratamientos; 2, 3 y 4 (0,739; 0,778 y 0,759 kg/día respectivamente) vs. el tratamiento 1(0,626 kg/día), similarmente se manifestó la GTP (T2: 81,33; T3: 85,67 y T4: 83,58 kg, vs T1: 68,87 kg). El Ca, Mg y K sanguíneos para T2, T3, y T4 (11,47; 10,80 y 11,08 mg Ca/dl respectivamente: 2,81; 2,89 y 2,84mg Mg/dl, respectivamente: 23,68, 21,93 y 25,83 mgK/dl respectivamente) superan (P<0,1) a T1 (9,4 mg Ca/dl: 2,23 mg Mg/dl y 19,92 mg K/dl). Los valores sanguíneos de fósforo para T3 y T4 (5,94 y 6,02 mg/dl respectivamente) son superiores (P<0,1) a T1 y T2 (5,24 y 5,54 mg/dl respectivamente). No existen diferencias estadísticas para Hb y Hct. De acuerdo a los resultados de esta investigación, el SMC en dosis de 50 y 100 g/animal/día fue efectivo en promover una adecuada tasa de crecimiento