Physical examination to screen for peripheral artery disease in a defined Primary Care population: A diagnostic accuracy study

INTRODUCTION

Peripheral arterial disease (PAD) is an underdiagnosed prevalent disease which implies high cardiovascular risk. Professionals usually depend on physical examination to screen for PAD.

OBJECTIVE

To assess the diagnostic accuracy of physical examination to screen for PAD in a rural Primary Care population and to evaluate the nurse-physician level of agreement in pedal pulse palpation.

METHODS

Diagnostic accuracy study in which two experienced professionals (physician-nurse) prospectively performed pedal pulse palpation (grading as absent, reduced, normal, or bounding), femoral bruit auscultation and calf circumference (index tests) comparing with Doppler ABI (reference test, positive cut-off: 0.9 ≥ ABI ≥ 1.4) in 158 consecutive subjects.

INCLUSION CRITERIA

presence of diabetes, dyslipidaemia, hypertension, smoking habit (current or former), or age ≥ 65.

RESULTS

Of 315 legs included, PAD was confirmed in 38 (12.1%) legs. Absent dorsalis pedis (DP) and posterior tibial (PT) pulses were found in 37 (11.7%) and 67 (21.3%) legs, respectively. Regarding nurse evaluation, when a positive test was set if DP or PT were absent (more sensitive cut-off), sensitivity was = 86.8 (95% CI: 74.8-98.9), specificity = 82.7 (95% CI: 78.0-87.3), likelihood ratio+ = 5.01 (95% CI: 3.77-6.67), likelihood ratio- = 0.16 (95% CI: 0.07-0.36), and diagnostic odds ratio (dOR) = 31.5 (95% CI: 11.7-84.8). Age, diabetes, and calcification (ABI ≥ 1.4) influenced the rate of a false negative finding in pedal palpation. Physician-nurse weighted kappa coefficient was = 0.649 (95% CI: 0.599-0.699). The presence of a femoral bruit auscultation had a dOR = 3.8 (95% CI: 1.1-13.1), and a calf circumference <34.55 cm had a dOR = 3.2 (95% CI: 1.6-6.4).

CONCLUSIONS AND RELEVANCE

In a mainly asymptomatic Primary Care population, pedal pulse palpation was by far the best diagnostic test, with good diagnostic accuracy and inter-rater agreement. In view of a high sensitivity and capacity to rule out the disease, pedal pulse palpation could be performed as a screening test for PAD and individuals at high cardiovascular risk.

Association Between Health-Related Quality of Life, Obesity, Fitness, and Sleep Quality in Young Adults: The Cuenca Adult Study

OBJECTIVE

The objectives of this study were to examine in university students: (a) the mean differences in the HRQoL among fat mass percentage, cardiorespiratory fitness (CRF) and sleep quality categories; and (b) the independent associations among fat mass percentage, CRF, and sleep quality with HRQoL.

PARTICIPANTS

376 students, 18-30 years old, from the University of Castilla-La Mancha in Cuenca, Spain (during 2009-2010).

METHOD

Cross-sectional study measuring % fat mass (DXA), CRF (20-m shuttle run test), sleep quality (Pittsburgh Sleep Quality Index), and HRQoL (SF-12 questionnaire).

RESULTS

The mean in Mental Component Summary (MCS) in men (p = .029) was lower in students in upper quartiles of % fat mass than in peers in other categories of % fat mass. Among men, MCS was significantly lower among those in the lowest quartile of CRF (p = .015), and among women, Physical Component Summary (PCS) was significantly lower among those in the lowest quartile of CRF (p = .047). MCS dimension of the HRQoL was lower in both men (p = .001) and women (p < .001) in upper quartiles of sleep quality. Multiple linear regression models showed that in men, CRF was associated with MCS (β = 0.25, p = .031), and sleep quality was associated with PCS (β = -0.24, p = .027) and MCS (β = -0.38, p < .001). In women, CRF was associated with PCS (β = 0.17, p = .018) and sleep quality with MCS (β= -0.44, p < .001).

CONCLUSIONS

Finally, our findings suggest that, regardless of adiposity and fitness, having good sleep habits may positively influence the quality of life in young adults.

Spectrum effect and spectrum bias in the oscillometric ankle brachial index to diagnose peripheral arterial disease: Clinical implications

BACKGROUND AND AIMS

The diagnostic performance of the oscillometric ankle brachial index (ABI) to detect peripheral arterial disease (PAD) varies among populations, suggesting a spectrum effect. When this heterogeneity modifies post-test probabilities, a spectrum bias arises. This study evaluates the presence and influence of spectrum effect and spectrum bias on test performance and clinical decisions.

METHODS

Oscillometric and Doppler ABI were compared in two settings: Primary-Care (333 legs) and Vascular-Service (41 legs). Spectrum effect was assessed using stratification and logistic regression, while spectrum bias was assessed through graphical and statistical tests based on predictive values and likelihood ratios, respectively.

RESULTS

Across subgroups, sensitivity ranged from 61.5% to 90.9%, and specificity from 81.8% to 99.1%. Logistic regression confirmed a spectrum effect in setting, diabetes, smoking status and age (univariate), and setting and diabetes (multivariate model). The positive likelihood ratio ranged from 5.0 to 89.1 in subgroups, leading to a spectrum bias in diabetic, smoking (both subgroups) and age (both subgroups). Therefore, a positive test ruled in differently the disease across subgroups, with a high rate of false positives in diabetic, smoking and >75-year-old patients. The negative likelihood ratio ranged from 0.09 to 0.39 in subgroups, with significant spectrum bias in Primary-Care patients, non-diabetics and smokers. Thus, in these subgroups, a negative test ruled out the disease with less certainty.

CONCLUSIONS

Spectrum effect and spectrum bias were found in oscillometric ABI to detect PAD, potentially affecting clinical decisions, especially for positive tests. Information about spectrum variables and the application of specific subgroups indicators are necessary.

Sleep patterns and cardiometabolic risk in schoolchildren from Cuenca, Spain

Sleep seems to have a significant influence on the metabolic syndrome (MetS). However, results in this association are still inconsistent in children. The aim of this study was to examine the influence of sleep characteristics in the MetS (index and factors) in Spanish children. Cross-sectional study including a sample of 210 children aged 8-to-11-years belonging to 20 schools from the province of Cuenca, Spain was conducted. Cardiometabolic risk and actigraphy sleep patterns were determined and analysed using correlation coefficients, ANCOVA models and a propensity score derivation model. Overall, children in the lower time in bed category and those who went to bed later (> 23:15h) showed worse values in the cardiometabolic profile and risk index. Differences were observed when the total time in bed was below 9h 15mins. Our study shows that short sleep duration could be a risk factor for cardiometabolic risk in children, and bedtime may independently influence this risk. In addition, our data suggests that children’s sleep hygiene should be incorporated in parenting educational programs.

Adaptation and validation of the Spanish version of the ORTO-15 questionnaire for the diagnosis of orthorexia nervosa

The aim of this study was the validation and analysis of the psychometric properties of a Spanish translation of the ORTO-15 questionnaire; an instrument designed to assess orthorexia nervosa behavior. Four hundred and fifty-four Spanish university students (65% women) aged between 18 and 51 years (M = 21.48 ± 0.31) completed the Spanish version of ORTO-15 and the Eating Disorders Inventory-2 (EDI-2). The Principal Component Analysis suggested a three-factor structure for the abbreviated 11-item version of the instrument. The internal consistency of the measurement was adequate (Cronbach's alpha = 0.80). The proposed test demonstrated a good predictive capacity at a threshold value of <25 (efficiency 84%, sensitivity 75% and specificity 84%). Our results support the psychometric properties of the proposed Spanish shortened-version of the ORTO-15 as being a reliable tool for assessing orthorexia nervosa. Its use is expected to greatly contribute to a better understanding of the impact of this disorder in Spain.

Factors affecting the validity of the oscillometric Ankle Brachial Index to detect peripheral arterial disease

BACKGROUND

The use of oscillometric Ankle Brachial Index (ABI) to diagnose peripheral arterial disease (PAD) has raised concern, especially due to a lack of agreement and sensitivity. This study aimed to evaluate those factors affecting the validity of oscillometric ABI in comparison to Doppler ABI to detect PAD.

METHODS

Through univariate and multivariate linear regression, we studied those factors affecting the differences between oscillometric and Doppler ABI; through univariate and multivariate logistic regression we analyzed the false negative rate of oscillometric ABI to detect PAD.

RESULTS

We analyzed 197 consecutive subjects (394 legs) from two settings: Primary Care and Vascular Service. The means of oscillometric ABI and Doppler ABI were 1.094 (95% CI: 0.843-1.345) and 1.073 (95% CI: 0.769-1.374) (P<0.001), respectively. In men, covariates explaining the differences between oscillometric and Doppler ABI were Doppler ankle blood pressure (β=-0.610, P<0.001), ankle circumference (β=0.176, P=0.004) and oscillometric brachial blood pressure (β=0.136, P=0.037); in women, those were weight (β=0.351, P<0.001) and Doppler ankle blood pressure (β=-0.318, P<0.001). Sensitivity and specificity of oscillometric ABI to detect PAD were 80.6% and 97.4%, respectively, and covariates explaining the rate of false negatives in PAD population were setting (Exp(β)=17.21, P=0.009) and tobacco (packs/year) (Exp(β)=1.049, P=0.002).

CONCLUSIONS

Although some factors influencing the lack of agreement between oscillometric and Doppler ABI were identified, the correction of oscillometric ABI seems impractical, since Doppler is needed, the bias is not always uniformly distributed and its clinical relevance is small. According to sensitivity, borderline oscillometric ABI in Primary Care settings and smokers suggest PAD.

The accuracy of an oscillometric ankle-brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis

INTRODUCTION

Peripheral arterial disease (PAD) remains underdiagnosed and undertreated, partly because of limitations in the Doppler ankle-brachial index (ABI), the non-invasive gold standard.

OBJECTIVE

This systematic review and meta-analysis aims to compare the diagnostic accuracy of the oscillometric ABI and the Doppler ABI, and to examine the influence of two approaches to analysis: legs vs subjects and inclusion of oscillometric errors as PAD equivalents vs exclusion.

METHODS

Systematic searches in EMBASE, MEDLINE, Web of Science and the Cochrane Library databases were performed, from inception to February 2017. Random-effects models were computed with the Moses-Littenberg constant. Hierarchical summary receiver operating characteristic curves (HSROC) were used to summarise the overall test performance.

RESULTS

Twenty studies (1263 subjects and 3695 legs) were included in the meta-analysis. The pooled diagnostic odds ratio (dOR) for the oscillometric ABI was 32.49 (95% CI: 19.6-53.8), with 65% sensitivity (95% CI: 57-74) and 96% specificity (95%CI: 93-99). In the subgroup analysis, the "per subjects" group showed a better performance than the "per legs" group (dOR 36.44 vs 29.03). Similarly, an analysis considering oscillometric errors as PAD equivalents improved diagnostic performance (dOR 31.48 vs 28.29). The time needed for the oscillometric ABI was significantly shorter than that required for the Doppler ABI (5.90 vs 10.06 minutes, respectively).

CONCLUSIONS AND RELEVANCE

The oscillometric ABI showed an acceptable diagnostic accuracy and feasibility, potentially making it a useful tool for PAD diagnosis. We recommend considering oscillometric errors as PAD equivalents, and a "per subject" instead of a "per leg" approach, in order to improve sensitivity. Borderline oscillometric ABI values in diabetic population should raise concern of PAD.

Insulin and bone health in young adults: The mediator role of lean mass

BACKGROUND

The positive relationship between lean mass (LM) and bone health is well known, but a positive association between insulin and LM has also been described. Insulin has some anabolic properties on bone through the stimulation of osteoblast differentiation, yet the role of LM as a confounder or mediator in this relationship remains uncertain.

OBJECTIVE

To examine whether the association between insulin levels and bone health is mediated by LM.

METHODS

A cross-sectional study was conducted at the Castilla La Mancha University (Spain) involving 466 young adults (113 young men; 19.5±2.3 years). LM and total-body bone mineral content (BMC) were measured by dual energy x-ray absorptiometry, and insulin was measured in fasting serum samples.

RESULTS

Young adults with high total LM had higher values of total-body BMC than their peers after controlling for age and sex, this relationship persisted after adjusting for insulin levels (p<0.001). In mediation analyses, insulin levels were positively associated with total-body BMC (b = 0.05; p<0.001) and total LM acted as an intermediate variable, attenuating the association between insulin levels and total-body BMC (b = -31.98; p>0.05) as indicated by Sobel test values for indirect effect (z = 4.43; p<0.001).

CONCLUSIONS

LM plays an important role in the relationship between insulin levels and bone health, in such a way that while increases in LM have a positive influence on bone health, they are also negatively associated with insulin levels.

Diagnostic Accuracy Study of an Oscillometric Ankle-Brachial Index in Peripheral Arterial Disease: The Influence of Oscillometric Errors and Calcified Legs

BACKGROUND

Peripheral arterial disease (PAD) is an indicator of widespread atherosclerosis. However, most individuals with PAD, in spite of being at high cardiovascular risk, are asymptomatic. This fact, together with the limitations of the Doppler ankle-brachial index (ABI), contributes to PAD underdiagnose. The aim of this study was to compare oscillometric ABI and Doppler ABI to diagnose peripheral arterial disease, and also to examine the influence of oscillometric errors and calcified legs on the PAD diagnoses.

METHODS AND FINDINGS

We measured the ankle-brachial indexes of 90 volunteers (n = 180 legs, age 70 ± 14 years, 43% diabetics) using both oscillometer OMRON-M3 and Doppler. For concordance analyses we used the Bland and Altman method, and also estimated the intraclass correlation coefficient. Receiver Operating Characteristic Curves were used to examine the diagnostic performance of both methods. The ABI means were 1.06 ± 0.14 and 1.04 ± 0.16 (p = 0.034) measured by oscillometer and Doppler ABIs respectively, with limits of agreement of ± 0.20 and intraclass correlation coefficient = 0.769. Oscillometer yielded 23 "error" measurements, and also overestimated the measurements in low ankle pressures. Using Doppler as gold standard, oscillometer performance for diagnosis of PAD showed an Area Under Curve = 0.944 (sensitivity: 66.7%, specificity: 96.8%). Moreover, when considered calcified legs and oscillometric "error" readings as arteriopathy equivalents, sensitivity rose to 78.2%, maintaining specificity in 96%. The best oscillometer cut-off point was 0.96 (sensitivity: 87%, specificity: 91%, positive likelihood ratio: 9.66 and negative likelihood ratio: 0.14).

CONCLUSION

Despite its limitations, oscillometric ABI could be a useful tool for the diagnosis of PAD, particularly when considering calcified legs and oscillometric "errors" readings as peripheral arterial disease equivalents.

Reliability and validity of the Spanish version of the Children's Sleep Habits Questionnaire (CSHQ-SP) in school-age children

BACKGROUND

Sleep disorders in schoolchildren are a common problem worldwide, and when are not adequately diagnosed and treated, their negative impact on daytime functioning may be significant. The aim of this study was to evaluate the psychometric properties of the Spanish version of the Children's Sleep Habits Questionnaire (CSHQ).

METHODS

Participants were 286 school-aged children from a community-based sample, aged 4 to 7 years. The sleep behaviour was evaluated using the CSHQ and actigraphy (ActiSleep monitor). The CSHQ was adapted to the Spanish language. The internal consistency of the questionnaire and the test-retest reliability between scores at baseline and three-weeks-later were estimated. Associations between CSHQ items and accelerometer sleep quality indicators were used as indicators of concurrent validity.

RESULTS

Cronbach's alpha coefficients for the subscales ranged from 0.60 to 0.81, and 0.81 for the full scale; the intraclass correlation coefficients ranged from 0.56 to 0.81. A moderate correlation was observed in sleep latency and awakenings measurements using both parents' reported sleep habits (CSHQ-SP) and sleep quality indicators (ActiSleep).

CONCLUSIONS

The CSHQ-SP has demonstrated adequate psychometric properties, and it serves as a useful instrument for clinical and research setting.

Conceptualizaciones sobre la atención a personas con demencia en residencias de mayores

A pesar de la importancia de las percepciones familiares en el análisis de la atención en residencias de mayores, apenas se han indagado estos ascpetcos. El objetivo de este estudio es conocer las preferencias y las áreas de mejora percibidas por los familiares sobre los cuidados a personas con demencia. Se realizó un estudio cualitativo, a partir de la Teoría Fundamentada, combinando dos técnicas de recogida de datos (observación participante y entrevistas en profundidad) en una muestra teórica de familiares de personas con demencia institucionalizadas. El modelo de atención óptima a personas con demencia, percibido por los participantes, se basó en una atención especializada e individualizada y en la participación de la familia en el cuidado. Entre las áreas de mejora se incluyeron aspectos relacionados con una mayor formación específica en Geriatría, relaciones humanas y con la cultura del trabajo institucional. Frente a la vigente tendencia de tecnificación del cuidado, las familias exigen una atención personalizada y en pequeña escala, donde ellas mismas sean parte activa del proceso de atención.

Association between parental socioeconomic status with underweight and obesity in children from two Spanish birth cohorts: a changing relationship

Background

Our objective was twofold: to estimate the prevalence of underweight, overweight, and obesity in two birth cohorts (1999–2000 and 2007–2008) from Castilla-La Mancha, Spain; and to examine the association between parental socioeconomic status (SES) and weight status in these two cohorts.

Methods

Cross-sectional analysis of baseline measurements was utilised in two cluster randomised trials. Using population-based samples of children from Castilla-La Mancha, Spain, 1158 children with a mean age of 9.5 years, born in the years 1999–2000 and 1588 children with a mean age of 5.3 years born in the years 2007–2008 participated. Children were classified according to the body mass index cut-offs proposed by the International Obesity Task Force criteria. An index of SES was calculated using questions regarding parental education and occupation levels.

Results

Prevalence of underweight was higher in the 2007–2008 birth cohort (20.5 %, 95 % CI: 18.5, 22.5) than in the 1999–2000 birth cohort (8.1 %, 95 % CI: 6.5, 9.7), and the overweight/obesity prevalence was 20.4 % (95 % CI: 18.4, 22.5) and 35.5 % (95 % CI: 32.7, 38.3) respectively. In the lower SES stratum, in the 2007–2008 birth cohort, the prevalence of underweight and overweight/obesity was 36.7 % (95 % CI: 22.2, 51.2) and 16.3 % (95 % CI: 4.9, 27.7) respectively, and 22.2 % (95 % CI: 2.8, 60.0) and 55.5 % (95 % CI: 21.2, 86.3) in the 1999–2000 cohort. The ratio between underweight:overweight/obesity showed higher values for all SES categories in 2007–2008 cohort, but particularly in the lower SES group (0.4 in the 1999–2000 cohort and 2.2 in the 2007–2008 cohort).

Conclusion

Underweight prevalence was lower in the cohort of children born in 1999–2000, and the prevalence of overweight and obesity was lower in the cohort of children born in 2007–2008. Furthermore, while in the 1999–2000 children’s cohort underweight was more frequent amongst children from high SES families and overweight/obesity was more frequent in children from low SES families, in the 2008–2009 children’s cohort the opposite was true.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2569-5) contains supplementary material, which is available to authorized users.

Effects of kiwi consumption on plasma lipids, fibrinogen and insulin resistance in the context of a normal diet

Background and aims

Among fruits, kiwi is one of the richest in vitamins and polyphenols and has strong anti-oxidant effects. We aimed to analyze the relationship between the consumption of kiwi and plasma lipid values, fibrinogen, and insulin resistance in adults within the context of a normal diet and physical-activity.

Methods

Cross-sectional study. Participants (N = 1469), who were free of cardiovascular diseases, completed a visit, which included the collection of information concerning the participant’s usual diet and kiwi consumption using a previously validated, semi-quantitative, 137-item food-frequency-questionnaire. Fasting laboratory determinations included plasma lipids, fibrinogen and insulin resistance. Regular physical-activity was determined using accelerometry.

Results

Consumers of at least 1 kiwi/week presented higher plasma values of HDL-cholesterol (mean difference 4.50 [95 % CI: 2.63 to 6.36]) and lower triglyceride values (mean difference −20.03 [95 % CI: −6.77 to −33.29]), fibrinogen values (mean difference −13.22 [95 % CI: −2.18 to −24.26]) and HOMAir values (mean difference −0.30 [95 % CI: −0.09 to −0.50]) (p < 0.05, for all comparisons) than those who consumed less than 1 kiwi per week. In an adjusted logistic regression analysis, this group had a lower odds-ratio for presenting plasmatic fibrinogen concentrations above 400 mg/dL (OR = 0.68, 95 % CI 0.49 to 0.95), HDL-Cholesterol plasma values below 45 mg/dL (OR = 0.57, 95 % CI 0.36 to 0.91) and a HOMAir above 3 (OR = 0.61, 95 % CI 0.37 to 1.00).

Conclusions

Consumption of at least one kiwi/week is associated with lower plasma concentrations of fibrinogen and improved plasma lipid profile in the context of a normal diet and regular exercise.

Risk of extrapyramidal side effects comparing continuous vs. bolus intravenous metoclopramide administration: a systematic review and meta-analysis of randomised controlled trials

AIMS AND OBJECTIVES

To provide evidence about whether intravenous metoclopramide continuous infusion is associated with fewer extrapyramidal side effects than bolus infusion.

BACKGROUND

Many studies have described the effects produced by the administration of metoclopramide, as a continuous intravenous infusion or intravenous bolus directly, but there is a lack of consensus about the best administration of this drug to minimise extrapyramidal side effects.

DESIGN

A meta-analysis was conducted.

METHODS

The search data base was conducted in: Cochrane Library, PubMed, Web of Knowledge and Scopus, to collect randomised controlled trials examining the association between extrapyramidal side effects and intravenous metoclopramide continuous or bolus infusion. Meta-analyses were conducted for the eligible randomised controlled trials by Comprehensive Meta-Analysis. Risk difference and 95% CIs were calculated with the Cochran's Q-statistic, and heterogeneity was assessed with the I(2) test.

RESULTS

Eleven randomised controlled trials were included. Meta-analysis showed that continuous intravenous infusion of metoclopramide produced less extrapyramidal side effects (8%; 95% CI, 5-11%; p < 0·001; I(2) = 65%). These improvements were particularly strong in studies scored ≥3 in the Jadad scale (12%; 95% CI, 3-24%; I(2) = 0%), in emergency patients (12%; 95% CI, 2-25%; I(2) = 0%), in patients who used concomitant drugs (9%; 95% CI, 5-12%; I(2) = 80%) and when observation (8%; 95% CI, 5-14%; I(2) = 69%) or analogue scale (7%; 95% CI, 1-13%; I(2) = 64%) were used to quantify the number of extrapyramidal reactions in patients.

CONCLUSIONS

Compared with bolus administration, continuous intravenous infusion of metoclopramide reduces the appearance of extrapyramidal side effects.

RELEVANCE TO CLINICAL PRACTICE

Continuous infusion is an effective intervention to reduce in patients discomfort caused by the extrapyramidal side effects of metoclopramide. Clinicians also reduce the time spent on alleviating these unwanted effects.

Self-reports versus parental perceptions of health-related quality of life among deaf children and adolescents

The aim of this study was to assess the agreement between deaf children's and adolescents' self-ratings of health-related quality of life (HRQoL) and their parents' proxy reports. This observational cross-sectional study included 114 deaf 8- to 18-years-old students and proxy family members. HRQoL was measured using the KIDSCREEN-27 questionnaire, which was adapted to Spanish sign language for children, with a written version for parents. Respondents completed a self-administered paper questionnaire. Parents' and children's mean scores differences were not significant, except for the "Autonomy and Parents" and "Peers and Social Support" dimensions. Children aged 8-11 years scored higher in some domains of QoL compared to those aged 12-18 years. The level of agreement between children/adolescents' and parents/proxies' responses was acceptable, except for the dimension "Autonomy and Parents." Overall, deaf children/adolescents' self-ratings of HRQoL did not differ from their parents' proxy reports; however, differences were found in the dimensions that explored the quality of the interaction of children/adolescents and parents, the perceived level of autonomy, and social relations and support.

Rationale and methods of a randomised cross-over cluster trial to assess the effectiveness of MOVI-KIDS on preventing obesity in pre-schoolers

BACKGROUND

Childhood obesity has become an alarming worldwide increasing public health problem. The earlier adiposity rebound occurs, the greater the risk of becoming obese during puberty and adolescence. It has been speculated about the potential influence of vigorous physical activity on modifying the age of onset of adiposity rebound. Moreover, studies aimed to evaluate the effectiveness of physical activity interventions programs on reducing adiposity and other cardiovascular risk factors in children younger than 6 years are scarce. This paper describes the rationale and methods of a study aimed to test the effectiveness of a two-years multidimensional pre-school intervention on preventing obesity and improving physical fitness during the adiposity rebound period.

METHODS/DESIGN

Twenty-one schools from the provinces of Cuenca and Ciudad Real, Spain, were randomised to an intervention and a control arm. In the first academic year, children in third grade of pre-school and first grade of primary school in the intervention group received the physical activity intervention (MOVI-KIDS). After an academic year schools were crossed over to the alternative arm. According to the socio-ecological model, the intervention included children, their parents and teachers, and the school environment where MOVI-KIDS was conducted. MOVI-KIDS consisted of: i) three-h/week sessions of recreational non-competitive physical activity in after-school time; ii) educational materials to parents and teachers about physical activity benefits and sedentary lifestyle risks; and iii) modifications in the playground to promote physical activity during recess. Baseline and post-intervention outcomes are going to be measured in both arms three times, at the beginning and at the end of first academic year, and at the end of the second academic year. Primary outcomes included body mass index, waist circumference, triceps skinfold thickness, percentage of both body fat and fat-free mass, and blood pressure. Secondary end points were physical activity, fitness, and carotid intima-media thickness.

DISCUSSION

This paper reports the design of a randomised cross-over cluster trial aimed at assessing the effectiveness of the multidimensional physical activity intervention (MOVI-KIDS) during two years in pre-school children.

TRIAL REGISTRATION

Clinical trials.gov: NCT01971840 . (Date of registration: Initial Release: 10/07/2013; Record Verification: 23/10/2013).

BMI as a mediator of the relationship between muscular fitness and cardiometabolic risk in children: a mediation analysis

Objective

Muscular fitness levels have been associated with cardiometabolic risk in children, although whether body weight acts as a confounder or as an intermediate variable in this relationship remains controversial. The aim of this study was to examine whether the association between muscular fitness and cardiometabolic risk factors is mediated by body mass index (BMI).

Design and Methods

Cross-sectional study using a sample of 1158 schoolchildren aged 8-11 years from the province of Cuenca, Spain. We measured anthropometrics and biochemical variables and we calculated a muscular fitness index as the sum of z-scores of handgrip dynamometry/weight and standing long jump, and we estimated a previously validated cardiometabolic risk index (CMRI). Linear regression models were fitted for mediation analysis to assess whether the association between muscular fitness and cardiometabolic risk was mediated by BMI.

Results

Children with normal weight (NW) had a better cardiometabolic risk profile than their overweight (OW) or obese (OB) peers after controlling for muscular fitness. Marginal estimated mean±SE values for NW, OW and OB categories of CMRI were -0.75±0.06<0.84±0.10<2.18±0.16 in boys and -0.73±0.06<0.96±0.10<2.71±0.17 in girls, both p<0.001. Children with higher levels of muscular fitness had a better cardiometabolic risk profile (CMRI marginal estimated mean±SE 1.04±0.13>0.05±0.09>-1.16±0.13 for lower, middle and upper quartiles of muscular fitness in boys and 1.01±0.16>0.10±0.09>-1.02±0.15 in girls, both p<0.001), but differences disappeared when controlling for BMI. BMI acted as a full mediator between muscular fitness and most cardiometabolic risk factors (Sobel test z=-11.44 for boys; z=-11.83 for girls; p<0.001 in CMRI mediation model) and as a partial mediator in the case of waist circumference (Sobel test z=-14.86 for boys; z=-14.51 for girls; p<0.001).

Conclusions

BMI mediates the association between muscular fitness and cardiometabolic risk in schoolchildren. Overall, good muscular fitness is associated with lower cardiometabolic risk, but particularly when accompanied by normal weight.

Gender differences on effectiveness of a school-based physical activity intervention for reducing cardiometabolic risk: a cluster randomized trial

Background

Studies that have examined the impact of a physical activity intervention on cardiometabolic risk factors have yielded conflicting results. The objective of this study was to assess the impact of a standardized physical activity program on adiposity and cardiometabolic risk factors in schoolchildren.

Methods

Cluster randomized trial study of 712 schoolchildren, 8–10 years, from 20 public schools in the Province of Cuenca, Spain. The intervention (MOVI-2) consisted of play-based and non-competitive activities. MOVI-2 was conducted during two 90-minute sessions on weekdays and one 150-minute session on Saturday mornings every week between September 2010 and May 2011. We measured changes in adiposity (overweight/obesity prevalence, body mass index [BMI], triceps skinfold thickness [TST], body fat %, fat-free mass, waist circumference) and other cardiometabolic risk factors (LDL-cholesterol, triglycerides/HDL-cholesterol ratio, insulin, C-reactive protein and blood pressure). The analyses used mixed regression models to adjust for baseline covariates under cluster randomization.

Results

Among girls, we found a reduction of adiposity in intervention versus control schools, with a decrease in TST (−1.1 mm; 95% confidence interval [CI] -2.3 to −0.7), body fat % (−0.9%; 95% CI −1.3 to −0.4), waist circumference (−2.7 cm; 95% CI −4.5 to −0.9), and an increase in fat-free mass (0.3 kg; 95% CI 0.01 to 0.6). The intervention also led to lower serum LDL-cholesterol and insulin levels. Among boys, a reduction in waist circumference (−1.4 cm; 95% CI −2.6 to −0.1; P = 0.03), and an increase in fat-free mass (0.5 kg; 95% CI 0.2 to 0.9; P = 0.003) was associated with the intervention versus control schools. The prevalence of overweight/obesity or underweight, BMI, and other cardiometabolic risk factors was not modified by the intervention. No important adverse events were registered.

Conclusions

An extracurricular intervention of non-competitive physical activity during an academic year, targeting all schoolchildren regardless of body weight, is a safe and effective measure to reduce adiposity in both genders and to improve cardiometabolic risk profile in girls.

Trial registration

Clinical trials NCT01277224.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-014-0154-4) contains supplementary material, which is available to authorized users.

Validity and reliability of the Spanish version of the 10-item CD-RISC in patients with fibromyalgia

Background

No resilience scale has been validated in Spanish patients with fibromyalgia. The aim of this study was to evaluate the validity and reliability of the 10-item CD-RISC in a sample of Spanish patients with fibromyalgia.

Methods

Design: Observational prospective multicenter study. Sample: Patients with diagnoses of fibromyalgia recruited from primary care settings (N = 208). Instruments: In addition to sociodemographic data, the following questionnaires were administered: Pain Visual Analogue Scale (PVAS), the 10-item Connor-Davidson Resilience scale (10-item CD-RISC), the Fibromyalgia Impact Questionnaire (FIQ), the Hospital Anxiety and Depression Scale (HADS), the Pain Catastrophizing Scale (PCS), the Chronic Pain Acceptance Questionnaire (CPAQ), and the Mindful Attention Awareness Scale (MAAS).

Results

Regarding construct validity, the factor solution in the Principal Component Analysis (PCA) was considered adequate, so the KMO test had a value of 0.91, and the Barlett’s test of sphericity was significant (χ2 = 852.8; gl = 45; p < 0.001). Only one factor showed an eigenvalue greater than 1, and it explained 50.4% of the variance. PCA and Confirmatory Factor Analysis (CFA) results did not show significant differences between groups. The 10-item CD-RISC scale demonstrated good internal consistency (Cronbach’s alpha = 0.88) and test-retest reliability (r = 0.89 for a six-week interval). The 10-item CD-RISC score was significantly correlated with all of the other psychometric instruments in the expected direction, except for the PVAS (−0.115; p = 0.113).

Conclusions

Our study confirms that the Spanish version of the 10-item CD-RISC shows, in patients with fibromyalgia, acceptable psychometric properties, with a high level of reliability and validity.