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Is greater adherence to the Mediterranean diet related to higher health-related quality of life among children and adolescents?: a systematic review and meta-analysis
(Springer, 2025-07-24) Victoria-Montesinos, Desirée; García Hermoso, Antonio; López-Moreno, Miguel; Ezzatvar, Yasmin; Gutiérrez Espinoza, Héctor; Quesada-Fernández, Gonzalo; Stubbs, Brendon; Smith, Lee; Kales, Stefanos N.; Ciencias de la Salud; Osasun Zientziak
Adherence to the Mediterranean diet (MedDiet) has been linked to better physical and mental health outcomes. However, its relationship with health-related quality of life (HRQoL) in children and adolescents has not been quantitatively assessed. To examine the association between adherence to the MedDiet and HRQoL in children and adolescents through a systematic review and meta-analysis of observational studies. PubMed, Scopus, Web of Science, and Cochrane Library were searched from inception through November 1, 2024. Observational studies assessing the association between MedDiet adherence and HRQoL in participants aged ¿ 19 years. Only studies using validated tools for both exposure and outcome were included. Two reviewers independently extracted data and assessed study quality using the National Heart, Lung, and Blood Institute tool. A random-effects model with a restricted maximum likelihood estimator was applied. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The primary outcome was the Spearman¿s correlation coefficient (r) between MedDiet adherence and HRQoL. Twenty-four studies (n = 28,692; weighted mean age = 12.6 years) from ten countries were included. Higher adherence to the MedDiet was associated with better HRQoL (r = 0.22; 95% confidence interval [CI], 0.13 to 0.30; p < 0.001), although effect sizes were modest and heterogeneity was high (inconsistency index [I2] = 99.8%). Subgroup and sensitivity analyses confirmed the robustness of findings across HRQoL domains (e.g., physical, emotional, school-related). Studies with unadjusted models reported stronger associations than those with covariate-adjusted models. Conclusions: Greater adherence to the MedDiet is modestly associated with higher HRQoL in children and adolescents. These findings support dietary interventions as a component of youth well-being strategies, although further longitudinal and interventional research is needed.
Open Access
Normative data of ultrasound quadriceps rectus femoris geometric values: the ECOSARC-2 study
(Elsevier, 2025-08-01) López Jiménez, Ester; Reinoso Párraga, Paola; González Ramírez, Alfonso; Neira Álvarez, Marta; Abizanda Saro, Adriana; Fernández González de la Riva, María Luisa; Alonso Bouzón, Cristina; Chavero Carrasco, Victoriano; Montemayor Galán, Gema; Rodríguez Solís, Juan; Alcantud Córcoles, Rubén; Ramírez Martín, Raquel; Pablos Hernández, Carmen de; Zambom Ferraresi, Fabrício; Dax Vásquez, Brian; Sagüillo González, Pedro Luis; Morón Merchante, Ignacio; García Molina, Rafael; Menéndez Colino, Rocío; Martínez Velilla, Nicolás; Andrés Pretel, Fernando; Gómez Jiménez, Elena; Sáez Blesa, Marta; Cortés Zamora, Elisa Belén; Avendaño Céspedes, Almudena; Abizanda, Pedro; Ciencias de la Salud; Osasun Zientziak
Objectives: To describe geometric muscle ultrasound normative values of Quadriceps Rectus Femoris (QRF) at midthigh in Spanish community-dwelling older adults. Secondary objectives included evaluating the associations between ultrasound measurements and physical function, muscle strength, frailty, and dependency in basic activities of daily living. Design: Cross-sectional study. Setting: Outpatient clinics of Geriatric Departments at seven University Hospitals and three Primary care settings of Spain. Participants: 424 community-dwelling persons 70 years old. Measurements:UltrasoundmeasurementswereacquiredusingaClarius1 L7HD3probe.QRFthickness(QRFT),QRF area(QRFA),subcutaneousadiposethickness(SAT),totalmid-thighthickness(TTT),andpennationangle(PA)were calculated. Normative values are provided, and associations with comorbidity, dependency, strength, frailty and physical function are described. Results: Meanagewas81.5years(range70 99),66.7%werefemale.MeanBarthelindexwas93(SD11),andmean FRAIL score was 1.1 (1.2). Mean SPPB was 8.7 (SD 2.9) and mean grip strength was 20.7 (8.0). Median values of QRFT,QRFA,SAT,TTT,andPAforwomenandmenwere14.2/16.1 [8_TD$DIF] mm,5.4/6.4cm2,15.1/9.2 [89_TD$DIF] mm,41.1/40.1, and10.0/10.6respectively. Functional variables were strongly associated with QRFT,QRFA, and TTTinmen,and PA with SPPB in both sexes. Conclusions: The ECOSARC-2 study provides normative values of geometric mid-thigh muscle ultrasound parameters in community-dwelling older adults. These values are essential for determining sex-specific cut-off points for conditions such as sarcopenia, frailty, malnutrition, and for predicting relevant outcomes.
Embargo
Hope-promoting communication with pediatric patients with chronic diseases and their families: a scoping review
(Wiley, 2025-07-08) Alvarenga, Willyane de Andrade; Leite, Ana Carolina Andrade Biaggi; Mendes de Carvalho, Thalicia; Da Silva Gonzaga, Barbara Vyctória; Soares de Morais, Maria Francisca; Pereira da Silva, Lucila; Charepe, Zaida; Nascimiento, Lucila; Ciencias de la Salud; Osasun Zientziak
Introduction: The way communication is conducted directly influences the professional-patient relationship, how patients cope with their diagnosis, and their sense of hope throughout treatment. This study aims to map the literature on strategies that healthcare professionals can use to promote hope in communication with pediatric patients and their families in the context of chronic illness. Based on this objective, the study highlights an algorithm to assist healthcare professionals in instilling hope in this population through communication. Design: Scoping review. Methods: This systematized review was conducted using the databases PubMed, LILACS, PsycInfo, Embase, CINAHL, and Scopus, employing the PCC framework and the Boolean operators AND and OR. The time frame was limited to the last 20 years (2004-2024). A total of 734 studies were identified across the databases, with an additional four retrieved through manual citation searches, resulting in 19 articles included in the final sample. Results: The findings highlight three key pillars for promoting hope in communication: (1) careful preparation for information delivery, which involves identifying the diverse needs of families and creating a physically comfortable and emotionally supportive environment; (2) providing information and emphasizing how it is presented-considering content, clarity, honesty, empathy, and adaptation to the recipient's specific needs; and (3) follow-up after information delivery, ensuring emotional support and active, skilled listening. Conclusions: Interpersonal communication between the healthcare professional, the patient, and the family was mainly focused on the transmission of information about the disease and treatment in a clear and empathetic manner, considering who is receiving the information and how the information is interpreted. Clinical Relevance: This review provides guidance for healthcare professionals in implementing communication strategies that foster hope in the context of pediatric chronic illness. Additionally, this guide may serve as a model for training students and healthcare professionals. Further research is needed to implement and explore additional effective communication strategies for this population across diverse cultural settings.
Open Access
Bridging sectors and disciplines to gain a critical understanding of the eco-social determinants of health inequities: the ESDHI-EU Conference
(Sage, 2025-05-21) Morrison, Joana; Tumas, Natalia; Moreno Mattar, Ornella ; Gutiérrez-Zamora Navarro, Mariana; Pericas, Juan M.; Martínez Herrera, Eliana ; Cash-Gibson, Lucinda; Caroz Armayones, Josep Maria; Ruisoto Palomera, Pablo; Zografos, Christos; Rodríguez Labajos, Beatriz; Vergés Vega, Paula; Londoño, Ángela; Bautista, Marya; Karaguesian, Claire; Núñez, Daniel; Muntané, Ferràn; Jiménez, Humberto; Vivas, Laila; Velásquez, Linda; Hsu, Po-Yen; Muntaner, Carles ; Benach, Joan; Ribbons, Aeve; Ciencias de la Salud; Osasun Zientziak; Institute for Advanced Social Research - ICOMMUNITAS
The current eco-social crisis is driven by an unsustainable socioeconomic model based on continued economic growth that exceeds planetary limits. Groups experiencing disadvantages are being disproportionately affected, further deepening global, regional, and local health inequities. Understanding the simultaneous ecological and social crises through a comprehensive approach across disciplines and sectors—including citizen participation—is essential for driving transformative change and paradigm shifts. Achieving genuine ecological sustainability, social justice, and health equity is critical for transitioning towards a new social-ecological paradigm in research and policy. This requires transformative research and policymaking in key areas—eco-social crisis; democracy, social inclusion and participation; geopolitics; and equitable, sustainable cities—all of which represent pressing challenges within this global crisis, and serve as thematic axes for the European conference Rethinking the Eco-Social Determinants of Health Inequities through the Transdisciplinary and Intersectoral Lens (ESDHI-EU), which will be held in Barcelona, Spain, on May 22–23, 2025, and will explore the root causes of health inequities from a transdisciplinary, intersectoral, and transnational perspective.
Open Access
Effects of branched-chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy: a randomized study
(American College of Gastroenterology, 2011-06-01) Les Bujanda, Íñigo; Doval, Eduardo; García-Martínez, Rita; Planas, Mercè; Cárdenas, Guillermo; Gómez, Pilar; Flavià, Montse; Jacas, Carlos; Mínguez, Beatriz; Vergara, Mercedes; Soriano, Germán; Vila, Carmen; Esteban, Rafael; Córdoba, Juan; Ciencias de la Salud; Osasun Zientziak
Objectives: protein intake impacts on nutritional status and may determine the recurrence of hepatic encephalopathy (HE). A low-protein diet has been considered the standard treatment after an episode of HE, while branched-chain amino acids (BCAA) have been shown to improve minimal HE. We performed a study to investigate the long-term effects of supplementing a protein-controlled diet with BCAA. Methods: a randomized, double-blind, multicenter study that included 116 patients with cirrhosis and a previous episode of HE was conducted in four tertiary care hospitals. All patients received a standard diet of 35 kcal/kg per day and 0.7 g of proteins/kg per day and a supplement of 30 g of BCAA (BCAA group) or maltodextrin (MDX group) during 56 weeks. Results: the actuarial risk of remaining free of HE did not differ between groups (BCAA47%, MDX34%, P0.274), but patients in the BCAA group exhibited a better outcome on two neuropsychological tests and an increase in the mid-arm muscle circumference. Recurrence was associated with low plasma albumin at baseline and a decrease in sodium and an increase in creatinine during follow-up. Patients with recurrence of HE exhibited a lack of improvement in global cognitive function. Conclusions: diet supplementation with BCAA after an episode of HE does not decrease recurrence of HE. However, supplementation with BCAA improves minimal HE and muscle mass. Identification of risk factors for recurrence of HE may allow the development of new preventive therapies that could decrease the neuropsychological sequelae of repeated episodes of HE.
Open Access
Duration of the acute hepatic encephalopathy episode determines survival in cirrhotic patients
(Sage, 2018-11-26) Ventura-Cots, Meritxell ; Carmona, Isabel ; Moreno, Carolina ; Ampuero, Javier; Simón-Talero, Macarena ; Sanpedro, Francesc ; Les Bujanda, Íñigo; Romero-Gómez, Manuel ; Genescà, Joan; Ciencias de la Salud; Osasun Zientziak
Background: Episodes of hepatic encephalopathy (HE) have been related to low survival rate. However, the relation between its clinical evolution and mortality has not been assessed. Methods: A retrospective analysis of 245 cirrhotic patients admitted for an acute episode of HE (⩾grade 2) or who developed an HE episode after an upper gastrointestinal bleeding (UGIB) event was performed to assess the relation between time in HE and transplant-free survival. Results: Median (IQR25–75) time in HE was 48 h (24–96 h) in the whole cohort. Patients who presented a longer time in HE (>48 h; n = 89) exhibited a lower transplant-free survival at 28 days (67.2% versus 88.9%, p < 0.001), 90 days (48.7% versus 73.8%, p < 0.001) and 365 days (30.3% versus 53.2%, p < 0.001), as compared to those with less time in HE (⩽48 h; n = 156). Survival rates remained significantly different, with lower percentages in the group with time in HE >48 h, when comparing patients according to baseline HE grade (2 versus ⩾3) or model for end-stage liver disease (MELD) function (⩽15 versus >15). Time in HE was also an independent risk factor for mortality at each time point, hazard ratio (HR) (95 CI%) 28 days 2.59 (1.39–4.84); 90 days 1.98 (1.28–3.1) and 365 days 1.5 (1.08–2.19). Conclusions: The duration of the acute HE episode determines survival in cirrhotic patients independently of liver function and baseline HE grade.
Open Access
Obstetric complications, cortical gyrification, and cognition in first-episode psychosis
(Cambridge University Press, 2025-07-22) Costas-Carrera, Ana; Verdolini, Norma; Mezquida, Gisela; Forte, María Florencia; Janssen, Joost; Garcia-Rizo, Clemente; Martínez-Aran, Anabel; Andres-Camazon, Pablo; Sánchez Torres, Ana María; Bergé, Daniel; Serna, Elena de la; Penadés, Rafael; Valli, Isabel; Amoretti, Silvia; PEPs Group; Ciencias de la Salud; Osasun Zientziak
Background. Obstetric complications (OCs) are associated with cognitive and brain abnormalities observed in patients with schizophrenia. Gyrification, a measure of cortical integrity sensitive to events occurring during the prenatal and perinatal periods, is also altered in firstepisode psychosis (FEP). We examined the relationship between OCs and gyrification in FEP, as well as whether gyrification mediates the relationship between OCs and cognition. Methods. We examined differences in the Local Gyrification Index (LGI) for the frontal, parietal, temporal, occipital, and cingulate cortices between 139 FEP patients and 125 healthy controls (HCs). Regression analyses explored whether OCs and diagnosis interact to explain LGI variation. Parametric mediation analyses were conducted to assess the effect of LGI on the relationship between OCs and cognition for FEP and HC. Results. Significant LGI differences were observed between FEP patients and HC in the left parietal and bilateral cingulate and occipital cortices. There was a significant interaction between OCs and diagnosis on the left cingulate cortex (LCC) that was specific to males (p = 0.04) and was driven by gestational rather than intrauterine OCs. In HCs, OCs had a direct effect on working memory (WM) (p = 0.048) in the mediation analysis, whereas in FEP, we observed no significant effect of OCs on either verbal or WM. Conclusions. OCs interact with diagnosis to predict LCC gyrification, such that males with FEP exposed to OCs exhibit the lowest LGI. OCs influence WM, and LCC gyrification may mediate this relation only in HC, suggesting a differential neurodevelopmental process in psychosis.
Open Access
Effects of 2 different rehabilitation programs on jumping performance after ACL reconstruction: a randomized controlled trial
(Lippincott, 2025-07-04) Jauregui Bidegain, Lucas; Izquierdo Redín, Mikel; Alfaro Adrián, Jesús; García Arroyo, Jaime; García-Tabar, Ibai; Sesma Mendaza, Andoni; Setuain Chourraut, Igor; Ciencias de la Salud; Osasun Zientziak
Background: Objective criteria-based rehabilitation (OCBR) has shown potential in improving muscle strength and reducing knee laxity following anterior cruciate ligament reconstruction (ACLR). Limited evidence exists regarding its effectiveness in restoring functional jumping capacity. The objective of this study was to compare the effects of 2 rehabilitation programs on vertical and horizontal jumping performance at 3 to 6 and 12 months after ACLR. Methods: A longitudinal clinical double-blind randomized controlled trial was carried out. Forty recreational athletes (30 males, 10 females; age: 24±6.9 years; height: 176.55±6.6 cm; weight: 73.58±12.3 kg), Tegner activity level of 7, were recruited. Participants were randomly assigned to either the OCBR or usual care rehabilitation (UCR) programs following primary ACLR. Vertical and horizontal jumping performance was assessed at 3-, 6-, and 12-month post-surgery. Results: OCBR group showed significantly better performance 6 months postoperatively among ACLR limbs in both vertical (unilateral drop jump 14.5±3.6 vs 11.6±4.6 cm, P<.05, ES=0.7; bilateral drop jump 30.4±6.4 vs 24.3±6.0, P<.05, ES=0.9) and horizontal jumping tasks (unilateral triple hop for distance 422.3±52.3 vs 340.4±53.1 cm, P<.05, ES=1.5; unilateral cross over hop for distance 355.4±52.0 vs309.7±70.4 cm, P<.05, ES=1.2). These differences remain consistent also at 12-months post-surgery compared to the UCR group between their operated limbs for vertical (unilateral drop jump 15.8±3.2 vs 12.2±3.3 cm, P<.05, ES=1.1; bilateral drop jump 30.3±4.9 vs 25.2±6.5, P<.05, ES=0.9) and horizontal maneuvers (unilateral triple hop for distance 452.1±54.9 vs 385.0 51.9 cm, P<.05, ES=1.6; unilateral cross over hop for distance 385.6 69.6 vs 285.1 60.3 70.4 cm, P<.05, ES=1.5). Conclusion: The OCBR program led to superior functional performance outcomes at 6- and 12-months following ACL surgery, highlighting its potential as an effective rehabilitation strategy. Implementing an OCBR program post-ACL reconstruction improves functional performance in jumping tasks at 6 and 12 months compared with UCR rehabilitation.
Open Access
La intubación prehospitalaria como factor pronóstico en la supervivencia de pacientes politraumatizados: un estudio de cohorte retrospectivo en Navarra
(Sociedad Española de Medicina de Urgencias y Emergencias, 2025-04-09) Zulet Murillo, Daniel; Ferraz Torres, Marta; Fortún Moral, Mariano; Belzunegui Otano, Tomás; Tamayo Rodríguez, Ibai; Rosell Ortiz, Fernando; Ciencias de la Salud; Osasun Zientziak
Objetivo. Conocer los factores asociados a la intubación orotraqueal (IOT) prehospitalaria y su influencia en la supervivencia de pacientes politraumatizados. Método. Estudio observacional de cohorte retrospectiva, realizado en Navarra, usando el registro Mayor Trauma de Navarra (1 de enero de 2010 - 31 de diciembre de 2019). Se analizaron variables clínicas y demográficas para estudiar la relación entre la IOT y la su pervivencia. Se utilizó regresión logística multivariable y un análisis de mortalidad ajustado por ponderación de probabilidad inversa de tratamiento para controlar factores de confusión. Resultados. De los 1.909 pacientes incluidos, 212 (11,1%) recibieron IOT prehospitalaria. Estos pacientes presentaron mayor gravedad, con puntuaciones más altas en las escalas Injury Severity Score (ISS) (35,9 vs 25,6; p < 0,001) y New Injury Severity Score (NISS) (43,8 vs 32,3; p < 0,001). La supervivencia fue menor en quienes requirieron IOT; sin embargo, tras el ajuste, la IOT no mostró una asociación significativa con la supervivencia. Los factores que más se asociaron con menor supervivencia fueron la edad avanzada, un exceso de base bajo y puntuaciones altas en las escalas Revised Trauma Score (RTS) y NISS: edad OR 1,06 (IC 95%: 1,04-1,09), exceso de base OR 0,92 (IC 95%: 0,86-0,98), RTS OR 0,52 (IC 95%: 0,39-0,67) y NISS OR 1,04 (IC 95%: 1,02-1,06).
Open Access
Clinical validity of the nursing diagnoses impaired gas exchange (00030) and ineffective breathing pattern (00032) in post-COVID-19 individuals
(Wiley, 2025-07-30) González-Falcón, Noemí; Pérez-Pérez, Aylin Guadalupe; Aguilar-Escamilla, Nathalie Lynette; Maldonado-Muñiz, Gabriela; Trejo-García, Claudia Atala; Escalada Hernández, Paula; Ciencias de la Salud; Osasun Zientziak
Purpose: To examine the clinical construct validity and specific causal validity of the nursing diagnoses of impaired gas exchange (00030) and ineffective breathing pattern (00032) in post-COVID-19 individuals. Methods: A correlational and cross-sectional study was conducted. A total sample of 199 individuals with a previous COVID-19 diagnosis, aged 18 years or older, was recruited. Participants attended consultations at two health units in Hidalgo, Mexico, between February and March 2022. After obtaining informed consent, the presence of the nursing diagnoses under study was assessed using checklists developed based on the defining characteristics and related factors described in the NANDA-I classification. These checklists were validated by a panel of experts. Findings: The mean age of participants was 35.76 ± 15 years; 56.3% were female, and 21.6% had at least one comorbidity. Additionally, 36.7% reported engaging in light physical activity, and the mean time elapsed since the COVID-19 diagnosis was 6.31 ± 5.6 months. Overall, 49.7% of participants were observed to have impaired gas exchange (00030), and 74.4% presented with ineffective breathing pattern (00032). Impaired gas exchange (00030) was associated with alterations in breathing depth (rho = 0.632), alterations in breathing rate (rho = 0.562), and ineffective breathing pattern (rho = 0.666). Meanwhile, ineffective breathing pattern (00032) was associated with hypoxia (rho = 0.367), decreased inspiratory pressure (rho = 0.350), and anxiety (rho = 0.611). Conclusions: Impaired gas exchange (00030) and ineffective breathing pattern (00032) demonstrate clinical construct validity and specific causal validity in post-COVID-19 individuals. Implications for Nursing Practice: Clinical validation enables the identification of populations to which the diagnoses can be applied, providing initial profiles of the diagnostic components in post-COVID-19 individuals. It also identifies statistically significant related factors and defining characteristics, contributing to more precise and evidence-based nursing interventions.
Embargo
Análisis de los factores de riesgo asociados a flebitis en el catéter venoso periférico: Proyecto Flebitis Zero
(Elsevier, 2025-07-29) Ferraz Torres, Marta; Sancho Sena, Elena; Eguillor de la Torre, Amaya; Cambra Vidart, Laura; Suárez-Mier, María Belén; Corcuera Martínez, María Inés; Ingeniería Eléctrica, Electrónica y de Comunicación; Ingeniaritza Elektrikoa, Elektronikoa eta Telekomunikazio Ingeniaritza; Ciencias de la Salud; Osasun Zientziak
Introducción: es necesario conocer la tasa de flebitis asociada a su uso y los factores de riesgo asociados al manejo del catéter vascular periférico que influye directamente sobre la presencia de flebitis. Metodología: estudio descriptivo observacional, realizado tras la implementación del Proyecto Flebitis Zero en un hospital terciario urbano de gran capacidad (> 1.000 camas) y de referencia de Navarra. La implantación del Proyecto Flebitis Zero se realizó de forma progresiva incorporando 4 unidades (2 médicas y 2 quirúrgicas) por año, finalizando en el mes de febrero del 2023. Seguidamente, se inició la recogida de datos para el presente estudio, en el mes de mayo del 2023. Resultados: se incluyeron 687 catéteres, 48,3% (332) catéteres fueron implantados en hombres frente a 51,7% (355) en mujeres con una edad media de 68 (DE 18,64). Se detectó una tasa de flebitis del 11,93%, siendo los factores de calibre de catéter y el lugar de inserción los directamente relacionados con la presencia de flebitis. Conclusiones: la presencia de flebitis está marcada tanto por factores modificables, siendo recomendable el uso de dispositivos de pequeño calibre y la zona de antebrazo los indicados para disminuir la tasa de flebitis.
Open Access
Association between adherence to the Mediterranean diet and metabolic syndrome in children and adolescents: a systematic review and meta-analysis
(BMJ Publishing Group, 2025-07-02) Dubey, Viney Prakash; García Hermoso, Antonio; López Gil, José Francisco; Rauckiene-Michaelsson, Alona; Vila-Chã, Carolina; Agostinis-Sobrinho, César; Ciencias de la Salud; Osasun Zientziak
Background: the Mediterranean diet has been associated with improved metabolic health among adults. This meta-analysis aimed to evaluate the association between adherence to a Mediterranean diet and metabolic syndrome among children and adolescents. Methods: a systematic review of the literature was conducted by searching PubMed, the Excerpta Medica Database (Embase, via OvidSP), Scopus and Web of Science, covering publications from inception to April 2024. Studies were included if they evaluated the association between adherence to a Mediterranean diet and metabolic syndrome among children and adolescents. A random-effects model was used to estimate the summary effect size. Results: a total of eight studies involving children and adolescents aged 6 to 19 years were included in the meta-analysis (n=6562, 50% girls). Low adherence to the Mediterranean diet was associated with greater odds of metabolic syndrome than was medium/high adherence (odds ratio [OR] = 2.18, 95% confidence interval [CI] 1.45 to 3.28; p < 0.001; inconsistency index [I2] = 64.15%). Conclusion: this meta-analysis suggested that increased adherence to a Mediterranean diet is associated with lower probabilities of having cardiometabolic risk among children and adolescents. Thus, our findings suggest that public health strategies are needed to implement and promote effective actions toward healthy eating habits in children and adolescents.
Open Access
Educational needs in geriatric medicine among health care professionals and medical students in COST Action 21122 PROGRAMMING: mixed-methods survey protocol
(JMIR Publications, 2025-06-03) Ogliari, Giulia; Masud, Tahir; Herghelegiu, Anna Marie; Pavic, Tajana; Wissendorff Ekdahl, Anne; Piotrowicz, Karolina; Duque, Sofía; Benetos, Athanase; Bogdanović, Nenad; Bonin-Guillaume, Sylvie; Frost, Rachael; Koca, Meltem; Kossioni, Anastassia; Kravvariti, Evrydiki; Martínez Velilla, Nicolás; McKeown, William; Roller Wirnsberger, Regina; Savas, Sumru; Vassallo, Michael; Yellon, Tamar; Petrovic, Mirko; Kotsani, Marina; Ciencias de la Salud; Osasun Zientziak
Background: The European Cooperation in Science and Technology (COST) Action 21122, PROmoting GeRiAtric Medicine in countries where it is still eMergING (PROGRAMMING) developed an online open survey to assess the educational interests and needs of health care professionals and final-year medical students across participating countries. This survey aims to establish a current baseline for developing educational content on geriatric medicine for nongeriatricians and a framework for its delivery. Objective: This paper describes the aim, development, structure, content, and dissemination of this survey. Methods: The mixed methods electronic survey, initially developed in English through a cocreation process with key stakeholders, was subsequently translated into 24 languages. It received ethics approval from multiple participating countries. Within- and cross-country analyses of the survey data will be conducted using descriptive and inferential statistics for quantitative data and content analyses for qualitative data. National and international teams will conduct analyses in parallel exploring responses within a specific country or region, professional category (or among medical students), or setting of work. Basic descriptive statistics and chi-square tests will evaluate differences in knowledge, relevance, and interest in geriatric topics across countries, professions, and settings of work. The effectiveness of formal education in geriatric medicine and clinical rotations in geriatric settings versus the lack thereof in promoting higher self-perceived knowledge on geriatric medicine topics will be explored using binary logistic regression. We will provide basic descriptive statistics (frequencies) of reported barriers to receiving further training in geriatric medicine and the effectiveness of various teaching methods as rated by the respondents and explore differences across countries, professions, and settings using chi-square tests. We will conduct qualitative content analyses of free-text responses to the questions exploring professionals’ and medical students’ thoughts on caring for older people and medical students’ thoughts on becoming geriatricians. Results: The survey included the following sections: Informed Consent, Demographics, Topics and Skills, Medical Students vs. Professionals, Current Profession (for professionals), Previous Education in Geriatric Medicine (for professionals), Education in Geriatric Medicine (for medical students), Interest in Care of Older People or Geriatric Medicine, Suggestions for Courses in Care for Older People or Geriatric Medicine, and Closure. The survey was disseminated between October 9, 2023, and June 5, 2024, and received 6099 responses; after cleaning, there were 5922 (97.1%) responses (n=5474, 92.43% from professionals and n=448, 7.57% from medical students). Conclusions: This survey’s findings will inform educational projects across the PROGRAMMING countries. We will share these findings with national and international stakeholders, including professional societies, medical schools, and other relevant organizations. We will advocate for professional educational curricula to include geriatric topics rated as relevant by the survey respondents and promote clinical rotations in geriatric settings and teaching methods rated as effective by the survey respondents.
Open Access
The role of muscular fitness on bone mineral content and areal bone mineral density in youth with type 1 diabetes
(Oxford University Press, 2025-06-05) Muñoz Pardeza, Jacinto; Gracia-Marco, Luis; López Gil, José Francisco; Hormazábal Aguayo, Ignacio; Huerta Uribe, Nidia; Mármol-Pérez, Andrés; Ezzatvar, Yasmin; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ciencias de la Salud; Osasun Zientziak
Context Type 1 diabetes in youth increases the risk of compromised bone health due to glycemic dysregulation. Muscular fitness may play a role in improving bone health during growth. Objective This study aimed to investigate the association between muscular fitness and bone health in youth with type 1 diabetes. Methods A total of 83 young individuals with type 1 diabetes (aged 6-18 years; 44.6% girls) from the Diactive-1 cohort study were followed for 2 years. Dual-energy x-ray absorptiometry whole-body scans were used to assess bone mineral content (BMC) and areal bone mineral density (aBMD) of the total body less head (TBLH), arms, legs, pelvis, and spine. Muscular fitness (handgrip strength, 1 repetition maximum, and muscle power) was assessed with a dynamometer and eGYM devices. Handgrip strength and TBLH bone parameters were age- and sex-standardized using the FitBack Project and BMD Childhood Study, respectively. Results Linear mixed models showed longitudinal associations of handgrip strength with TBLH-BMC (unstandardized beta coefficient [B] = 17.18, 95% confidence interval [CI] 12.47-21.90) and TBLH-aBMD (B = 0.004, 95% CI 0.002-0.006); RM with TBLH-BMC (B = 20.09, 95% CI 10.88-29.31) and TBLH-aBMD (B = 0.007, 95% CI 0.004-0.011); and power with TBLH-BMC (B = 26.80, 95% CI: 17.31-36.28) and TBLH-aBMD (B = 0.009, 95% CI 0.005-0.012). Comparable results were observed across the other regions (P < .05). Additionally, analyses with standardized data confirmed the relationships of handgrip z-scores with TBLH-BMC z-scores (B = 0.19, 95% CI 0.08-0.30) and TBLH-aBMD z-scores (B = 0.350, 95% CI: 0.210-0.490). Conclusion In pediatric patients with type 1 diabetes, higher muscular fitness could serve as a complementary therapeutic strategy to preserve or enhance bone health.
Open Access
Trans-ancestry genome-wide association study of childhood body mass index identifies novel loci and age-specific effects
(Cell Press, 2025-04-10) Downie, Carolina G.; Shrestha, Poojan; Okello, Samson; Yaser, Mohammad; Lee, Harold H.; Wang, Yujie; Krishnan, Mohanraj; Chen, Hung-Hsin; Justice, Anne E.; Chittoor, Geetha; Josyula, Navya Shilpa; Gahagan, Sheila; Blanco, Estela; Burrows, Raquel; Correa-Burrows, Paulina; Albala, Cecilia; Santos Martín, José Luis; Angel, Bárbara; Lozzoff, Betsy; Hartwig, Fernando Pires; Horta, Bernardo; Brina, Karisa Roxo; Isasi, Carmen R.; Qi, Qibin; Gallo, Linda C.; Perreira, Krista M.; Thyagarajan, Bharat; Daviglus, Martha; Horn, Linda van; González, Franklyn; Bradfield, Jonathan P.; Hakonarson, Hakon; Grant, Struan F.A.; Below, Jennifer E.; Felix, Janine; Graff, Mariaelisa; Divaris, Kimon; North, Kari E.; Ciencias de la Salud; Osasun Zientziak
Over the past 30 years, obesity prevalence has markedly increased globally, including among children. Although genome-wide association studies (GWASs) have identified over 1,000 genetic loci associated with obesity-related traits in adults, the genetic architecture of childhood obesity is less well characterized. Moreover, most childhood obesity GWASs have been restricted to severely obese children, in relatively small sample sizes, and in primarily European-ancestry populations. To identify genetic loci associated with early-childhood body mass index (BMI), we performed GWAS of BMI Z scores in eight ancestrally diverse cohorts: ZOE 2.0 cohort, the Santiago Longitudinal Study (SLS), the Vanderbilt University BioVU biobank, the Geisinger MyCode Health Initiative biobank, Study of Latino (SOL) Youth, Pelotas (Brazil) Birth Cohort, Cameron County Hispanic Cohort (CCHC), and Viva La Familia cohort. We subsequently performed inverse-variance-weighted fixed-effect meta-analysis of these results with previously published GWAS summary statistics of BMI Z scores of children in the Early Growth Genetics (EGG) Consortium and the Norwegian Mother and Child Cohort (MoBa), constituting a final total of 84,804 individuals. We identified 39 genome-wide significant loci associated with childhood BMI, including three putatively novel loci (EFNA5 and DTWD2, RP11-2N5.1 on chromosome 5, and LSM14A on chromosome 19). We also observed a dynamic nature of genetic loci-BMI associations across the life course, with distinct effects across childhood and adulthood, highlighting possible critical periods for early-childhood interventions. These findings strengthen calls for larger population-based studies of children across age strata and across diverse populations.
Embargo
Chaotic (laissez-faire) teaching: the most harmful style for students' psychological needs?
(Elsevier, 2025-07-24) Bouten, Arne; Diloy-Peña, Sergio; Abós, Ángel; García González, Luis; Haerens, Leen; De Cocker, Katrien; Ciencias de la Salud; Osasun Zientziak
Self-Determination Theory (SDT) has been widely used to understand how different teaching styles impact student outcomes. Previous research has mainly focused on the negative effects of controlling teaching, while the influence of chaotic (laissez-faire) teaching has been less explored. This study examines how students' perceptions of highly chaotic (i.e., abandoning) and highly controlling (i.e., domineering) teaching approaches are related to the satisfaction and frustration of student basic psychological needs in secondary physical education (PE). The study involved 916 students in Belgium (58% girls; 15.37 ± 1.62 years old) and 1124 students in Spain (52% girls; 14.60 ± 1.51 years old). Using linear mixed-effects models, we found that both abandoning and domineering teaching approaches were adversely associated with students' basic psychological needs. The abandoning approach showed the strongest positive association with overall need frustration in both samples. Moreover, the abandoning approach was most strongly associated with competence and relatedness frustration in both countries, as well as with lower competence satisfaction in Spain. Both approaches showed a similar positive relationship with autonomy frustration. This study expands our understanding of demotivating teaching by demonstrating the harmful potential of highly chaotic teaching, beyond the well-known harmful effects of controlling teaching. The consistency of the findings across both countries highlights the international relevance of this research. These findings suggests that reducing highly chaotic (i.e., laissez-faire) teaching should be a priority in international educational practices and policies. Future research could investigate the causes, effects, and potential moderators of chaotic teaching to further guide educational policy and practice in different cultural contexts.
Embargo
Analysis of sociodemographic and linguistic influences on verbal fluency performance in Basque and Catalan bilingual adults
(Oxford University Press, 2025-08-11) Olabarrieta Landa, Laiene; Rivera, Diego; Alegret, Montserrat; Pérez-Cordón, Alba; Forte, Anabel; Arango Lasprilla, Juan Carlos; Ciencias de la Salud; Osasun Zientziak
The aim of the study was to generate norms for letter, semantic, and verb fluency tests for Basque and Catalan speakers from Spain. The sample consisted of 275 bilinguals aged between 18 and 85 years who completed the tests for each language (Basque-Spanish or Catalan-Spanish) with order counterbalanced. The influence of predictors was evaluated with Generalized Linear Mixed Models. Language by letter and type of language by semantic category interactions were found, where people scored higher in letter fluency when tested in Spanish than in Basque or Catalan, and produced more words in the animals category compared to fruits and occupations. Production increased in all tests with higher education. Letter and semantic fluency scores increased until ages 40-45, after which they decreased, except for action fluency, where Basque speakers had decreased scores with age. Basque men scored higher than Basque women in letter and semantic fluency, but lower in verb fluency; while Catalan women scored higher than Catalan men in semantic and verb fluency, but lower in letter fluency. The study provides, for the first time, verbal fluency norms for Basque and enriches norms availability for Catalan. Socio-psycholinguistics aspects may have an impact on performance.
Open Access
Clinical-epidemiological predictors of phlebitis associated with peripheral intravenous catheters in Spanish hospitals: results of a national cohort study
(Elsevier, 2025) Cernuda-Martínez, José Antonio; Cobo-Sánchez, José Luis; Alarcón-Duque, Eva María; Moreno-Rubio, Esther; Suárez Mier, María Belén; Río-Pisabarro, María del Camino del; Ferraz Torres, Marta; Flebitis Zero Group; Ciencias de la Salud; Osasun Zientziak
Background: Peripheral intravenous catheters (PIVC) are essential medical devices, yet they frequently lead to complications such as phlebitis, infiltration, and occlusion. Identifying risk factors is key to reducing these complications. Objectives: To estimate the incidence of PIVC‑associated phlebitis in Spanish hospitals and identify clinical and epidemiological risk factors. Methods: We performed a prospective cohort study in 80 Spanish hospitals from 1 to 28 February 2023. Adult inpatients (≥18 years) receiving PIVCs in non‑ICU, non‑emergency, non‑pediatric wards were eligible. A total of 13,812 PIVCs in 9387 patients were followed daily by trained nurses until catheter removal, phlebitis onset (Maddox grade ≥ 2), or 15 days. We calculated cumulative incidence and incidence density per 100 catheter‑days. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) for predictors—sex, age group, number of infused medications, hospital size, and dwell time. Results: Phlebitis occurred in 1302 PIVCs (cumulative incidence 9.43 %; incidence density 0.14 per 100 person‑hours). Independent risk factors were female sex (HR 1.32, 95 % CI 1.21–1.45), age 65–79 years (HR 1.25, 95 % CI 1.12–1.40), administration of ≥ 2 medications (HR 1.50, 95 % CI 1.35–1.67), and hospital size ≥ 1000 beds (HR 1.30, 95 % CI 1.12–1.52). Phlebitis risk peaked 48–96 h post‑insertion. Conclusions: Phlebitis incidence remains above recommended levels. Multivariable analysis identified female sex, a higher number of infused medications, older patient age, larger hospital size, and longer PIVC dwell time as the main independent predictors of phlebitis.
Open Access
Microglial SIRT2 deficiency aggravates cognitive decline and amyloid pathology in Alzheimer's disease
(Academic Press, 2025-10-01) Sola-Sevilla, Noemi; Garmendia-Berges, Maider; Aleixo, Mikel; Mera-Delgado, Mª Carmen; Solas, Maite; Tordera, Rosa M.; García-Carracedo, Lucía; Expósito, Sara; Anaya-Cubero, Elena; Fernández Irigoyen, Joaquín; Guruceaga, Elizabeth; Santamaría Martínez, Enrique; Martín, Eduardo D.; Puerta, Elena; Ciencias de la Salud; Osasun Zientziak
Sirtuin 2 (SIRT2), a NAD+-dependent deacetylase, has been implicated in aging and neurodegenerative diseases such as Alzheimer's disease (AD). While global SIRT2 inhibition has shown promise in reducing amyloid-beta pathology and cognitive deficits in different mouse models of AD, peripheral SIRT2 inhibition has been associated with adverse effects, such as increased inflammation. This suggests that targeted inhibition of specific cellular populations within the brain may represent a more precise and effective approach for the treatment of AD. To explore this hypothesis, we generated a conditional microglial SIRT2 knockout mouse model in the context of AD. Our results reveal that microglial SIRT2 reduction does not confer protective effects in the APP/PS1 model; rather, it aggravates cognitive decline, accelerates amyloid plaque deposition, and increases levels of pro-inflammatory cytokines at early stages of AD pathology. Transcriptomic analysis further indicates that SIRT2-deficient microglia exhibit altered expression of genes associated with aging and synaptic dysfunction. This phenotype was accompanied by increased phagocytosis of PSD95 and impaired long-term potentiation. These findings suggest that while SIRT2 inhibition in some contexts may be beneficial, targeted inhibition within microglia could accelerate AD progression, underscoring the need for cell-specific approaches when considering SIRT2 as a therapeutic target.
Open Access
Comparison of the power spectral changes of the voluntary surface electromyogram and M wave during intermittent maximal voluntary contractions.
(Springer, 2014-06-11) Rodríguez Falces, Javier; Izquierdo Redín, Mikel; González Izal, Miriam; Place, Nicolas; Ciencias de la Salud; Osasun Zientziak; Ingeniería Eléctrica y Electrónica; Ingeniaritza Elektrikoa eta Elektronikoa
Introduction: To compare the power spectral changes of the voluntary surface electromyogram (sEMG) and of the compound action potential (M wave) in the vastus medialis and vastus lateralis muscles during fatiguing contractions. Methods: Interference sEMG and force were recorded during 48 intermittent 3-s isometric maximal voluntary contractions (MVC) from 13 young, healthy subjects. M waves and twitches were evoked using supramaximal femoral nerve stimulation between the successive MVCs. Mean frequency (F mean), and median frequency were calculated from the sEMG and M waves. Muscle fiber conduction velocity (MFCV) was computed by cross-correlation. Results: The power spectral shift to lower frequencies was significantly greater for the voluntary sEMG than for the M waves (P < 0.05). Over the fatiguing protocol, the overall average decrease in MFCV (~25 %) was comparable to that of sEMG F mean (~22 %), but significantly greater than that of M-wave F mean (~9 %) (P < 0.001). The mean decline in MFCV was highly correlated with the mean decreases in both sEMG and M-wave F mean. Conclusions: The present findings indicated that, as fatigue progressed, central mechanisms could enhance the relative weight of the low-frequency components of the voluntary sEMG power spectrum, and/or the end-of-fiber (non-propagating) components could reduce the sensitivity of the M-wave spectrum to changes in conduction velocity.