Objective: To describe the standardization process and reliability of anthropometric and bioelectrical impedance analysis (BIA) measurements. We examined both intra- and interobserver errors for ...skinfolds, circumferences and BIA. Methods: For the intraobserver error assessment, first of all, 202 adolescents in the pilot study (110 boys, 92 girls, aged 13.64+/-0.78 years) were assessed. For the second intraobserver and interobserver assessments, 10 adolescents were studied (5 boys and 5 girls). Results: The pilot study's intraobserver technical errors of measurement (TEMs) were between 0.12 and 2.9 mm for skinfold thicknesses, and between 0.13 and 1.75 cm for circumferences. Intraobserver reliability for skinfold thicknesses was greater than 69.44% and beyond 78.43% for circumferences. The final workshop's intraobserver TEMs for skinfold thicknesses and circumferences were smaller than 1; for BIA resistance TEMs were smaller than 0.1 omega and for reactance they were smaller than 0.2 omega. Intraobserver reliability values were greater than 95, 97, 99 and 97% for skinfold thicknesses, circumferences, BIA resistance and reactance, respectively. Interobserver TEMs for skinfold thicknesses and circumferences ranged from 1 to 2 mm; for BIA they were 1.16 and 1.26 omega for resistance and reactance, respectively. Interobserver reliability for skinfold thicknesses and circumferences were greater than 90%, and for BIA resistance and reactance they were greater than 90%. Conclusions: After the results of the pilot study, it was necessary to optimize the quality of the anthropometric measurements before the final survey. Significant improvements were observed in the intraobserver reliabilities for all measurements, with interobserver reliabilities being higher than 90% for most of the measurements. The Healthy Lifestyle in Europe by Nutrition in Adolescence Study aims to describe total body fat percentage and anthropometric indices of body fat distribution in European adolescents.
The objectives of this study were to investigate the relationship between inflammatory parameters (CRP, c-reactive protein; AGP, α1-acid glycoprotein), iron status indicators (SF, serum ferritin; ...sTfR, soluble transferrin receptor) and body mass index (BMI) z-score, fat-free mass (FFM) and fat mass (FM) in European adolescents. Differences in intake for some nutrients (total iron, haem and non-haem iron, vitamin C, calcium, proteins) were assessed according to BMI categories, and the association of nutrient intakes with BMI z-score, FM and FFM was evaluated.
A total of 876 adolescents participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence-Cross Sectional Study were included in the study sample.
Mean CRP values (standard error; s.e.) were significantly higher in overweight/obese adolescents (1.7±0.3 and 1.4±0.3 mg/l in boys and girls, respectively) than in thin/normal-weight adolescents (1.1±0.2 and 1.0±0.1 mg/l in boys and girls, respectively) (P<0.05). For boys, mean SF values (s.e.) were significantly higher in overweight/obese adolescents (46.9±2.7 μg/l) than in thin/normal-weight adolescents (35.7±1.7 μg/l) (P<0.001), whereas median sTfR values did not differ among BMI categories for both boys and girls. Multilevel regression analyses showed that BMI z-score and FM were significantly related to CRP and AGP (P<0.05). Dietary variables did not differ significantly among BMI categories, except for the intake of vegetable proteins, which, for boys, was higher in thin/normal-weight adolescents than in overweight/obese adolescents (P<0.05).
The adiposity of the European adolescents was sufficient to cause chronic inflammation but not sufficient to impair iron status and cause iron deficiency.
Alors que le surpoids et l’obésité de l’adolescent ont été largement étudiés ces dernières années, il n’existe que peu d’information sur la prévalence et les conséquences de la maigreur chez ...l’adolescent en dehors des troubles des conduites alimentaires. Le but de cette étude était d’évaluer la prévalence, les caractéristiques cliniques et physiques, ainsi que les conséquences de la maigreur dans une population d’adolescents européens en bonne santé.
Parmi les 3528 adolescents sains (étaient exclus grâce aux questionnaires et l’examen clinique les adolescents présentant une maladie chronique ou un trouble des conduites alimentaires), âgés de 12,5 à 17,5 ans, ayant participé à l’étude européenne HELENA, 214 (41 % de garçons) maigres définis par les courbes internationales IOTF (IMC) ont été inclus dans cette étude ancillaire, et comparés aux adolescents normopondéraux (n=2497). Leur phénotype était étudié : examen clinique, condition physique, activité physique (AP), comportements sédentaires, et apports alimentaires. Un bilan sanguin a été réalisé dans un sous-groupe (33 % de la population). Les comparaisons entre les 2 groupes ont été réalisées grâce à des modèles de régression linéaire pour les variables continues et des modèles de régression logistique pour les variables catégorielles. Le stade pubertaire et le centre ont été inclus comme facteurs de confusion.
La prévalence de la maigreur était de 7,9 % : 8,6 % chez les filles et 7,1 % chez les garçons. La pression artérielle systolique était significativement plus basse chez les adolescents minces (109,3±11,3 vs 115,0±12,5 ; p<0,001). L’âge d’apparition du premier cycle menstruel était significativement plus tardif chez les adolescentes maigres que chez celles ayant un poids normal (13,1±1,1 vs 12,5±1,2 ; p<0,001). La force musculaire des membres supérieurs (différence de 20 % ; p<0,001) et le temps passé en AP d’intensité légère (160,5±37,7 vs 166,7±40,7 ; p<0,05) étaient significativement plus faibles chez les adolescents minces. Les apports caloriques et protéiques étaient similaires entre les deux groupes. De même, la qualité de l’alimentation (62,0±13,5 vs 62,2±13,8) n’était pas significativement inférieure chez les adolescents maigres, mais le pourcentage d’adolescents qui omettaient le petit-déjeuner était plus bas chez les adolescents minces (17,1 % vs 27,7 %). La créatininémie et la résistance à l’insuline (indice HOMA) étaient plus bas chez les adolescents maigres, alors que le taux de vitamine B12 était plus élevé (p<0,05).
La maigreur affecte une proportion notable d’adolescents européens en bonne santé. Toutefois, elle n’est associée ni à un déséquilibre alimentaire, ni à des conséquences potentiellement néfastes sur la santé.
Summary
Background
Socioeconomic status has been associated with obesity in children and adolescents. This association may be dependent according with where adolescents lives.
Objective
The aim of ...this study was to evaluate the association between different socioeconomic indicators such as parental education and occupation and socioeconomic status with abdominal obesity in adolescents from two observational studies: the Healthy Lifestyle in Europe by Nutrition in Adolescence cross‐sectional study (HELENA‐CSS) and the Brazilian Cardiovascular Adolescent Health (BRACAH) study.
Methods
European (n = 3192, aged 12.5–17.5 years, with 53.1% girls from HELENA‐CSS) and Brazilian (n = 991, aged 14–18 years, with 54.5% girls from BRACAH study) adolescents from two cross‐sectional studies were included in this analysis. Complete data on waist circumference (WC), height, socioeconomic status indicators and several confounders were collected. Socioeconomic indicators were measured using a self‐reported questionnaire in order to assess the family social status of the adolescents. Multilevel linear regression models were used to examine associations, and results were adjusted for potential confounders.
Results
Adjusted results showed inverse associations between mother's and father's education levels (p < 0.001) and father's occupation level (p < 0.001) with waist‐to‐height ratio (WHtR) and WC in HELENA‐CSS girls. Similarly in European girls, socioeconomic indicators by socioeconomic status and maternal occupation level were associated with WHtR. In HELENA‐CSS boys, the same significant association was found between WHtR and WC with maternal occupation level. Moreover, in European boys WHtR was also associated with parental education. In Brazilian adolescents, both indicators of abdominal obesity did not remain associated with the independents variables, after adjustment for potential confounders.
Conclusions
Abdominal obesity was associated with socioeconomic indicators in higher‐income countries, but this association was not observed in a lower‐middle‐income country.
Abstract
Introduction
polyvascular atherosclerotic involvement is one of the definitions of extreme CV risk. For this reason, the search for carotid or lower limb asyntomatic atherosclerotic ...pathology can be useful to guarantee more intensive treatments for these individuals, who have already had a heart attack. Purpose: the aim was to understand how much the polyvascular patients can improve in functional terms after Cardiological Rehabilitation, comparing them with monovasculars. Besides, the study purpose was to evaluate how many patients are reclassified with an active research of asyntomatic atherosclerotic pathology with carotid ultrasound and Ankle Brachial Index (ABI).
Methods
The study sample was composed by 87 patients who underwent a cardiological rehabilitation cycle at the Niguarda hospital in Milan from March 2021 to April 2022. Of these, personal, medical, clinical, laboratory and instrumental data were collected. Functional improvement was assested as the difference in meters walked on the 6–minutes walking test (6MWT) on the start day (6MWT–1) and on the end day of rehabilitation (6MWT–2). All patients performed an ABI (to evaluate asyntomatic PAD) and a carotid ultrasound (to evaluate asyntomatic cerebrovascular disease).
Results
pre–riclassification, polyvascolar patients (13) compared to monovascular (74), in addition to being on average older (70 years vs 59 years, p=0.01), males (100% vs 73%, p<0.001) and having had more previous recurrent myocardial infarctions (46% vs 8%, p=0.002), are less performing in terms of 6MWT–1 (428m vs 514m, p=0.002) and 6MWT–2 (517m vs 597m, p=0.008). About absolute functional improvement from the beginning to the end of rehabilitation, there are no statistically significant differences (81m vs 82m, p=0.919). Following reclassification, 7 patients switched from monovascular (67) to polyvascular (20).
Conclusions
our data showed that polyvascular patients can improve as much as monovasculars after Cardiological Rehabilitation. Furthermore, following ABI and carotid ultrasound, 8% of patients were reclassified. Polyvascular patients may receive more targeted and intensive therapies if properly diagnosed.
The aim of this study was to evaluate the transitory stress levels and the anxiety state in children submitted to conventional and computerized dental anesthesia. Twenty children (7 to 12 years) were ...randomly assigned to receive conventional and computerized dental anesthesia. To investigate the hypothesis that transitory stress could be lower after using computerized anesthesia compared to conventional anesthesia, cortisol levels in saliva were measured before and after each technique. Anxiety was also evaluated individually by answering the State-Trait Anxiety Inventory for Children (STAIC). Numerical data were analyzed statistically by the Mann-Whitney non-parametric test (5% significance level). Salivary cortisol levels increased in 8 (40%) patients after conventional anesthesia and in 9 (45%) patients after computerized anesthesia, with no statistically significant difference between the two types (p=0.34). In the same way, no statistically significant difference was found between the techniques (p=0.39) related to the psychological analysis based on the STAIC scores. Local anesthesia using either conventional anesthesia or a computerized delivery system produced similar level of stress/anxiety in pediatric patients, using both quantitative and qualitative analyses.
O objetivo deste estudo foi avaliar os níveis de estresse transitório e o estado de ansiedade em crianças submetidas à anestesia dental convencional e computadorizada. Vinte crianças (7 a 12 anos de idade) foram randomicamente designadas para receber anestesia dental convencional e computadorizada. Para investigar a hipótese que o estresse transitório poderia ser menor após a anestesia computadorizada, comparada à anestesia convencional, os níveis de cortisol na saliva foram medidos antes e depois de cada técnica. A ansiedade também foi avaliada individualmente por meio do State-Trait Anxiety Inventory for Children (STAIC). Os dados numéricos foram analisados estatisticamente pelo teste não paramétrico de Mann-Whitney (nível de significância de 5%). Os níveis salivares de cortisol aumentaram em 8 (40%) pacientes após anestesia convencional e em 9 (45%) pacientes após anestesia computadorizada, sem diferença estatisticamente significante entre os dois tipos (p=0,34). Da mesma maneira, não foi encontrada diferença estatisticamente significante entre as técnicas (p=0,39) com relação à análise psicológica baseada nos escores STAIC. Anestesia local usando tanto a anestesia convencional quanto o sistema de aplicação computadorizado produziu nível similar de estresse/ansiedade em pacientes infantis, utilizando análises quantitativa e qualitativa.
Abstract Introduction Data regarding prevalence and clinical management of hypertensive emergencies and urgencies are lacking and heterogeneous. Our goal is to characterize patients with hypertensive ...emergencies and urgencies admitted to the Emergency Department (ED) of Niguarda hospital and Pio XI Hospital of Desio. In this population we also want to evaluate factors associated with organ damage, adherence to guidelines and the impact of Blood Pressure (BP) management on in–hospital mortality. Method We performed a multi–centre retrospective study collecting data about all adult patients with systolic BP ≥ 180 mmHg and/or diastolic BP ≥120 mmHg admitted to our hospitals‘ ED during 2017 and 2019. Results Admission to ED for BP elevation were 1838 (0.95% of total admission to ED), of whom 38% were hypertensive emergencies and 62% were hypertensive urgencies. Patients with hypertensive emergencies were older, mainly male, with more comorbidities and more symptomatic at ED admission. In the emergencies group, we observe a SBP mean reduction of 39.50 mmHg (±26.35) and a DBP mean lowering of 16.28 mmHg (±17.57); the most used drugs were furosemide, nitroglycerin and parenteral labetalol. In the urgencies group, the mean reduction was 39.09 mmHg (±22.46) for SBP and 15.34 mmHg (±16.07) for DBP. The most used drug was short–acting nifedipine benzodiazepine and amlodipine in this group. Age, sex, clinical history of heart failure and chronic obstructive pulmonary disease, symptoms at ED admission ad eGFR have been recognised as factors associated with organ damage. Instead, BP at ED admission and its management didn’t appear to have a significant impact on outcomes. Conclusions Our study demonstrated better adherence to guidelines in the treatment of hypertensive emergency than of hypertensive urgencies. Furthermore, no significant association were found between the BP management in the ED and in–hospital mortality.
Abstract Background PCSK9 inhibitors antibodies (PCSK9–i) are a valid option to reduce LDL cholesterol in patients who failed to reach therapeutic target with maximized lipid–lowering therapies or in ...patient with statins intolerances. These antibodies reduce the frequency of new cardiovascular events, however if this effect is due only to LDL reduction or also to an improvement in arterial function and structure is yet to be proved. Our study aim was to evaluate aortic stiffness (Pulse Wave Velocity – PWV), carotid’s Intima–Media Thickness (IMT) and endothelial function (brachial Flow Mediated Dilatation – FMD) in patients treated with Alirocumab and Evolocumab. Methods This is a monocentric prospective longitudinal study on patients who received PCSK9–i administrations at the Niguarda Hospital’s cardiovascular rehabilitation and prevention unit. They underwent 3 evaluations of PWV, FMD and IMT (T0 the same day of the first injection, T1 after 6 months and T2 after 12 months of therapy). Results 39 patients concluded the 12 months period. The group average age is 66.8 ± 7.6 years, most of them were male (64.1%). LDL cholesterol average levels were significantly reduced by the therapy (128.3 ± 27.7 vs 44.7 ± 29.3 mg/dL, p<0.001), however, there were no significant changes in PWV (10.2 ± 3.0 vs 10.6 ± 2.5 m/s, p=0.404), FMD (8.6 ± 7.0 vs 8.9 ± 7.4 %, p=0.560) and IMT (768.7 ± 175.4 vs 733.5 ± 147.2 µm, p=0.270) values. Conclusions It was not possible to prove a significant effect of PCSK9–i on vascular properties, however, the stability of these indexes may suggest a deceleration of the atherosclerotic disease which it could have worsen in this population, especially considering the risk factors of our patients.
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