Jesús Ramírez-Rodrigo

A computer tool for cardiovascular risk estimation according to Framingham and SCORE equations

Background  Currently, we have different scales to estimate the cardiovascular risk of one individual. The most commonly used in clinical practice are the Framingham method and the SCORE project. Both are based on mathematical models that take into account the presence and intensity of various risk factors for cardiovascular morbidity and mortality. Aims and objectives  The aim of our study was to develop a measurement system that allows unifying criteria of both models. Thus, we will be able to estimate the cardiovascular risk globally in a cohort of patients instead of individually. Methods  The study included a representative subgroup of 50 patients treated at in the Endocrinology Service of Virgen de las Nieves University Hospital, Granada, below 30 years or above 75 years. The equations used in the present study were in strict compliance with the original publications. The reliability and validity of results were tested, comparing them with results obtained using calculation programs developed, available on-line. The degree of similarity was determined by means of the Dice index and the distance between our values and those of the other programs were compared by using the expression: Da-b  = √Σ(a - b)(2) Results  The results of the present study demonstrated our application to be reliable and valid for cardiovascular risk assessment. Our observations also demonstrated differences in the criteria applied to create cardiovascular risk calculation tools. This may have repercussions on clinical decisions for some patients, suggesting a need to compare and standardize these criteria, ensuring that programs developed for this calculation correctly manage the different risk categories considered. Conclusion  The present study validates a computer tool developed for the simultaneous calculation of cardiovascular disease probability by applying Framingham-Anderson and Framingham-Wilson methods, the Spanish adaptations of Regicor and Dorica, and the SCORE project.

Health-Related Quality of Life, Gender, and Culture of Older People Users of Health Services in the Multicultural Landscape of the City of Ceuta (Spain) A Cross-Sectional Study

Introduction: Perceptions of health-related quality of life (HRQOL) are influenced by sociodemographic variables and by cultural-religious concepts of health, disease, and old age, among others. Purpose: To assess the HRQOL of older people in a population with a long history of multiculturalism, the city of Ceuta (Spain), and to compare the results with Spanish reference values. Method: A total of 372 individuals (55.4% females) were interviewed using the Spanish version of the Short Form-36 questionnaire. The subjects’ mean age was 70.9 (SD = 5) years: 253 were Christians, 93 Muslims, and 26 Jews, representing the proportions in the overall population of these cultural-religious groups. Results: HRQOL differs according to the cultural-religious affiliation, which specifically affects social and psychological dimensions. Discussion and Conclusions: All groups obtained lower social function scores than the reference values, especially the Muslim and Jewish groups. Implications for Practice: Health care providers may consider integrating culturally sensitive interventions to improve HRQOL.

Should arm span or height be used in calculating the BMI for the older people? Preliminary results.

AIMS AND OBJECTIVES To consider using arm span rather than height for calculating the body mass index, as a parameter that offers greater long-term stability, for the nutritional assessment of persons aged over 65 years. BACKGROUND The body mass index presents certain drawbacks for the nutritional screening of older people suffering malnutrition or at risk of malnutrition, due to the anthropometric changes that occur with increasing age, especially the progressive loss of height. DESIGN Observational, cross-sectional study, using nonprobabilistic convenience sampling, with anthropometric measurements and nutritional screening in older men and women, divided into two groups: (1) aged 65-75 years and (2) aged over 75 years. METHODOLOGY Height and arm span were measured to calculate two separate indices of body mass: body mass index (weight/height) and body mass index.1 (weight/arm span). Nutritional screening was conducted using the Mini Nutritional Assessment Short-Form, which includes the body mass index as an anthropometric measure. RESULTS Our results reveal statistically significant differences between the two indices, for the sample analysed. Body mass index.1 classifies a larger number of older people as suffering malnutrition and fewer as being at nutritional risk. When this new index is used, there is a displacement of the subjects at risk, thus increasing the number considered at risk of malnutrition and in need of appropriate therapeutic intervention. Therefore, the use of body mass index.1 would enable more people suffering malnutrition, who would otherwise remain untreated, to be attended. CONCLUSIONS As arm span, as an anthropometric measure, remains unchanged over time, it could be used instead of height, as an alternative index (body mass index.1) to the conventional body mass index. Further research is needed to determine the association between body mass index.1 and clinical status parameters to determine optimum cut-off points. RELEVANCE TO CLINICAL PRACTICE This study describes the greater stability of body mass index.1 with respect to body mass index for nutritional screening, and the resulting benefits for nutritional monitoring and intervention for older people.

Functional Capacity and Physical Exercise in Older Women Living in a RuralEnvironment: A Correlational Cross-sectional Study

Introduction: The evaluation of functional capabilities in older adults is an important indicator of health status. The aim of this study is to analyse the degree of association between physical activity and functional capacity among women aged 65 years and older, living in a rural environment. Method: This was a observational, cross-sectional correlational study of women attending physical fitness programmes for adults. Functional assessment was performed using the Barthel Index of basic activities of daily living, the Lawton and Brody scale for instrumental and advanced activities of daily living, and the Senior Fitness Test for the physical parameters associated with functional mobility (strength, flexibility, balance and aerobic endurance). Results: Women who exercise were found to be more satisfied with their functional capacity (84% vs. 44%) and obtained better scores in all the tests conducted (p<0.0001). Physical exercise is inversely associated with the degree of dependence for daily activity and functional physical capacity. Conclusions: These results corroborate the benefits of physical exercise with respect to preventing dependence in older women living in rural areas, and highlight the long-term consequences of a sedentary lifestyle.

Efecto de un programa de actividad física en el medio acuático sobre las constantes hemodinámicas en mujeres embarazadas

OBJECTIVE To evaluate the effect of a physical activity programme in the aquatic environment with immersion up to the neck, of six weeks duration, on haemodynamic constants in pregnant women. METHODS A six-week physical activity programme in the aquatic environment was carried out with a total of 46 pregnant women, who were distributed into an experimental group (n = 18), which participated in the programme, and a control group (n = 28), which followed routine care. In both groups different haemodynamic measurements were evaluated before and after the program. RESULTS At the beginning of the programme the mean systolic blood pressure was similar between groups, but diastolic blood pressure was slightly higher in the experimental group. When the measurements at the last session were compared, arterial pressures (systolic, diastolic and mean) were significantly higher in the control group (p <.050). Similarly, the initial plasma volume values did not differ between groups, but after the intervention, the control group women showed a higher mean (p <.010). The fraction of sodium excretion (FENa) increased significantly in the experimental group, after the programme, with a mean three times higher (p <.050). Aldosterone plasma levels did not show significant differences between the groups in the different measurements. CONCLUSION A programme of swimming and immersion exercises in pregnant women contributes to hydrosaline balance, preventing an excessive increase in usual plasma volume during pregnancy and in the activity of the renin-aldosterone axis.

Efectividad de un programa de actividad física mediante el método Pilates en el embarazo y en el proceso del parto

OBJECTIVE To assess the effectiveness and safety of a physical activity programme based on use of the Pilates method, over eight weeks in pregnant women, on functional parameters, such as weight, blood pressure, strength, flexibility and spinal curvature, and on labour parameters, such as, type of delivery, episiotomy, analgesia and newborn weight. METHOD A randomized clinical trial was carried out on pregnant women, applying a programme of physical activity using the Pilates method, designed specifically for this population. A sample consisting of a total of 105 pregnant women was divided into two groups: intervention group (n=50) (32.87±4.46 years old) and control group (n=55) (31.52±4.95 years old). The intervention group followed a physical activity programme based on the Pilates method, for 2 weekly sessions, whereas the control group did not follow the program. RESULTS Significant improvements (p<0.05) in blood pressure, hand grip strength, hamstring flexibility and spinal curvature, in addition to improvements during labour, decreasing the number of Caesareans and obstructed labour, episiotomies, analgesia and the weight of the newborns were found at the end of the intervention. CONCLUSION A physical activity programme of 8 weeks based on the Pilates method improves functional parameters in pregnant women and benefits delivery.

The Pilates method and cardiorespiratory adaptation to training

ABSTRACT Although all authors report beneficial health changes following training based on the Pilates method, no explicit analysis has been performed of its cardiorespiratory effects. The objective of this study was to evaluate possible changes in cardiorespiratory parameters with the Pilates method. A total of 45 university students aged 18–35 years (77.8% female and 22.2% male), who did not routinely practice physical exercise or sports, volunteered for the study and signed informed consent. The Pilates training was conducted over 10 weeks, with three 1-hour sessions per week. Physiological cardiorespiratory responses were assessed using a MasterScreen CPX apparatus. After the 10-week training, statistically significant improvements were observed in mean heart rate (135.4–124.2 beats/min), respiratory exchange ratio (1.1–0.9) and oxygen equivalent (30.7–27.6) values, among other spirometric parameters, in submaximal aerobic testing. These findings indicate that practice of the Pilates method has a positive influence on cardiorespiratory parameters in healthy adults who do not routinely practice physical exercise activities.