The objective of this work was to study mortality increase in Spain during the first and second academic semesters of 2020, coinciding with the first 2 waves of the Covid-19 pandemic; by sex, age, and education.

An observational study was carried out, using linked populations and deaths’ data from 2017 to 2020. The mortality rates from all causes and leading causes other than Covid-19 during each semester of 2020, compared to the 2017–2019 averages for the same semester, was also estimated. Mortality rate ratios (MRR) and differences were used for comparison.

All-cause mortality rates increased in 2020 compared to pre-covid, except among working-age, (25–64 years) highly-educated women. Such increases were larger in lower-educated people between the working age range, in both 2020 semesters, but not at other ages. In the elderly, the MMR in the first semester in women and men were respectively, 1.14, and 1.25 among lower-educated people, and 1.28 and 1.23 among highly-educated people. In the second semester, the MMR were 1.12 in both sexes among lower-educated people and 1.13 in women and 1.16 in men among highly-educated people.

Lower-educated people within working age and highly-educated people at older ages showed the greatest increase in all-cause mortality in 2020, compared to the pre-pandemic period.

Telemedicine uses information and communication technologies to provide services in the field where the distance is a critical factor. The aim of the present study is to describe the experience of a synchronous telemedicine between two hospitals in Spain and Angola.

This is a retrospective observational study of all synchronous telemedicine sessions conducted between the Hospital Nossa Senhora da Paz in Angola and the Vall d'Hebron University Hospital in Spain from January 2011 to December 2014.

Seventy-two cases were discussed in the telemedicine sessions. The average age of patients was 18.02 (SD 13.75) years and mostly women (54.38 percent). Reasons to discuss the cases were 46.47 percent doubts in the diagnosis and therapeutic management, 15.47 percent were purely formative cases, and only 8.45 percent treatment doubt. At the time of presentation, 29 percent of the patients were already diagnosed, 95 percent of whom with infectious disease diagnostic, and from the undiagnosed patients 36 percent presented a febrile syndrome.

This study shows the viability of synchronous telemedicine between European and African countries without an excessively sophisticated technology.

One of the main health-related worries for older adults is becoming dependent. Even healthy older adults may worry about becoming dependent, generating guilt feelings due to the anticipation of future needs that others must solve. The guilt associated with self-perception as a burden has not been studied in older adults, and there is no instrument available to measure these feelings.

To adapt the Self-Perceived Burden Scale (SPBS; Cousineau et al., 2003) for the assessment of feelings of guilt for perceiving oneself as a burden for the family in older adults without explicit functional or cognitive impairment.

Participants were 298 older adults living independently in the community. Participants completed the assessment protocol, which included measures of guilt associated with self-perception as a burden, depressive and anxious symptomatology, self-perceived burden, and sociodemographic information.

Results from exploratory, parallel and confirmatory factor analyses suggest that the scale, named Guilt associated with Self-Perception as a Burden Scale (G-SPBS), has a unidimensional structure, explaining 57.04% of the variance of guilt. Good reliability was found (Cronbach’s alpha = .94). The results revealed significant (p < .01) positive associations with depressive and anxious symptomatology.

These findings suggest that the G-SPBS shows good psychometric properties which endorse its use with healthy community older adults. Also, guilt associated with perceiving oneself as a burden seems to be a relevant variable that can contribute to improving our understanding of psychological distress in older adults.

An unprecedented wave of patients with acute respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) hit emergency departments (EDs) in Lombardy, starting in the second half of February 2020. This study describes the direct and indirect impacts of the SARS-CoV-2 outbreak on an urban major-hospital ED.

Data regarding all patients diagnosed with COVID-19 presenting from February 1 to March 31, 2020, were prospectively collected, while data regarding non-COVID patients presenting within the same period in 2019 were retrospectively retrieved.

ED attendance dropped by 37% in 2020. Two-thirds of this reduction occurred early after the identification of the first autochthonous COVID-19 case in Lombardy, before lockdown measures were enforced. Hospital admissions of non-COVID patients fell by 26%. During the peak of COVID-19 attendance, the ED faced an extraordinary increase in: patients needing oxygen (+239%) or noninvasive ventilation (+725%), transfers to the intensive care unit (+57%), and in-hospital mortality (+309%), compared with the same period in 2019.

The COVID-19 outbreak determined an unprecedented upsurge in respiratory failure cases and mortality. Fear of contagion triggered a spontaneous, marked reduction of ED attendance, and, presumably, some as yet unknown quantity of missed or delayed diagnoses for conditions other than COVID-19.

Hypertension is a public health problem and its prevalence in children is on the rise, often continuing into adulthood and increasing the risk related cardiovascular complications. Sleep plays an essential role in children's growth and several studies suggest that insufficient sleep duration is associated with hypertension in adults. However, few studies have evaluated this association in children. Thus, the aim of the study is to ascertain whether the sleep duration is a risk factor for elevated blood pressure (BP) in children.

We studied 776 children (5–18 years old), (46.7% male, 78.8% 5–13 years, 73.6% overweight/obesity). Weight and height were measured and body mass index (BMI) was calculated. BP was measured with an electronic manometer to find a 25.3% of children with an elevated systolic BP (SBP, > P90th) and 14% with an elevated diastolic BP (DBP, > P90th) (Task Force 2017). Sleep duration was assessed by asking the parents “¿How many hours does your child sleep in a typical weekday?”. Weekday sleep hours were considered since they are more representative of children's routines than weekend hours. Hours were converted into a dichotomous variable based on the fulfillment or not of the “Canadian 24-Hour Movement Guidelines for Children and Youth recommendations”: 9–11 hours for 5- to 13-year-olds; 8–10 hours for 14- to 17-year-olds.

A spearman correlation analysis was performed between sleep duration, SBP and DBP. Then, a general linear model analysis adjusted for BMI Z-score was done to evaluate differences in SBP and DBP between children following the sleep recommendations. Analyses were stratified by sex and age range (5–13 and 14–17).

In girls 5–13 years, we found a significant negative correlation between sleep duration and body mass index (BMI) (r = -0.226, p = 0.000) and between sleep and systolic BP (r = -0.188, p = 0.001). Girls 5–13 years not following sleep recommendations showed significantly higher SBP values than those who followed the recommendations (112 ± 11 mmHg vs. 106 ± 12 mmHg, p = 0.007), independently of BMI. No significant differences were observed in girls 14–17 years nor in males.

In the present study, we show that girls 5–13 years with shorter sleep duration show increased SBP values independently of BMI, in contrast to previous studies which showed similar associations that disappeared when adjusting for BMI. Our results support the need for wider strategies in population education so that sleep recommendations are followed by children in the general population.

Obesity is known to be associated with a low-grade inflammatory state. Most studies reporting inflammation in obesity have been done in pubertal children or adults or have focused only on the relation between body mass index (BMI) and the classical inflammatory markers. Nerve growth factor (NGF), monocyte chemoattractant protein–1 (MCP-1) and hepatocyte growth factor (HGF) are adipokines previously shown to be involved in the inflammatory context of obesity and metabolic syndrome but few studies have been conducted in children.

To evaluate the association between NGF, MCP-1, HGF with total and abdominal adiposity and in prepubertal and pubertal children.

889 children participated in a prospective obesity case-control study (50.2% males, 72% prepubertals, 27% overweight and 43% obesity), paired by age and sex. The relationship between total fat (assessed using the BMI, the sum of skinfolds thickness (SF) and fat mass index (FMI) from bioelectrical impedance analysis and waist circumference as a surrogate marker of abdominal obesity) and plasma concentrations of MCP-1, HGF, and NGF was studied in prepubertal and pubertal children.

Linear regression analysis for prepubertal and pubertal children, adjusting for age, sex and center was used.

NGF was associated with WC, with a stronger association in prepubertal than in pubertal children. MCP-1 was positively associated with WC, SF, FMI and BMI in pubertal children whereas HGF was positively associated with WC and BMI only in prepubertal children. The strongest associations were between WC and NGF (β 0.123 95%CI 0.133, 0.709; p < 0.001) in prepubertal children and WC and MCP-1 (β 0.123 95%CI 0.438, 2.035; p < 0.001) in pubertal children.

Total and abdominal adiposity are related to plasma concentrations of adipokines in prepubertal and pubertal children with obesity. Adipokines such as NGF, HGF and MCP-1 have not been so well studied so far in obese children. Particularly, NGF was associated with WC and BMI in prepubertal children and with WC in pubertal children. The association between this neurotrophin, secreted by adipose tissue and involved in the development and survival of sympathetic neurons, with adiposity, especially in prepubertal children, could suggest an anti-inflammatory mechanism and thus be a potential therapeutic target.

None

Introduction: Dietary habits are established from a very young age. Parental role modeling is an important factor influencing the eating behavior of their children. Drinking behavior may have an impact in the development of childhood obesity. This study aimed to explore the correlations of core drinking beverages between parents and their children.

Materials and Methods: The present study included children of 3.5–5.5 years and their parents from the (Multifactorial evidence-based approach using behavioral models in understanding and promoting fun, healthy food, play and policy for the prevention of obesity in early childhood) ToyBox study. The study was a kindergarten-based family-involved intervention, in preschool children from six European countries: Belgium, Bulgaria, Germany, Greece, Poland, and Spain. For this study, we analyzed data from the baseline cross-sectional survey.

Data on consumption frequency of water, homemade or fresh fruit juice, prepacked fruit juice, light beverages and sugared sweetened beverages consumption from parents and their children was obtained via a validated food frequency questionnaire. Parents were given examples of serving sizes and asked about how to self-report their usual consumption per day or week. Beverage consumption of children was reported by their parents and information about frequency and portion sizes was collected. Body weight and height of children was measured and classified according to the International Obesity Task Force (IOTF). Bivariate correlations were performed to analyze beverage consumption (servings per day) in children and their parents.

Results: The studied sample included 5266 pairs of children (49.2% girls) and parents (91.7% women) that were included in the analysis.

Girls presented higher correlations in water (r2 = 0,317) and sugar sweetened beverages (r2 = 0,302), whereas boys, presented slightly higher correlations of light soft drinks (r2 = 0,273), pure fruit juices (r2 = 0,308) and prepacked fruit juices (r2 = 0,324), all of them at < 0.01 level of significance. Considering boys and girls together, a slightly higher significant correlation coefficients were found between children-parents’ dyads with overweight/obesity compared to normal weight children-parentś for sugar sweetened beverages (r2 = 0,303) and light soft drinks (r2 = 0,396).

Discussion: Beverage consumption of children and their parents were found to be moderately correlated. Overweight children seem to have better correlations with their parents in relation of sugar sweetened beverages and light soft drinks. Parents should encourage a healthy beverage consumption for their own health and most important, because there are key role models to their children.

Caregivers’ commitment to personal values is linked to caregivers’ well-being, although the effects of personal values on caregivers’ guilt have not been explored to date. The goal of this study is to analyze the relationship between caregivers´ commitment to personal values and guilt feelings.

Participants were 179 dementia family caregivers. Face-to-face interviews were carried out to describe sociodemographic variables and assess stressors, caregivers’ commitment to personal values and guilt feelings. Commitment to values was conceptualized as two factors (commitment to own values and commitment to family values) and 12 specific individual values (e.g. education, family or caregiving role). Hierarchical regressions were performed controlling for sociodemographic variables and stressors, and introducing the two commitment factors (in a first regression) or the commitment to individual/specific values (in a second regression) as predictors of guilt.

In terms of the commitment to values factors, the analyzed regression model explained 21% of the variance of guilt feelings. Only the factor commitment to family values contributed significantly to the model, explaining 7% of variance. With regard to the regression analyzing the contribution of specific values to caregivers’ guilt, commitment to the caregiving role and with leisure contributed negatively and significantly to the explanation of caregivers' guilt. Commitment to work contributed positively to guilt feelings. The full model explained 30% of guilt feelings variance. The specific values explained 16% of the variance.

Our findings suggest that commitment to personal values is a relevant variable to understand guilt feelings in caregivers.

To prospectively assess the associations between lean fish, fatty fish and total fish intakes and risk of stroke in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain).

Fish intake was estimated from a validated dietary questionnaire. Cox proportional hazards regression models were used to assess the association between the intakes of lean fish, fatty fish and total fish and stroke risk. Models were run separately for men and women.

Five Spanish regions (Asturias, San Sebastian, Navarra, Granada and Murcia).

Individuals (n 41 020; 15 490 men and 25 530 women) aged 20–69 years, recruited from 1992 to 1996 and followed-up until December 2008 (December 2006 in the case of Asturias). Only participants with definite incident stroke were considered as cases.

During a mean follow-up of 13·8 years, 674 strokes were identified and subsequently validated by record linkage with hospital discharge databases, primary-care records and regional mortality registries, comprising 531 ischaemic, seventy-nine haemorrhagic, forty-two subarachnoid and twenty-two unspecific strokes. After multiple adjustments, no significant associations were observed between lean fish, fatty fish and total fish consumption and the risk of stroke in men or women. In men, results revealed a non-significant trend towards an inverse association between lean fish (hazard ratio=0·84; 95 % CI 0·55, 1·29, Ptrend=0·06) and total fish consumption (hazard ratio=0·77; 95 % CI 0·51, 1·16, Ptrend=0·06) and risk of total stroke.

In the EPIC-Spain cohort, no association was found between lean fish, fatty fish and total fish consumption and risk of stroke.