Obesity is caused by fat accumulation. BMI Z-score is used to classify the different degrees of weight status in children and adolescents. However, this parameter does not always express the true percentage of body fat. Our objective was to determine the degree of agreement between the fat mass percentage measured by DXA and the stratification of weight according to BMI Z-score in the pediatric age group. We designed a descriptive cross-sectional study. The patients were classified as underweight/normal weight with Z-scores between −2 and +0.99, overweight from 1 to 1.99, obese from 2 to 2.99, and very obese ≥3. We included 551 patients (47% girls), with a mean age of 11.5 ± 2.8 years (3.7–18 years). Higher BMI Z-scores were associated with a higher percentage of total fat (p < 0.001). However, there were important overlaps between both parameters, such that the BMI Z-score classified patients with the same percentage of total fat mass as having a different nutritional status classification. In conclusion, the stratification of weight status according to BMI Z-score revealed that 46.7% of patients had a fat percentage that did not correspond to their classification. For a more accurate weight assessment in clinical practice, we recommend combining anthropometric indices with diagnostic tools that better correlate with DXA, such as electrical bioimpedance.

Background: Different and conflicting data have been published concerning thyrotropin (TSH) levels among small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) newborns. The hypothesis of this study was that SGA preterm infants have higher TSH levels than those who are not underweight do. Methods: This cross-sectional study analyzed the TSH levels of all preterm newborns with a negative congenital hypothyroidism screening result (TSH <7.5 μIU/mL). Secondary variables were sex, birth weight (SGA, AGA), days of life at blood extraction, maternal origin, gestational age, and being a twin or not. Two multiple linear regression models were constructed comparing TSH levels in SGA and AGA or the z-score for birth weight and the remaining variables. Results: A sample including 5819 preterm infants was obtained: 53.8% male, 23.3% twins, and 3.3% SGA. TSH concentrations were 2.16 ± 2.0 μIU/mL for the SGA infants and 1.80 ± 1.5 μIU/mL for the AGA infants (p = 0.012), with a negative correlation (p < 0.001) between TSH levels and the z-score for the weight of the newborn. The multivariate analysis comparing TSH levels between SGA and AGA gave the following: SGA (B = 0.46, p < 0.001), Latin American mother (B = −0.16, p = 0.029), days of life at blood extraction (B = −0.26, p < 0.001), and gestational age ≤28 weeks (B = −0.56, p < 0.001). Using the z-score for the weight, the associations were: maternal origin North Africa (B = 0.19, p = 0.042), days of life at blood extraction (B = −0.27, p < 0.001), gestational age ≤28 weeks (B = −0.55, p < 0.001), and z-score for weight (B = −0.12, p < 0.001). Conclusions: Our multivariate analysis suggests that TSH concentrations are higher in SGA infants than they are in AGA infants, and this should be taken into account when establishing a reference interval appropriate for this population. The clinical relevance remains unknown, but lines of research are opened that may allow a better understanding of the long-term morbidities in these newborns.

Background. Pharmacological non-adherence in chronic diseases is 40–65%. No predictive profile of non-adherence exists in patients with multiple chronic diseases. Our study aimed to quantify the prevalence of non-adherence to pharmacological treatment and its associated factors in patients who visit pharmacies in Spain. Methods. This observational cross-sectional study included patients with one or more chronic diseases. The variables analyzed were demographics, diseases involved, self-medication, information about disease, and lifestyle. The main variable was adherence using the Morisky–Green test. A total of 132 pharmacies collaborated, providing 6327 patients representing all Spain regions (April–December 2016). Bivariate and multivariate analyses were performed and the area under the receiver operating characteristic (ROC) curve was calculated. Results. Non-adherence was 48.4% (95% confidence interval (CI): 47.2–49.7%). The variables that reached significance in the multivariate model were: difficulty in taking medication, self-medication, desire for more information, smoking, lower physical activity, younger age and number of chronic treatments. Discrimination was satisfactory (area under the ROC curve = 70%). Our study found that 50% patients was non-adherent and we obtained a profile of variables associated with therapeutic non-adherence. Conclusions. It is cause for concern that in patients with multiple diseases and taking multiple medications, there is an association between non-adherence, self-medication and worse lifestyle.

Background.Little research exists on the impact of paid work on academic performance of students of health sciences. No research exists on this subject for students in Colombia.Objectives.This paper seeks to analyze the impact of paid work on academic performance among nursing students. Design, settings and participants: cross-sectional research, involving 430 of nursing students from the National University of Colombia (N= 566).Methods.Variables analyzed: sex, age, work activity, attendance, current semester, degree subjects studied and unavailable, lost credits, grades during the second semester of 2013, and delayed semesters. Subgroups analyzed: (i) according to labor activity: do not work, work up to 20 h and work more than 20 h per week; (ii) Grade point average: failing is considered as less than 3.0 and passing 3.0 or above out of 5.0. Percentage of delayed semesters were calculated. Qualitative and quantitative variables were analyzed for groups by work activity. The percentage and probability of students getting a grade point average less than 3.0 and delaying semesters were calculated by multivariate logistic regression.Results. A total of 219 of the students work (50.9%), the main reason is socioeconomic, of which 99 (45.2%) work more than 20 h per week and have an increased risk of failing, which is higher in the first semester. They also get lower grades, lose more credits and take longer to finish the degree. The logistic bivariate regressions of success (grade point average, credits gained, courses gained and not having delayed semesters) reduce with work, above all in those who work more than 20 h per week and increase as the number of semesters completed increases, independent of sex.Conclusion.A high percentage of nursing students work more than 20 h per week. The compatibility of paid work with studies in university nursing students has a negative impact on academic performance, more so when they work more than 20 h per week. This negative impact diminishes as the student completes semesters, irrespective of the sex of the students.

To determine out-of-hospital cardiac arrest mortality in the province of Alicante (Spain) and its associated factors. Cross-sectional observational study of all patients who received cardiopulmonary resuscitation (CPR) by the Emergency Medical Services (EMS) (n = 422) in the province of Alicante in 2013. To determine associated factors, a binary logistic regression model was constructed. Primary outcome: death before arriving at the hospital. Predictive variables: gender, age, artificial respiration, prior functional status, asystole, cardiogenic aetiology, bystander CPR, time from the cardiac arrest to the arrival of the EMS and location of cardiac arrest. There were 337 deaths (79.9%; 95% CI: 76.0–83.7%). Factors independently associated (p<0.05) with death were: male gender (OR = 2.11; 95% CI: 1.20–3.72; p = 0.010), asystole (OR = 1.99, 95% CI: 1.17–3.39; p = 0.012), cardiac arrest at home (OR = 2.44; 95% CI: 1.42–4.18; p = 0.001) and an increased time between arrest and EMS arrival (OR = 1.05, 95% CI: 1.01–1.09, p = 0.009). Having a worse prior functional status had a tendency towards significance (OR = 0.56, 95% CI: 0.31–1.02, p = 0.059). Mortality was high. The associated factors were: male gender, asystole, worse prior functional status, longer time from the cardiac arrest to the arrival of the EMS and having the cardiac arrest at home. The clearly negative impact of experiencing a cardiac arrest at home necessitates modifying training policies in Spain. These policies should be focused on providing information about CPR in schools in order to decrease the mortality of these events.