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• Data regarding the use of isavuconazole in non-neutropenic IFI patients is scarce. • Our study positions isavuconazole as a safe treatment for these patients. • Isavuconazole could be used in patients with QT elongation. • Mortality and clinical response are comparable to other antifungals. • Isavuconazole could replace other triazoles as reference treatment. Information is scarce on clinical experiences with non-neutropenic patients with invasive fungal infection (IFI) receiving isavuconazole. We aimed to report the safety and effectiveness of this drug as a first-line treatment or rescue in real life. A retrospective, observational multicentric study of non-neutropenic patients who received isavuconazole as an IFI treatment at 12 different university hospitals (January 2018-2022). All patients met criteria for proven, probable or possible IFI according to EORTC-MSG. A total of 238 IFIs were treated with isavuconazole during the study period. Combination therapy was administered in 27.7% of cases. The primary IFI was aspergillosis (217, 91.2%). Other IFIs treated with isavuconazole were candidemia (n = 10), mucormycosis (n = 8), histoplasmosis (n = 2), cryptococcosis (n = 2), and others (n = 4). Median time of isavuconazole treatment was 29 days. Only 5.9% (n = 14) of cases developed toxicity, mainly hepatic-related (10 patients, 4.2%). Nine patients (3.8%) had treatment withdrawn. Successful clinical response at 12 weeks was documented in 50.5% of patients. Isavuconazole is an adequate treatment for non-neutropenic patients with IFIs. Toxicity rates were low and its effectiveness was comparable to other antifungal therapies previously reported. [Display omitted] [ABSTRACT FROM AUTHOR]

Gastroparesis is a common motor disorder of the upper gastrointestinal tract. Surgical management presents a challenge, particularly in regions lacking proprietary data or experience with surgical approaches to this condition. This study aimed to compare surgical outcomes of patients undergoing gastric bypass vs. pyloroplasty for refractory gastroparesis, for the first time in Colombia. A longitudinal study was conducted on 16 patients with refractory gastroparesis undergoing pyloroplasty or laparoscopic gastric bypass at a tertiary referral center in Colombia between January 2018 and December 2020. Ten (62.5%) patients underwent gastric bypass, and 93.8% were women. Surgical time was significantly shorter with pyloroplasty (p = 0.001), as well as time to symptom resolution (50% vs. 30% within the first 24 h, and 100% vs. 70% at 15 days). The preoperative and postoperative mean body mass index (BMI) was 29.7 (21.3—33.4) and 23.1 (20.9—25.4), respectively. Both groups were similar in all analyzed characteristics except for a higher BMI in the gastric bypass group (p = 0.01). Gastric bypass resulted in a reduction of approximately 20% of the baseline BMI value, compared to 5% with pyloroplasty. This study found that both techniques were feasible and safe for surgical treatment of refractory gastroparesis. Gastric bypass may be preferred for obese patients due to greater weight loss, which could impact additional outcomes. [ABSTRACT FROM AUTHOR]

Research-creation is a methodological proposal still under construction. It is surprising how the field of communication has been inserted in this discussion, although it was the faculties of arts, architecture and design who, at least in Colombia, initiated the debate that culminated with its institutional recognition. Thiis article makes a state of the art of research-creation in the Colombian audiovisual field, based, first, on a literature review and, second, on a look at the offer of postgraduate training in the country. For the review of scientific publications, the EBSCO and SCOPUS databases were used to retrieve documents in Spanish that included the terms "research + creation". Preference was given to publications containing reflections on the method or the conceptualization of research-creation itself. The final list contemplates a corpus of 65 documents, in which the levels that define the discussion are identified: epistemological, methodological and creative. For the review of the postgraduate offerings, the database of the National System of Higher Education Information -SNIES- was used, where the postgraduate programs that declared some component or emphasis on research-creation were selected. The analysis shows the approaches registered in the identified graduate programs. In sum, this paper aims to contribute to the discussion on the place of communication in the construction of research-creation. [ABSTRACT FROM AUTHOR]

Introduction: Cutaneous Leishmaniasis is a neglected tropical disease caused by a parasite. The most common presumptive diagnostic tool for this disease is the visual examination of the associated skin lesions by medical experts. Here, a mobile application was developed to aid this pre-diagnosis using an automatic image recognition software based on a convolutional neural network model. Material and Methods: A total of 2022 images of cutaneous diseases taken from 2012 to 2018 were used for training. Then, in 2019, machine learning techniques were tested to develop an automatic classification model. Also, a mobile application was developed and tested against specialized human experts to compare its performance. Results: Transfer learning using the VGG19 model resulted in a 93% accuracy of the classification model. Moreover, on average, the automatic model performance on a randomly selected skin image sample revealed a 99% accuracy while, the ensemble prediction of seven human medical expert’s accuracy was 83%. Conclusion: Mobile skin monitoring applications are crucial developments for democratizing health access, especially for neglected tropical diseases. Our results revealed that the image recognition software outperforms human medical experts and can alert possible patients. Future developments of the mobile application will focus on health monitoring of Cutaneous Leishmaniasis patients via community leaders and aiming at the promotion of treatment adherence. [ABSTRACT FROM AUTHOR]

To compare water- versus land-based exercise programs, as part of a multidisciplinary intervention, on physical fitness and health-related quality of life in overweight and obese adolescents. A total of 151 overweight and obese adolescents (age: 13.2 ± 1.8 years) were divided into: 1) a water-based intervention (WB; n = 28); 2) a land-based intervention (LB; n = 57); and 3) a control group (CG; n = 66). Anthropometric measures, body composition, flexibility, abdominal strength/endurance, cardiorespiratory fitness and health-related quality of life were assessed prior and by the end of a 16-week intervention. Both the water- and land-based interventions were part of a multidisciplinary program focusing on behavioral changes. Fat Mass (%) was significantly reduced in both intervention groups and a higher progression was observed in the WB group (− 9.8 ± 7.2% versus − 6.1 ± 6.2%; p < 0.05 for pre-to-post changes within-groups). However, LB increased more abdominal strength than WB (69.6 ± 165.8% versus 53.4 ± 83.4%; p < 0.05) and significantly increased social (19.7 ± 88.8%), psychosocial (5.1 ± 15.1%) and total score (6.3 ± 14.8%), which was observed in neither WB nor CG. The intervention groups did not change body weight (WB: − 1.7 ± 5.3%; LB: 0.1 ± 3.4%; p > 0.05 for both groups) and increased ( p < 0.05) fat-free mass (WB: 4.6 ± 4.0%; LB: 4.4 ± 4.1%), VO2 max (WB: 9.3 ± 7.8%; LB: 11.0 ± 13.4%), and physical dimension of quality of life (WB: 9.2 ± 17.2%; LB: 8.9 ± 18.0%) differently of what was observed in CG. The physical dimension improvement observed in the land-based and water-based samples was associated with decreased percentage fat mass (r = 0.282 and 0.229; p < 0.05). We suggest water- and land-based physical exercises within a multidisciplinary program promote similar improvements in body composition, physical fitness and health-related quality of life in overweight and obese adolescents. [ABSTRACT FROM AUTHOR]

In our daily life, we use our senses to acquire information about the objects that surround us. However, the information processing that allows for the recognition and consecutive classification of those objects into categories remains unclear. Our purpose is to analyze the categorization mechanism taking into account: (a) package visual metrics and (b) consumer perceptions of this basic visual information. First of all, we quantitatively analyzed the physical characteristics of 52 bottle silhouettes of seven soft drink categories: sports drinks, water, flavored water, sodas, fruit juices, malt drinks and tea. We found that measures of the shape of the bottles can model the membership to a product category. Our first experiment tested how accurately consumers could recognize product category from real bottle silhouettes. We found that the visual characteristics that differentiate product category silhouettes are lid width and bottle shape (body kurtosis). Our second experiment tested the capacity of consumers to recognize artificially created bottle silhouettes. When basic information, such as the product shape is modified, consumers are not always capable of recognizing its corresponding category. We concluded that the physical attributes of bottles are related to the categorization process of the bottle content made by consumers. These findings may provide guidelines for new bottle designs that capitalize on existing categorization rules based on consumer perception. [ABSTRACT FROM AUTHOR]

Introduction. Isolated splenic metastases are a rare finding. Though several primary tumors can produce splenic metastases, including lung carcinoma, there are very few documented cases of isolated splenic metastases from lung carcinoma. This report presents such a case in which the splenic metastasis was removed with laparoscopic splenectomy. Presentation of Case. A 69-year-old woman with a history of lung carcinoma presented with several months of abdominal pain. Abdominal CT identified a splenic mass which was resected laparoscopically. Pathology confirmed a splenic metastasis from a primary large cell lung carcinoma. Discussion. Due to its anatomical and physiological characteristics, the spleen is a well-protected organ with respect to metastatic spread. The rarity of such metastases means that there is no evidence-based form of management. This case presents this rare metastatic occurrence and the successful management of the disease via laparoscopic splenectomy. Conclusions. This case confirms that splenic metastases can result from a primary lung carcinoma. Furthermore, the case supports successful management of this pathology by laparoscopic splenectomy. [ABSTRACT FROM AUTHOR]

This paper elaborates a journey through the concept of cultural industries from the aesthetic perspective. It is a reflection that arises within the research of "everyday esthetics and literature", which aims to address the literary reading from the perspective of everyday aesthetics in the context of training Communication and Audiovisual Languages students, i.e., training professionals who will generate and manage content in the Cultural Industries. A documentary research methodology was followed, tracking the major theoretical contributions reviewed by critics in the field. At the end discussion on the field of emergencies in which some concerns arose during the exercise and that fuels future research. [ABSTRACT FROM AUTHOR]

The world of life is a concept that corresponds to a philosophical construction in which the discussion of everyday life and communication opens. While science has been focused on the greater systems of thought and action, everyday life is revisited as the space where the individual responds dialectically, intentionally and actively to the social system. This article gathers the first part of the theoretical framework of the qualitative research project with a hermeneutic approach entitled "Everyday aesthetics and Literature", intending to establish everyday aesthetics based on the study of literature at Communication Departments. [ABSTRACT FROM AUTHOR]

Background/purpose Recent research on the age-dependent changes of facial skin has analyzed their correlation with changes in image and colorimetric properties using mainly first- and second-order statistics. The aim of this study is to reveal the importance of third-order statistics and relate those image properties to skin age perception. Methods Photographs of the faces of 118 Japanese women ranging in age from 13 to 80 years were taken in a controlled environment. Subsequently, 10 Japanese subjects rated the age perception of skin patches from the cheek area of the original facial images. Results The age estimation of the skin patches was highly correlated with its chronological age proving that our skin patches contain enough information for age estimation. Also, the perceived age was significantly high correlated to color and lightness statistical values. Specifically, age perception was significantly high correlated with third-order statistics of all channels in CIELAB1976. Conclusion Our results reveal the importance of higher order statistics for the development of nonintrusive skin quality assessments of the skin. [ABSTRACT FROM AUTHOR]

Age perception is a better biomarker of skin aging than chronological age. However, the optical cues that determine the perception of human skin age are difficult to assess given the complex interactions between light and the multi layered structure of the skin. The aim of the present study is to clarify the independent contribution of both diffuse and specular reflection components to the skin age perception. First, according to our results, subjects were able to estimate the age of skin only by using the diffuse reflection component. Moreover, we showed that inclusion of the specular reflection component added on average 5 years to their age estimation. Second, by artificially manipulating the specular component, we concluded that the luminance distribution affects the perceived age of the skin. [ABSTRACT FROM AUTHOR]

Abstract: We investigated the effect that the parameters of luminance distribution in fresh food have on our visual perception of its freshness. We took pictures of the degradation over 32h in freshness of a cabbage. We used original images, which were patches of the pictures taken at different sampling hours, and artificially generated pictures, called “matched images,” created by fitting the luminance histogram shape of the original image (taken at the 1st hour) to those at various freshness stages using a luminance histogram-matching algorithm. Nine participants rated the perceived freshness of the original and the matched images on a scale of degradation. As a result, we found that the participants could quantitatively estimate the degradation in freshness of the cabbage simply by looking at the presented images. Some parameters of the luminance histograms monotonically change with decreasing freshness, indicating that the freshness of cabbage can be estimated using these parameters. However, the freshness ratings for the matched images after the 8th hour of degradation had lower modification than those for the respective original images. These results suggest that the luminance distribution in the vegetable texture partly contributes to visual freshness perception but other variables, such as spatial patterns, might also be important for estimating visual freshness. [Copyright &y& Elsevier]

Consumers' sensory evaluation of fruits to determine the expected quality is a frequent practice. However, consumers' assessment of fruit quality is an ambiguous concept. This research aimed to determine the preferred fruit image when consumers decide that it is ready to eat, or it is too old. This within-subjects experimental design was conducted through an online survey using four fruits: avocado, banana, lulo, and guava. The questionnaire used a two-alternative forced-choice method: From a pair of fruit images, participants chose which one they preferred to eat, and which was too old. The results showed that participants do not always agree on the fruit image they find to be ready to eat, whereas the results for assessing an old fruit mimic the fruit maturity condition. Thus, food quality standards should use sensory evaluations that assess ideas that matter to the consumer. The value of this research is to provide a methodological approach to evaluate the consumers' expectations, which will be helpful within agricultural processes and the distribution chain. [ABSTRACT FROM AUTHOR]

• Soft drinks package shapes can communicate product characteristics like its taste and cost. • The perceived sweetness of a soft drink can increase by lowering the height of the shape and increasing the area in the lower portion of a bottle. • The perceived price of a soft drink can increase by expanding the observed area, increasing the variance (curves) of the shape and having a higher lid. This research supports the cross-modal correspondence between the shape of the bottle and consumers' perception of sweetness and price using physical measures of beverage bottles. Images that add visual weight to the lower section of a package increase the perception of attributes associated with sweetness. In terms of price, the shape of the bottle is informative about its volume, which is the cue predictor of price. Through a within-subject experiment, we evaluated consumers' perceptions of sweetness and price for a sample of 15 soft drink bottle silhouettes. These perceptions were correlated with the psychophysical characteristics of the silhouettes. Results reveal that sweetness has a negative correlation with height and the visual weight towards the bottom of the bottle. Instead, the price has a positive correlation with the area, width, height, lid, and variance of the bottle shape. Practical implications support having a package design that is consistent with product positioning and attributes. [ABSTRACT FROM AUTHOR]

Introduction: The impact of remdesivir on mortality in patients with COVID-19 is still controversial. We aimed to identify clinical phenotype clusters of COVID-19 hospitalized patients with highest benefit from remdesivir use and validate these findings in an external cohort. Methods: We included consecutive patients hospitalized between February 2020 and February 2021 for COVID-19. The derivation cohort comprised subjects admitted to Hospital Clinic of Barcelona. The validation cohort included patients from Hospital Universitari Mutua de Terrassa (Terrassa) and Hospital Universitari La Fe (Valencia), all tertiary centers in Spain. We employed K-means clustering to group patients according to reverse transcription polymerase chain reaction (rRT-PCR) cycle threshold (Ct) values and lymphocyte counts at diagnosis, and pre-test symptom duration. The impact of remdesivir on 60-day mortality in each cluster was assessed. Results: A total of 1160 patients (median age 66, interquartile range (IQR) 55–78) were included. We identified five clusters, with mortality rates ranging from 0 to 36.7%. Highest mortality rate was observed in the cluster including patients with shorter pre-test symptom duration, lower lymphocyte counts, and lower Ct values at diagnosis. The absence of remdesivir administration was associated with worse outcome in the high-mortality cluster (10.5% vs. 36.7%; p < 0.001), comprising subjects with higher viral loads. These results were validated in an external multicenter cohort of 981 patients. Conclusions: Patients with COVID-19 exhibit varying mortality rates across different clinical phenotypes. K-means clustering aids in identifying patients who derive the greatest mortality benefit from remdesivir use. [ABSTRACT FROM AUTHOR]

Background: We described the real‐life epidemiology and causes of infections on the different therapy phases in patients undergoing chimeric antigen receptor (CAR) T‐cells directed towards CD19+ or BCMA+ cells. Methods: All consecutive patients receiving CAR T‐cell therapy at our institution were prospectively followed‐up. We performed various comparative analyses of all patients and subgroups with and without infections. Results: Ninety‐one adults mainly received CAR T‐cell therapy for acute leukaemia (53%) and lymphoma (33%). We documented a total of 77 infections in 47 (52%) patients, 37 (48%) during the initial neutropenic phase and 40 (52%) during the non‐neutropenic phase. Infections during the neutropenic phase were mainly due to bacterial (29, 78%): catheter infections (11 [38%] cases), endogenous source (5 [17%]), and Clostridioides difficile (5 [17%]). Patients receiving corticosteroids after CAR T‐cell therapy had a higher risk of endogenous infection (100% vs. 16%; p =.006). During the non‐neutropenic phase, bacterial infections remained very frequent (24, 60%), mainly with catheter source (8, 33%). Respiratory tract infections were common (17, 43%). Conclusions: Infections after CAR T‐cell therapy were frequent. During the neutropenic phase, it is essential to prevent nosocomial infections and balance the use of antibiotics to lower endogenous bacteraemia and Clostridial infection rates. [ABSTRACT FROM AUTHOR]

Background: We aimed to describe a cohort of hematologic patients with COVID‐19 treated with antivirals early. Methods: Non‐interventional chart review study. Comparison of baseline characteristics and outcomes in high‐risk hematologic patients treated with remdesivir between December 2021 and April 2022 versus those treated with nirmatrelvir/ritonavir between May and August 2022. Results: Eighty‐three patients were analyzed. Forty‐two received remdesivir, and 41 nirmatrelvir/ritonavir. Patients with remdesivir were younger, vaccinated with lower number of doses, and received prior corticosteroids less frequently and sotrovimab, hyperimmune plasma and corticosteroids more often. Viral shedding median (IQR) duration was 18 (13–23) and 11 (8–21) days in the remdesivir and nirmatrelvir/ritonavir groups, respectively (p = 0.004). Median (IQR) Ct values before treatment were similar in both groups. Within 5 days of treatment, median (IQR) Ct values were 26 (23–29) and 33 (30–37) in the remdesivir and nirmatrelvir/ritonavir groups, respectively (p < 0.0001). All patients were hospitalized for remdesivir administration and only four (9.8%) in the nirmatrelvir/ritonavir group. The overall outcomes in this cohort of COVID‐19 patients with Omicron variant was good, as no patient needed oxygen or ICU admission. One patient in remdesivir group died from septic shock. No severe adverse event was recorded in both treatment groups. Conclusions: Patients with hematologic malignancies and non‐severe COVID‐19 who received nirmatrelvir/ritonavir experienced faster decrease in viral load and shorter viral shedding. Furthermore, besides the advantage of oral administration, nirmatrelvir/ritonavir administration reduced the need of hospital admission. [ABSTRACT FROM AUTHOR]

Objectives We aimed to describe the clinical outcomes and duration of viral shedding in high-risk patients with haematological malignancies hospitalized with COVID-19 during Omicron variant predominance who received early treatment with antivirals. Methods We conducted a prospective observational study on high-risk haematological patients admitted in our hospital between December 2021 and March 2022. We performed detection techniques on viral subgenomic mRNAs until negative results were obtained to document active, prolonged viral replication. Results This analysis included 60 consecutive adults with high-risk haematological malignancies and COVID-19. All of these patients underwent early treatment with remdesivir. Thirty-two (53%) patients received combined antiviral strategies, with sotrovimab or hyperimmune plasma being added to remdesivir. The median length of viral replication—as measured by real-time RT-PCR and/or subgenomic RNA detection—was 20 (IQR 14–28) days. Prolonged viral replication (6 weeks after diagnosis) was documented in six (10%) patients. Only two patients had prolonged infection for more than 2 months. Overall mortality was 5%, whereas COVID-19-related mortality was 0%. Conclusions Current outcomes of high-risk patients with haematological malignancies hospitalized with COVID-19 during Omicron variant predminance are good with the use of early antiviral strategies. Persistent viral shedding is uncommon. [ABSTRACT FROM AUTHOR]

Objectives: To describe current resistance to the β-lactams empirically recommended in the guidelines in bloodstream infection (BSI) episodes caused by Gram-negative bacilli (GNB).Methods: Retrospective, multicentre cohort study of the last 50 BSI episodes in haematological patients across 14 university hospitals in Spain. Rates of inappropriate empirical antibiotic therapy (IEAT) and impact on mortality were evaluated.Results: Of the 700 BSI episodes, 308 (44%) were caused by GNB, mainly Escherichia coli (141; 20.1%), Klebsiella spp. (56; 8%) and Pseudomonas aeruginosa (48; 6.9%). Among GNB BSI episodes, 80 (26%) were caused by MDR isolates. In those caused by Enterobacterales, 25.8% were ESBL producers and 3.5% were carbapenemase producers. Among P. aeruginosa BSI episodes, 18.8% were caused by MDR isolates. Overall, 34.7% of the isolated GNB were resistant to at least one of the three β-lactams recommended in febrile neutropenia guidelines (cefepime, piperacillin/tazobactam and meropenem). Despite extensive compliance with guideline recommendations (91.6%), 16.6% of BSI episodes caused by GNB received IEAT, which was more frequent among MDR GNB isolates (46.3% versus 6.1%; P < 0.001). Thirty day mortality was 14.6%, reaching 21.6% in patients receiving IEAT.Conclusions: Current resistance to empirical β-lactams recommended in febrile neutropenia guidelines is exceedingly high and IEAT rates are greater than desired. There is an urgent need to adapt guidelines to current epidemiology and better identify patients with a high risk of developing MDR GNB infection. [ABSTRACT FROM AUTHOR]

• Over 9% of patients hospitalized for COVID-19 will present a co-infection. • Independent risk factors for co-infection were identified. • When procalcitonin values are <0.2 ng/mL, co-infection is very rare. • High ferritin values and oxygen saturation >94% are also uncommon in co-infection. We described the current incidence and risk factors of bacterial co-infection in hospitalized patients with COVID-19. Observational cohort study was performed at the Hospital Clinic of Barcelona (February 2020–February 2021). All patients with COVID-19 who were admitted for >48 hours with microbiological sample collection and procalcitonin (PCT) determination within the first 48 hours were included. A total of 1125 consecutive adults met inclusion criteria. Co-infections were microbiologically documented in 102 (9.1%) patients. Most frequent microorganisms were Streptococcus pneumoniae (79%), Staphylococcus aureus (6.8%), and Haemophilus influenzae (6.8%). Test positivity was 1% (8/803) for blood cultures, 10.1% (79/780) for pneumococcal urinary antigen test, and 11.4% (15/132) for sputum culture. Patients with PCT higher than 0.2, 0.5, 1, and 2 ng/mL had significantly more co-infections than those with lower levels (p=0.017, p=0.031, p<0.001, and p<0.001, respectively). In multivariate analysis, oxygen saturation ≤94% (OR 2.47, CI 1.57–3.86), ferritin levels <338 ng/mL (OR 2.63, CI 1.69–4.07), and PCT higher than 0.2 ng/mL (OR 1.74, CI 1.11–2.72) were independent risk factors for co-infection at hospital admission owing to COVID-19. Bacterial co-infection in patients hospitalized for COVID-19 is relatively common. However, clinicians could spare antibiotics in patients with PCT values <0.2, especially with high ferritin values and oxygen saturation >94%. [ABSTRACT FROM AUTHOR]

The obesity epidemic is a global challenge that requires evidence-based intervention to slow the emergence of weight-related illness in children and adolescents. Thus, effective treatments are urgently needed. This study aimed to analyze whether there is relationship between the initial stage of readiness for behavior change (SRBC) and the results obtained through participation in a multidisciplinary program of obesity treatment (MPOT). The study included 113 overweight or obese children and adolescents who participated in an intervention for 16 weeks, in which the categorical variable was the SRBC. The dependent variables included: anthropometric measures of body composition, hemodynamic parameters (e.g., blood pressure values), and health-related physical fitness. Although stages 1 and 2 had greater improvements in flexibility than those in stage 5, and stage 1 had greater percentage changes in abdominal strength than those in stage 5, children and adolescents in the highest stage had greater percentage changes for anthropometric, hemodynamic and cardiorespiratory fitness, suggesting an impact of the stage of change on the effects of a MPOT. This study suggests that SRBC plays a role in obesity treatment in Brazilian children and adolescents and warrants consideration when enrolling patients to intervention. [ABSTRACT FROM AUTHOR]

To propose a response criterion for analyzing the intervention success by verifying patient outcomes after a multidisciplinary obesity treatment program in Brazilian children and adolescents. Obese children and adolescents (n = 103) completed a 16-week multidisciplinary intervention (IG) and were compared to the control group (CG) (n = 66). A cluster of parameters (e.g. total domain of HRQoL; BMI z-score; cardiorespiratory fitness; body mass; waist circumference; fat mass; lean mass) were measured pre and post-intervention, and the sum of the median percentage variation and the percentile 25 and 75 were used from IG and CG to determine the responsiveness to the program. We are proposing four ranges in which children and adolescents may be classified after the intervention: (1) CG percentile 50 values or lower are considered non-responsive to the intervention, (2) values greater than CG percentile 50 but lower than IG percentile 50 are considered slightly responsive, (3) values greater than IG percentile 50 but lower than IG percentile 75 were considered as moderately responsive, and (4) values greater than IG percentile 75 were considered very responsive.Conclusions: This criterion may serve as a complementary tool that can be employed to monitor the response to this model of multidisciplinary intervention. What is Known: • The effectiveness of multidisciplinary obesity interventions is usually determined by comparing changes in selected outcomes in the intervention versus versus control group. • There is no consensus about what should be assessed before and after the intervention program, which makes difficult to compare different programs and to determine their rate of responsiveness. What is New: • This study proposes a response criteria to pediatric obesity interventions following a similar model compared to ours based on key variables that presents low cost and high applicability in different settings. [ABSTRACT FROM AUTHOR]

Purpose: This feasibility study aimed to analyze the effects of a multidisciplinary (e.g., psychological, nutritional and water-based exercise interventions) obesity treatment program on resting heart rate variability (rHRV) indices according to the degree of excess body mass (overweight vs obesity) in adolescents. Additionally, we tested the association between changes in rHRV indices with changes in body composition and cardiorespiratory fitness.Methods: Twenty-five adolescents completed the study, 11 from the overweight group (OWG) and 14 from the obese group (OBG) classified according to body mass index. Anthropometric measures, autonomic cardiac function (measured by rate-to-rate interval analyses), lean mass and body fat, and cardiorespiratory fitness were assessed prior to and after the 16-week intervention period.Results: Both groups increased their parasympathetic indices (e.g., standard deviation 1) [OWG: Δ = 8.5 (1.7-15.3) ms; magnitude of change: “likely”; OBG: Δ = 11.4 (4.3-18.4) ms; “very likely”] and cardiorespiratory fitness [OWG: Δ = 2.0 (1.1-2.8) mL/kg/min; “likely”; OBG: Δ = 2.4 (1.5-3.3) mL/kg/min; “Almost certain”] with a slightly greater magnitude of change for the OBG. The OWG showed greater changes in body composition [e.g., body fat: Δ = −3.2 (-4.6 to −1.8) kg “Very likely”] when compared to the OBG [Δ = −2.8 (−4.4 to −1.3) kg “Possible”]. Inverse and large correlations were noted for changes in body fat markers (%) and changes in parasympathetic indices of rHRV (%) (i.e., rMSSD and SD1).Conclusions: These results provide evidence that a multidisciplinary program improves parasympathetic indices, body composition, and cardiorespiratory fitness independent of the degree of excess body mass. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of a Multidisciplinary Obesity Treatment Program (PMTO) on parent-proxy perceptions and self-reported health-related quality of life (HRQoL) in overweight and obese adolescents. Methods: Ninety-two overweight and obese adolescents aged 10-18 years were assigned to the PMTO. HRQoL was assessed with the Pediatric Quality of Life Inventory (PedsQLTM 4.0), administered to the adolescents and their parents/guardians at baseline and post-intervention. This intervention lasted 16 weeks and was based on cognitive behavioral therapy with the involvement of a psychologist, a nutritionist and exercise professionals. Results: Adolescents reported improved physical [pre: 78.13 (21.1) to post: 84.38 (18.8); p < 0.001; effect size: 0.43], social [pre: 80.0 (30.0) to post: 85.0 (20.0); p = 0.033; effect size: 0.10], psychosocial [pre: 75.0 (22.8) to post: 76.67 (19.6); p = 0.013; effect size: 0.18], and total [pre: 75.0 (17.4) to post: 79.35 (16.8); p = 0.001; effect size: 0.28] domain scores. As for parent-proxy perceptions, improvements for all domains, except school domain, were noted ( p < 0.05; effect sizes: from 0.26 to 0.34) post-intervention. At baseline, parents presented lower scores than the adolescents' HRQoL for all domains ( p < 0.05). However, following the intervention, parents only had lower scores than their children for the physical and total domains of the HRQoL scale. Conclusions: In addition to improving HRQoL in the adolescents, the PMTO improved parent-proxy perceptions of their children's HRQoL. [ABSTRACT FROM AUTHOR]

Objective: To compare body composition, hemodynamic parameters, health-related physical fitness, and health-related quality of life of adolescents with anthropometric diagnosis of overweight, obesity, and severe obesity. Methods: 220 adolescents with excess body weight were enrolled. They were beginners in a intervention program that included patients based on age, availability, presence of excess body weight, place of residence, and agreement to participate in the study. This study collected anthropometric and hemodynamic variables, health-related physical fitness, and health-related quality of life of the adolescents. To compare the three groups according to nutritional status, parametric and non-parametric tests were applied. Significance level was set at p<0.05. Results: There was no significant difference in resting heart rate, health-related physical fitness, relative body fat, absolute and relative lean mass, and health-related quality of life between overweight, obese, and severely obese adolescents (p>0.05). Body weight, body mass index, waist and hip circumference, and systolic blood pressure increased as degree of excess weightincreased (p<0.05). Dyastolic blood pressure of the severe obesity group was higher than the other groups (p<0.05). There was an association between the degree of excess weight and the prevalence of altered blood pressure (overweight: 12.1%; obesity: 28.1%; severe obesity: 45.5%; p<0.001). The results were similar when genders were analyzed separately. Conclusion: Results suggest that overweight adolescents presented similar results compared to obese and severely obese adolescents in most of the parameters analyzed. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the association between cardiac parasympathetic activity and cardiorespiratory fitness, insulin, and hemodynamic profile in overweight and obese adolescent girls and boys (aged 12-16 years). Data were taken from the Multidisciplinary Obesity Treatment Program. Only post-intervention measurements are presented herein. Body composition, cardiorespiratory fitness, blood pressure, and metabolic profile (insulin and glucose profile) of adolescents were assessed. Cardiac parasympathetic activity was determined by resting heart rate variability, which was analyzed using a heart rate monitor. Greater parasympathetic cardiac activity was associated with higher levels of cardiorespiratory fitness in both girls and boys (0.375 ≤ r ≤ 0.900), while the sympathetic-vagal balance was negatively related to maximal oxygen uptake (VO) in girls ( r = 0.478). An association between lower parasympathetic activity and insulin resistance was noted in girls (mean of R- R intervals [RRmean] and homeostasis model assessment insulin-resistance index [HOMA-IR]: r = −0.678), while greater systolic blood pressure (SBP) and lower parasympathetic activity were associated in both sexes (RRmean and SBP: r = −0.526; high frequency [HF (nu)] and SBP: r = −0.754). In conclusion, autonomic nervous system activity was associated with cardiorespiratory fitness, insulin resistance, and SBP in overweight and obese adolescents. The identification of these potential relationships assists with the establishment of future long-term exercise interventions that evaluate the improvements in parasympathetic nervous system activity, in addition to metabolic profile and cardiorespiratory fitness in overweight and obese adolescents. [ABSTRACT FROM AUTHOR]