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Weight, length, and skinfold thicknesses were measured in 4634 term and preterm neonates. Sex and weight/length ratio were important determinants of the amount and distribution of the subcutaneous fat store at birth. Gestational age, weight, length, and other ponderal indices did not explain subcutaneous fat variability.

Newborns usually lose 5-10% of their initial weight during the first 4 days of life. Our aim, using bioelectrical impedance (BI), was to study the body composition of healthy term newborns and the nature of the changes which accompany this physiological weight loss. Forty-three healthy term newborns, all with adequate weight for their gestational age, were studied during the first 3 days of life. Weight and BI were taken on the 1st, 2nd, and 3rd days of life, always at the same time of the day. Total body water (TBW), percentage of total body mass hydration (%TBW), and amount of body solids were calculated. Average weight at birth was 3,297+/-381 g, length 50.04+/-1.75 cm, and gestational age 39.9+/-0.84 weeks. Weight, TBW, and body solids decreased progressively during the first 3 days of life (p<0.000). By day 3, weight loss represented 5.67+/-1.98% of birth weight, but %TBW increased slightly (1.72%; p<0.000). These results suggest that, during physiological weight loss, body composition modifications are produced in the term newborn by a decrease in TBW and loss of body solids. The level of body hydration increases slightly, since the loss of body solids is greater than the loss of TBW. The use of BI can help us in the study of body composition and the short- and/or long-term changes produced therein, in the newborn.

The pattern and distribution of subcutaneous fat in term and preterm newborns has been assessed by skinfold thicknesses (ST), describing gender and gestational age variations. Weight, length and ST (triceps, biceps, subscapular and suprailiac) were measured in 4634 neonates (2445 males and 2189 females) aged from 32 to 41 gestational weeks. Central to total skinfold ratio (CTS), (suprailiac + subscapular)/sum of 4 ST, was calculated. Males were heavier and longer than females. The sum of 4 ST and CTS was higher in females at every gestational age (with significant differences from 35 weeks) and also the sum of 4 ST per kg body weight (P < 0.05 from 32-33 weeks). Throughout the gestational period, ST increased significantly (P < 0.0001) but CTS did not show variations, neither in males nor in females. term and preterm females have a more centralised pattern and more amount of subcutaneous fat than males. Central to total skinfold ratio must be considered as an index of centripetal fat store which is independant of gestational age.

Introduction: In the recent decades, children overweight have been tripled in our living conditions. Sociocultural factors as parents' background may become a risk agent. Purpose: To estimate the influence of mother's background on overweight risk at the age of 6. Procedure: Longitudinal study of Aragonese children population- representative cohort from birth to 6 years old (n= 1,560). Sociocultural and family anthropometric features, type of feed and postnatal growth according to mother's background were evaluated. High overweight incidence at the age of 6 and the mother's immigrant background was analyzed after being adjusted by different covariants. Results: 23.4% of the cross section were children of immigrant background mothers. The sociocultural and family anthropometric features, the type of feed and the postnatal growth differed in the immigrant background group (underage mothers, lower smoking habits during pregnancy, greater weight gain during pregnancy, a lower educational level of parents, greater habitat incidence in urban areas and a lower percentage of low birthweight children). The overall incidence of 6 years old overweight was 30.3% (15% overweight and 15.3% obesity): from a 39.4% (18.1% overweight and 21.3% obesity) in the immigrant background group, and from 28.4% (14.4% overweight and 14% obesity) in the Spanish group (p= 0.001; relative risk= 1.63; confidence interval of 95%: 1.21-2.22). Immigrant mother's background remained as an overweight separate risk factor after adjusting the analysis by the remaining covariants. Conclusions: The overweight incidence in immigrant mothers' children is higher than those of Spanish mothers' at the age of 6. This fact may become a separate risk factor for obesity development since childhood.

Introduction: Chorioamnionitis (CA) has been associated with an increased risk of preterm delivery and adverse neurological outcomes in premature newborn infants. Aim: To determine whether exposure to CA is associated with elevated concentrations of inflammatory cytokines and with increased prevalence of neurological disorders in preterm infants. Materials and methods: One hundred fifty-seven preterm infants were studied during the period from 2002 to 2004. Forty-three (27.4%) of these newborns had been exposed to maternal CA. Serum ytokine concentrations (IL6, IL8, TNF) were measured twice, in cord blood and 48 h after delivery. We evaluated the development of perinatal asphyxia and intraventricular haemorrhage, and assessed neurodevelopmental outcomes at the age of 2 years using the Denver Developmental Screening Test. Results: In newborns exposed to CA, compared with those without CA, cord levels of IL6 (26.7 ± 22.2 vs 9.8 ± 6.2 pg/mL) and TNF (50.6 ± 30.1 vs 35.3 ± 21.0 pg/mL) were significantly higher; but there were no differences between the two groups in terms of either IL8 in cord blood or cytokine values 48 h after delivery. Exposure to CA was associated with a higher risk of a low 5-minute Apgar score (RR 2.3; 95% IC 1.38-3.85; p= 0.001), intraventricular haemorrhage (RR 1.32; 95% IC 1.04-1.67; p= 0.04), and neurodevelopmental disorders as assessed by the Denver test at age the of 2 years (RR 1.57; 95% IC 1.07- 2.31; p= 0.002). Conclusions: The results suggest that preterm infants exposed to maternal CA are at a higher risk of poor neurological outcome. Cord blood levels of IL6 and TNF confirm the diagnosis of CA, but show no relation to later neurological findings. [PUBLICATION ABSTRACT]

Breastfeeding is the best way to feed infants as the properties of breast milk confer many short and longer-term benefits. As recommended by the World Health Organization, exclusive breastfeeding should continue throughout the first 6 months of life and, after this time, be accompanied by complementary feeding for as long as the mother and infant want. Data from our general population show that the mean duration of breastfeeding does not exceed 3-5 months, early cessation during the first month occurs in 30% of cases and only 10%-20% of the motherinfant dyads maintain it up to 6 months. We review the risk factors for the initiation and continuation of breastfeeding, the best moments to promote breastfeeding on the part of health institutions and the most effective actions. At the same time, we present the PALMA project, the purpose of which is to evaluate the effectiveness of a multidisciplinary intervention program to promote breastfeeding at the primary care level, comparing a group of infants with a control group. [PUBLICATION ABSTRACT]

Many global environmental agendas, including halting biodiversity loss, reversing land degradation, and limiting climate change, depend upon retaining forests with high ecological integrity, yet the scale and degree of forest modification remain poorly quantified and mapped. By integrating data on observed and inferred human pressures and an index of lost connectivity, we generate a globally consistent, continuous index of forest condition as determined by the degree of anthropogenic modification. Globally, only 17.4 million km 2 of forest (40.5%) has high landscape-level integrity (mostly found in Canada, Russia, the Amazon, Central Africa, and New Guinea) and only 27% of this area is found in nationally designated protected areas. Of the forest inside protected areas, only 56% has high landscape-level integrity. Ambitious policies that prioritize the retention of forest integrity, especially in the most intact areas, are now urgently needed alongside current efforts aimed at halting deforestation and restoring the integrity of forests globally. Mapping and quantifying degree of forest modification is critical to conserve and manage forests. Here the authors propose a new quantitative metric for landscape integrity and apply it to a global forest map, showing that less than half of the world’s forest cover has high integrity, most of which is outside nationally designed protected areas.

Emotional disorders (ED) are highly prevalent worldwide. The PsicAP trial, conducted in Spain, demonstrated the benefits of adding transdiagnostic cognitive behavioural therapy (TD-CBT) to treatment as usual (TAU) for the attention of these disorders in primary care (PC). Here we describe the design of a stepped wedge randomized controlled trial (RCT), inspired by the PsicAP project. This RCT has two main aims: 1) to test the implementation of the PsicAP protocol in a real clinical setting, further evaluating possible mechanisms of change underlying the efficacy of TD-CBT (emotional regulation, alliance, and therapist experience and training), and 2) to assess the impact of psychotropic medication use on neuropsychological function and treatment outcomes. A single-blind multicentre RCT with a stepped wedge design will be conducted. Participants (N=320) will be randomly assigned to an experimental group (EG1) or to a waiting list group (WG). The EG1 will receive immediate treatment and the WG will remain on the waiting list for 3 months. After this time, the WG will become a second experimental group (EG2) that will receive the same treatment as EG1 (PsicAP protocol). Patients will be assessed at post-treatment, at 3 and 9 months. Before starting treatment, a random subsample of patients (n=90) will undergo a neuropsychological assessment. These patients will be assigned to three groups based on their use of psychotropic medication at the time of randomization: no psychotropic medication, short-term use (< 3 months) and long-term use (≥ 3 months). All 90 participants will undergo the same neuropsychological assessment at one year. The RCT is expected to run from 01/05/23 to 01/10/25. The results of this trial are expected to provide further support for the efficacy of the PsicAP TD-CBT protocol, as well as insight into the mechanisms of change that lead to the positive therapeutic outcomes of this protocol. In addition, this study will help determine the effects of short- and long-term psychotropic use on neuropsychological function and therapeutic outcomes. In short, it is hoped that this RCT will help to better understand how to implement evidence-based psychological treatment in the PC setting. EURADICT 2013-001955-11/ ISRCTN58437086.

Resistance training (RT) and n-3 polyunsaturated fatty acids (n-3 PUFA) supplementation have emerged as strategies to improve muscle function in older adults. Overweight/obese postmenopausal women (55–70 years) were randomly allocated to one of four experimental groups, receiving placebo (olive oil) or docosahexaenoic acid (DHA)-rich n-3 PUFA supplementation alone or in combination with a supervised RT-program for 16 weeks. At baseline and at end of the trial, body composition, anthropometrical measures, blood pressure and serum glucose and lipid biomarkers were analyzed. Oral glucose tolerance tests (OGTT) and strength tests were also performed. All groups exhibit a similar moderate reduction in body weight and fat mass, but the RT-groups maintained bone mineral content, increased upper limbs lean mass, decreased lower limbs fat mass, and increased muscle strength and quality compared to untrained-groups. The RT-program also improved glucose tolerance (lowering the OGTT incremental area under the curve). The DHA-rich supplementation lowered diastolic blood pressure and circulating triglycerides and increased muscle quality in lower limbs. In conclusion, 16-week RT-program improved segmented body composition, bone mineral content, and glucose tolerance, while the DHA-rich supplement had beneficial effects on cardiovascular health markers in overweight/obese postmenopausal women. No synergistic effects were observed for DHA supplementation and RT-program combination.

INTRODUCTION Pragmatic research studies that include diverse dyads of persons living with dementia (PLWD) and their family caregivers are rare. METHODS Community‐dwelling dyads were recruited for a pragmatic clinical trial evaluating three approaches to dementia care. Four clinical trial sites used shared and site‐specific recruitment strategies to enroll health system patients. RESULTS Electronic health record (EHR) queries of patients with a diagnosis of dementia and engagement of their clinicians were the main recruitment strategies. A total of 2176 dyads were enrolled, with 80% recruited after the onset of the pandemic. PLWD had a mean age of 80.6 years (SD 8.5), 58.4% were women, and 8.8% were Hispanic/Latino, and 11.9% were Black/African American. Caregivers were mostly children of the PLWD (46.5%) or spouses/partners (45.2%), 75.8% were women, 9.4% were Hispanic/Latino, and 11.6% were Black/African American. DISCUSSION Health systems can successfully enroll diverse dyads in a pragmatic clinical trial.