Background The optimal distribution between physical activity (PA) levels and sedentary behaviour (SB) for the greatest benefits for body composition among older adults with overweight/obesity and chronic health conditions remains unclear. We aimed to determine the prospective association between changes in PA and in SB with concurrent changes in body composition and to examine whether reallocating inactive time into different physical activity levels was associated with 12-month change to body composition in older adults. Methods Longitudinal assessment nested in the PREDIMED-Plus trial. A subsample (n = 1564) of men and women (age 55–75 years) with overweight/obesity and metabolic syndrome from both arms of the PREDIMED-Plus trial was included in the present analysis. Participants were followed up at 6 and 12 months. Physical activity and SB were assessed using validated questionnaires. Out of 1564 participants, 388 wore an accelerometer to objectively measure inactive time and PA over a 7-day period. At each time point, participants’ body composition was measured using dual-energy X-ray absorptiometry (DXA). Standard covariate-adjusted and isotemporal substitution modelling were applied to linear mixed-effects models. Results Increasing 30 min of total PA and moderate-to-vigorous physical activity (MVPA) was associated with significant reductions in body fat (β − 0.07% and − 0.08%) and visceral adipose tissue (VAT) (− 13.9 g, and − 15.6 g) at 12 months (all p values < 0.001). Reallocating 30 min of inactive time to MVPA was associated with reductions in body fat and VAT and with an increase in muscle mass and muscle-to-fat mass ratio (all p values < 0.001). Conclusions At 12 months, increasing total PA and MVPA and reducing total SB and TV-viewing SB were associated with improved body composition in participants with overweight or obesity, and metabolic syndrome. This was also observed when substituting 30 min of inactive time with total PA, LPA and MVPA, with the greatest benefits observed with MVPA. Trial registration International Standard Randomized Controlled Trial (ISRCTN), 89898870. Retrospectively registered on 24 July 2014

dimensión salud en familias pertenecientes a diferentes consultorios del médico y la enfermera de la familia. Métodos: se realizó un estudio transversal en 840 familias pertenecientes a 12 consultorios pertenecientes a siete áreas de salud en La Habana. L a dimensión socioeconómica estuvo representada por condiciones de la vivienda y de la familia, y la de salud por las densidades de hipertensión, diabetes y hábito de fumar. Resultados: no existió asociación entre el nivel de escolaridad y la densidad de diabéticos y fumadores, solo en relación con la hipertensión se apreció algún indicio de asociación lineal con la escolaridad, no hubo indicios de asociación entre las variables de salud y la posesión de equipos de primera y segunda necesidad en la vivienda. Los tres factores de riesgo exhibieron claras tendencias en relación con la percepción de la situación económica. Entre los que aprecian que su condición económica es mala o muy mala, hay densidades altas de las tres entidades, las desigualdades socioeconómicas no se asociaron con la densidad de los factores de riesgo. Conclusiones: la relación entre las desigualdades socioeconómicas y la situación de salud en Cuba es baja.

high volume EDs (81%). The majority saw patients presenting with OUD at least 1-5 times a week (43%) or more than 6 times per week (32%). Over half (54.6%) of the participants felt dissatisfied with the care their patients receive for OUDs in the ED. The most commonly reported interventions for patients with OUD included: provision of a take-home naloxone (54.1%), referral to a methadone/buprenorphine clinic (60.7%), referral to an addiction clinic (73.2%), and/ or instructions to see their family physician (74.3%). Most physicians never or rarely provided buprenorphine in the ED (74%) or via outpatient script (78%). Most (89%) never or rarely provided a prescription for other medications to prevent withdrawal symptoms. Physicians identified pre-printed order sets (91%), phone (92%) or on-site (88%) access to addiction specialists, on-site case managers (93%), and rapid access to addictions clinics (73%) as useful supports. Respondents identified written protocols as the most useful educational tool, followed by in-person presentations (75%) and brief online learning modules (75%). Conclusion: Clinical guidelines now strongly recommend buprenorphine as first line treatment for OUD, and ED-initiated and ED-prescribed buprenorphine have been found to be both feasible and effective. However, buprenorphine for OUD is currently underutilized in Canadian EDs, and only half of physicians surveyed routinely offer take-home naloxone. The reasons for this are likely multifactorial and systemic, and naloxone and buprenorphine may not always be available in EDs. Uptake of evidence-based recommendations may work to improve ED provider satisfaction in caring for patients with OUD. We will seek options to rapidly disseminate the simple interventions identified in this study, including pre-printed order sets and protocols.

Many people with spinal cord injury (SCI) develop chronic pain, including neuropathic pain. Unfortunately, current treatments for this condition are often inadequate because SCI-associated neuropathic pain is complex and depends on various underlying mechanisms and contributing factors. Multimodal treatment strategies including but not limited to pharmacological treatments, physical rehabilitation, cognitive training, and pain education may be best suited to manage pain in this population. In this study, we developed an educational resource named the SeePain based on published pain literature, and direct stakeholder input, including people living with SCI and chronic pain, their significant others, and healthcare providers with expertise in SCI. The SeePain was then 1) systematically evaluated by stakeholders regarding its content, comprehensibility, and format using qualitative interviews and thematic analysis, and 2) modified based on their perspectives. The final resource is a comprehensive guide for people with SCI and their significant others or family members that is intended to increase health literacy and facilitate communication between SCI consumers and their healthcare providers. Future work will quantitatively validate the SeePain in a large SCI sample.