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Temporal variations in the frequency of multiple maternities in many Western European countries have been described. However, within a single country, regional differences are observed. Urban industrialized regions and rural agricultural areas have experienced in recent decades a distinct decline in multiple deliveries, which in cases have been related to maternal age and parity changes. Research on multiple deliveries in Spain is scarce and none of the studies go back to the beginning of the 20th century or consider regional variation over an extended period of time. The present paper is a yearly study on multiple deliveries in Spain since 1900 including a geographical analysis. Rather than dealing with recent changes in multi-parity, this paper is concerned with Spain's long-term national variation (between 1900 and 2006). The changing pattern of double and triple deliveries was analyzed using data from the Spanish National Statistics Institute (INE). Twinning rates in Spain are low in comparison to those of equivalent periods in other countries, and the minimum rates correspond to the 1980s decade. Results were interpreted by taking into account the influence of age at maternity and reproductive variation up to 1990. A good fit between observed and predicted rates was obtained after the application of models, which besides maternal age and parity, include their interaction. Regarding territorial variability, the values corresponding to southern, northern and insular Spanish provinces are consistent with an earlier reduction of the crude birth rate in the north-east regions and latter in the southern regions and the Canary Islands. [ABSTRACT FROM AUTHOR]

Older people are increasingly being cared for in the community across Europe. Dependent care in Spain largely remains a private issue involving family carers and migrant women from developing countries. Qualitative research on respite care has contributed to our understanding of respite as a subjective experience. Nonetheless, how care-givers relieve the burden of care is still not fully understood. Migrant care-givers are present in family life but their need for rest remains unseen. The aim of the study presented in this paper was to contrast family care-givers and migrant care-givers' strategies for relief from their caring role. Care-givers rest by thinking, doing and being but in a different manner from that of care-giving, that is: when they are a different person. To leave the life of care-giving is the general strategy that family care-givers use to rest from their care-giving selves while turning to one's own world describes the way migrant care-givers seek to relieve the burden of care. The comparative analysis shows that both strategies have in common the necessity to disconnect from the care-giving identity and that both migrant and family care-givers employ strategies that are false exits to a care-giving identity: they apparently relieve the burden of care. Respite goes beyond places, times and activities; as family care itself, it requires identity. [ABSTRACT FROM PUBLISHER]

Critical reviews of the literature on the factors that influence physical activity among older adults have argued that existing theoretical frameworks should be extended by integrating those that deal with the complex processes of socialisation and social learning. This paper explores some of the social processes that influence older people's participation in physical activity (beyond that associated with everyday domestic tasks). A questionnaire with items on personal, social and environmental characteristics was completed by a random sample of older adults in the Madrid Autonomous Region (Spain). Significant relationships were found between the type of physical activity participation and: being physically active at earlier life stages, socio-economic status, the encouragement of others or social support in being active, and the knowledge and availability of local facilities. Some cases were observed of re-socialisation into physical activity among those who had been inactive earlier in life, and both appropriate environmental and supportive social conditions appeared instrumental. The findings could usefully inform the design of future social programmes to promote active lifestyles in later life, but given the complexity of the socialisation processes, it would be advisable for future studies to examine other than the four factors featured in the presented analysis, such as the role of cultural differences. [ABSTRACT FROM AUTHOR]

The design and evaluation of social policies requires information systems that enable social intervention with the people targeted by the programmes and services and that also offer indicators for the follow-up and monitoring of the policies adopted. The article presents the process of validation of a tool for diagnosing situations of social difficulty arising from social exclusion. The scale has been implemented in one of Spain's seventeen Autonomous Communities and has been selected on the basis of Good Practice under the European Social Fund. Expert judges were consulted for content validity; the metric properties of the scores obtained by the scale were examined and an exploratory factorial analysis (EFA) was performed to study the internal structure. The results show that the scale has adequate levels of content validity, construct validity and internal consistency. The SiSo Scale supplies a synthetic index of Social Position, providing professionals with the technical tools needed to carry out social diagnoses and simultaneously giving valid and reliable information on the social condition of people in a situation of social exclusion, which can guide social policy decision-making. [ABSTRACT FROM AUTHOR]

This research evaluates the prevalence of inadequate folate status in early pregnancy, the pattern of prenatal folic acid (FA) supplementation and associated factors in Spanish pregnant women from the ECLIPSES study, which included 791 participants prior gestational week 12. A cross-sectional evaluation of erythrocyte folate levels was performed at recruitment and used to calculate the prevalence of folate deficiency (erythrocyte folate < 340 nmol/l) and insufficiency (erythrocyte folate < 906 nmol/l). Sociodemographic and lifestyle data as well as information on prenatal FA supplementation were recorded. Descriptive and multivariate statistical analyses were performed. The prevalence of folate deficiency and insufficiency were 9·6 % and 86·5 %, respectively. Most of women used prenatal FA supplements, but only 6·3 % did so as recommended. Supplementation with FA during the periconceptional period abolished folate deficiency and reduced folate insufficiency. Prenatal FA supplementation with ≥1000 µg/d in periconceptional time and pregnancy planning increased erythrocyte folate levels. The main risk factor for folate insufficiency in early pregnancy was getting prenatal FA supplementation out of the periconceptional time (OR 3·32, 95 % CI 1·02, 15·36), while for folate deficiency they were young age (OR 2·02, 95 % CI 1·05, 3·99), and smoking (OR 2·39, 95 % CI 1·30, 4·37). In addition, social and ethnic differences according to folate status were also identified. As conclusion, periconceptional FA use is crucial for achieving optimal folate levels in early pregnancy. Pregnancy planning should focus on young women, smokers, those with low consumption of folate-rich foods, low socio-economic status or from ethnic minorities. [ABSTRACT FROM AUTHOR]

Objective: To evaluate diets in terms of nutritional characteristics and quality from the perspectives of health, greenhouse gas emissions (GHGE) and possible associations with each other in a representative sample of students at a public university.Design: Cross-sectional. Dietary intake was evaluated with a validated FFQ, and diet quality was assessed through the Healthy Eating Index (HEI-2010) and MedDietScore (MDS). GHGE data were obtained from the literature. In addition, sex, socio-economic status (SES) and body fat (BF) status were analysed as covariates.Setting: Basque Autonomous Community, Spain.Participants: Totally, 26 165 healthy adults aged 18-28 years.Results: Student diets were characterised by low consumption of carbohydrates (38·72 % of total energy intake (TEI)) and a high intake of lipids (39·08 % of TEI). Over half of the participants had low dietary quality. The low-emitting diets were more likely to be consumed by subjects with low HEI-2010 scores (β: 0·039 kg eCO2/1000 kcal/d) and high MDS scores (β: -0·023 kg eCO2/1000 kcal/d), after controlling for sex, SES and BF status. Both the low-emitting and healthy diets were more likely to be consumed by women and by those with normal BF percentage.Conclusions: UPV/EHU university students' diets were characterised by moderate quality from a nutritional perspective and moderate variation in the size of carbon footprints. In this population, diets of the highest quality were not always those with the lowest diet-related GHGE; this relationship depended in part on the constructs and scoring criteria of diet quality indices used. [ABSTRACT FROM AUTHOR]

Objective: Polyphenols are antioxidant compounds with an impact on different health factors. Thus, it is important to have precise tools to estimate the intake of polyphenols. This study focuses on the development of an intuitive tool to estimating the intake of dietary total polyphenols.Design: The tool was developed in a spreadsheet to improve accessibility and use. It is divided into six different meals for each of the 7 d with a similar format to 24-h diet recalls. The total polyphenol values of 302 foods were included and the possibility of own values.Setting: Framework of the European project Stance4Health, Granada, Spain.Participants: This tool was tested on 90 participants in different stages of life (girls, women and pregnant women). Ages ranged from 10 to 35 years.Results: The total polyphenol intake obtained was of 1790 ± 629 mg polyphenols/d. The highest consumption of polyphenols was observed in pregnant women (2064 mg/d). Polyphenols intake during the weekend was lower for the three groups compared to the days of the week. The results were comparable with those of other studies.Conclusions: The current tool allows the estimation of the total intake of polyphenols in the diet in a fast and easy way. The tool will be used as a basis for a future mobile application. [ABSTRACT FROM AUTHOR]

Objective: To assess whether higher adherence to the traditional Mediterranean diet (MedDiet) was associated with lower consumption of ultra-processed foods (UPF) and lower free sugar intake.Design: Cross-sectional analysis of baseline information among participants in the SENDO project, a Spanish paediatric cohort. Dietary information was collected through a semi-quantitative FFQ. Food items were classified according to the NOVA classification. Adherence to the MedDiet was evaluated through the KIDMED index.Setting: Spain.Participants: Three hundred eight-six children (52 % boys) with a mean age of 5·3 years old (sd 1·0) were included in the analysis.Results: 74·4 % of the children had moderate adherence to the MedDiet (mean KIDMED score: 5·9 points; sd 1·7) and overall, 32·2 % of the total energy intake came from UPF. Each two additional points in the KIDMED score was associated with 3·1 % (95 % CI 2·1, 4·0) lower energy intake from UPF. Compared to those with low adherence to the MedDiet, children with medium and high adherence reported 5·0 % (95 % CI 2·2, 7·7) and 8·5 % (95 % CI 5·2, 11·9) lower energy intake from UPF, respectively. We also found that 71·6 % of the variability in free sugar intake was explained by the variability in UPF consumption.Conclusions: Adherence to the traditional MedDiet was inversely associated with energy intake from UPF. Furthermore, most of the variability in free sugar intake was explained by the variability of UPF consumption. Public health strategies are needed to strengthen the adherence to the MedDiet in pre-schoolers while regulating the production, marketing and advertising of UPF. [ABSTRACT FROM AUTHOR]

This study compared how older people use quality information to choose residential care providers in England, the Netherlands and Spain (Catalonia). The availability of information varies between each country, from detailed inspection and survey information in the Netherlands, through to a lack of publicly available information in Catalonia. We used semi-structured interviews and group workshops with older people, families and professionals to compare experiences of the decision-making process and quality information, and also to explore what quality information might be used in the future. We found that most aspects of the decision-making experience and preferences for future indicators were similar across the three countries. The use of quality information was minimal across all three, even in England and the Netherlands where information was widely available. Differences arose mainly from factors with the supply of care. Older people were most interested in the subjective experiences of other residents and relatives, rather than ‘hard’ objective indicators of aspects such as clinical care. We find that the amount of publicly available quality information does not in itself influence the decisions or the decision-making processes of older people and their carers. To improve the quality of decisions, more effort needs to be taken to increase awareness and to communicate quality in more accessible ways, including significant support from professionals and better design of quality information. [ABSTRACT FROM AUTHOR]

Background: Few randomised clinical trials have examined the efficacy of an intervention aimed at improving psychosocial functioning in bipolar disorder.Aims: To examine changes in psychosocial functioning in a group that has been enrolled in a functional remediation programme 1 year after baseline.Method: This was a multicentre, randomised, rater-masked clinical trial comparing three patient groups: functional remediation, psychoeducation and treatment as usual over 1-year follow-up. The primary outcome was change in psychosocial functioning measured by means of the Functioning Assessment Short Test (FAST). Group×time effects for overall psychosocial functioning were examined using repeated-measures ANOVA (trial registration NCT01370668).Results: There was a significant group×time interaction for overall psychosocial functioning, favouring patients in the functional remediation group (F = 3.071, d.f. = 2, P = 0.049).Conclusions: Improvement in psychosocial functioning is maintained after 1-year follow-up in patients with bipolar disorder receiving functional remediation. [ABSTRACT FROM AUTHOR]

BackgroundThe different incidence rates of, and risk factors for, depression in different countries argue for the need to have a specific risk algorithm for each country or a supranational risk algorithm. We aimed to develop and validate a predictD-Spain risk algorithm (PSRA) for the onset of major depression and to compare the performance of the PSRA with the predictD-Europe risk algorithm (PERA) in Spanish primary care.MethodA prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multi-level logistic regression and inverse probability weighting to build the PSRA. In Spain (4574), Chile (2133) and another five European countries (5184), 11 891 non-depressed adult primary care attendees formed our at-risk population. The main outcome was DSM-IV major depression (CIDI).ResultsSix variables were patient characteristics or past events (sex, age, sex×age interaction, education, physical child abuse, and lifetime depression) and six were current status [Short Form 12 (SF-12) physical score, SF-12 mental score, dissatisfaction with unpaid work, number of serious problems in very close persons, dissatisfaction with living together at home, and taking medication for stress, anxiety or depression]. The C-index of the PSRA was 0.82 [95% confidence interval (CI) 0.79–0.84]. The Integrated Discrimination Improvement (IDI) was 0.0558 [standard error (s.e.)=0.0071, Zexp=7.88, p<0.0001] mainly due to the increase in sensitivity. Both the IDI and calibration plots showed that the PSRA functioned better than the PERA in Spain.ConclusionsThe PSRA included new variables and afforded an improved performance over the PERA for predicting the onset of major depression in Spain. However, the PERA is still the best option in other European countries. [ABSTRACT FROM PUBLISHER]