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Background This paper aims at assessing the effectiveness of the package of road safety measures implemented after road safety was included in the political agenda in the year 2004 on the number of road traffic-injured people in Spain. Methods An evaluation study was performed using an interrupted time-series design. The study population was people injured in road traffic crashes in Spain between 1 January 2000 and 31 December 2006. The road traffic crashes database of the General Directorate for Traffic was used. The dependent variable was the monthly number of people injured, stratified by sex, age, severity and type of road user. The explanatory variable (intervention) compared the post-intervention period (2004-6) with the pre-intervention period (2000-3). Quasi-Poisson regression models were adjusted, controlling for time trend and for seasonality. Results Results show a reduction in the risk of being injured for both men (RR 0.91; 95% CI 0.87 to 0.95) and women (RR 0.89; 95% CI 0.85 to 0.94). Risk reductions were observed across all age groups and all road users, except for pedestrians. Conclusions The present study suggests that prioritising road safety reduces the number of people injured in road traffic collisions. [ABSTRACT FROM AUTHOR]

Background: This study assesses the impact on safety of a system designed to enhance sleep in car passengers. The system holds the head posteriorly and limits its rotation in the sagittal and frontal planes, modifying the occupant's head position. This device may have an influence on the interaction between the occupant and the vehicle restraint systems. Methods: It was a randomised, prospective, single-blind, cross-over controlled study in which 41 volunteers were exposed to using the system while riding as car passengers. Whether the device influenced the posture of the occupants and prevented them from adopting out-of-position (OOP) configurations was also analysed. Occupants were videotaped while they were using both the innovative system (cases) and their normal sleeping device (controls), if any. Results: Controls were exposed to OOP situations in 825 occasions (18.4%; 95% CI 17.3% to 19.6%), while cases were exposed in 416 occasions (9.3%; 95% CI 8.4% to 10.2%). The paper also analysed how many cases and controls were exposed at least once to a particular event and how frequent a single participant incurred in an OOP situation. In both cases, the innovative device showed a reduction in exposition. When OOP situations were grouped into severe, moderate and minor events, the innovative device produced a statistically significant reduction in the occurrence of severe and moderate events. Conclusions: A device originally designed to improve comfort and rest in car passengers has been found to reduce the exposure of the occupants to being OOP while resting in the car. [ABSTRACT FROM AUTHOR]

Objective: Studies evaluating the long-term impact of smoking laws on secondhand smoke (SHS) exposure using airborne markers are scarce. This study aimed to assess the long-term impact of the Spanish smoking law on SHS levels, using a specific and objective marker. Methods: Follow-up study, measuring vapour-phase nicotine levels before the implementation of the law and 6, 12 and 24 months after the initial assessment. A total of 443 samples were taken at baseline in eight different regions in offices in the public administration, private sector, universities and hospitality venues. Results: Two years after the law was implemented, the nicotine concentration decreased by a minimum of 60% in public administration, university and private sector offices, as well as in venues where smoking was totally banned. However, nicotine levels significantly increased by 40% in hospitality venues allowing smoking. No significant differences were found in hospitality venues with areas for smokers and non-smokers or in pubs and discotheques. Conclusions: Two years after the smoking law came into force, levels of SHS exposure in the workplace were significantly lower than before the law was implemented. Importantly, however, SHS levels were even higher than before the law was implemented in venues still allowing smoking. The data obtained in this study clearly show that the ‘Spanish model’ is not protecting the health of hospitality workers and that a complete ban is required. Furthermore, this study highlights the importance of long-term monitoring of compliance with smoking laws over time. [ABSTRACT FROM AUTHOR]

Background Polychlorinated biphenyls (PCB) are persistent organic pollutants (POP) that are consumed because of their bioaccumulation through the food chain. Recent studies have suggested the implication of POPs in the development of metabolic diseases such as type 2 diabetes and obesity. However, this relationship is not entirely consistent, and has not been investigated in longitudinal studies. The purpose of this study was to prospectively examine the association between dietary intake of PCBs and the incidence of obesity in the Seguimiento Universidad de Navarra (SUN) Project. Methods Our study included 12 313 participants without obesity at baseline, who were followed-up for a median of 8.1 years. Dietary intakes of PCBs, expressed as WHO toxic equivalents, were assessed at baseline through a 136-item semiquantitative food-frequency questionnaire. The published concentration levels of PCBs measured in samples of food consumed in Spain were used to estimate intakes. Multivariable Cox regression models were fitted to estimate HRs and 95% CI for incident obesity. Results During follow-up, we observed 621 incident cases of obesity. After adjustment for total energy intake and additional adjustment for potential confounders, participants in the fifth quintile of PCBs intake were at higher risk of becoming obese (adjusted HR: 1.58; (95% CI 1.21 to 2.06)) compared to those in the first quintile. The linear trend test was statistically significant (p<0.001). Conclusions Dietary intake of PCBs as estimated using a food frequency questionnaire was associated with a higher incidence of obesity. Nevertheless, further longitudinal studies are needed to confirm our results. [ABSTRACT FROM AUTHOR]

Background Information on the validity of self-reported cases of stroke and acute myocardial infarction (AMI) is varied. The aim of this study was to assess the validity and agreement of self-reported prevalent cases of stroke and AMI in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). Methods At recruitment, 1992-1996, and in the follow-up (3 years after recruitment), each participant in the Spanish EPIC cohort (15 630 men and 25 808 women) was asked if a doctor had ever said that they had had a stroke or AMI, and the results were compared with information available in medical records. Validity of self-reported prevalent cases of stroke and AMI was examined by calculating sensitivity, specificity, positive predictive values and κ statistics. Results The sensitivity of self-reported prevalent cases of stroke was 81.3% and that for AMI was 97.7%. The positive predictive value was 22.2% and 60.7% for stroke and AMI, respectively, whereas specificity was very high (>99%) for both diseases. The agreement between self-report questionnaire results and medical records was substantial (κ=0.75) for AMI but not for stroke (κ=0.35). Conclusion Self-reported information on stroke and AMI included in the EPIC questionnaire is a valid instrument for the assessment of AMI disease but should be used with caution in stroke. [ABSTRACT FROM AUTHOR]

Background Inequities in the distribution of environmental exposures may add an extra burden to socially disadvantaged populations, especially when acting during vulnerable periods such as pregnancy and early life, but such inequities may be more complex and uncertain than is generally assumed. We therefore examine whether socioeconomic inequities exist in pregnancy exposures to multiple common environmental contaminants in air, water and food. Methods A Spanish population-based birth cohort study enrolled over 2000 pregnant women between 2004 and 2008. Questionnaires assessed parental education, occupation, country of birth, diet and many other factors. Environmental pollutant assessments included nitrogen dioxide as a marker of traffic-related air pollution, trihalomethanes as a marker of tap water disinfection by-products, organochlorine biomarkers measured in maternal serum during pregnancy (polychlorinated biphenyls (PCB), dichlorodiphenyl dichloroethylene (p,p′-DDE), hexachlorobenzene and β-hexachlorocyclohexane) and mercury concentrations measured in cord blood. Results Associations between socioeconomic status indicators and nitrogen dioxide and trihalomethanes were generally weak and inconsistent in direction. Concentrations of PCB, hexachlorobenzene and mercury were higher in higher social classes than lower social classes. p,p′-DDE and β-hexachlorocyclohexane were not related to social class. Social class explained between 1% and 5% of the variability in pollutant concentrations, much less than other variables such as region of residence, country of birth and maternal age. Discussion This study demonstrates that the general assumption that more disadvantaged populations have higher levels of exposure to environmental pollution does not always hold and requires further elucidation in different international settings. [ABSTRACT FROM AUTHOR]

Background This study evaluates the influence of socioeconomic position (SEP) over the life course on change in health-related quality of life (HRQoL) in older adults. Methods A prospective cohort of 2117 individuals aged 60 years and over. In 2001, SEP was measured over the life course as social class in childhood (approximated by father's occupation), as educational level completed and as adult social class (occupation of household head). HRQoL was measured with the SF-36 health questionnaire. Changes from 2001 to 2003 in the scores for the physical component summary (PCS) and the mental component summary (MCS) of the SF-36 were calculated, and individuals were classified into three categories: decline (decrease of >5 points), no change (change of 5 to +5 points) and improvement (increase of >5 points) in HRQoL. Results After adjustment for baseline HRQoL, lifestyle, chronic illness, educational level and adult social class, low childhood social class was associated with a higher risk of both a decline and an improvement in the SF-36 PCS and MCS. The risk of decline in PCS and MCS and of improvement in MCS increased with the cumulative number of adverse SEP over the life course. Subjects who rose in social class from childhood to adulthood showed the greatest improvement on the SF-36 PCS and MCS. Conclusion These results on the relation between SEP and changes in HRQoL in older adults support the three models proposed to explain health inequalities over the life course: the existence of critical periods, the accumulation of adverse SEP and social mobility. [ABSTRACT FROM AUTHOR]

Background: Obesity has become a global public health problem, which also affects children. It has been proposed that the educational interventions during childhood could be a key strategy in the prevention of obesity. Objective: To evaluate the efficacy of an intervention on food habits and physical activity in school children. Methods: A 2-year cluster-randomised prospective study with two parallel arms was used to evaluate an intervention programme in children in their first year of primary schooling (5--6 years of age) in schools in the city of Granollers. The intervention consisted of the promotion of healthy eating habits and physical activity by means of the educational methodology Investigation, Vision, Action and Change (IVAC). At the beginning and at the end of the study (2006 and 2008) the weight and height of each child was measured in situ, while the families were given a self-report physical activity questionnaire and the Krece Plus quick test. Results: Two years after the beginning of the study, the body mass index of the children in the control group was 0.89 kg/m2 higher than that of the intervention schools. The intervention reduced by 62% the prevalence of overweight children. Similarly, the proportion of children that ate a second piece of fruit and took part in an after-school physical activity increased in the intervention group. In the control group, the weekly consumption of fish was reduced. Conclusions: The educational intervention in healthy eating habits and physical activity in the school could contribute to lessen the current increase in child obesity. [ABSTRACT FROM AUTHOR]

Background Few data exist on the psychosocial factors associated with attrition in longitudinal surveys. This study was undertaken to determine psychosocial and sociodemographic predictors of attrition from a longitudinal study of the onset and persistence of episodes of major depression in primary care. Methods A systematic random sample of general practice attendees was recruited in seven Spanish provinces between October 2005 and February 2006. Major depression was diagnosed using the Composite International Diagnostic Interview and a set of 39 individual and environmental risk factors for depression were assessed at baseline and after 6 and 12 months of follow-up. Data were analysed using multilevel logistic regression. Results 7777 primary care attendees aged 18-75 years were selected, of whom 1251 (16.1%) were excluded. Of the remaining 6526, 1084 (16.6%) refused to participate. Thus, 5442 patients (attending 231 family physicians in 41 health centres) were interviewed at baseline, of whom 3804 (70%) and 3567 (66%) remained at 6 and 12 months of follow-up, respectively. The province and sociodemographic factors were stronger predictors of attrition than psychosocial factors. Depression and anxiety had no effect but other psychosocial factors affected attrition. There were different profiles for the patients lost at 12 months when predictors measured at baseline versus 6 months were included. Conclusions These findings suggest that several psychosocial factors might be considered factors of attrition in primary care cohorts and confirm that baseline characteristics are insufficient for analysing nonresponse in longitudinal studies, indicating that different retention strategies should be applied for patients interviewed at 6 and 12 months. [ABSTRACT FROM AUTHOR]