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Objective: Various studies have identified factors associated with risk of mortality in patients with SARS-CoV-2 infection. However, their sample size has often been limited and their results partially contradictory. This study evaluated factors associated with COVID-19 mortality in the population of Madrid over 75 years of age, in infected patients, and in hospitalized patients up to January 2021., Patients and Methods: This population-based cohort study analyzed all residents of the Community of Madrid born before January 1, 1945 who were alive as of December 31, 2019. Demographic and clinical data were obtained from primary care electronic medical records (PC-Madrid), data on hospital admissions from the Conjunto Mínimo Básico de Datos (CMBD, Minimum Data Set), and data on mortality from the Índice Nacional de Defunciones (INDEF, National Death Index). Data on SARS-CoV-2 infection, hospitalization, and death were collected from March 1, 2020 to January 31, 2021., Results: A total of 587,603 subjects were included in the cohort. Of them, 41,603 (7.1%) had confirmed SARS-CoV-2 infection, of which 22,362 (53.7% of the infected individuals) were hospitalized and 11,251 (27%) died. Male sex and age were the factors most closely associated with mortality, though many comorbidities also had an influence. The associations were stronger in the analysis of the total population than in the analysis of infected or hospitalized patients. Mortality among hospitalized patients was lower during the second wave (33.4%) than during the first wave (41.2%) of the pandemic., Conclusion: Age, sex, and numerous comorbidities are associated with risk of death due to COVID-19. Mortality in hospitalized patients declined notably after the first wave of the pandemic., (© 2022 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Objective: To explore the association between hearing loss and social frailty in a sample of Spanish older adults recruited from primary health care network., Method: Cross-sectional study on a sample of 445 non-institutionalized adults aged 65 or more years (190 men and 255 women), recruited from primary care centers in Spain. Three self-reported hearing impairment questions were used to assess hearing loss. Social frailty was deemed to exist when the person presented two or more of the following conditions: living alone, absence of a person to provide help, infrequent contact with family, infrequent contact with friends, lack of confident and lack of help for daily activities in the last 3 months. To study the association between hearing loss and social frailty we used logistic regression models adjusted for potential confounders, including physical frailty., Results: The mean age of participants was 76.2 years (77.5 years for women). More than half of the participants (54.4%) reported hearing loss and the frequency of social frailty was 23.2%. Hearing loss was associated with social frailty (adjusted odds ratio [aOR]=1.78; 95% confidence interval [95%CI]: 1.04-3.06). However, the association was sex-dependent (p for interaction=0.041). In stratified analysis, the association was only found in women (aOR=3.21; 95%CI: 1.44-7.17)., Conclusions: Hearing loss was associated with social frailty in women, but not in men. Longitudinal studies are needed to confirm this association and to understand the differential effect of gender., (Copyright © 2020 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To systematically describe the school nutritional policies of the 17 autonomous communities of Spain., Method: Through a search of bibliographic databases, web pages and other official information systems, 183 documents of interest were identified. Information was systematically collected with the SNIPE (school nutrition index of programme effectiveness) questionnaire, adapted to Spain, and validated by reference staff of the regional government's health and education ministries., Results: The main objective of the policies is to prevent obesity and improve the nutrition of schoolchildren. The 17 autonomous communities cover the school canteen service, 11 cafeteria and vending machines, and 9 the breakfast service. All communities use the Consensus Document on School Food as a reference for the content of the menu and the nutritional quality of the products offered at the school; however, only 4 of them have regulated these aspects. The evaluation of policy objectives ranges from 58.8% of the autonomous communities for food supply to 5.9% for rotation and menu quality., Conclusion: Although all the autonomous communities have standards for the school menu, the standards for the rest of the food supply vary across them; also, evaluation of objectives is scarce and only 4 communities have approved mandatory regulations. Nutritional standards should be reviewed according to current scientific knowledge and enacted by law, in compliance with the current legislation (Act 17/2011)., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Quantify the impact of reducing the consumption of red/processed meats on cardiovascular mortality and all-cause mortality of the Spanish adult population based in 5 revisions published., Participants and Main Measurements: We defined exposure as consumption of ≥3 servings/week of red or processed meats and considered four possible scenarios of exposed population (30%-60%). Based on data from the Spanish National Statistics Institute, we calculated the weighted mortality between 40 and 80years. Using the relative risks (RR) and 95% confidence intervals (CI) published by the referred revisions (RR=0.88; IC95%: 0.84-0.93 for all-cause mortality and RR=0.92; IC95%: 0.90-0.93 for cardiovascular mortality), we calculated the expected mortality rate in both exposed and unexposed categories. By multiplying these rates by the number of exposed individuals, we estimated the attributable number of yearly deaths., Results: If 60% of the population was exposed, with a 95%CI, the number of cardiovascular deaths that could be averted each year if population consumed <3 servings/week of red or processed meats was between 2.112 and 3.055. If was exposed that 30%, the difference in the yearly number of potentially averted deaths was between 1.079 and 1.577., Conclusions: Even under the most conservative assumption, the benefit, at the population level, of reducing red or processed meats consumption <3 servings/week on cardiovascular mortality is important. The conclusions of the recently published reviews contradicted their own results and contributed to a state of confusion that can create substantial harm for public health., (Copyright © 2020 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The latest European Society of Cardiology Heart Failure (HF) guidelines define three types of HF according to the ejection fraction (EF): HF with reduced EF (HFrEF) when EF<40%, HF with mid-range EF (HFmrEF), when EF 40-49%, and HF with preserved EF (HFpEF) when EF≥50%. The objective of this study was to analyse the characteristics and results of elderly patients hospitalised with HF according to the new classification using EF., Methods: A prospective study was carried out with 531 HF patients aged ≥75 years classified according to EF, and admitted in the geriatric wards of 6 hospitals in Spain. An analysis was performed on the demographic and clinical characteristics, as well as well as the morbidity and mortality at one year of follow-up., Results: As regards EF, 17.1% had HFrEF, 10% had HFmrEF, and 72.9% had HFpEF. Patients with HFmrEF were more similar to those with HFrEF in terms of a younger age, predominance of men, and previous admission due to HF. This was also the case with the use of drugs for neurohormonal blockade. Patients with HFrEF (compared to those with HFmrEF and HFpEF), had higher mortality (35.2%, 24.5%, and 25.6%, respectively), more readmissions for HF (17.6%, 15.1%, and 14.5%, respectively), and more events (61.5%, 45.3%, and 52.5%, respectively), although there were no significant differences. There were also no differences observed in the survival analysis between the EF groups and the time-dependent outcome variables., Conclusions: In elderly patients hospitalised with HF, those classified as HFmrEF did not show any clear differences with respect to those with HFrEF or HFpEF. There were no differences in terms of morbidity and mortality., (Copyright © 2020 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: In Spain, one third of all children and two-thirds of adults suffer from excess weight, a condition that generates a direct excess medical cost of 2000 million Euros. Obesogenic food environments cause obesity by promoting the consumption of sugar-sweetened beverages and ultra-processed foods. Accordingly, we propose five priority policies capable of reversing the epidemic of obesity and related non-communicable diseases through the creation of healthy food environments., The Power (poder in Spanish) of Food Policies: Advertising (Publicidad): regulation of unhealthy food and drink advertisements carried by all media and targeted at children, and prohibition of sponsorships of congresses, conferences or sports events and endorsements by scientific associations or health professionals. Supply (Oferta): promotion of a 100% healthy supply of goods on sale in vending machines sited at educational, health and sports centres. Demand (Demanda): levying a tax of at least 20% on sugar-sweetened beverages, accompanied by subsidies or reduced taxes on healthy foods and availability of drinking water free of charge at all public venues and areas. Labelling (Etiquetado): effective application of the Nutri-Score through the use of incentives, regulation and public-tender mechanisms. Reformulation (Reformulación): revising and redrawing reformulation agreements with the industry, setting more ambitious goals and mandatory compliance., A Final Thought: These five proposed interventions, all of which have been successfully applied in other countries, will serve to raise population awareness and have a positive impact on health and the economy, through reducing the health care costs of obesity and enhancing work productivity. These measures should form part of a wide-ranging transformation of the food system, with agri-food policies that foster the sustainable production of healthy foods., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To describe the nutritional content of products offered in food and drink vending machines at secondary schools in the Madrid Autonomous Community (Spain), and to evaluate these items' adherence to the nutritional recommendations of the National Health System Consensus Document on School Food., Methods: Cross-sectional study of a sample of 330 secondary schools in Madrid across the period 2014-2015. Secondary school vending machines were identified by telephone interview. The products offered in a representative sample of six machines were identified by inspection in situ, and their nutritional composition was obtained from the labelling., Results: A total of 94.5% of the 55 products on offer failed to comply with at least one nutritional criterion of the Consensus Document on School Food. The recommendation relating to sugar content registered the highest level of non-compliance, with 52.7% of products, followed by the recommendations relating to energy (47.3%) and fats (45.5%). The mean number of unmet criteria was 2.2, with this figure being higher in foods than in drinks (2.8 versus 1; p <0.01)., Conclusion: Almost all the products on display in secondary school vending machines in Madrid were in breach of the Consensus Document on School Food, mainly due to an excess of calories, sugars and fats. Compulsory nutritional criteria and a procedure for monitoring adherence should be established, specifying those responsible for performing this task and the corrective measures to be applied in the event of non-compliance., (Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: The use of the Spanish National Death Index (S-NDI) is increasing as it is free and easily accessible. Prompted by unexpected findings when linking two cohorts of patients with the S-NDI, this study was performed to evaluate the quality of mortality data from this source., Methods: Individual records of two cohorts of persons admitted to drug abuse treatment in Barcelona (n=19,974) and Madrid (n=17,557) were linked with the S-NDI and then with the National Statistics Institute (NSI) to assign vital status. The sensitivity and specificity of the S-NDI in relation to the NSI and estimates of mortality with both systems were obtained. Underestimation of mortality by the S-NDI for the same period in the whole of Spain was also calculated., Results: For Madrid, from 1997-2008, independent searches in the S-NDI underestimated mortality by 18.9% compared with the NSI. A subsequent individualized search limited to deaths detected by the NSI but not by the S-NDI reduced underestimation to 13.9%. For Barcelona, underestimation with a combined search (independent plus limited) was 3.3%. From 2001-2002, underestimation with combined searches reached 32.3% in Madrid and 7.3% in Barcelona. Underestimation was also seen in the general Spanish population (1.8% in 1997-2008 and 9.3% in 2001-2002). From 1997-2008, the specificity of independent searches in the S-NDI was 100%, but its sensitivity in Madrid was only 81%., Conclusions: The quality of the S-NDI is good enough for many uses in the health sector, but this index underestimates mortality with substantial spatiotemporal variations. The quality of the S-NDI could be increased by improving its search algorithms, enabling on-line tabulations of the main results, and introducing quality controls and routine evaluations., (Copyright © 2011 SESPAS. Published by Elsevier España. All rights reserved.)

Objectives: The Program for Prevention and Health Promotion (PPHP) of the Spanish Society of Family and Community Medicine was launched at the end of the 1980s and its main objective is to integrate preventive and health promotion activities in daily clinical practice in primary care. The aim of the present study was to determine the level of compliance with the preventive activities of the PPHP., Methods: We performed a comprehensive literature search of PPHP publications to assess the implementation and impact of the program., Results: The distinct evaluations carried out since the beginning of the program show that both compliance and registration of preventive activities have improved over time. The PPHP has been positively evaluated by both health professionals and patients. Family physicians in Spain carry out preventive activities more often than other European family physicians., Conclusions: The PHPPS continues to operate 24 years after its initiation. However, some adaptations are needed since the Spanish health system is changing. Proposed modifications are related to accessibility and to providing a more effective response to users. In elderly patients, life expectancy should be assessed and priorities for preventive interventions should be set accordingly., (Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.)

Introduction and Objectives: The ENRICA study aims to assess the frequency and distribution of the main components of the natural history of cardiovascular disease in Spain, including food consumption and other behavioral risk factors, biological risk factors, early damage of target organs, and diagnosed morbidity., Methods: A cross-sectional survey of 11,991 individuals representative of the non-institutionalized population aged 18 years and older in Spain was conducted from June 2008 to October 2010. Data collection comprised 3 sequential stages: a) computer-assisted telephone interview to obtain information on lifestyle, knowledge and attitudes about cardiovascular disease risk factors, and the signs and symptoms of heart attack and stroke, subjective health, and morbidity; b) first home visit, to collect blood and urine samples for analysis by a central laboratory, and c) second home visit, to measure anthropometric variables and blood pressure and to administer a computer-assisted dietary history; data on functional limitations are also collected from participants aged 65 years and older., Discussion: The ENRICA study has shown the feasibility of a large home-based health interview and examination survey in Spain. It will provide valuable information to support and evaluate national strategies against cardiovascular disease and other chronic diseases in Spain. Moreover, a 3-year prospective follow-up of the study participants, including a new physical exam, is planned to start in the second semester of 2011 and will update lifestyle information and biological variables. (ClinicalTrials.gov number, NCT01133093)., (Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Background and Objective: To examine the association between sleep duration and functional limitation in older adults from Spain., Subjects and Methods: Cross-sectional study with 3,708 individuals representative of the non-institutionalized population aged ≥ 60 years in Spain. Sleep duration was self-reported, and the functional limitations in the instrumental activities of daily living (IADL) were assessed., Results: Functional limitations in IADL were identified in 1,424 (38.4%) participants. In analyses adjusted for sociodemographic and lifestyle variables, the percentage of participants with limitation in IADL was higher in those who slept ≤ 5 hours (odds ratio [OR]=1.56; 95% confidence interval [CI]=1.18-2.06) or ≥ 10 hours (OR=2.08; 95%CI=1.67-2.60; p for trend<0.001) than in those who slept 8 hours. The association between long sleep (≥ 10 hours) and functional limitations held even after adjustment for comorbidity and sleep quality (OR=1.77; 95%CI=1.38-2.28) while the association between short sleep (≤ 5 hours) and functional limitation no longer held after this adjustment (OR=1.10; 95%CI=0.80-1.50)., Conclusion: In older adults, long sleep duration is a marker of functional limitations independent of comorbidity., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Introduction and Objectives: Information on trends in physical activity is very scarce in Mediterranean countries, which have the highest sedentariness in Europe. This study describes recent trends in leisure time physical activity (LTPA) and at work in the Madrid region., Methods: The data were taken from representative annual surveys of population aged 18-64 years, between 1995-2008, 28,084 people participated. We calculated total energy, quantified in metabolic equivalent (MET-1 h per week), spent on LTPA and on light LTPA (<3 MET), moderate LTPA (3-6 MET) and vigorous LTPA (>6 MET). The annual change in LTPA was estimated by linear regression, and occupational activity by logistic regression, adjusting for age, gender and educational level., Results: The total amount of LTPA in MET-1 h per week declined by 19.8% (P<.001) between 1995-2008; for both genders, all age groups and educational levels, except for those with the lowest level of education. The adjusted annual change in MET-1 h per week was: -0.21 (P<.001) for total LTPA; -0.1 (P<.001) for light; -0.08 (P<.001) for moderate; and -0.03 (P=.192) for vigorous. This decline is reflected by a shift to the left of the LTPA distribution in the population. Occupational physical inactivity has increased in the general population (odds ratio for annual change=1.01; 95% confidence interval, 1-1.02); specially in women, young and middle aged, and intermediate educational level., Conclusions: There has been a decline in LTPA, mainly in light and moderate activities, accompanied by greater occupational physical inactivity. This could have contributed to the increase in obesity in the Community of Madrid between 1995-2008., (Copyright © 2010 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.)

Background and Objective: There are no studies in Spain on the extent of obesity in adult immigrants. The aim of this paper is to present the frequency and distribution of obesity among immigrants living in Madrid., Patients and Method: We selected subjects between 18 and 64 years of age. Body Mass Index was used as an estimator of obesity. Immigrant status was defined according to country of birth. The results show the unadjusted and adjusted prevalence of obesity for different immigrant groups., Results: The percentage of obesity was higher in the immigrant population than in the Spanish population, except for the group of immigrants from western countries. According to gender, male immigrants from Eastern Europe and Latin America and women from Asia, Africa and Eastern Europe were the most obese., Conclusion: The highest prevalence of obesity among immigrants has also been observed in studies conducted in other countries. The prevalence of obesity among immigrants may be due to a more intense exposure to obesogenic factors both before arrival and during their residence in Spain.

Introduction and Objectives: To determine whether adults in Madrid, Spain adhere to leisure-time physical activity (LTPA) recommendations and to identify factors associated with adherence., Methods: A telephone survey of 12,037 individuals, representative of the Madrid population aged 18-64 years, was conducted. The LTPA level was quantified in metabolic equivalent (MET) hours per week from answers to a questionnaire on the frequency and duration of LTPA. This level was compared with the recommendation to engage in at least moderate activity >or=150 min/week or vigorous activity >or=60 min/week. Factors associated with adherence to the recommendation were identified using logistic regression analysis., Results: The mean LTPA level was 17.3 MET-hours/ week (95% confidence interval [CI], 16.9-17.7 MET-hours/week) and 28.8% (95% CI, 28%-29.7%) adhered to the recommendation. The recommended level was achieved more frequently in men than women (odds ratio [OR]=2.41; 95% CI, 2.20-2.64). In comparison with younger individuals, adherence decreased gradually with age until 60-64 years, when the OR was 0.20 (95% CI, 0.15-0.25). Compared with less well-educated individuals, the university-educated were more likely to meet the recommendation (OR=2.28; 95% CI, 1.82-2.87). Obese individuals achieved it less frequently (OR=0.49; 95% CI, 0.40-0.61) than normal-weight individuals. Those whose job involved low-intensity physical activity achieved it more frequently than those with sedentary occupations (OR=1.21; 95% CI, 1.10-1.34)., Conclusions: The majority of adults in Madrid did not achieve the recommended LTPA level. Adherence was lower in women, older individuals, the less well-educated and the obese, while it was greater in those with a job involving low-intensity physical activity.

This study reports on the level of knowledge about correct blood pressure (BP) measurement procedures among 175 third-year and 176 sixth-year students at a medical faculty and 58 third-year students at a nursing college. Only 51.8% of all students thought that they knew how to measure BP correctly (28.6% in the third year and 61.9% in the sixth year at the medical faculty and 91.4% at the nursing college). Among sixth-year medical students, 12.5% knew the appropriate cuff size, 35% that the stethoscope diaphragm should not be placed under the cuff, and 43% that the cuff deflation rate affects BP measurement. Among nursing students, 33% knew the appropriate cuff size, 22% that an outpatient's BP should be measured more than once during each visit, and 55% that a diagnosis of hypertension can only be made if the BP is elevated on more than one visit.

Background and Objective: Cardiovascular mortality attributable to high blood pressure in Spain is not available at present., Patients and Method: Population attributable risk and number of cardiovascular deaths attributable to high systolic blood pressure (> or = 120 mmHg) were estimated for the Spanish population aged 50-89 years, according to classical formulae. Relative risk data were drawn from the Prospective Studies Collaboration, meta-analysis of 61 studies on blood pressure and mortality, with data on one million subjects (30,000 from South Europe) with no prior vascular disease. Blood pressure prevalence was drawn from 2 nationwide surveys in Spain, for subjects aged 50-59 years and 60-89 years old, respectively. Cardiovascular deaths occurred in Spain were drawn from official statistics (year 2004)., Results: The number of annual cardiovascular deaths attributable to high blood pressure was 44,401, which represents 54% of the carFdiovascular deaths occurred in people over 50 years: 17,312 for ischemic heart disease, 15,599 for stroke, and 11,490 for other cardiovascular diseases. The highest number of attributable deaths lie in hypertension grade 1 and 2 (32,638) and in those over 70 years (36,345). Normal and high-normal blood pressure accounted for 6% of all attributable cardiovascular deaths., Conclusions: One in 2 cardiovascular deaths occurred annually in Spanish individuals over 50 years are attributable to high blood pressure, 90% of them are attributable to hypertension.

Introduction: This study examined the association of self-care behavior and patients' knowledge about self-care with rehospitalization among older adults with heart failure (HF)., Methods: Case-control comparison (116 cases and 209 controls) nested in a prospective cohort of patients aged 65 years and older admitted for HF at 4 Spanish hospitals. Cases were patients experiencing a first emergency rehospitalization in the 6 months following the index hospital admission. Controls were patients who did not undergo a rehospitalization during such time-period., Results: The number of self-care behaviors was inversely associated with the frequency of readmission (p for linear trend: 0.006). Compared with patients showing the appropriate self-care behavior, hospital readmission was more frequent among those who did no go for a walk daily or did not engage in any daily physical activity (hazard ratio [HR] 1.55; 95% confidence limits [CL] 1.04-2.29), and among those who did not keep their medical appointments (HR 1.82; 95% CL 1.10-3.02). Hospital readmission was also more frequent among patients who: failed to take their medication at the scheduled time (HR 2.07; 95% CL 1.15-3.72); stopped taking their medication when it disagreed with them (HR 1.76; 95% CL 1.08-2.85); and failed to adhere to their drug treatment (HR 1.96; 95% CL 1.29-2.98). Furthermore, the fewer the number of behaviors which patients knew to be required for self-care, the greater the frequency of rehospitalization (p for linear trend:0.029)., Conclusions: A lower degree of self-care and of patients' knowledge about self-care predicted a higher risk of hospital readmission.

Introduction and Objectives: This study provides an estimate of the prevalence of depression, and identifies associated medical and psychosocial factors, in elderly hospitalized patients with heart failure (HF) in Spain., Methods: The study included 433 patients aged 65 years or more who underwent emergency admission at four Spanish hospitals between January 2000 and June 2001 and who had a primary or secondary diagnosis of HF. Depression was defined as the presence of three or more symptoms on the 10-item Geriatric Depression Scale., Results: In total, 210 (48.5%) study participants presented with depression: 71 men (37.6%) and 139 women (57.0%). Depression was more common in patients with the following characteristics: NYHA functional class III-IV (adjusted odds ratio or aOR=2.00, 95% confidence interval or 95% CI, 1.23-3.24), poor score on the physical domain of the quality-of-life assessment (aOR=3.14; 95% CI, 1.98-4.99), being dependent for one or two basic activities of daily living (BADLs) (aOR=2.52; 95% CI, 1.41-4.51), being dependent for > or =3 BADLs (aOR=2.47; 95% CI, 1.20-5.07), being limited in at least one instrumental activity of daily living (aOR=2.20: 95% CI, 1.28-3.79), previous hospitalization for HF (aOR=1.71; 95% CI, 1.93-5.45), spending more than 2 hours/day alone at home (aOR=3.24; 95% CI, 1.93-5.45), and being dissatisfied with their primary care physician (aOR=1.90; 95% CI, 1.14-3.17)., Conclusions: Depression is very common in elderly hospitalized patients with HF and is associated with several medical and psychosocial factors. The high prevalence of depression, the poorer prognosis for HF in patients with depressive symptoms, and the existence of simple diagnostic tools and effective treatment argue in favor of systematic screening for depression in these patients.

Background and Objective: The assess the prevalence of overweight and obesity in school children from the province of Cuenca in 2004, and to examine changes in the main cardiovascular risk factors in school children from the city of Cuenca from 1992 through 2004., Subjects and Method: Cross sectional survey of 1166 schoolchildren 9-10 years old from 22 public schools of the province of Cuenca. We also analyzed data from 3 earlier, methodologically similar, cross-sectional surveys of school children from the city of Cuenca carried out in 1992, 1996 and 1998., Results: In 2004, among children aged 9-10 years from the province of Cuenca, 22.0% (95% confidence interval [CI], 19.53-24.37) were overweight and 8.8% (95% CI, 7.16-10.50) were obese. From 1992 through 2004, among children aged 9-10 years from the city of Cuenca, we registered a 12.2% absolute increase in the prevalence of overweight or obesity among males, which did no reach statistical significance (p > 0.05). Among women, changes in body mass index were of lower magnitude and with no statistical significance. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased (p < 0.05) in both sexes, with a greater decline in females. Among the latter, SBP decreased -9.22 mmHg (95% CI, -7.0 to -11.5) and DBP -5.9 mmHg (95% CI, -4.23 to -7.50). Non high density lipoproteins-cholesterol decreased among males (-18.1 mg/dl; 95% CI, -26.0 to -10.1 mg/dl) and among females (-23.7 mg/dl; 95% CI, -30.8 to -16.6 mg/dl). High density lipoproteins-cholesterol increased 6.3 mg/dl (95% CI, 2.6-10.0 mg/dl) in males and 5.1 mg/dl (95% CI, 1.9-8.2 mg/dl) in females. Triglycerides did not show substantial changes over the study period., Conclusions: Prevalence of overweight or obesity in schoolchildren of Cuenca is among the highest in Europe. From 1992 through 2004 in the city of Cuenca, frequency of overweight or obesity might have increased among males, while blood pressure and the lipid profile improved in both sexes.

We describe the magnitude and trends of obesity in Spain and of its main determinants, associated both with the increase in energy intake and the reduction of energy expenditure. Such determinants include factors from the individual subjects and from their environment. We also present the main features of the strategy for the Nutrition, Physical Activity, and the Prevention of Obesity, fostered by the Ministry of Health, as well as plans and activities carried out by the Regional Governments, to control this health disorder. We conclude that effective and sustained implementation of these activities is badly needed. It should be made along with the monitoring of obesity and its determinants in the general population. Research in this field should also be strengthened because social determinants of obesity are not known in depth, and the effectiveness of many of the interventions proposed by the national and regional initiatives is not well established yet. Moreover, in the next future, the effectiveness of intervention models applied to control the smoking epidemic must be assessed to examine its usefulness in the control of obesity. An example of this type of interventions is the limitation of the publicity of nutrient-poor and energy-dense foods addressed to children.

Introduction and Objectives: To investigate the association between a patient's social network and hypertension risk in older adults in Spain and to determine whether the nature of the social network is related to a patient's awareness of hypertension, to disease treatment and control, or to adherence to hypertension drug therapy., Patients and Method: Cross-sectional study of 3483 subjects representative of the non-institutionalized Spanish population aged 60 years or more. Logistic regression analysis, adjusted for sex, age, educational level, lifestyle and frequency of medical consultation, was used to derive odds ratios (ORs) for associations between characteristics of the social network (e.g., marital status, cohabitation status, frequency of contact with family members, and frequency of contact with friends and neighbors) and aspects of hypertension., Results: The hypertension risk in married individuals and those living with others was less than in those who were unmarried (OR=0.79; 95% confidence interval [CI] 0.67-0.94) or who lived alone (OR=0,75; 95% CI, 0.61-0.93). Men who saw their friends frequently were more likely to be aware of hypertension (OR=1.57; 95% CI, 1.19-2.07). Women who saw their friends or neighbors frequently were less likely to be aware (OR=0.70; 95% CI, 0.51-0.97). No clear relationship between social network characteristics and other hypertension-related variables was observed., Conclusions: In older adults, hypertension was associated with aspects of social integration, such as marital and cohabitation status. Among hypertensives, awareness of hypertension was partly related to the frequency of contact with family and friends or neighbors.

Background and Objective: Our purpose was to examine sociodemographic factors and lifestyle customs associated with weight change in the older adult population of Spain., Subjects and Method: Prospective cohort study conducted from 2001 to 2003 among a cohort of 2,384 people representative of the non-institutionalized Spanish population aged 60 years and over. Data were collected through home interviews, and main statistical analysis was performed through polytomous logistic regression., Results: Over the 2-year follow-up, 27.9% of men and 27.3% of women lost > or = 3 kg, and 18.2% of men and 16.9% of women gained > or = 3 kg. Among men, a loss of > or = 3 kg was more likely among former smokers (odds ratio [OR] = 1.58; 95% confidence interval [CI], 1.13-2.23) and among those with higher body mass index (BMI) (p for linear trend < 0.0001). A weight gain of > or = 3 kg was also more frequent in former smokers (OR = 1.93; 95% IC, 1.28-2.90). In addition, the risk of gaining > or = 3 kg decreased progressively with the increase in the frequency of physical activity at leisure time (p for linear trend < 0.0001). Among women, results were similar to those in men, though in former smokers there was no association with weight changes., Conclusions: In the older adult population, BMI, physical activity at leisure time, and a former smoker status are associated with weight change in the short term. Intervention on physical activity should be a priority, because it is the main modifiable factor, is associated with health-related quality of life, and it could contribute to avoid excess weight.

Objectives: To describe the clustering of behavior-related risk factors in the adult population of the Autonomous Community of Madrid (Spain) and evaluate the association between the level of aggregation of these factors and suboptimal subjective health., Methods: Data were drawn from the Non-communicable Disease Risk-Factor Surveillance System (Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles [SIVFRENT]). We studied the associations between smoking, high-risk alcohol consumption, leisure-time sedentariness and unbalanced diet in 16,043 persons aged 18-64 years and compared the observed against the expected proportions. Logistic regression was used to estimate the association between clustering of risk factors and suboptimal health (fair, poor and very poor)., Results: Almost 20% of subjects had 3 or 4 risk factors simultaneously. Most combinations of 3 risk factors exceeded expectations and, in particular, 4 factor clustering yielded observed/expected quotients of 2.15 (95% confidence interval [CI]: 1.93-2.38) in men and 2.96 (95% CI, 2.46-3.46) in women. In both sexes, the individual factor most closely associated with the remaining risk factors was smoking. Aggregation of risk factors was more frequent among men, younger age groups and subjects with low educational level. Compared with persons with none of the 4 risk factors, those that simultaneously had 3 or 4 more frequently reported suboptimal subjective health (OR = 2.49; 95% CI, 1.59-3.90 in men and OR = 1.96; 95% CI, 1.29-2.97 in women)., Conclusions: Behavior-related risk factors tend to aggregate, and this accumulation is higher among men, younger age groups, and subjects with a low educational level. A greater level of clustering is associated with a higher frequency of suboptimal perceived health.

Background and Objective: Certain diseases related to smoking have recently decreased in Spanish adults. This study estimated the burden of smoking-attributable mortality in Spain currently and in previous years., Population and Method: Smoking prevalence and mortality in Spain, and relative risks for death from the Cancer Prevention Study II were used to estimate tobacco-attributable mortality in the Spanish population aged 35 years and over., Results: In 2001, 54,233 deaths were attributable to tobacco use (49,366 in men and 4,867 in women). This represents a global reduction in comparison with the 55,613 deaths attributed to tobacco in 1998 (51,431 in men and 4,182 in women). One out of four current attributable deaths were untimely deaths occurred before age 65 years., Conclusions: A reduction in the number of smoking-attributable deaths is observed for the first time in Spain, as a result of a clear reduction among men. However, the overall decrease of smoking-related deaths is too small, and the burden of smoking-attributable mortality in Spain remains too high.

Objective: To illustrate -for the first time with Spanish data- the usefulness of telephone-interview-based surveillance of non-communicable diseases risk factors for the purpose of drawing up public health policies., Methods: We analysed information from the Non-Communicable Disease Risk Factor Surveillance System (Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles- SIVFRENT) for the period 1995-2003. This system is based on monthly telephone interviews covering a representative population sample, aged 18-64 years. 18,049 interviews were conducted for the whole period. Indicators of overweight and obesity, sedentary lifestyle, diet, tobacco and alcohol consumption, preventive practices, accidents and injuries, and road safety were calculated. The time trend was estimated using average annual prevalence ratios, obtained from generalised linear models with binomial family and logarithmic link., Results: Among men, the changes of greatest magnitude corresponded to an increase in overweight and obesity, which registered a relative annual rise of 3.7%, and a decrease in dieting (-3%), high alcohol consumption (-6.1%) and non-use of safety belts (-4%). Among women, there was a marked increase in overweight and obesity (3.3%), cessation of smoking (3.1%) and recourse to mammograms (6.4%), and a decrease in dieting (-4.1%) and non-use of safety belts (-4.5%)., Conclusions: Although important progress was observed in a number of indicators, such as tobacco and alcohol consumption, road safety and the undertaking of preventive practices, the situation worsened in others, i.e., fundamentally the increase in overweight and obesity.