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Background: Women report a heightened concern of (breast) cancer, relative to other chronic conditions. This experimental study investigated whether such heightened concern may be a function of availability bias. Methods: participants (N = 750; 100% female) were randomly assigned to one of two experimental conditions: in the recall condition, they were asked to name the health condition they feared most; in the recognition condition, they picked the disease they feared most out of a list of chronic conditions. Results: The probability of selecting cancer as the most frightening disease varied as a function of experimental condition χ2 (10) = 112.13, p < 0.001. Participants in the recall condition were almost twice as likely to select cancer as the most frightening disease (N = 240, 59.10%) as those in the recognition condition (N = 121, 35.20%), who most frequently selected neurological diseases as the most threatening. The majority of participants believed that cancer was the disease receiving the most media attention (86.27%) (prior to the COVID-19 pandemic), and the one accounting for the highest number of deaths among Spanish females (63.50%). Conclusions: altogether, these results provide experimental evidence that availability bias may partly account for misperceptions and a heightened fear of cancer, which may narrow the scope of women's information-seeking and health-preventive behaviors. [ABSTRACT FROM AUTHOR]

This document analyzes a survey conducted in three geographical areas in Spain, focusing on centers for individuals with cerebral palsy (CP). The study aims to determine the adherence rate to recommended physical activity guidelines, assess if there is a decline in interest in physical activity over time, identify the stage at which this decline occurs, and explore potential mechanisms, tools, or strategies to sustain long-term engagement in regular physical activity for this population. The 36-item questionnaire comprises multiple-choice, open-ended, and Likert scale-type questions. Data were collected on physical activity frequency and duration, daily living activities, and demographics. Statistical analysis identified patterns and relationships between variables. Findings reveal that only a 17.6% meets the World Health Organization (WHO) recommendations regarding regular physical activity (RPA), decreasing in frequency or number of days a week, (3.7 d/w to 2.9 d/w; p < 0.01) and duration (50.5 min/d to 45.2 min/d; p < 0.001) with age, especially for those with higher Gross Motor Function Classification System (GMFCS) mobility levels. Obesity slightly correlates with session duration (ρ = −0.207; p < 0.05), not mobility limitations. Gender has no significant impact on mobility, communication, or physical activity, while age affects variables such as body mass index (BMI) and engagement (p < 0.01). A substantial proportion follows regular physical activities based on health professionals' advice, with interest decreasing with age. To improve adherence, focusing on sports-oriented goals, group sessions, and games is recommended. These findings emphasize the importance of personalized programs, particularly for older individuals and those with greater mobility limitations. [ABSTRACT FROM AUTHOR]

Vitamin D is an essential nutrient to be consumed in the habitual dietary intake, whose deficiency is associated with various disturbances. This study represents a validation of vitamin D status estimation using a semi-quantitative FFQ, together with data from additional physical activity and lifestyle questionnaires. This information was combined to forecast the serum vitamin D status. Different statistical methods were applied to estimate the vitamin D status using predictors based on diet and lifestyle. Serum vitamin D was predicted using linear regression (with leave-one-out cross-validation) and random forest models. Intraclass correlation coefficients, Lin's agreement coefficients, Bland–Altman plots and other methods were used to assess the accuracy of the predicted v. observed serum values. Data were collected in Spain. A total of 220 healthy volunteers aged between 18 and 78 years were included in this study. They completed validated questionnaires and agreed to provide blood samples to measure serum 25-hydroxyvitamin D (25(OH)D) levels. The common final predictors in both models were age, sex, sunlight exposure, vitamin D dietary intake (as assessed by the FFQ), BMI, time spent walking, physical activity and skin reaction after sun exposure. The intraclass correlation coefficient for the prediction was 0·60 (95 % CI: 0·52, 0·67; P < 0·001) using the random forest model. The magnitude of the correlation was moderate, which means that our estimation could be useful in future epidemiological studies to establish a link between the predicted 25(OH)D values and the occurrence of several clinical outcomes in larger cohorts. [ABSTRACT FROM AUTHOR]

The objectives of this paper were to evaluate the association of subjective memory complaints (SMC) with perceived state of health, mood and episodic memory (associative and everyday memory). We studied these areas using two different complaint assessment methods (three general questions and a validated scale). The study included 269 older adults (aged 65-87) with age-related memory changes, but without cognitive impairment. They were evaluated with Mini-cognitive Exam, Rivermead Behavioural Memory Test (a test of everyday memory), Paired Associates Learning Test, Memory Failures of Everyday Questionnaire, three memory complaints questions, Nottingham Health Profile and Geriatric Depression Scale. The results indicated that memory for everyday performance, mood and perceived health were independent predictors of SMC, with mood and perceived health being stronger predictors than actual memory performance. Age was not associated with subjective memory and, with regard to level of education, only the illiterate level was associated with SMC. A specific questionnaire on subjective memory was found to be preferable to an aggregate of complaints questions on self-reported memory; only health profile was found to predict the outcomes on memory complaints questions. Our conclusion is that a group of underlying factors other than everyday memory were playing a role in SMC; these SMC of subjects with age-related memory changes were mainly associated with subjective evaluations of their health. [ABSTRACT FROM AUTHOR]

Type 1 diabetes (T1D) is a chronic disease that is usually diagnosed in childhood, underscoring the importance of early disease control for overall wellbeing. Our aim was to design an explanatory model of subjective emotional wellbeing in children and adolescents with T1D. A longitudinal study was conducted at the Reina Sofia University Hospital in Cordoba (Spain). A total of 151 patients (mean age = 14.50, SD = 2.67; 41.1% girls) participated at T1, while 97 participated at T2 (mean age = 14.93, SD = 2.56; 39.2% girls). Participants completed a self-report questionnaire. Descriptive, reliability, correlation, path, and mediation analyses were performed. The explanatory model showed excellent fit indices [χ2 (10) = 8.62, p = 0.57, RMSEA = 0.00, 95% [0.00, 0.10], CFI = 1.00, GFI = 0.98, AGFI = 0.93, and TLI = 1.01]. The results showed significant and positive relationships between family social support and subjective emotional wellbeing and improved self-care skills. Self-efficacy presented a mediating role between family social support and subjective emotional wellbeing. Given that self-efficacy is a self-regulatory mechanism and a determinant of health, it is argued that future psychoeducational interventions could aim to improve self-efficacy to manage chronic diseases, to achieve greater emotional wellbeing in children and adolescents with T1D. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to evaluate the psychological impact on nursing students at the end of period of confinement during the first wave of the COVID‐19 outbreak in Spain. Design: A cross‐sectional study reported in line with the STROBE guidelines. Methods: Nursing students were invited to complete an online questionnaire at the end of the 2019–2020 academic year using convenience sampling. The questionnaire collected data on sociodemographic factors, work, and life experiences in relation to COVID‐19, habits and lifestyle using the World Health Organization Five Well‐Being Index (WHO‐5) and the Generalized Anxiety disorder‐7 scale. Variables related to anxiety were analysed using multiple lineal regression analysis, Results: The prevalence of low psychological well‐being in the 203 students was 44.3% and of anxiety 55.7%. In the multivariate analysis the variables associated with anxiety were having worked in the pandemic, having had symptoms of COVID‐19 and having been afraid of getting infected. Conclusions: The levels of anxiety due to the COVID‐19 pandemic in nursing students have been high, and levels of psychological well‐being have been low. The fact of having worked during the pandemic, having had symptoms compatible with COVID‐19 or being afraid of getting infected are associated with the highest scores for anxiety. Relevance to clinical practice: This study gives more evidence on the psychological impact on nursing students during the first wave of the pandemic in Spain. This can be used to design anxiety management programmes for inclusion into teaching syllabuses. It also gives arguments for the setting up of psychological and emotional support services for these students and other healthcare professionals working during the pandemic. [ABSTRACT FROM AUTHOR]

Prenatal methyl donor deficiency leads to homocysteine accumulation in the brain and impaired neurodevelopment in rats. We investigated the effect of moderately elevated preconception fasting total plasma homocysteine (tHcy) on child neurodevelopment in a prospective study of 67 and 76 mother-child pairs at 4 months and 6 years of age, respectively. Fasting blood samples at 2-10 weeks preconception, from the cord (nonfasting) and the mother and child 6 years after birth, were collected. Psychomotor and mental development were assessed at 4 months using the Bayley Scale of Infant Development (BSID) and cognitive development at 6 years using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). Highest tertile preconception tHcy (≥9.04 µmol/L) was categorized as moderately elevated and low-mid tertile tHcy as normal. Children, born to mothers with moderately elevated compared to normal preconception tHcy, scored lower [mean (95% CI)] in the BSID psychomotor [115 (105, 124) vs. 126 (121, 130), p = 0.03] and mental [101 (93, 109) vs. 113 (107, 119), p = 0.03] development tests. Multiple logistic regression analysis showed that moderately elevated compared to normal preconception tHcy was associated with greater probability, OR (95%CI), of scoring in the lowest tertile for BSID psychomotor development (≤120): 4.0 (1.1, 14.3) and lowest tertiles for WPPSI full (≤111), verbal (≤104) and performance (≤111), intellectual quotient: 6.0 (1.5, 23.7), 3.5 (1.1, 11.2) and 4.1 (1.1, 15.7), respectively. We conclude that moderately elevated preconception tHcy is inversely associated with psychomotor and cognitive development scores in infants and children. [ABSTRACT FROM AUTHOR]

Background: In a context of increasing demand and pressure on the public health expenditure, appropriateness of colonoscopy indications is a topic of discussion. The objective of this study is to evaluate the appropriateness of colonoscopy requests performed in a primary care (PC) setting in Catalonia. Methods: Cross-sectional descriptive study. Out-patients >14 years of age, referred by their reference physicians from PC or hospital care settings to the endoscopy units in their reference hospitals, to undergo a colonoscopy. Evaluation of the appropriateness of 1440 colonoscopy requests issued from January to July 2011, according to the EPAGE-II guidelines (European Panel on the Appropriateness of Gastrointestinal Endoscopy). Results: The most frequent indications of diagnostic suspicion requests were: rectal bleeding (37.46 %), abdominal pain (26.54 %), and anaemia study (16.78 %). The most frequent indications of disease follow-up were adenomas (58.1 %), and CRC (31.16 %). Colonoscopy was appropriate in 73.68 % of the cases, uncertain in 16.57 %, and inappropriate in 9.74 %. In multivariate analysis, performed colonoscopies reached an OR of 9.9 (CI 95 % 1.16-84.08) for qualifying as appropriate for colorectal cancer (CRC) diagnosis, 1.49 (CI 95 % 1.1-2.02) when requested by a general practitioner, and 1.09 (CI 95 % 1.07-1.1) when performed on women. Conclusions: Appropriateness of colonoscopy requests in our setting shows a suitable situation in accordance with recognized standards. General practitioners contribute positively to this appropriateness level. It is necessary to provide physicians with simple and updated guidelines, which stress recommendations for avoiding colonoscopy requests in the most prevalent conditions in PC. [ABSTRACT FROM AUTHOR]

Background: It is known that making people change their habits is challenging. It is crucial to identify the most effective approach that general practitioners (GPs) should use to help their patients change unhealthy habits. The objective this study was to assess the efficacy of a multifactorial intervention based on Motivational Interviewing performed by general practitioners to enhance lipid levels in patients with dyslipidemia, as compared to standard care. Methods: A multicenter, controlled, randomized, cluster, two-parallel arm trial with a 12-month follow-up conducted in 25 community health centers of the Spanish. 38 GPs and 227 primary care patients with uncontrolled dyslipidemia were included in the trial. GPs performed an intervention based either on Motivational Interviewing (MI) or standard practice. Lipid levels were measured, and the control degree was analyzed based on the criteria of clinical guidelines. Results: 107 were assigned to the Experimental Group (EG) and 120 to the Control Group (CG). An overall improvement was achieved in total cholesterol levels (Mean Difference -MD- = -19.60; 95 % CI:-15.33 at-23.87 mg/dl; p< 0.001), LDL-cholesterol levels (MD = -13.78; 95 % CI: -9.77 at -17.79 mg/dl; p < 0.001 ) and triglycerides (MD = -19.14; CI 95 %: -11.29 at -26.99 mg/dl; p < 0.001). No differences were found between the two groups. However, when we assessed the degree of lipid control by combining cholesterol <200 mg/dl and LDL-cholesterol < 130 mg/dl parameters, it was observed that a higher percentage of patients achieved target figures in the EG versus CG (13.1 % vs. 5.0 %; adjusted OR = 5.77, 95% CI: 1.67-19.91). Conclusion: A Motivational Interviewing-based approach conducted by Primary Care physicians aimed at patients with dyslipidemia, achieved a significant reduction in all lipid parameters, cardiovascular risk, weight reduction and the adherence to the Mediterranean diet, similar to that obtained with the usual intervention and superior in the proportion of patients achieving combined lipid control goals and the level of physical exercise. [ABSTRACT FROM AUTHOR]

Background. Educational initiatives for informal caregivers have proved efficient at reducing some of their symptoms, consequence of their involvement in care giving. However, more progress must be made in terms of the design of more successful interventions. Aims: Randomized clinical trial to test the efficiency of an Education Program for Primary Informal Caregivers of Hospitalized Dependent Patients in relation to their burden, mental and physical health, and care related knowledge. Methods. Design: Cluster Randomized Trial. Sample: 151 participants, primary caregivers of hospitalized, dependent patients, carried out from February 2009 to March 2010. They were assigned at random to two groups: one received an intensive educational program (n = 78), and the other just a generic speech (n = 73). The degree of burden of caregivers was recorded (Zarit Test), as well as their physical and mental health (SF12) and their knowledge of caregiving, before, immediately, after and one and a half months after the intervention. These analyses were carried out according to the Generalized Estimated Equations Method, in order to assess any possible improvements. Results. Participants´ burden did not improve, as measured by Zarit Test (p = 0,338), nor did their physical (p = 0,917) or mental health (p = 0,345). However there was an improvement in their hygiene caregiving (p = 0,001) and mobility care giving (p = 0,001). Conclusions. Caregivers found useful the education program, providing them with an informal support group. Interventions need to be longer and more customized as well as adapted to specific demands. There is a lack of validated questionnaires to assess improvements in care knowledge. There is a need to develop programs that contemplate continuity of care from primary to specialized caregiving. [ABSTRACT FROM AUTHOR]

Background This study is done to compare the effect of adjunctive therapy with pregabalin versus usual care (UC) on health-care costs and clinical and patients consequences in generalized anxiety disorder (GAD) subjects with partial response (PR) to a previous selective serotonin reuptake inhibitor (SSRI) course in medical practice in Spain. Methods Post hoc analysis of patients with PR to SSRI monotherapy enrolled in a prospective 6-month naturalistic study was done. PR was defined as a Clinical Global Impression (CGI) scale score ≥3 and insufficient response with persistence of anxiety symptoms ≥16 in the Hamilton Anxiety Rating Scale (HAM-A). Two groups were analyzed: 1) adjunctive therapy (AT) with pregabalin (150–600 mg/day) to existing therapy and 2) UC (switching to a different SSRI or adding another anxiolytic different than pregabalin). Costs included GAD-related health-care resources utilization. Consequences were a combination of psychiatrist-based measurements [HAM-A, CGI, and Montgomery-Asberg Depression Rating Scale (MADRS)] and patientreported outcomes [Medical Outcomes Study Sleep (MOS-sleep) scale, disability (World Health Organization Disability Assessment Schedule II (WHO-DAS II) and quality-of-life (Euro Qol-5D (EQ-5D)]. Changes in both health-care costs and scale scores were compared separately at end-of-trial visit by a general linear model with covariates. Results Four hundred eighty-six newly prescribed pregabalin and 239 UC GAD patients [mean (SD) HAM-A 26.7 (6.9) and CGI 4.1 (0.5)] were analyzed. Adding pregabalin was associated with significantly higher mean (95% CI) score reductions vs. UC in HAM-A [–14.9 (–15.6; –14.2) vs. –11.2 (–12.2; –10.2), p < 0.001] and MADRS [–11.6 (–12.2; –10.9) vs. –7.8 (–8.7; –6.8), p < 0.001]. Changes in all patient-reported outcomes favored significantly patients receiving pregabalin, including quality-of-life gain; 26.4 (24.7; 28.1) vs. 19.4 (17.1; 21.6) in the EQ-VAS, p < 0.001. Health-care costs were significantly reduced in both cohorts yielding similar 6-month costs; €1,565 (1,426; 1,703) pregabalin and €1,406 (1,200; 1,611) UC, p = 0.777. The effect of sex on costs and consequences were negligible. Conclusion In medical practice, GAD patients with PR to SSRI experienced greater consequence improvements with adjunctive therapy with pregabalin versus UC, without increasing healthcare cost. The effect of pregabalin was independent of patient gender. [ABSTRACT FROM AUTHOR]

Background There are doubts on whether patients feel that they have sufficient information for actively participating in clinical decisions. Objective To describe the type of information that patients receive. To determine whether patients consider this information sufficient, and whether it contributes or not to improve clinical safety. To identify the barriers for patient participation in clinical decision making. Study Design Cross-sectional study with 764 patients and 327 physicians. Study Setting and participants Fourteen health centres belonging to three primary care districts and three hospitals in Spain. Principal Findings Just 35.1% (268) (95% CI 32.2, 39.1%) of patients preferred to have the last word in clinical decisions. Age (39 vs. 62%, P < 0.001) and severity of illness (38 vs. 46%, P = 0.002) increased the tendency to take a passive role. In 85.1% (650) (95% CI 83.3, 88.3%) of the cases, patients reported having received sufficient information. Lack of consultation time (29.6%, 95% CI 25.8, 32.5%) and patients' use of Internet or other sources (19.2%, 95% CI 16.4, 22.2%) were identified as new obstacles to doctor-patient communication by the patients. Only 19.6% (64) (95% CI 15.4, 24.2%) of doctors considered that they could intervene to involve patients in the decisions. Discussions and Conclusions The majority of patients prefer the decisions to be made by their doctor, especially those with more severe illnesses, and older patients. Patients are not normally informed about medication interactions, precautions and foreseeable complications. The information provided by general practitioners does not seem to contribute enough to the patient involvement in clinical safety. [ABSTRACT FROM AUTHOR]

Background: A recent meta-analysis suggested evidence for an effect of exposure to ambient air pollutants on risk of certain congenital heart defects. However, few studies have investigated the effects of traffic-related air pollutants with sufficient spatial accuracy. Objectives: We estimated associations between congenital anomalies and exposure to traffic-related air pollution in Barcelona, Spain. Method: Cases with nonchromosomal anomalies (n = 2,247) and controls (n = 2,991) were selected from the Barcelona congenital anomaly register during 1994–2006. Land use regression models from the European Study of Cohorts for Air Pollution Effects (ESCAPE), were applied to residential addresses at birth to estimate spatial exposure to nitrogen oxides and dioxide (NOx, NO2), particulate matter with diameter ≤ 10 μm (PM10), 10–2.5 μm (PMcoarse), ≤ 2.5 μm (PM2.5), and PM2.5 absorbance. Spatial estimates were adjusted for temporal trends using data from routine monitoring stations for weeks 3–8 of each pregnancy. Logistic regression models were used to calculate odds ratios (ORs) for 18 congenital anomaly groups associated with an interquartile-range (IQR) increase in exposure estimates. Results: In spatial and spatiotemporal exposure models, we estimated statistically significant associations between an IQR increase in NO2 (12.2 μg/m3) and coarctation of the aorta (ORspatiotemporal = 1.15; 95% CI: 1.01, 1.31) and digestive system defects (ORspatiotemporal = 1.11; 95% CI: 1.00, 1.23), and between an IQR increase in PMcoarse (3.6 μg/m3) and abdominal wall defects (ORspatiotemporal = 1.93; 95% CI: 1.37, 2.73). Other statistically significant increased and decreased ORs were estimated based on the spatial model only or the spatiotemporal model only, but not both. Conclusions: Our results overall do not indicate an association between traffic-related air pollution and most groups of congenital anomalies. Findings for coarctation of the aorta are consistent with those of the previous meta-analysis. [ABSTRACT FROM AUTHOR]

Objective. The objective of this study was to analyse the performance of the Assessment of SpondyloArthritis International Society (ASAS) criteria for the classification of SpA in early SpA clinics.Methods. We used a cross-sectional study of patients referred to early SpA units within the ESPERANZA programme (a Spanish nationwide health management programme designed to provide excellence in diagnosis and care for early SpA). Patients were eligible if they were <45 years of age and had any of the following: (i) a 2-year history of inflammatory back pain; (ii) back or joint pain with psoriasis, anterior uveitis, radiographic sacroiliitis, family history of SpA or positive HLA-B27; or (iii) asymmetric arthritis. We excluded patients for whom imaging (X-rays/MRI) or HLA-B27 results were not available. We analysed the performance (sensitivity and specificity) of different classification criteria sets, taking the rheumatologist’s opinion as the gold standard.Results. The analysis included 775 patients [mean age 33 (s.d. 7) years; 55% men; mean duration of symptoms 11 (s.d. 6) months]; SpA was diagnosed in 538 patients (69.5%). A total of 274 (67.9%) patients with chronic back pain met the ASAS axial criteria, 76 (56.3%) patients with arthritis but not chronic back pain fulfilled the ASAS criteria for peripheral SpA and 350 (65.1%) fulfilled all the ASAS criteria. The sensitivity and specificity of the ASAS criteria set were 65% and 93%, respectively (axial criteria: sensitivity 68%, specificity 95%). The sensitivity and specificity for the ESSG and Amor criteria were 58% and 90% and 59% and 86%, respectively.Conclusion. Despite performing better than the Amor or ESSG criteria, the ASAS criteria may be limited to detection of early forms, particularly in populations in which MRI is not extensively available or in populations with a low prevalence of HLA-B27. [ABSTRACT FROM PUBLISHER]

Background Neighbourhood characteristics may contribute to differences in physical inactivity. Purpose To evaluate whether the availability of sports facilities helps explain the differences in physical inactivity according to the economic context of the neighbourhood. Methods 6607 participants representative of the population aged 16–74 years, resident in Madrid (Spain) in 2005, were analysed. Using ORs calculated by multilevel logistic regression, the association between per capita income of the neighbourhood of residence and physical inactivity was estimated, after adjusting for age, population density, individual socioeconomic characteristics and the availability of green spaces. The analysis was repeated after further adjustment for the availability of sports facilities to determine if this reduced the magnitude of the association. Results Residents in the neighbourhoods with the lowest per capita income had the highest OR for the prevalence of physical inactivity. In participants aged 16–49 years, after adjusting for the availability of sports facilities, the magnitude of the OR in the poorest neighbourhoods with respect to the richest neighbourhoods increased in men (from 2.22 to 2.35) and declined by 13% in women (from 2.13 to 1.98). In contrast, in the population aged 50–74 years, this adjustment reduced the magnitude of the OR by 21% in men (from 2.00 to 1.80) and by 53% in women (from 2.03 to 1.48). Conclusions The poorest neighbourhoods show the highest prevalence of physical inactivity. The availability of sports facilities explains an important part of this excess prevalence in participants aged 50–74 years, but not in younger individuals. [ABSTRACT FROM AUTHOR]

Objective The study aims to determine the prevalence of undiagnosed comorbid mood disorders in patients suffering chronic musculoskeletal pain in a primary care setting and to identify sleep disturbances and other associated factors in these patients, and to compare the use of health services by chronic musculoskeletal pain patients with and without comorbid mood disorders. Design Cross-sectional study. Subjects A total of 1,006 patients with chronic musculoskeletal pain from a representative sample of primary care centers were evaluated. Outcome Measures Pain was measured using a visual analog scale and the Primary Care Evaluation of Mental Disorders questionnaire was used to measure mood disorders. Results We observed a high prevalence of undiagnosed mood disorders in chronic musculoskeletal pain patients (74.7%, 95% confidence interval [ CI] 71.9-77.4%), with greater comorbidity in women (adjusted odds ratio [ OR] = 1.91, 95% CI 1.37-2.66%) and widow(er)s (adjusted OR = 1.87, 95% CI 1.19-2.91%). Both sleep disturbances (adjusted OR = 1.60, 95% CI 1.17-2.19%) and pain intensity (adjusted OR = 1.02, 95% CI 1.01-1.02%) displayed a direct relationship with mood disorders. Moreover, we found that chronic musculoskeletal pain patients with comorbid mood disorders availed of health care services more frequently than those without ( P < 0.001). Conclusions The prevalence of undiagnosed mood disorders in patients with chronic musculoskeletal pain is very high in primary care settings. Our findings suggest that greater attention should be paid to this condition in general practice and that sleep disorders should be evaluated in greater detail to achieve accurate diagnoses and select the most appropriate treatment. [ABSTRACT FROM AUTHOR]

The effects of bread consumption change over time on anthropometric measures have been scarcely studied. We analysed 2213 participants at high risk for CVD from the PREvención con DIeta MEDiterránea (PREDIMED) trial to assess the association between changes in the consumption of bread and weight and waist circumference gain over time. Dietary habits were assessed with validated FFQ at baseline and repeatedly every year during 4 years of follow-up. Using multivariate models to adjust for covariates, long-term weight and waist circumference changes according to quartiles of change in energy-adjusted white and whole-grain bread consumption were calculated. The present results showed that over 4 years, participants in the highest quartile of change in white bread intake gained 0·76 kg more than those in the lowest quartile (P for trend = 0·003) and 1·28 cm more than those in the lowest quartile (P for trend < 0·001). No significant dose–response relationships were observed for change in whole-bread consumption and anthropometric measures. Gaining weight (>2 kg) and gaining waist circumference (>2 cm) during follow-up was not associated with increase in bread consumption, but participants in the highest quartile of changes in white bread intake had a reduction of 33 % in the odds of losing weight (>2 kg) and a reduction of 36 % in the odds of losing waist circumference (>2 cm). The present results suggest that reducing white bread, but not whole-grain bread consumption, within a Mediterranean-style food pattern setting is associated with lower gains in weight and abdominal fat. [ABSTRACT FROM PUBLISHER]

Background Mortality increases during heat waves have been reported worldwide. The magnitude of these increases can vary within regions according to sociodemographic and urban landscape characteristics. The objectives of this study were to explore this variation and its determinants, and to identify the most heat-vulnerable areas by mapping heat vulnerability. Methods We conducted a time-stratified case-crossover analysis using daily mortality in the Barcelona metropolitan area during the warm seasons of 1999-2006. Temperature data on the date of death were assigned to each individual, which were assigned to their census tract of residence. Eight census tract-level variables on socioeconomic or built environment characteristics were obtained from the census. Residence surrounding greenness was obtained from satellite data. The relative risk (RR) of mortality after three consecutive hot days (defined as those exceeding the 95th percentile of maximum temperature) was calculated via conditional logistic regression. Effect modification was examined by including interaction terms. Results Analyses were based on 52 806 deaths. The effect of three consecutive hot days was a 30% increase in all-cause mortality (RR=1.30, 95% CI 1.24 to 1.38). Heterogeneity of this effect was observed across census tracts. The effect of heat on mortality was higher in the census tracts with a large percentage of old buildings (RR=1.21, 95% CI 1.00 to 1.46), manual workers (RR=1.25, 95% CI 0.96 to 1.64) and residents perceiving little surrounding greenness (RR=1.29, 95% CI 1.01 to 1.65). After three consecutive hot days, mortality doubled in the most heat-vulnerable census tracts. Conclusions Sociodemographic and urban landscape characteristics are associated to mortality risk during heat waves and are useful to build heat vulnerability maps. [ABSTRACT FROM AUTHOR]

Objective: Chronic pain and depression are frequent conditions in primary care patients. Depression is frequently overlooked in the presence of pain of uncertain origin. The aim is to measure the prevalence and clinical correlates of unrecognized comorbid mood disorders and chronic pain of uncertain origin in older primary care patients, and to elucidate the differences with younger adults with the same conditions. Design: Cross-sectional study. Setting: Primary care centres in Spain. Participants: Patients (n= 2720) with persistent pain of uncertain origin. Measurements: Pain characteristics, sites and intensity (Visual Analogical Scales), depression (PRIME-MD interview), clinical characteristics and health services use. Results: We observed a similarly high (80.5%) prevalence of undiagnosed mood disorders (especially major depressive disorders) among older and younger adult patients with comorbid chronic pain complaints of uncertain origin. Older patients suffered pain that was more intense, longer lasting and located in a higher number of different areas, when compared to younger patients. Pain intensity was a factor associated with suffering from mood disorders among patients above 65 years, whilst the number of pain sites was a more important factor among younger patients. Conclusions: Depression is highly associated with pain of uncertain origin in older patients with differences in pain characteristics when compared to younger patients. The robust comorbid relationship between both conditions should alert clinicians to specifically look for depression in the presence of poorly explained painful symptoms. [ABSTRACT FROM AUTHOR]

Objective. Treatment with anthracyclines may cause cardiac dysfunction, but the sequence of anthracycline-induced heart lesions has been incompletely characterized. NADPH oxidase, a key mediator of oxidative cardiac damage and remodeling, modulates anthracycline clinical cardiotoxicity. Our aim was to determine which cardiac histological lesions are specifically induced by anthracycline treatment and to investigate the role of NADPH functional genetic polymorphisms in their development. Patients and Methods. Using a retrospective case-control design, we evaluated cardiac histological lesions and NADPH genotype (polymorphisms rs1883112, rs4673, and rs13058338) in 97 consecutive decedents with a cancer diagnosis (48 treated with anthracyclines). Results. Myocytolysis (60%), patched myocardial necrosis (19%), and myocardial fibrosis (diffuse and patched; 62% and 23%, respectively) were associated with anthracycline treatment. In patients receiving anthracyclines, NADPH oxidase polymorphism rs4673 protected against focal myocardial necrosis (odds ratio [OR], 0.11; 95% confidence interval [CI], 0.20-0.63) whereas rs1883112 was strongly associated with cardiac fibrosis (OR, 5.11; 95% CI, 1.59 -16.43), which was present in all homozygotes. Conclusion. Anthracyclines induce a cardiac remodeling pattern characterized by interstitial or patched fibrosis. The contribution of the functionally relevant NADPH polymorphisms rs1883112 and rs4673 to anthracycline-related heart lesions provides a plausible explanation for their modulation of cardiotoxicity. If confirmed, these findings may lead to better individualized strategies for early detection and prevention of anthracycline cardiotoxicity. [ABSTRACT FROM AUTHOR]

Objective: To contribute to the validation of the revised BMI-MNA-SF and CC- MNA-SF with regard to association and agreement with the full-MNA, considered as gold standard, in nursing homes in Spain. Design: Prospective analysis. Setting: Nursing homes. Participants: Eight hundred ninety five subjects aged 65 or older meeting inclusion criteria. Measurements: Correlation, diagnostic accuracy and agreement between the revised MNA short forms and the MNA full form. Results: The MNA-SFs correlated strongly with the full MNA version (Pearson's correlation coefficient r=0.904; p<0.001). High values of sensitivity, specificity and predictive values were obtained for the BMI- MNA-SF and CC-MNA-SF against the full-MNA when the dichotomized categorizations 'malnourished-at risk of malnutrition' vs 'well nourished' and 'malnourished' vs 'at risk of malnutrition-well nourished' were considered (Youden's index at least 0.695 in all cases). Areas under the ROC curves also reached high values (BMI-SF: 0.950 and CC-SF: 0.923 for the first categorization; BMI-SF: 0.979 and CC-SF: 0.978 for the second one) showing both tests excellent accuracy with the full-MNA. The agreement between the MNA-SFs and the full-MNA was quantified as the percentage of correct classifications. The BMI-MNA-SF classified 83.80% correctly and the CC-MNA-SF classified 78.55% correctly. Significant proportions of subjects were underestimated by both MNA-SFs. Just about 6% of overestimations were found in both cases. Conclusion: The revised BMI-MNA-SF and CC-MNA-SF are rapid, easy and reliable tools capable to identify malnourished individuals and those who are at risk of malnutrition with minimal misclassifications with potential harm in nursing home residents. Due to the special characteristics of elderly staying in these institutions, the CC-MNA-SF is a good option to replace the BMI-MNA-SF when BMI is not available. [ABSTRACT FROM AUTHOR]

Background: Research on women's responses to intimate partner violence (IPV) has largely been limited to women who have been exposed to severe physical violence with scarce generalisation. This study aimed to analyse how Spanish abused women from different backgrounds and with different IPV characteristicsrespond to violence.Method: Women experiencing IPV before the previous year (1469) were selected from a large cross-sectional national survey of adult women recruited during 2006-7among female patients seeking medical care for whatever reason in primary healthcare services. The outcome variables were women's responses to IPV and the predictor variables were personal and social resources profiles and characteristics of the abuse (type,duration and women's age at onset). Stepwise logistic regression models were fitted.Results: 87.5% of abused women took some kind of action to overcome IPV. Significant differences on personal and social profile and type and duration of the abuse were detected between the three strategic responses: distancing, in process and inhibition. The probability of a woman responding with a distancing strategy (seeking outside help or leaving temporarily) is almost three times greater if she is employed, was young when the abuse began, had experienced physical and psychological abuse and when the abuse was under 5 years.Conclusions: The results of this study show that personal and social resources and the specificcircumstances of the abuse should be taken into account to understand women's responses to IPV.Well-validated interventions targeted at abusedwomen's needs and the circumstances of IPV remain a priority. [ABSTRACT FROM AUTHOR]

BACKGROUND: Dozens of studies link acute exposure to particulate matter (PM) air pollution with premature mortality and morbidity, but questions remain about which species and sources in the vast PM mixture are responsible for the observed health effects. Although a few studies exist on the effects of species and sources in U.S. cities, European cities.which have a higher proportion of diesel engines and denser urban populations.have not been well characterized. Information on the effects of specific sources could aid in targeting pollution control and in articulating the biological mechanisms of PM. OBJECTIVES: Our study examined the effects of various PM sources on daily mortality for 2003 through 2007 in Barcelona, a densely populated city in the northeast corner of Spain. METHODS: Source apportionment for PM ≤2.5 μm and ≤10 m in aerodynamic diameter (PM2.5 and PM10) using positive matrix factorization identified eight different factors. Case-crossover regression analysis was used to estimate the effects of each factor. RESULTS: Several sources of PM2.5, including vehicle exhaust, fuel oil combustion, secondary nitrate/organics, minerals, secondary sulfate/organics, and road dust, had statistically significant associations (p <.0.05) with all-cause and cardiovascular mortality. Also, in some cases relative risks for a respective interquartile range increase in concentration were higher for specific sources than for total PM2.5 mass. CONCLUSIONS: These results along with those from our multisource models suggest that traffic, sulfate from shipping and long-range transport, and construction dust are important contributors to the adverse health effects linked to PM. [ABSTRACT FROM AUTHOR]

Previous studies on the association between alcohol intake and the development of the metabolic syndrome (MetS) have yielded inconsistent results. Besides, few studies have analysed the effects of red wine (RW) consumption on the prevalence of the MetS and its components. As moderate RW drinkers have a better lipid profile and lower incidence rates of diabetes, hypertension and abdominal obesity, all components of the MetS, it was hypothesised that moderate RW consumption could be associated with a lower prevalence of the MetS. In the present cross-sectional study of 5801 elderly participants at a high cardiovascular risk included in the PREDIMED (Prevención con Dieta Mediterránea) study, 3897 fulfilled the criteria of the MetS at baseline. RW intake was recorded using a validated 137-item FFQ. Multiple logistic regression analysis was carried out to estimate the association between RW intake and the prevalence of the MetS. Compared with non-drinkers, moderate RW drinkers ( ≥ 1 drink/d) were found to have a reduced risk of prevalent MetS (OR 0·56, 95 % CI 0·45, 0·68; P< 0·001), a lower risk of having an abnormal waist circumference (OR 0·59, 95 % CI 0·46, 0·77; P< 0·001), low HDL-cholesterol concentrations (OR 0·42, 95 % CI 0·32, 0·53; P< 0·001), high blood pressure (OR 0·28, 95 % CI 0·17, 0·45; P< 0·001) and high fasting plasma glucose concentrations (OR 0·67, 95 % CI 0·54, 0·82; P< 0·001) after adjusting for several confounders. This association was found to be stronger in female participants, in participants aged < 70 years and in participants who were former or current smokers. No significant association was found between RW intake ( ≥ 1 drink/d) and TAG concentrations. In conclusion, moderate RW consumption is associated with a lower prevalence of the MetS in an elderly Mediterranean population at a high cardiovascular risk. [ABSTRACT FROM PUBLISHER]