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Background: Incorrect perceptions of high rates of peer alcohol and tobacco use are predictive of increased personal use in student populations. Correcting misperceptions by providing feedback has been shown to be an effective intervention for reducing licit drug use. It is currently unknown if social norms interventions are effective in preventing and reducing illicit drug use in European students. The purpose of this paper is to describe the design of a multi-site cluster controlled trial of a web-based social norms intervention aimed at reducing licit and preventing illicit drug use in European university students., Methods/design: An online questionnaire to assess rates of drug use will be developed and translated based on existing social norms surveys. Students from sixteen universities in seven participating European countries will be invited to complete the questionnaire. Both intervention and control sites will be chosen by convenience. In each country, the intervention site will be the university that the local principal investigator is affiliated with. We aim to recruit 1000 students per site (baseline assessment). All participants will complete the online questionnaire at baseline. Baseline data will be used to develop social norms messages that will be included in a web-based intervention. The intervention group will receive individualized social norms feedback. The website will remain online during the following 5 months. After five months, a second survey will be conducted and effects of the intervention on social norms and drug use will be measured in comparison to the control site., Discussion: This project is the first cross-national European collaboration to investigate the feasibility of a social norms intervention to reduce licit and prevent illicit drug use among European university students. FINAL TRIAL REGISTRATION NUMBER: DRKS00004375 on the 'German Clinical Trials Register'.

The available large prospective studies supporting an inverse association between better adherence to the Mediterranean diet and lower mortality have mainly included older adults. It is not clear whether this inverse association is also present among younger individuals at lower mortality risk. Our aim was to assess the association between adherence to the Mediterranean diet and total mortality in middle-aged adults from the Seguimiento Universidad de Navarra (SUN) Project. We followed 15,535 Spanish university graduates for a mean of 6.8 y. Their mean age was 38 ± 12 y, 59.6% were females, and all were initially free of cardiovascular disease, cancer, and diabetes. A validated FFQ was used to assess dietary habits. Adherence to the Mediterranean diet was categorized into 3 groups according to the Mediterranean Diet Score (low, 0-2 points; moderate, 3-5 points; and high, 6-9 points). The outcome variable was total mortality. Cox proportional hazards models were used to estimate HR and 95% CI. We adjusted the estimates for sex, age, years of university education, BMI, smoking, physical activity, television watching, history of depression and baseline hypertension, and hypercholesterolemia. We observed 125 deaths during 105,980 person-years of follow-up. The fully adjusted HR for moderate and high adherence were 0.58 (95% CI: 0.34, 0.99; P = 0.05) and 0.38 (95% CI: 0.21, 0.70; P = 0.002), respectively. For each 2-point increment in the Mediterranean Diet Score, the HR of death was 0.72 (95% CI: 0.58, 0.91; P = 0.006). Among highly educated, middle-aged adults, adherence to the traditional Mediterranean diet was associated with reduced risk of death.

Objective: Risk factors for differentiated thyroid carcinoma (DTC) are poorly understood, but serum TSH levels, thyroid nodularity, and presence of autoimmunity are well-recognized factors that modulate DTC prevalence. TSH stimulates proliferation of both normal and neoplastic follicular cells. Consequently, thyroid-stimulating immunoglobulins (TSI), because of its TSH-like action, should induce DTC progression in patients with Graves' disease (GD). The study objective was to compare the prevalence of incidental DTC in patients undergoing thyroidectomy for benign thyroid disease., Methods: The pathology reports of 372 patients with preoperative diagnosis of euthyroid multinodular goiter (EMG) or hyperthyroidism were reviewed. Scintigraphy results and serum TSI levels were used to diagnosed either GD or hyperactive MG (HMG) to hyperthyroid subjects. Prevalence of DTC in each category was calculated using a Chi-square test., Results: EMG, GD, and HMG were diagnosed in 221, 125, and 26 patients. There were 58 DTCs, distributed as follows [n (%)]: EMG, 49 (22.2%); GD, 8 (6.4%), and HMG, 1 (3.8%). Difference in prevalence of incidental DTC between the groups was statistically significant (p<0.001). After adjustment for age, patients with EMG had a greater DTC prevalence than GD patients, with an OR of 4.17 (p<0.001). Tumor size (mm, mean ± SD) was 6.92 ± 11.26, 1.97 ± 1.85, and 9.0 for EMG, GD and HMG respectively (p=0.017)., Conclusions: Incidental DTC was less prevalent in GD as compared to EMG irrespective of age. This finding may suggest a predisposition to develop DTC in patients with thyroid nodular disease and/or a potential effect of autoimmunity to protect against development of neoplastic disease., (Copyright © 2011 SEEN. Published by Elsevier Espana. All rights reserved.)

Purpose: To estimate the prevalence and causes of bilateral blindness and visual impairment in an urban institutionalized population aged 65 years and older., Methods: A total of 392 nursing home residents completed a standardized eye examination, including measurement of visual acuity (VA), intraocular pressure, lens opacity grading, indirect ophthalmoscopy, and photography of the macular area. The major causes of vision loss identified for all participants were blindness and visual impairment., Results: The average subject age was 82 years (65-97); women outnumbered men 263 to 129. The prevalence of bilateral blindness (VA > or =1.0 logarithm of the minimum angle of resolution [logMAR]) was 14.9% (43/288); the prevalence of visual impairment (VA > or =0.5 and 1.0 logMAR) was 31.9% (92/288). Blindness and visual impairment increased significantly with age (p<0.05), odds ratio (OR) 1.047 and 1.088, respectively. Cataract was the most common cause of bilateral blindness and visual impairment (27.9% and 44.6%, respectively) followed by pathologic myopia (23.3%) and age-related macular degeneration (AMD) (20.9%) for blindness, and by AMD (27.2%) and pathologic myopia (12%) for visual impairment. Fifty percent of subjects with visual loss had the potential for improved vision with medical or surgical intervention., Conclusions: Although the prevalences were high, these data are important since it is difficult for epidemiologic studies to include aged, institutionalized individuals, although their numbers are increasing. Recognition of the predominant causes of visual loss dependent on age is fundamental for early diagnosis and treatment of ocular diseases. Many cases of low vision can be treated with appropriate ophthalmologic care.

Background and Objective: To evaluate prospectively the association between dietary fat intake and the incidence of cataracts in participants from the SUN cohort., Patients and Methods: Among 12308 men and women, initially free of cataracts and followed-up for up to 6 years, we identified 182 incident cases of cataracts. Fatty acids intake was assessed by a validated 136-item semiquantitative food frequency questionnaire. Socio-demographic and anthropometric characteristics, lifestyle, health-related habits and information about medical conditions were also collected. Incident cases of cataract were ascertained by self-reports using a biennale questionnaire., Results: Participants belonging to the highest category of omega-6 fatty acids intake had a non-significantly reduced risk of cataracts in the model adjusted for potential confounders but not for other fatty acids (adjusted OR: 0.58; 95% CI: 0.33, 1.03). When all types of fatty acids (saturated, monounsaturated, polyunsaturated omega-6 and polyunsaturated omega-3) were included simultaneously in the same multivariable model, this inverse association became significant (adjusted OR: 0.54 95%CI: 0.29, 0.99). There were no significant associations between other dietary fats and the risk of cataracts., Conclusion: High intake of omega-6 fatty acids showed a modest but significant inverse association with the development of cataracts., (Copyright 2009 Elsevier España, S.L. All rights reserved.)

Introduction: This paper presents the results of a study on the psychometric properties of an authorized Spanish version of the McMaster Family Assessment Device, a self-report measure of family functioning., Materials and Methods: The study sample comprised 60 psychiatric patients and their family member and 60 controls, without mental health problems, and their family member., Results: Compared to other studies, all subscales displayed adequate temporal stability and acceptable reliability. While the instrument discriminated well between the two groups of families on all subscales, the results nevertheless indicated limitations in the inter-item discriminant capacity of the "Roles" subscale. Factor analysis resulted in a three-factor model that does not coincide with the established structure of this instrument., Conclusion: Proposals to improve and adapt questionnaire are discussed with a view to make it applicable to cultures other than the one it was developed. Theoretical models relating to psychosocial aspects such as family functioning, albeit compatible in some areas, should be viewed with caution in cultures different to that in which the model originates.

Few studies have focused on the long-term influence of the climate on the prevalence of asthma. The aim of this study is to establish the influence of geo-climatic conditions on the prevalence of asthma symptoms both in adolescents and schoolchildren, and to discover if this influence is associated with their time trends. Eight centres in Spain performed both ISAAC phases I (1994) and III (2002) in children 13-14 years old. Six of them also surveyed children 6-7 years old. For each age group and phase, about 3,000 children were surveyed per centre. This study examines the prevalence of current wheeze and severe current wheeze in two different geo-climatic zones, coast and plateau, considering their relative humidity and temperature range. In both age groups, the mean asthma prevalence on the coast, for phase I and III, was significantly higher than on the plateau. Living on the plateau was an independent protective factor for current wheeze and severe current wheeze for the two age groups. Within the coastal centres, the increase of the annual relative humidity was a statistical significant risk factor for current wheeze, the same trend existing for current severe wheeze. These effects were independent of the sex and of the phase of the study. The prevalence of asthma and severe asthma symptoms is more frequent on the coast of Spain as compared to the inner plateau. This finding was repeated both in 1994 and in 2002.

Purpose: There is evidence to suggest a beneficial effect of physical activity on several mental disorders., Methods: The study aim was to assess the association between low physical activity during leisure time (or sedentary lifestyles) and the incidence of mental disorders in 10,381 participants, from a Spanish dynamic prospective cohort of university graduates followed up for 6 yr (the SUN study). The baseline assessment included a validated questionnaire on physical activity during leisure-time and sedentary activities. A subject was classified as an incident case of mental disorder if he or she reported a physician diagnosis of depression, anxiety or stress, and/or the use of antidepressant medication or tranquilizers in at least one of the follow-up questionnaires., Results: The odds ratios (OR) and 95% confidence intervals (CI) of a mental disorder for successive levels of leisure-time physical activity were 1 (reference), 1.00 (0.81, 1.23), 0.99 (0.81, 1.21), 0.72 (0.58, 0.89), and 0.81 (0.65, 1.00) (P for trend: < 0.01). The OR for subjects who spent more than 42 h.wk(-1) watching television and/or using the computer was 1.31 (95% CI = 1.01, 1.68) as compared with those spending less than 10.5 h.wk(-1)., Conclusion: Our findings suggest a joint association of leisure-time physical activity and sedentary behavior on the incidence of mental disorders.

Objective: [corrected] To describe the results obtained for circularvection times (tCV) in a study of the phenomenon of visual-vestibular interaction for a population with vestibular pathology and to analyze differences in its calculation among patients reporting a worsening of their symptoms with visual stimuli., Material and Methods: A detailed case history was taken for all patients, followed by a sensory organization test using computerized dynamic posturography and the calculation of their tCV., Results: The mean tCV results were: tCV2= 6.32+/-3.17 s; tCV3=6.57+/-3.68 s; tCVr=6.27+/-6.02 s. Significant differences were obtained in tCV2 (P=.046) and tCVr (P=.023)., Conclusions: tCV is a diagnostic test using simple tools that can help differentiate patients in whom the visual stimulus is influenced.

Due to changes in the age structure of the population the number of frail elderly diabetics is rising. This change is accompanied by an increase in nursing care efforts and requirements in both home care services and nursing homes. The aim of this study was to evaluate the quality of care in the home care and nursing home setting concerning the structure, the process and the outcome quality at the institutional and patient level. This is an observational transversal study. At the institutional level a standardised questionnaire of the German Diabetes Research Institute was sent to all nursing homes (37) and home care services (88) in Dresden. At the patient level 37 homebound patients and 46 residents were recruited. A Geriatric assessment and a clinical examination were performed and a blood sample was analysed. Patients with moderate or severe cognitive impairment were excluded. The prevalence of diabetes in home care services was 27.2% and in nursing homes 36.1%. The participation rate among the institutions was 21.6% (n = 27). In 14% (n = 12) of the diabetic patients the HbA1c was above 8% (poor metabolic control) and in 24% (20) it was between 7% and 8% (regular metabolic control). 56.6% (n = 21) of the homebound elderly diabetics and 46.7% (n = 21) of the nursing home residents with diabetes were hospitalized at least once during the last 12 months. Our study showed a high prevalence of diabetes in both types of institutions in Dresden and a high hospitalisation rate of the elderly diabetics, although 62% of the patients had an optimum metabolic control. These facts indicate that the quality of care of frail elderly diabetics concerning the multimorbidity might be further improved.

Background: Current scientific knowledge upholds the possibility of considering a cause-effect relationship to exist between the degree of physical activity and the onset of different diseases. Des pite this, physical activity is not a very well-rooted practice among the population, which is progressively becoming more sedentary. This study is aimed at describing the prevalence of sedentarism among the population of Pamplona, as well as ascertaining what factors have the greatest bearing thereon., Methods: A cross-sectional study was conducted by means of a postal survey on a significant sample of the age 18-65 population of Pamplona. The survey used included an evaluation of the degree of physical activity based on the Paffenbarger physical activity questionnaire. A bivariate and multivariate analysis was made using logic regression., Results: A total of 76.6% of the females have a sedentary lifestyle, whilst this percentage drops to 56.7% among males. Sedenta rism increases with age, up to 80.3% of males and 86.3% of females being respectively sedentary in the oldest age group., Conclusions: The sociodemographic factors such as sex, age, formal education, occupation and marital status seem to be determi ning factors of the sedentary lifestyle, while smoking and being overweight or obese are not. Among the young, the females not having a college education and married men who are smokers seem to be target populations for promoting physical activity.

Background and Objective: Recent approval of docetaxel in combination with cisplatin (DP) for non-small cell lung cancer (NSCLC) treatment means that an assessment of its effectiveness and toxicity is necessary. The aim of this study was to evaluate docetaxel/cisplatin combination versus other cisplatin-based regimens as the front-line treatment of metastatic or locally advanced NSCLC., Material and Method: We searched randomized and controlled phase III clinical trials comparing DP versus other cisplatin combinations. Patients had to be diagnosed of advanced NSCLC and had not previously received chemotherapy.A meta-analysis was performed using the Mantel-Haenzel method. Antitumoral activity and adverse events were both evaluated. We also made a heterogeneity test and determined the NNT Index (Number Needed to Treat) for two-year survival., Results: We found three clinical trials that fulfilled our criteria. Results showed significant enhanced two-year survival for DP (11-47% higher than others), but a greater incidence of diarrhea (odds ratio [OR] = 2.525; confidence interval 95% [CI], 1.697-3.756]). Heterogeneity was significant for response, anemia and thrombopenia. NNT was 17 patients for two-year survival., Conclusions: DP is a good option in first-line therapy of advanced NSCLC. The two-year survival is significantly longer and its toxic profile similar to other treatments, except for diarrhea.

Background: The demand placed on both hospital as well as extrahospital emergency care units currently continues to increase at a growing rate. This study has a twofold objective: the quantification and study of the personal characteristics of the users who are demanding emergency care and assessing whether televised soccer games have any bearing on the utilization of emergency care services., Methods: A longitudinal descriptive study (9,723 users demanding care) and study of cases and controls (1,284 users demanding care) according to whether or not a soccer game was being televised by means of a logistic regression model. The associations were quantified by means of the odds ratio (OR). Those dealt with by telephone or in infirmaries were not included in the study., Results: A total 10.6% of the demand involved home visits, 4.8% of this total having been sent to hospital. A total 13.3% of the demand corresponds to individuals visiting from other healthcare districts, a total of 65 being overusers of emergency care (8 or more visits). The month of August (32.3%). Sundays (44.56%) and the 12:00 p.m.-2:00 p.m. timeframe (8.38%) are the times when the greatest demand for care occurs, the differences being statistically significant. Televised soccer games were associated to a 19.8% (p < 0.001) rise in demand as compared to the control period., Conclusions: A high degree of use of the extrahospital emergency care units has been found to exist, a major part of the demand being concentrated at highly specific points in time. A major degree of care is provided to those visiting from outside their own healthcare districts. Television soccer game broadcasts is associated with the greater utilization of the emergency care services.

Background and Objective: In Spain there is a lack of specific instruments for the evaluation of deviance of the body image in adolescents. The aim of this research was to design and to validate a specific instrument for the evaluation of adolescent body dissatisfaction., Subjects and Method: We carried out 6 studies utilizing 2 samples of 91 and 569 school adolescents aged 12 to 19 years. In studies 1, 2 and 3 we designed a questionnaire with items selected from the bibliography to analyze the discriminate power. In studies 4, 5 and 6, various indexes of reliability and validity were calculated and scores were typified., Results: The eventual questionnaire was made up of 32 items with 6 categories of responses. The reliability for the scale was: Cronbach's alpha for the whole sample, 0.91 (from 0.66 in the group of boys aged 17-19 years to 0.93 in the group of girls aged 14-16 years). The concurrent validity led to indexes between 0.67 and 0.89 using other instruments, and the factorial analysis showed 4 factors explaining 50.3% of the variance., Conclusions: Our research provides a new instrument for the evaluation of body dissatisfaction. This instrument is designed specifically for adolescents and has a good reliability and validity when compared to other available instruments.