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Background: Choline and betaine intakes have been related to cardiovascular health. Objectives: We aimed to explore the relation between 1-y changes in dietary intake of choline or betaine and 1-y changes in cardiometabolic and renal function traits within the frame of the PREDIMED (PREvención con DIeta MEDiterránea)-Plus trial. Methods: We used baseline and 1-y follow-up data from 5613 participants (48.2% female and 51.8% male; mean ± SD age: 65.01 ± 4.91 y) to assess cardiometabolic traits, and 3367 participants to assess renal function, of the Spanish PREDIMEDPlus trial. Participants met ≥3 criteria of metabolic syndrome and had overweight or obesity [BMI (in kg/m2) ≥27 and ≤40]. These criteria were similar to those of the PREDIMED parent study. Dietary intakes of choline and betaine were estimated from the FFQ. Results: The greatest 1-y increase in dietary choline or betaine intake (quartile 4) was associated with improved serum glucose concentrations (−3.39 and −2.72 mg/dL for choline and betaine, respectively) and HbA1c levels (−0.10% for quartile 4 of either choline or betaine intake increase). Other significant changes associated with the greatest increase in choline or betaine intake were reduced body weight (−2.93 and −2.78 kg, respectively), BMI (−1.05 and −0.99, respectively), waist circumference (−3.37 and −3.26 cm, respectively), total cholesterol (−4.74 and −4.52 mg/dL, respectively), and LDL cholesterol (−4.30 and −4.16 mg/dL, respectively). Urine creatinine was reduced in quartile 4 of 1-y increase in choline or betaine intake (−5.42 and −5.74 mg/dL, respectively). Conclusions: Increases in dietary choline or betaine intakes were longitudinally related to improvements in cardiometabolic parameters. Markers of renal function were also slightly improved, and they require further investigation. This trial was registered at https://www.isrctn.com/ as ISRCTN89898870. Am J Clin Nutr 2022;116:1565–1579., Ministerio de Ciencia e Innovacion through Proyectos de I+D+i "Retos Investigacion" RTI2018-095569-B-I00 Ministerio de Ciencia e Innovacion through Programacion Conjunta Internacional PCI2018-093009, European Research Council (ERC) European Commission 20142019 340918, CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III (ISCIII), through the Fondo de Investigacion para la Salud (FIS) - European Regional Development Fund PI13/00673 PI13/00492 PI13/00272 PI13/01123 PI13/00462 PI13/00233 PI13/02184 PI13/00728 PI13/01090 PI13/01056 PI14/01722 PI14/00636 PI14/00618 PI14/00696 PI14/01206 PI14/01919 PI14/00853 PI14/01374 PI14/00972 PI14/00728 PI14/01471 PI16/00473, A Instituto de Salud Carlos III (ISCIII), through the Fondo de Investigacion para la Salud (FIS) - European Regional Development Fund PI16/00662 PI16/01873 PI16/01094 PI16/00501 PI16/00533 PI16/00381 PI16/00366 PI16/01522 PI16/01120 PI17/00764 PI17/01183 PI17/00855 PI17/01347 PI17/00525 PI17/01827 PI17/00532 PI17/00215 PI17/01441, The Instituto de Salud Carlos III (ISCIII), through the Fondo de Investigacion para la Salud (FIS) - European Regional Development Fund PI17/00508 PI17/01732 PI17/00926 PI19/00957 PI19/00386 PI19/00309 PI19/01032 PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, PI19/01332, PI20/01802, PI20/00138 PI20/01532 PI20/00456 PI20/00339 PI20/00557 PI20/00886 PI20/01158, Especial Action Project "Implementacion y evaluacion de una intervencion intensiva sobre la actividad fisica Cohorte PREDIMED-Plus", Recercaixa grant 2013ACUP00194, ICREA (Catalan Institution for Research and Advanced Studies) under the ICREA Academia program SEMERGEN grant, Government of Navarra Department of Health 61/2015, Fundacio La Marato de TV3 grant 201630.10, AstraZeneca T2D 2017, Junta de Andalucia PI0458/2013 PS0358/2016 PI0137/2018, Center for Forestry Research & Experimentation (CIEF), European Commission PROMETEO/2017/017, Balearic Islands Government 35/2011, Spanish Ministerio de Ciencia e Innovacion y Ministerio de Universidades Spanish State Research Agency Juan de la Cierva Program FJC2018-038168-I

The potential role of the lipidome in atrial fibrillation (AF) development is still widely unknown. We aimed to assess the association between lipidome profiles of the Prevención con Dieta Mediterránea (PREDIMED) trial participants and incidence of AF. We conducted a nested case–control study (512 incident centrally adjudicated AF cases and 735 controls matched by age, sex, and center). Baseline plasma lipids were profiled using a Nexera X2 U-HPLC system coupled to an Exactive Plus orbitrap mass spectrometer. We estimated the association between 216 individual lipids and AF using multivariable conditional logistic regression and adjusted the p values for multiple testing. We also examined the joint association of lipid clusters with AF incidence. Hitherto, we estimated the lipidomics network, used machine learning to select important network-clusters and AF-predictive lipid patterns, and summarized the joint association of these lipid patterns weighted scores. Finally, we addressed the possible interaction by the randomized dietary intervention.Forty-one individual lipids were associated with AF at the nominal level (p per+1SD of 1.32 (95% confidence interval: 1.16–1.51; p Current Controlled Trials number, ISRCTN35739639.

En la asignatura Matemática para las carreras con perfiles de ciencia y técnica, se incluye el estudio de las ecuaciones diferenciales ordinarias de primer y segundo orden y su aplicación a la solución de ejercicios y problemas, contenido de enseñanza con elevadas exigencias para el aprendizaje de los estudiantes por cuanto deben integrar varios sistemas de conocimientos y habilidades estudiados con antelación. Es objetivo de este ensayo valorar didácticamente las potencialidades del estudio de las ecuaciones diferenciales para la formación integral de los futuros profesionales de las ciencias. El enfoque se sustenta en la perspectiva de la enseñanza por problemas y la aplicación integrada de habilidades matemáticas generalizadas; se ofrecen ejemplos y reflexiones teórico-metodológicas orientadoras.

Mediante instrumentos evaluativos se ha constatado que en la provincia Ciego de Ávila existen estudiantes con dificultades en el aprendizaje de la Matemática, debido a insuficiencias en la integración de las habilidades matemáticas. A partir de antecedentes científicos generados en el proyecto de investigación “La integración de las habilidades matemáticas en la provincia de Ciego de Ávila” relacionados con los fundamentos teóricos metodológicos y con el diagnóstico, se presenta una concepción didáctica para aplicar integradamente las habilidades matemáticas. Su objetivo es socializar una concepción didáctica para la aplicación integrada de las habilidades matemáticas en la solución de ejercicios y problemas.

Se evaluó el efecto de factores ambientales y de manejo del pastoreo sobre la producción de forraje y leche en praderas de alfalfa en el centro de México durante el 2009 al 2011. Se analizaron registros de la composición de sólidos de leche (grasa+proteína+lactosa) y producción de leche; en la pradera, la composición química, la materia seca de forraje (MS) ofrecida (MFO), tasa de acumulación de forraje (TAF), carga animal (CA) y otras variables.La información ambiental para el sitio se obtuvo de bases de datos por percepción remota. Del 2009 al 2011 el área de pastoreo fue creciente y el nivel de suplementación decreciente, resultando en una producción de: 17.3, 14.7 y 13.5 t MS ha-1año-1, utilización de la pradera de 75, 71 y 73%, CA de 3.7, 3.1 y 2.7 vacas ha-1, producción de leche de 19290, 13419 y 12563 kg ha-1 año-1 y sólidos de leche de 2409, 1638 y 1554 kg ha-1 año-1. Por regresión múltiple, los días de descanso y la temperatura nocturna explicaron la TAF. La temperatura diurna y la CA explicaron la MFO; la producción de leche dependió de la TAF, temperatura diurna y energía del alimento; los sólidos totales de la MFD y la energía del alimento. La estrategia de suplementación debe apoyar de octubre a abril, donde la TAF está por debajo del promedio, además la masa de forraje residual debe ser de 400 a 500 kg de MS ha-1 para maximizar la TAF en el siguiente ciclo de pastoreo.

The current study aims to examine the influence of personality traits (alternative Zuckerman model) and driving anger in the explanation of risky driving style in individuals convicted for road safety offences (N = 245), using as a basis an adaptation of the context-mediated model. This is a transversal, descriptive study designed to be implemented by means of surveys, in which took part 245 men convicted of road safety offences from five prisons in Galicia (a region in northwestern Spain) took part. The average age of the participants was 38.73 years (Sx-9.61), with a range between 18 and 64 years. All participants had three or more years of driving experience. Our data shows that the Impulsive-Sensation Seeking (Imp-SS) personality trait had a direct and positive effect on dangerous driving, while the Activity (Act) trait had a direct but negative effect. The Aggression-Hostility (Agg-Host) trait, in turn, influenced the risky driving style, but not directly, but by raising driving anger levels, so it acted as a powerful mediator between the Aggression-Hostility (Agg-Hos) trait and the risky driving style. In general, our research partially replicates and expands previous findings regarding the model used, the aggression-hostility personality trait (Agg-Host) was placed in the distal context, driving anger in the proximal context, while age and personality traits Activity (Act) and Impulsive-Sensation Seeking (Imp-SS) were direct predictors. The results of this study may have practical implications for the detection and rehabilitation of offenders and penalties for road safety offences.

Each year, 1.35 million people worldwide die due to Road Traffic Injuries (RTI), highlighting the need for further research. The risk of RTI is usually estimated as the number of casualties divided by the level of exposure in a population. Identifying the most appropriate exposure measures is one of the most important current challenges in this field. This paper presents an analysis of exposure measures used in empirical studies on road accidents. The results show a large variability in the exposure measures used, ranging from more general measures (such as population figures or vehicle fleet) to more specific measures related to mobility (such as number of trips, distances or travel time). A comparison of the risk patterns found shows that there is a partial consensus on the profiles with the highest risk of road traffic injuries. In conclusion, there is a need for the international standardization of criteria and data to be recorded, at least injury severity and measures of exposure to mobility, as the travel time disaggregated by socio-demographic variables and mode of transport. Such data would provide higher-quality results on risk profiles and facilitate the implementation of more effective, knowledge-based road safety policies.

The role of gender and age in the risk of Road Traffic Injury (RTI) has not been fully explored and there are still significant gaps with regard to how environmental factors, such as road type, affect this relationship, including mobility as a measure of exposure. The aim of this research is to investigate the influence of the environmental factor road type taking into account different mobility patterns. For this purpose, a cross-sectional study was carried out combining two large databases on mobility and traffic accidents in Andalusia (Spain). The risk of RTI and their severity were estimated by gender and age, transport mode and road type, including travel time as a measure of exposure. Significant differences were found according to road type. The analysis of the rate ratio (Ratemen/Ratewomen), regardless of age, shows that men always have a higher risk of serious and fatal injuries in all modes of transport and road types. Analysis of victim rates by gender and age groups allows us to identify the most vulnerable groups. The results highlight the need to include not only gender and age but also road type as a significant environmental factor in RTI risk analysis for the development of effective mobility and road safety strategies.

OBJECTIVES: Psychological and educational interventions for the prevention of depression have a small-to-moderate effect. However, little is known about their effectiveness in the workplace. We aimed to evaluate the effectiveness of such interventions through a systematic review and meta-analysis of randomized controlled trials (RCT). METHODS: We searched PubMed, PsycINFO, EMBASE, CENTRAL, CIS-DOC and Open Grey for RCT. Search was supplemented with manual searches of reference lists of relevant meta-analyses and trials. We included RCT that assessed either the incidence of depression or the reduction of depressive symptoms, which excluded participants with baseline depression. Measurements were required to have been made using validated instruments and participants recruited in the workplace. Independent evaluators selected studies, evaluated risk bias (Cochrane Collaboration’s tool) and extracted from RCT. The combined OR was estimated using the fixed-effects model. Heterogeneity was measured by I^2 and Cochrane’s Q. RESULTS: Of the 1963 abstracts reviewed, 69 were selected for review in fulltext. Only three RCT met our inclusion criteria, representing 1246 workers from three different countries and continents. The combined odds ratio was 0.25 [95% confidence interval (CI) 0.11–0.60, P=0.002]; I^2=0% and Q=0.389 (P=0.823). The risk of bias was low in one RCT and moderate and high in the other two, respectively. CONCLUSION: Psychological or educational interventions in the workplace may prevent depression, although the quality of evidence was low.

Background The identification of risk groups for road traffic injuries (RTI) is essential for effective prevention strategies. This information is still limited in several geographical areas. The aim of this study was to evaluate the risk of RTI according to gender, age, mode of transport, type of journey and injury severity in a Southern European region. Methods A cross-sectional study was conducted during the period from January 2008 to December 2013 in Andalusia (South of Spain). We estimated the specific morbidity rates by gender, mode of transport and age. The relative risk assessment was performed by Poisson regression models adjusted by gender, age, type of journey, injury severity and mode of transport. The measure of exposure was person − hours travelled. Results Except for pedestrians, the highest RTI rates were found in women. This pattern was still fulfilled in minor injuries. In serious and fatal injuries, the trend was reversed with the risk of increased RTI in men. The most hazardous mode of transport was motorcycles, while public transport was the safest. Injury severity was positively associated with age for all modes of transport, except motorcycles where the opposite was the case. Finally, the risk of serious or fatal injury was greater in long-distance trips. Conclusions In our Southern European region, preventive strategies should be targeted in men, young and older people, motorcycles and long-distance drivers, as they present a higher risk of serious and fatal injuries.

Aims The aim of this study was to evaluate the effect of the Mediterranean diet (MedDiet) on the incidence of heart failure (HF), a pre-specified secondary outcome in the PREDIMED (PREvencion con DIeta MEDiterranea) primary nutrition-intervention prevention trial. Methods and results Participants at high risk of cardiovascular disease were randomly assigned to one of three diets: MedDiet supplemented with extra-virgin olive oil (EVOO), MedDiet supplemented with nuts, or a low-fat control diet. Incident HF was ascertained by a Committee for Adjudication of events blinded to group allocation. Among 7403 participants without prevalent HF followed for a median of 4.8 years, we observed 29 new HF cases in the MedDiet with EVOO group, 33 in the MedDiet with nuts group, and 32 in the control group. No significant association with HF incidence was found for the MedDiet with EVOO and MedDiet with nuts, compared with the control group [hazard ratio (HR) 0.68; 95% confidence interval (CI) 0.41–1.13, and HR 0.92; 95% CI 0.56–1.49, respectively]. Conclusion In this sample of adults at high cardiovascular risk, the MedDiet did not result in lower HF incidence. However, this pre-specified secondary analysis may have been underpowered to provide valid conclusions. Further randomized controlled trials with HF as a primary outcome are needed to better assess the effect of the MedDiet on HF risk. Trial registration: ISRCTN35739639.

The objective of this study was to evaluate the prospective associations between dietary glycemic index (GI) and glycemic load (GL) and the risk for invasive breast cancer incidence in postmenopausal women at high cardiovascular disease (CVD) risk. This study was conducted within the framework of the PREvención con DIeta MEDiterránea (PREDIMED) study, a nutritional intervention trial for primary cardiovascular prevention. We included 4010 women aged between 60 and 80 years who were initially free from breast cancer but at high risk for CVD disease. Dietary information was collected using a validated 137-item food frequency questionnaire. We assigned GI values using the International Tables of GI and GL values. Cases were ascertained through yearly consultation of medical records and through consultation of the National Death Index. Only cases confirmed by results from cytology tests or histological evaluation were included. We estimated multivariable-adjusted hazard ratios for invasive breast cancer risk across tertiles of energy-adjusted dietary GI/GL using Cox regression models. We repeated our analyses using yearly repeated measures of GI/GL intakes. No associations were found between baseline dietary GI/GL and invasive breast cancer incidence. The multivariable hazard ratio and 95% confidence interval (CI) for the top tertile of dietary GI was 1.02 (95% CI: 0.42-2.46) and for dietary GL was 1.00 (95% CI: 0.44-2.30) when compared with the bottom tertile. Repeated-measures analyses yielded similar results. In sensitivity analyses, no significant associations were observed for women with obesity or diabetes. Dietary GI and GL did not appear to be associated with an increased risk for invasive breast cancer in postmenopausal women at high CVD risk.

[Background]: Inflammation is known to be related to the leading causes of death including cardiovascular disease, several types of cancer, obesity, type 2 diabetes, depression-suicide and other chronic diseases. In the context of whole dietary patterns, the Dietary Inflammatory Index (DII®) was developed to appraise the inflammatory potential of the diet. [Objective]: We prospectively assessed the association between DII scores and all-cause mortality in two large Spanish cohorts and valuated the consistency of findings across these two cohorts and results published based on other cohorts., [Design]: We assessed 18,566 participants in the “Seguimiento Universidad de Navarra” (SUN) cohort followed-up during 188,891 person-years and 6790 participants in the “PREvencion con DIeta MEDiterránea” (PREDIMED) randomized trial representing 30,233 person-years of follow-up. DII scores were calculated in both cohorts from validated FFQs. Higher DII scores corresponded to more proinflammatory diets. A total of 230 and 302 deaths occurred in SUN and PREDIMED, respectively. In a random-effect meta-analysis we included 12 prospective studies (SUN, PREDIMED and 10 additional studies) that assessed the association between DII scores and all-cause mortality., [Results]: After adjusting for a wide array of potential confounders, the comparison between extreme quartiles of the DII showed a positive and significant association with all-cause mortality in both the SUN (hazard ratio [HR] = 1.85; 95% CI: 1.15, 2.98; P-trend = 0.004) and the PREDIMED cohort (HR = 1.42; 95% CI: 1.00, 2.02; P-trend = 0.009). In the meta-analysis of 12 cohorts, the DII was significantly associated with an increase of 23% in all-cause mortality (95% CI: 16%–32%, for the highest vs lowest category of DII)., [Conclusion]: Our results provide strong and consistent support for the hypothesis that a pro-inflammatory diet is associated with increased all-cause mortality. The SUN cohort and PREDIMED trial were registered at clinicaltrials.gov as NCT02669602 and at isrctn.com as ISRCTN35739639, respectively., Supported by the official funding agency for biomedical research of the Spanish Government, Instituto de Salud Carlos III (ISCIII), through grants provided to research networks specifically developed for the trial (RTIC G03/140, to R.E.; RTIC RD 06/0045, to Miguel A. Martínez-González) and through Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERobn), and by grants from Centro Nacional de Investigaciones Cardiovasculares (CNIC 06/2007), Fondo de Investigación Sanitaria–Fondo Europeo de Desarrollo Regional (Proyecto de Investigación (PI) 04-2239, PI 05/2584, CP06/00100, PI07/0240, PI07/1138, PI07/0954, PI 07/0473, PI10/01407, PI10/02658, PI11/01647, P11/02505, PI13/00462, PI13/00615, PI13/01090, PI14/01668, PI14/01798, PI14/01764), Ministerio de Ciencia e Innovación (Recursos y teconologia agroalimentarias(AGL)-2009-13906-C02 and AGL2010-22319-C03 and AGL2013-49083-C3-1- R), Fundación Mapfre 2010, the Consejería de Salud de la Junta de Andalucía (PI0105/2007), the Public Health Division of the Department of Health of the Autonomous Government of Catalonia, Generalitat Valenciana (Generalitat Valenciana Ayuda Complementaria (GVACOMP) 06109, GVACOMP2010-181, GVACOMP2011-151), Conselleria de Sanitat y, PI14/01764 AP; Atención Primaria (CS) 2010-AP-111, and CS2011-AP-042), and Regional Government of Navarra (P27/2011).). Drs. Shivappa and Hébert were supported by grant number R44DK103377 from the United States National Institute of Diabetes and Digestive and Kidney Diseases.

OBJECTIVE There is very little information available about the characteristics of drivers convicted for traffic offences. The objective of this study was to perform a comparative analysis of the psychosocial characteristics of Spanish prison inmates convicted of road traffic offences (CRTOs), drivers serving a prison sentence for other types of offence (DCOOs), and drivers with no criminal record (DNCRs), in order to identify the psychosocial predictors associated with RTOs. Methods The study sample comprised 434 male participants divided into three groups: CRTO (n = 240); DCOO (n = 85); and DNCR (n = 105). Instruments included an interview on sociodemographic data, driving behaviour, and past offences, as well as a set of tests to evaluate personality traits (ZKPQ-50CC), driving-related aspects (MDSI-S and DAS), and alcohol dependence (AUDIT). Results A logistic regression analysis showed the following to be reliable predictors of RTOs: low education level (p 8 (p Conclusions The results obtained have significant practical implications for designing and implementing traffic offenders programmes. Language: en

Significant changes have been applied to the regulation of criminal law concerning road traffic in Spain, in a similar way to many of the countries surrounding us. This has led to a gradual increase in the number of individuals who are convicted with custodial sentences or sentenced to community service. Nevertheless, the available data on the psychosocial traits of road traffic offence convicts is highly limited. The objective of this qualitative study is to provide more insight into those convicted of road traffic offences through the use of focus groups, thus enabling the analysis of their attitudes towards sentences related to road safety offences, opinions regarding their driving styles, the profile of convicts of road traffic offences and how they feel about being labelled as delinquents. The results of this study are particularly relevant with regards to improving the rehabilitation process of convicts of road safety offences.

ResumenObjetivosDescribir el entorno psicosocial de los profesionales sanitarios de la sanidad pública en atención primaria y hospitalaria, compararlo con el de la población asalariada española y valorar el efecto de los factores de riesgos psicosociales sobre síntomas relacionados con el estrés percibido.DiseñoEstudio observacional transversal, con muestreo aleatorio estratificado.EmplazamientoTrabajadores de atención sanitaria de la provincia de Granada, distribuidos en 5 centros hospitalarios y 4 distritos sanitarios.ParticipantesSe invitó a 738 empleados (personal facultativo y de enfermería) del Servicio Andaluz de Salud (SAS).Mediciones principalesCuestionario CopSoQ/Istas21, desarrollado para el análisis del ambiente psicosocial en el trabajo de forma multidimensional. Los síntomas de estrés se midieron con el cuestionario Stress Profile.ResultadosLa tasa de respuesta fue del 67,5%. En comparación con la población laboral española, nuestra muestra mostró altos niveles de exigencias psicológicas cognitivas, emocionales y sensoriales, posibilidades de desarrollo personal y sentido de su trabajo. El personal facultativo de atención primaria es el que presenta un ambiente psicosocial más desfavorable, aunque todos los grupos mostraron niveles elevados de síntomas relacionados con el estrés percibido. El análisis multivariante mostró que las variables asociadas con el estrés percibido fueron menor edad y posibilidades de relación social, el conflicto de rol, y mayores exigencias psicológicas emocionales e inseguridad en el trabajo.ConclusionesNuestros hallazgos muestran que el ambiente psicosocial de los trabajadores sanitarios difiere del de la población asalariada española, siendo más desfavorable en el colectivo de facultativos/as de atención primaria.AbstractObjectiveTo describe the psychosocial environment of health professionals in public health in primary and hospital care, and compare it with that of the general Spanish working population, as well as to evaluate the effect of psychosocial risk factors on symptoms related to perceived stress.DesignCross-sectional study with stratified random sampling.SettingHealth care workers in the province of Granada, distributed in 5 hospitals and 4 health districts.ParticipantsA total of 738 employees (medical and nursing staff) of the Andalusian Health Service (SAS) were invited to take part.Main measurementsCopSoQ/Istas21 questionnaire developed for the multidimensional analysis of the psychosocial work environment. Stress symptoms were measured with the Stress Profile questionnaire.ResultsThe response rate was 67.5%. Compared with the Spanish workforce, our sample showed high cognitive, emotional, and sensory psychological demands, possibilities for development and sense of direction in their work. Primary care physicians were the group with a worse psychosocial work environment. All the groups studied showed high levels of stress symptoms. Multivariate analysis showed that variables associated with high levels of stress symptom were younger and with possibilities for social relations, role conflict, and higher emotional demands, and insecurity at work.ConclusionsOur findings support that the psychosocial work environment of health workers differs from that of the Spanish working population, being more unfavorable in general practitioners.

Background: Substantial evidence suggests that consuming 1-2 servings of fish per week, particularly oily fish (e.g., salmon, herring, sardines) is beneficial for cardiovascular health due to its high n-3 polyunsaturated fatty acid content. However, there is some concern that the mercury content in fish may increase cardiovascular disease risk, but this relationship remains unclear. Methods: The PREDIMED trial included 7477 participants who were at high risk for cardiovascular disease at baseline. In this study, we evaluated associations between mercury exposure, fish consumption and cardiovascular disease. We randomly selected 147 of the 288 cases diagnosed with cardiovascular disease during follow-up and matched them on age and sex to 267 controls. Instrumental neutron activation analysis was used to assess toenail mercury concentration. In-person interviews, medical record reviews and validated questionnaires were used to assess fish consumption and other covariates. Information was collected at baseline and updated yearly during follow-up. We used conditional logistic regression to evaluate associations in the total nested case-control study, and unconditional logistic regression for population subsets. Results: Mean (+/- SD) toenail mercury concentrations (mu g per gram) did not significantly differ between cases (0.63 (+/- 0.53)) and controls (0.67 (+/- 0.49)). Mercury concentration was not associated with cardiovascular disease in any analysis, and neither was fish consumption or n-3 fatty acids. The fully-adjusted relative risks for the highest versus lowest quartile of mercury concentration were 0.71 (95% Confidence Interval [CI], 0.34, 1.14; p(trend) = 0.37) for the nested case-control study, 0.74 (95% CI, 0.32, 1.76; p(trend) = 0.43) within the Mediterranean diet intervention group, and 0.50 (95% CI, 0.13, 1.96; p(trend) = 0.41) within the control arm of the trial. Associations remained null when mercury was jointly assessed with fish consumption at baseline and during follow-up. Results were similar in different sensitivity analyses. Conclusions: We found no evidence that mercury exposure from regular fish consumption increases cardiovascular disease risk in a population of Spanish adults with high cardiovascular disease risk and high fish consumption. This implies that the mercury content in fish does not detract from the already established cardiovascular benefits of fish consumption., This study was funded by the Spanish Ministry of Health (ISCIII), PI1001407, Thematic Network G03/140, RD06/0045, FEDER (Fondo Europeo de Desarrollo Regional), and the Centre Catala de la Nutricio de l'Institut d'Estudis Catalans. The Fundacion Patrimonio Comunal Olivarero and Hojiblanca SA (Malaga, Spain), California Walnut Commission (Sacramento, CA), Borges SA (Reus, Spain) and Morella Nuts SA (Reus, Spain) donated the olive oil, walnuts, almonds and hazelnuts, respectively, used in the study.

La siniestralidad vial es una de las grandes preocupaciones de la sociedad actual y, a pesar de que se ha mejorado mucho en este aspecto en la ultima decada, gracias a los esfuerzos de las administraciones publicas, a los adelantos tecnicos y a la concienciacion ciudadana, aun es todo un reto reducir al minimo las preocupantes cifras de siniestralidad a causa del trafico, ya que no es desproporcionado afirmar que estamos ante un verdadero problema de magnitud publica a nivel mundial.