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The use of health services prior to suicide has been little studied in countries with low suicide rates and, on the other hand, little is known on the use of concrete medical specialties other than primary care or mental health services.To analyze the use of different types of health services, the psychiatric diagnosis, and treatments received in the year prior to suicide in the region of Gipuzkoa (Spain), a country with low rates of suicide and public universal access to healthcare.This is a retrospective descriptive study. We included all suicides registered by the official legal body between 2010 and 2017.388 suicides were analyzed. 78.9% had some contact with the health service in the last year. Primary care was the most used (60% contacted in the last 12 months and 23.5% in last week) followed by non-psychiatric outpatient specialties, mainly neurology, ophthalmology, and rehabilitation. Hospital discharges in the last month were 3 times higher from non-psychiatric units than from psychiatry (5.9% vs 1.8%). Only 32.5% contacted an outpatient psychiatric service the last year and less than 50% had a prescription of psychotropic drugs. The most frequent psychiatric diagnosis was F40-F49 (29.2%).Results expand the available knowledge and highlight the role of concrete non-psychiatric specialties (including both outpatient and inpatient services) in suicide prevention. Percentages of healthcare use are in line with other countries including some with different healthcare models and higher suicide rates. HIGHLIGHTSHealthcare use is high but similar to countries with higher suicide ratesThe use of several non-psychiatric specialties (outpatientinpatient) stands outOnly 1 in 3 saw a psychiatrist and 1 in 2 might have received a psych. diagnosis.

Resumen: Las encuestas de salud son una herramienta clave para la toma de decisiones en políticas de salud y para la planificación de los servicios de salud. El uso de métodos estadísticos para áreas pequeñas que utilizan información de diferentes ámbitos geográficos puede resultar útil para estimar indicadores de salud a una escala geográfica menor que la originalmente considerada en el diseño de una encuesta. Abstract: Health surveys are a key tool for decision-making in health policies and health services planning. The use of small-area statistical methods that use information at different geographic levels may be useful for estimating health indicators at a lower geographical level than originally considered in the survey design. Palabras clave: Análisis de áreas pequeñas, Encuesta de salud, Estadística espacial, Keywords: Small area analysis, Health survey, Spatial statistics

Both, cardiorespiratory fitness and abdominal obesity are independently associated with developing cardiovascular disease and its risk factors. However, the relationship between both attributes is unclear. We examine the relationship between cardiorespiratory fitness and the risk of developing abdominal obesity, and secondarily, other adiposity measures. Retrospective observational study of a cohort of 1284 sedentary patients, who had participated in a clinical trial of physical activity promotion carried out in Spain (2003–2007). At baseline, they were free of cardiovascular disease, hypertension, diabetes, dyslipidemia and/or abdominal obesity, with an indirect VO2max measurement, were 19–80 years old, 62% women, and had completed the two year follow-up. The exposure factor was cardiorespiratory fitness categorized as high, moderate or low, according to tertiles of VO2max values. The main outcome measure was the risk of developing abdominal obesity, as defined by waist circumference >102 (men) and >88 (women) cm. Secondary outcomes were the risk of developing: general obesity, excess body fat, and their combination (“defined” obesity). At two years, 10.5% of the participants had developed abdominal obesity: 6.1% in the high cardiorespiratory fitness tertile, 9.7% in the moderate tertile (adjusted odds ratio, 1.20; 95% confidence interval 0.68–2.10), and 15.7% in the low tertile (adjusted odds ratio, 2.29; 95% confidence interval 1.34–3.91). Moreover, 2.2% of participants in the high cardiorespiratory fitness tertile developed “defined” obesity as did 5.4% in the low tertile (adjusted odds ratio, 2.90; 95% confidence interval 1.15–7.29). Low cardiorespiratory fitness levels are associated with a higher risk of developing abdominal and “defined” obesity.

Health surveys are a key tool for decision-making in health policies and health services planning. The use of small-area statistical methods that use information at different geographic levels may be useful for estimating health indicators at a lower geographical level than originally considered in the survey design.

Background. Functional capacity is a prognostic factor for coronary patients; accordingly, they are recommended to walk. Objective. To assess whether an exercise program supervised in primary care increases their functional capacity more than unsupervised walking. Methods. A randomized clinical trial was carried out at eight primary care centres of the Spanish Health Service and involving 97 incident cases of low-risk acute coronary patients

Aims To assess the association between attendance at antenatal education sessions and breastfeeding during the first year of life. Background Although there is evidence that antenatal education encourages breastfeeding, the size and duration of its effect remain unclear. Design A prospective cohort study. Methods The study was conducted in Bizkaia (North of Spain) between May 2005–June 2007 with a consecutive sample of 614 primiparas. Women were classified into three groups according to whether they had received antenatal education and, if so, how many classes (0, 1–4, or 5 or more). Telephone interviews at 1·5, 3, 6 and 12 months were used to estimate the risk of cessation of any breastfeeding and to compare the groups with Cox proportional hazards regression models adjusted for potential confounders. Findings Initially, 90% of women breastfed their infants, with no differences between the groups. During the first month, the risk of cessation of any breastfeeding was three times as high among non-attendees and twice as high among women who attended 1–4 classes compared with those who attended 5 or more classes. The risk was, however, similar in the three groups from the end of first month onwards. Conclusion The results suggest that though antenatal education may be associated with higher rates of breastfeeding in our setting this is only the case for the first month after the birth. Further research is necessary to optimize this beneficial effect to achieve long-term continuation of breastfeeding.

The aim of this study was to assess the reliability and convergent validity of the 7-day Physical Activity Recall (7-day PAR) interview in a sample of the Spanish population. Valid 7-day PAR interviews were conducted and RT3 accelerometer measurements taken for 160 subjects from the primary care population aged 24-83, 75 men and 85 women. Two 7-day PAR interviews were conducted, with a one-week interval, with 147 of these participants. Test-retest reliability was assessed using intraclass correlation coefficients. Convergent validity between the 7-day PAR and the accelerometer data were examined using Spearman's correlation coefficients, and the kappa index of agreement was calculated. The 7-day PAR reliability coefficients were 0.68 (95%CI: 0.58-0.76) for total energy expenditure, 0.65 (95%CI: 0.54-0.73) for the activity dose, and 0.61 (95%CI: 0.50-0.70) and 0.75 (95%CI: 0.67-0.81) for time spent on moderate and vigorous-intensity activity, respectively. These coefficients ranged from 0.91 to 0.96 in participants who reported a typical week in both interviews. Convergent validity ranged from 0.25 for time spent on vigorous activity to 0.52 for the activity dose, and the kappa index was 0.43 (95%CI: 0.30-0.56). Reliability and convergent validity coefficients in the Spanish population were generally moderate and similar to those found in other studies.

Introduccion y objetivos Evaluar el efecto de un programa de promocion de la actividad fisica (PEPAF) realizado por medicos de familia en la disminucion del riesgo cardiovascular. Metodos Ensayo clinico por conglomerados en el que se asigno aleatoriamente a 56 medicos de familia a un grupo de intervencion (n = 29) y un grupo de control (n = 27). Entre los pacientes reclutados, se analizo a los que estaban entre 30 y 74 anos (1.915 PEPAF y 1.783 controles). Intervencion: consejo sobre los beneficios de la actividad fisica a todos los pacientes y prescripcion a un subgrupo que acepto una consulta adicional (30%). Medidas: factores de riesgo y riesgo cardiovascular con la escala Framingham-D’Agostino. Resultados A los 12 meses se observo un descenso significativo de las presiones arteriales sistolica y diastolica y la presion de pulso en los dos grupos (controles, 2,93, 1,81 y 1,15 mmHg; PEPAF, 3,35, 1,4 y 1,94 mmHg) respecto a la evaluacion basal. Hubo incremento del colesterol de las lipoproteinas de alta densidad (controles, 1,73 mg/dl; PEPAF, 2,67 mg/dl) y descenso del indice aterogenico (controles, 0,12; PEPAF, 0,16) respecto al basal (p Conclusiones La inclusion de pacientes en el proyecto fue eficaz para mejorar el control de los factores de riesgo y reducir el riesgo cardiovascular; no se observaron diferencias entre el grupo de control y el que recibio promocion de la actividad fisica.

Objectives To study the association between proximity to air polluting industrial facilities and mortality in the Basque Country (Spain) in the 1996e2003 period. Methods A cross-sectional ecological study with 1465 census sections (CS) as units of analysis with a mean population of 1257 inhabitants. Association of CS mortality with proximity of industries of the European Pollutant Emission Register was studied by type of industrial activity and adjusted for social deprivation. Two distance thresholds (1 km and 2 km) were used as proxies for exposure in a ‘near versus far’ analysis. Causes of mortality studied were: all causes; tracheal, bronchial, and lung cancer; haematological tumours; ischaemic heart disease; cerebrovascular diseases; chronic diseases of the lower respiratory tract; and breast cancer (in women). Poisson’s generalised linear mixed models (GLMM) with two random effects (heterogeneity and structured spatial variability) were used in a fully Bayesian environment. Results Men living in sections within 1 km from energy production industries had greater mortality from tracheal, bronchial, and lung cancer [CI90% 6% to 53%] as compared with people living further. Women had greater mortality from ischaemic heart disease [CI90% 1% to 17%] and respiratory illness [CI90% 1% to 24%] within 2 km from metal-processing industries. On the contrary, within the 1 km buffer from mineral industries, mortality was lower for all causes [CI90% � 20% to � 6%] and for ischaemic heart disease [CI90% � 40% to � 10%] in women, and from respiratory diseases in men [CI90% � 39% to � 4%], while it was greater for breast cancer in women [CI90% 2% to 28%] within the 2 km buffer. Conclusions Analysis of mortality by census sections is a helpful exploratory tool for investigating environmental risk factors and directing actions to sites and risk factors with a greater impact on health. Further epidemiological andenvironmentalinvestigationsaroundmetal-processing and energy-producing plants are required.

Census track level socioeconomic inequalities in mortality are described in the Basque Country and its three main cities in the 1996-2003 period. An ecological crosssectional study of small areas was performed. Using principal component analysis a socioeconomic deprivation index was calculated. The mortality risk for each census track and the relation between mortality and socioeconomic deprivation were studied by means of hierarchical Bayesian models. Geographical patterns of the mortality risk and the deprivation index were similar, with higher mortality in more deprived areas. In the Basque Country as a whole the magnitude of the association between mortality and deprivation was higher in men than in women. In the cities, the association was only apparent for men. These results are useful to guide health policies and identify geographical areas with greater needs., Se describen las desigualdades socioeconómicas en la mortalidad por secciones censales en el País Vasco y en sus tres capitales durante el período 1996-2003. Se realizó un estudio ecológico transversal de áreas pequeñas. Mediante el análisis de componentes principales se calculó un índice de privación socioeconómica. El riesgo de mortalidad de cada sección censal, y la relación entre la mortalidad y la privación socioeconómica se estudiaron mediante modelos Bayesianos jerárquicos. Los patrones geográficos del riesgo de mortalidad y del índice de privación fueron similares, con mayor mortalidad en las áreas de mayor privación. En el conjunto del País Vasco la magnitud de la asociación entre la privación y la mortalidad fue mayor en los hombres que en las mujeres. En las capitales esa asociación sólo se evidenció para los hombres. Estos resultados son útiles para orientar las políticas de salud e identificar las áreas geográficas que precisan una mayor atención. [fr] On décrit les inégalités socio-économiques dans la mortalité par sections de recensement au Pays Basque et ses trois capitales pendant la période 1996-2003. Une étude écologique transversale d’aires petites a été accomplie. Au moyen de l’analyse de composantes principales, on a calculé un index de privation socio-économique. Le risque de mortalité de chaque section, et le rapport entre la mortalité et la privation socioéconomique ont été étudiés utilisant des modèles Bayesians hiérarchiques. Les patrons géographiques du risque de mortalité et de l’index de privation étaient semblables, étant la mortalité plus grande dans les aires avec une plus grande privation. Dans l’ensemble du Pays Basque la grandeur de l’association entre la privation et la mortalité était plus grande chez les hommes que chez les femmes. Dans les capitales l’association était evidente seulement chez les hommes. Ces résultats sont utiles pour orienter les politiques de santé et pour identifier les aires géographiques qui ont besoin d’une plus grande attention.

Background The relationship between deprivation and mortality in urban settings is well established. This relationship has been found for several causes of death in Spanish cities in independent analyses (the MEDEA project). However, no joint analysis which pools the strength of this relationship across several cities has ever been undertaken. Such an analysis would determine, if appropriate, a joint relationship by linking the associations found. Methods A pooled cross-sectional analysis of the data from the MEDEA project has been carried out for each of the causes of death studied. Specifically, a meta-analysis has been carried out to pool the relative risks in eleven Spanish cities. Different deprivation-mortality relationships across the cities are considered in the analysis (fixed and random effects models). The size of the cities is also considered as a possible factor explaining differences between cities. Results Twenty studies have been carried out for different combinations of sex and causes of death. For nine of them (men: prostate cancer, diabetes, mental illnesses, Alzheimer’s disease, cerebrovascular disease; women: diabetes, mental illnesses, respiratory diseases, cirrhosis) no differences were found between cities in the effect of deprivation on mortality; in four cases (men: respiratory diseases, all causes of mortality; women: breast cancer, Alzheimer’s disease) differences not associated with the size of the city have been determined; in two cases (men: cirrhosis; women: lung cancer) differences strictly linked to the size of the city have been determined, and in five cases (men: lung cancer, ischaemic heart disease; women: ischaemic heart disease, cerebrovascular diseases, all causes of mortality) both kinds of differences have been found. Except for lung cancer in women, every significant relationship between deprivation and mortality goes in the same direction: deprivation increases mortality. Variability in the relative risks across cities was found for general mortality for both sexes. Conclusions This study provides a general overview of the relationship between deprivation and mortality for a sample of large Spanish cities combined. This joint study allows the exploration of and, if appropriate, the quantification of the variability in that relationship for the set of cities considered. This article was partially funded by Ministerio de Economia y Competitividad via the research grant MTM2010-19528 (jointly financed with European Regional Development Fund), the FIS-FEDER projects: PI042013, PI040041, PI040170, PI040069, PI042602, PI040388, PI040489, PI042098, PI041260, PI040399, PI08/1488, PI08/0330 and by the CIBER Epidemiología y Salud Publica (CIBERESP), Spain SI

To evaluate the effect of a program promoting physical activity (PEPAF) implemented by family physicians on cardiovascular risk reduction.The cluster randomized clinical trial involved 56 family physicians randomly allocated to an intervention group (n=29) and a control group (n=27). Of the patients recruited, only those aged 30-74 years (1915 PEPAF and 1783 control) were included in the analysis. The intervention involved giving general advice about the benefits of physical activity to all patients and prescribed advice to a subgroup of patients (30%) who agreed to an additional consultation. Outcome measures included risk factors and cardiovascular risk assessed using the Framingham-D'Agostino scale.A significant decrease from baseline in systolic and diastolic blood pressure and pulse pressure was observed after 12 months in both groups (control group: -2.93 mmHg, -1.81 mmHg and -1.15 mmHg, respectively; PEPAF group: -3.35 mmHg, -1.4 mmHg, and -1.94 mmHg, respectively). The high-density lipoprotein cholesterol level increased (control group: +1.73 mg/dl; PEPAF group: +2.67 mg/dl), while the atherogenic index decreased (by 0.12 and 0.16 in the two groups, respectively), all from baseline (P.05). Cardiovascular risk decreased by 0.68 (95% confidence interval [CI], 0.13-1.25) in the control group and 0.79 (95%CI, 0.22-1.35) in the PEPAF group. There was no significant difference in the improvement at 12 months between the groups.Patients' participation in the project was effective in improving control of risk factors and decreasing cardiovascular risk. No significant difference in outcome was observed between the control group and the group participating in the program promoting physical activity.

Background: To evaluate agreement between cardiovascular risk in sedentary patients as estimated by the new Framingham-D’Agostino scale and by the SCORE chart, and to describe the patient characteristics associated with the observed disagreement between the scales. Design: A cross-sectional study was undertaken involving a systematic sample of 2,295 sedentary individuals between 40–65 years of age seen for any reason in 56 primary care offices. An estimation was made of the Pearson correlation coefficient and kappa statistic for the classification of high risk subjects (≥20% according to the Framingham-D’Agostino scale, and ≥5% according to SCORE). Polytomous logistic regression models were fitted to identify the variables associated with the discordance between the two scales. Results: The mean risk in males (35%) was 19.5% ± 13% with D’Agostino scale, and 3.2% ± 3.3% with SCORE. Among females, they were 8.1% ± 6.8% and 1.2% ± 2.2%, respectively. The correlation between the two scales was 0.874 in males (95% CI: 0.857–0.889) and 0.818 in females (95% CI: 0.800–0.834), while the kappa index was 0.50 in males (95% CI: 0.44%–0.56%) and 0.61 in females (95% CI: 0.52%–0.71%). The most frequent disagreement, characterized by high risk according to D’Agostino scale but not according to SCORE, was much more prevalent among males and proved more probable with increasing age and increased LDL-cholesterol, triglyceride and systolic blood pressure values, as well as among those who used antihypertensive drugs and smokers. Conclusions: The quantitative correlation between the two scales is very high. Patient categorization as corresponding to high risk generates disagreements, mainly among males, where agreement between the two classifications is only moderate.

Physical activity promotion is a priority, but contribution of physicians' interventions is unclear. The effectiveness of the PEPAF ("Experimental Program for Physical Activity Promotion"), which was implemented exclusively by physicians in routine primary care from October 2003 to December 2004, was assessed.Fifty-six Spanish family physicians were randomized to either the intervention (n = 29) or standard care (n = 27) arm of the trial. The physicians recruited 4317 physically inactive patients (2248 for intervention and 2069 for control protocols) from a systematic sample after assessing their physical activity in routine practice. Intervention physicians provided advice to all patients and a physical activity prescription to the subgroup attending an additional appointment (30%). The main outcome measure was the change in physical activity measured by blinded nurses using the 7-Day Physical Activity Recall. Secondary outcomes included cardiorespiratory fitness and health-related quality of life.At 6 months, intervention patients increased physical activity more than controls (adjusted difference, 18 min/wk [95% confidence interval, 6-31 min/wk]; metabolic equivalent tasks x hours per week, 1.3 [95% CI, 0.4-2.2]). The proportion of the population achieving minimal physical activity recommendations was 3.9% higher in the intervention group (1.2%-6.9%; number needed to treat, 26). No differences were found in secondary outcomes. The effect of intervention was positively modified in subjects older than 50 years (Por = .01) and in the prescription subgroup (P.001).Family physicians were effective for increasing physical activity of primary care patients. Overall clinical effect was small but relevant for population public health. Within the intervention program, clinically relevant effects were seen in patients receiving a physical activity prescription. Trial Registration clinicaltrials.gov Identifier: NCT00131079.

Although there is some experience in the study of mortality inequalities in Spanish cities, there are large urban centers that have not yet been investigated using the census tract as the unit of territorial analysis. The coordinated projectSocioeconomic and environmental inequalities in mortality in Spanish cities. The MEDEA projectwas designed to fill this gap, with the participation of 10 groups of researchers in Andalusia, Aragon, Catalonia, Galicia, Madrid, Valencia, and the Basque Country. The MEDEA project has four distinguishing features: a) the census tract is used as the basic geographical area; b) statistical methods that include the geographical structure of the region under study are employed for risk estimation; c) data are drawn from three complementary data sources (information on air pollution, information on industrial pollution, and the records of mortality registrars), and d) a coordinated, large-scale analysis, favored by the implantation of coordinated research networks, is carried out. The main objective of the present study was to explain the methods for smoothing mortality indicators in the context of the MEDEA project. This study focusses on the methodology and the results of the Besag, York and Mollié model (BYM) in disease mapping. In the MEDEA project, standardized mortality ratios (SMR), corresponding to 17 large groups of causes of death and 28 specific causes, were smoothed by means of the BYM model; however, in the present study this methodology was applied to mortality due to cancer of the trachea, bronchi and lung in men and women in the city of Barcelona from 1996 to 2003. As a result of smoothing, a different geographical pattern for SMR in both genders was observed. In men, a SMR higher than unity was found in highly deprived areas. In contrast, in women, this pattern was observed in more affluent areas.

Aunque la experiencia en el estudio de las desigualdades en la mortalidad en las ciudades españolas es amplia, quedan grandes núcleos urbanos que no han sido investigados utilizando la sección censal como unidad de análisis territorial. En este contexto se sitúa el proyecto coordinado «Desigualdades socioeconómicas y medioambientales en la mortalidad en ciudades de España. Proyecto MEDEA», en el cual participan 10 grupos de investigadores de Andalucía, Aragón, Cataluña, Galicia, Madrid, Comunitat Valenciana y País Vasco. Cabe señalar cuatro particularidades: a) se utiliza como área geográfica básica la sección censal; b) se emplean métodos estadísticos que tienen en cuenta la estructura geográfica de la región de estudio para la estimación de riesgos; c) se aprovechan las oportunidades que ofrecen 3 fuentes de datos complementarias (información sobre contaminación atmosférica, información sobre contaminación industrial y registros de mortalidad), y d) se emprende un análisis coordinado de gran alcance, favorecido por la implantación de la redes temáticas de investigación. El objetivo de este trabajo es explicar los métodos para la suavización de indicadores de mortalidad en el proyecto MEDEA. El artículo se centra en la metodología y los resultados del modelo de mapa de enfermedades de Besag, York y Mollié (BYM). Aunque en el proyecto se han suavizado, mediante el modelo BYM, las rezones de mortalidad estandarizadas (RME) correspondientes a 17 grandes grupos de causas de defunción y 28 causas específicas, aquí se aplica esta metodología a la mortalidad por cáncer de tráquea, de bronquios y de pulmón en ambos sexos en la ciudad de Barcelona durante el período 1996-2003. Como resultado se aprecia un diferente patrón geográfico en las RME suavizadas en ambos sexos. En los hombres se observan unas RME mayores que la unidad en los barrios con mayor privación socioeconómica. En las mujeres este patron se observa en las zonas con un mayor nivel socioeconómico Although there is some experience in the study of mortality inequalities in Spanish cities, there are large urban centers that have not yet been investigated using the census tract as the unit of territorial analysis. The coordinated project «Socioeconomic and environmental inequalities in mortality in Spanish cities. The MEDEA project» was designed to fill this gap, with the participation of 10 groups of researchers in Andalusia, Aragon, Catalonia, Galicia, Madrid, Valencia, and the Basque Country. The MEDEA project has four distinguishing features: a) the census tract is used as the basic geographical area; b) statistical methods that include the geographical structure of the region under study are employed for risk estimation; c) data are drawn from three complementary data sources (information on air pollution, information on industrial pollution, and the records of mortality registrars), and d) a coordinated, large-scale analysis, favored by the implantation of coordinated research networks, is carried out. The main objective of the present study was to explain the methods for smoothing mortality indicators in the context of the MEDEA project. This study focusses on the methodology and the results of the Besag, York and Mollié model (BYM) in disease mapping. In the MEDEA project, standardized mortality ratios (SMR), corresponding to 17 large groups of causes of death and 28 specific causes, were smoothed by means of the BYM model; however, in the present study this methodology was applied to mortality due to cancer of the trachea, bronchi and lung in men and women in the city of Barcelona from 1996 to 2003. As a result of smoothing, a different geographical pattern for SMR in both genders was observed. In men, a SMR higher than unity was found in highly deprived areas. In contrast, in women, this pattern was observed in more affluent areas Estudio parcialmente financiado por el proyecto «Mortalidad en áreas pequeñas Españolas y Desigualdades socio-Económicas y Ambientales (MEDEA)»: PI04/0399 (GRECS, Universitat de Girona), PI04/2013 (ASPB, Barcelona), PI04/0388 (Departamento de Sanidad y Servicio Vasco de Salud, Gobierno Vasco), PI04/0041 (CNE, ISCIII), PI04/0170 (Conselleria de Sanitat, València); por la Red de Centros de Epidemiología y Salud Pública (FISS C03/09); y por el CIBER de Epidemiología y Salud Pública (CIBERESP) SI

Objectives To estimate the prevalences of the main groups of congenital anomalies and to assess their trend over time. Design Population-based study of prevalences. Setting The Basque Country, Spain. Participants All births and all congenital anomalies diagnosed prenatally, at birth or during the first year of age, in all hospitals of the country, from 1999 to 2008. Main outcomes measures Total diagnosed prevalences and prevalences at birth of all chromosomal and non-chromosomal anomalies, Down9s syndrome, anomalies of the nervous system, urinary, limbs, digestive system and congenital heart defects. Results Mean age (SD) of women at childbirth and the proportion of them over 35 years of age shifted from 32.1 (4.5) years, with 18.3% in 1999–2001, to 32.3 (4.7) years, with 23.9% in 2006–2008. Between 1999 and 2008, 991 cases of chromosomal anomalies and 3090 of non-chromosomal anomalies were diagnosed, which yields, respectively, total prevalences of 5.2‰ and of 16.2‰. Among chromosomal anomalies, Down9s syndrome is the most frequent (2.9‰). With marginal statistical significance, the results point at an increasing trend in total diagnosed chromosomal anomalies, but a decreasing one in prevalences at birth. Among non-chromosomal congenital anomalies, congenital heart defects are the most frequent (5.2‰) one. Rates of all non-chromosomal, urinary and limb anomalies grew during the study period, whereas those of congenital heart defects and anomalies of the digestive system did not change significantly. Conclusions In the Basque Country, rates of chromosomal anomalies are higher than the overall estimated prevalence in European countries, and continue to increase slightly, which may be related to the rise in maternal age. Rates of non-chromosomal anomalies are within the European frequent range of values, and the increases observed need to be checked in the following years.

incluye "Erratum to: Cancer mortality inequalities in urban areas: a Bayesian small area analysis in Spanish cities" BACKGROUND: Intra-urban inequalities in mortality have been infrequently analysed in European contexts. The aim of the present study was to analyse patterns of cancer mortality and their relationship with socioeconomic deprivation in small areas in 11 Spanish cities. METHODS: It is a cross-sectional ecological design using mortality data (years 1996-2003). Units of analysis were the census tracts. A deprivation index was calculated for each census tract. In order to control the variability in estimating the risk of dying we used Bayesian models. We present the RR of the census tract with the highest deprivation vs. the census tract with the lowest deprivation. RESULTS: In the case of men, socioeconomic inequalities are observed in total cancer mortality in all cities, except in Castellon, Cordoba and Vigo, while Barcelona (RR = 1.53 95%CI 1.42-1.67), Madrid (RR = 1.57 95%CI 1.49-1.65) and Seville (RR = 1.53 95%CI 1.36-1.74) present the greatest inequalities. In general Barcelona and Madrid, present inequalities for most types of cancer. Among women for total cancer mortality, inequalities have only been found in Barcelona and Zaragoza. The excess number of cancer deaths due to socioeconomic deprivation was 16,413 for men and 1,142 for women. CONCLUSION: This study has analysed inequalities in cancer mortality in small areas of cities in Spain, not only relating this mortality with socioeconomic deprivation, but also calculating the excess mortality which may be attributed to such deprivation. This knowledge is particularly useful to determine which geographical areas in each city need intersectorial policies in order to promote a healthy environment. This article was partially supported by Fondo de Investigaciones Ssanitarias (FIS) projects numbers PI042013, PI040041, PI040170, PI040069, PI042602 PI040388, PI040489, PI042098 , PI041260, PI040399, PI081488 and by the CIBER en Epidemiología y Salud Pública (CIBERESP), Spain and by the program of "Intensificación de la Actividad Investigadora (Carme Borrell)" funded by the "Instituto de Salud Carlos III" and "Departament de Salut. Generalitat de Catalunya". Sí

Background Physical activity promotion is a priority, but contribution of physicians' interventions is unclear. The effectiveness of the PEPAF (“Experimental Program for Physical Activity Promotion”), which was implemented exclusively by physicians in routine primary care from October 2003 to December 2004, was assessed. Methods Fifty-six Spanish family physicians were randomized to either the intervention (n = 29) or standard care (n = 27) arm of the trial. The physicians recruited 4317 physically inactive patients (2248 for intervention and 2069 for control protocols) from a systematic sample after assessing their physical activity in routine practice. Intervention physicians provided advice to all patients and a physical activity prescription to the subgroup attending an additional appointment (30%). The main outcome measure was the change in physical activity measured by blinded nurses using the 7-Day Physical Activity Recall. Secondary outcomes included cardiorespiratory fitness and health-related quality of life. Results At 6 months, intervention patients increased physical activity more than controls (adjusted difference, 18 min/wk [95% confidence interval, 6-31 min/wk]; metabolic equivalent tasks × hours per week, 1.3 [95% CI, 0.4-2.2]). The proportion of the population achieving minimal physical activity recommendations was 3.9% higher in the intervention group (1.2%-6.9%; number needed to treat, 26). No differences were found in secondary outcomes. The effect of intervention was positively modified in subjects older than 50 years ( P ≤ .01) and in the prescription subgroup ( P Conclusions Family physicians were effective for increasing physical activity of primary care patients. Overall clinical effect was small but relevant for population public health. Within the intervention program, clinically relevant effects were seen in patients receiving a physical activity prescription. Trial Registration clinicaltrials.gov Identifier:NCT00131079

Background Further research is needed to improve the evidence regarding determinants of physical activity (PA) as a crucial step to plan higher effective intervention strategies. The goal of the present study is to identify socio-demographic and clinical characteristics of primary care (PHC) insufficiently active patients that are associated with longitudinal changes in the level of physical activity. Methods Longitudinal analysis of baseline socio-demographic and clinical predictors of physical activity change in insufficiently active PHC patients who participated in a PA-promoting multi-centre randomized clinical trial conducted from October 2003 through March 2006. The primary outcome measure was the self-reported physical activity assessed with the 7-day Physical Activity Recall (PAR), at baseline, 6, 12 and 24 months. Baseline covariates included sex, age, social class, anthropometric measures and other cardiovascular risk factors or associated diseases (Diabetes, HTA, tobacco use, etc.), and stage of readiness to change PA. Generalized linear mixed models were used to estimate longitudinal association of studied variables on PA change over the three follow-up measurements. Results A total of 3691 patients (85% of the 4317 recruited in the trial) with at least one follow-up measurement were included in the longitudinal analysis. At baseline, analysed patients (mean age: 50.6 years; 64.6% women) devoted 34.7 minutes and 2.36 metabolic equivalent hours per week (MET.h/week) to moderate and vigorous physical activity. Older age, male gender, higher social class, lower BMI, diagnosis of diabetes or hypertension, and measurement season were significant predictors of PA longitudinal change. The effect of baseline readiness to change on PA dose was modified by time, showing a positive gradient in favour of those with more readiness to change that increases significantly at 12 and 24 months (p-value interaction < .0001). Conclusions Identified baseline characteristics such as readiness to change and risk factors can guide physicians to prioritize time and intervention efforts for maximizing their impact on insufficiently active PHC patients.