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Anonymous questionnaires are frequently used in research with adolescents in order to obtain sincere answers about sensitive topics. Most longitudinal studies include self-generated identification codes (SGICs) to match information. Typical elements include a combination of letters and digits from personal data. However, these data may make the participant feel that their answers are not truly anonymous, and some studies using these types of SGICs have been perceived as not entirely anonymous by some participants. Furthermore, data protection laws could place limits on research carried out with these codes. The objective of our article is to test an SGIC with a higher degree of anonymity. We conducted two studies. In Study 1, we tested the perceived anonymity of this new SGIC code. Adolescents aged 12 to 18 years ( N = 601) completed an anonymous questionnaire about lifestyles and risk behaviors, which also included the SGIC. Adolescents with and without risk behaviors were compared regarding whether or not they answered to the SGIC questions. We did not find any differences to suggest that participants felt identifiable. In Study 2, we assessed the efficiency of the new SGIC. At baseline, 123 students from two high schools (eighth grade) filled in questionnaires consisting of the new SGIC and their full names. Two years later, these same students (then in the 10th grade) were invited to fill in the same information again (116 students responded to this second call). A total of 97 students were present in both waves. The SGIC showed a moderate performance, with good enough indices of recall and precision. Evidence suggests that the new SGIC is a suitable tool for the anonymous matching of adolescents in follow-ups of school cohorts.

Alcohol consumption among adolescents is a social and public health issue. School-based programs are needed to prevent the onset of alcohol consumption during adolescence. Information and communication technologies offer new promising approaches to deliver preventive programs to these populations. The most traditional, successful programs use group dynamics within the classroom. However, the usefulness of social interaction features (SIF) within internet-based interventions remains unclear. The current scoping review aims to identify and evaluate the effectiveness of online and mobile psychosocial preventive interventions that use SIF, and that target adolescents. Web of Science, Scopus and Google Scholar were electronically searched for all articles published between January 2011 and December 2020. Articles reporting on school-based, web-based interventions for adolescents to prevent alcohol consumption and that encouraged any kind of interaction between users ('social interactions') were eligible for inclusion. Fourteen articles were included in the review. These articles assessed eight preventive programs. Six programs showed positive results on outcome variables. In two of them, it was possible to determine that their success was partially due to the SIF. SIF seem to be useful to enhance the receptivity and usefulness of web-based prevention programs, but the current evidence of their effectiveness is scarce. More evidence is required to assess the effectiveness of these features and to improve programs having the objective of preventing the consumption of alcohol among young people.Alcohol consumption among adolescents is a social and public health issue. School-based programs are needed to prevent the onset of alcohol consumption during adolescence. Information and communication technologies offer new promising approaches to deliver preventive programs to these populations. The most traditional, successful programs use group dynamics within the classroom. However, the usefulness of social interaction features (SIF) within internet-based interventions remains unclear. The current scoping review aims to identify and evaluate the effectiveness of online and mobile psychosocial preventive interventions that use SIF and target adolescents. Thus, we conducted a scoping review with the aim to identify online and mobile psychosocial preventive interventions that use SIF to reduce adolescent drinking behavior. Our literature review identified eight different programs. Six of them showed positive results on outcome variables. However, only in two of these programs was it possible to determine that their success was partially due to the SIF. SIF seem to be useful to enhance the receptivity and usefulness of web-based prevention programs, but more evidence with appropriate research methods is required to assess these social features' effectiveness to improve web-based prevention programs for young people.

The main objective of this study was to analyze the relationship between structured, unstructured, and family leisure activities on the frequency of adolescent alcohol intake across three different countries (Spain, Peru, and The Netherlands). The self-control of adolescents was also investigated as a moderator in the relationship between leisure activities and alcohol consumption. Methodology: This research involved 4608 adolescents aged between 12 and 17 from three countries (Spain, Peru, and The Netherlands). In Spain and Peru, data was collected through a self-report questionnaire which was part of the Your Life project. In The Netherlands, a self-questionnaire was used, collected by the University of Utrecht. A multiple logistic regression was performed for each country. Results: The results showed that participation in unstructured leisure activities increased the likelihood of drinking more frequently and more heavily in all three countries. Structured leisure activities, in general, did not have a significant predictive effect on alcohol consumption in any of the countries. Family leisure activities reduced the risk of engaging in yearly alcohol use and yearly binge drinking among adolescents, especially in The Netherlands and Spain. The protective effect of family leisure and unstructured leisure risk on yearly alcohol use applied especially to Dutch adolescents with a low level of self-control. Discussion: The article emphasizes the need for parents to engage in leisure activities with their child, participation in unstructured activities is not to be encouraged.

Background: Several instruments have been developed to assess adolescent dating violence but only few have been validated in Spanish-speaking settings. Some instruments are too long and may not be feasible to include them in a multipurpose questionnaire. We developed an instrument to be used in the YourLife project, an international project about young people lifestyles. Objective: We aimed to analyze the psychometric properties of this instrument in three Spanish-speaking countries (Chile, Ecuador, and Spain). Method: We included 1049 participants, aged 13–18 years. Exploratory and confirmatory factor analyses were conducted. Associations between dating violence and variables expected to covariate with it (substance use, school peer aggression, justification of dating violence, and relationship power imbalance), were tested. Results: Two different constructs (psychological and physical/sexual) for suffered and perpetrated violence were identified and confirmed in the three countries. The dating violence subscales had Cronbach’s alpha scores higher than 0.85. The strongest associations between dating violence and variables related to it were found within the relationship power imbalance items, suggesting that these items may be useful to detect adolescent dating violence when a specific questionnaire cannot be implemented. Conclusion: This instrument seems to be adequate to assess suffered and perpetrated adolescent dating violence within a multipurpose questionnaire among schooled adolescents.

Este libro reune escritos que vinculan la antropologia cristiana con las ciencias de la salud mental para un reenfoque en clave humanista del estudio de la psique humana. Estas paginas quieren promover un debate academico vivo entre profesionales cristianos de multiples confesiones y, al mismo tiempo, crear un espacio de encuentro entre la reflexion antropologica y las aportaciones de las disciplinas de salud mental. Ademas, en los ensayos aqui presentados, hay una apuesta por superar el efecto reduccionista de los modelos imperantes en las ciencias de la salud mental que, con frecuencia, dejan fuera cualquier alusion a lo trascendente.

This study aimed to determine the associations between parental monitoring and affection and three adolescent lifestyle aspects: constructive leisure, non-constructive leisure and substance use. A cross-sectional study was conducted in four countries (Chile, Mexico, Spain and Peru). Adolescents aged 12&ndash, 15 self-completed a multi-purpose questionnaire. Multiple logistic regressions were performed to analyse the association between the parental monitoring and affection variables and the outcomes in terms of the children&rsquo, s lifestyles. The results indicate that parental monitoring is conducive to more constructive leisure and less non-constructive leisure and seems to be conducive to the prevention of substance use. Furthermore, parental affection is conducive to constructive leisure and the prevention of substance use. The discussion focuses on the fact that the family can be a protective resource associated with positive adolescent development.

© 2018, © 2018 Journal of Moral Education Ltd. How young people spend time out of school is important for their character development. In this article we explore the relationships between adolescents’ leisure time and other aspects of their lives, with a particular focus on religion. Using a data set generated by secondary school students in Peru and El Salvador (n = 6085) for a public health project, YOURLIFE, we conducted multiple logistic regression analyses of the relationships between religious identification, salience and practice; five indicators of adolescent risk behaviors; and, four indicators of prosocial attitudes and behaviors. In addition to not participating in risk behaviors such as sex, smoking, drinking alcohol and taking illicit drugs, these analyses show significant relationships between religion and prosocial activities and attitudes. These data are considered in the context of the wider debate over the role of religion in adolescent character development in Latin America and elsewhere.

Background Sexually transmitted infections can be spread through oral and anal heterosexual sex. There are few data on these practices in Sub-Saharan Africa. We analyzed the prevalence of heterosexual oral and anal sex among HIV Voluntary Counseling and Testing (VCT) attendees in Kinshasa and the associated sociodemographics, perceptions and behavioral factors. Methods OKAPI (Observational Kinshasa AIDS Prevention Initiative) prospective cohort study. It evaluates the VCT impact on HIV-related knowledge and behaviors at 6 and 12-month follow-up. Since April 2016 until April 2018, 797 persons aged 15–59 years were HIV tested and replied to a baseline interview, including information about anal and oral sex. Descriptive, bi- and multivariate analyses were performed using baseline data. Results Among 718 sexually active participants reporting heterosexual sex, 59% had had oral sex, 22% anal sex and 18% both practices. Among participants reporting “not” having had sex, 6% reported oral sex, 3% anal sex and 1% both. Oral sex was associated with a daily use of the Internet/mobile phone, perceiving low community HIV risk, reporting HIV-related behaviors (multiple partners, inconsistent condom use, anal, paid and forced sex) and having been pregnant. Being married-monogamous was inversely associated with oral sex. Anal sex was directly associated with having other risk sexual behaviors. Conclusions Oral and anal sex were common among people reporting heterosexual sex in Kinshasa. Perceiving a low community HIV risk and having other sexual risk behaviors are associated with these practices, which are commonly not considered as risky despite their strong association with HIV/STIs. They need to be considered when designing preventive strategies in Kinshasa.

Introduction Structured and unstructured leisure are known protective and risk factors, respectively, for alcohol consumption during adolescence. However, little is known about the interaction between the two leisure types and alcohol consumption. Method A cross-sectional study was performed among high-school students in El Salvador and Peru. Schooled adolescents, aged 13–18 (N = 5640), completed a self-administered questionnaire about risk behaviors, including their leisure activities and whether they had consumed alcoholic beverages. They were classified into tertiles of the amount of time of both structured and unstructured activities. A non-conditional multivariate logistic regression was conducted to evaluate the association of both types of leisure with alcohol consumption. We also used a likelihood ratio test to assess the potential interaction of structured and unstructured leisure time in alcohol consumption. Results Alcohol consumption was much more frequent among adolescents in the highest tertile of unstructured leisure time compared to the lowest one (Adjusted OR: 5.52; 95% CI: 4.49–6.78), and less frequent among those from the highest tertile of structured leisure time compared to the lowest one (Adjusted OR: 0.66; 95% CI: 0.55–0.80). We did not find an interaction effect between structured and unstructured leisure time with regard to initiation of alcohol consumption. Discussion The study suggests that structured leisure is not enough to compensate for the possible harmful effect of unstructured leisure. Parents, educators and policy makers might be advised to discourage unstructured leisure among adolescents, and not simply to encourage structured leisure.

BACKGROUND Alcohol consumption among adolescents is a mainly public health issue. To prevent alcohol consumption onset during adolescence, school-based programs are needed. A key element of program success is to encourage active participation of the students, which is achieved through group dynamics with peer interactions within the class. However, some of these methods require trained adults to be delivered. Game technologies can offer new promising approaches in the development of preventive programs promoting peer interactions without adult training. Game technologies can offer new promising approaches in the development of preventive programs promoting peer interactions. OBJECTIVE The current systematic review aims to identify online interventions with peer interactions features designed to address alcohol use among adolescents, and evaluate the effectiveness of these interventions. METHODS Web of Science and Scopus were electronically searched for all articles published between January, 2011 and June, 2018. Articles reporting on school-based, web-based interventions for teenagers to prevent alcohol that encouraged any kind of interaction within users were eligible for inclusion. A total of 1067 studies were identified, of which 88 were thoroughly analyzed according to our review protocol. RESULTS Five studies met inclusion criteria. Four of them showed positive results on outcome variables, although it is not possible to determine if social interaction among students contributed to their success in three of them. One protocol paper of a randomized trial currently underway was also identified. CONCLUSIONS We conclude that game technologies that contain social interaction elements seem to present benefits to adolescent health within alcohol consumption prevention programs but more research is needed on this.

The aim of this study was to investigate the association between the adherence to empirically derived dietary patterns and gestational diabetes mellitus (GDM) risk and of healthy lifestyles with the prevention of GDM defining an overall healthy score. The Seguimiento Universidad de Navarra project is a Mediterranean cohort of university graduates started in 1999. We included 3455 pregnant women. During a mean follow-up of 10·3 (sd 3·3) years, we identified 173 incident GDM cases. Two major dietary patterns were identified using principal component analysis: the Western dietary pattern (WDP) (characterised by a high consumption of meat-based products and processed foods) and the Mediterranean dietary pattern (MDP) (characterised by a high consumption of vegetables, fruits, fish and non-processed foods). A low-risk score for GDM was defined taking into account important risk factors (age, BMI and unhealthy dietary pattern) for GDM. Positive association was found in the multivariable model between the highest quartile of adherence to WDP and GDM incidence compared with the lowest quartile (OR 1·56; 95 % CI 1·00, 2·43). No association was found between adherence to the MDP and GDM incidence (OR 1·08; 95 % CI 0·68, 1·70 for the highest quartile compared with the lowest). Women who adhered to all three low-risk factors had a 76 % lower risk of GDM (OR 0·24; 95 % CI 0·10, 0·55) compared with women who did not adhere to any factor before pregnancy. In conclusion, our results reinforce the importance of dietary recommendations and other two factors (low BMI and young age at pregnancy) in pre-gravid women.

Objectives To evaluate the prevalence of HIV-related misconceptions in an outpatient centre of Kinshasa (Democratic Republic of Congo) and analyse the association between these beliefs and HIV infection. Methods A case–control study was carried out from December 2010 until June 2012. We assessed 1630 participants aged 15–49 attending a primary outpatient centre in Kinshasa: 762 HIV Voluntary Counselling and Testing attendees and 868 blood donors. A 59-item questionnaire about knowledge, attitudes and practice was administered during a face-to-face interview, followed by an HIV test. Cases and controls were respondents with a newly diagnosed HIV-positive or HIV-negative test, respectively. Unconditional logistic regression was used to analyse the association between misconceptions and HIV seropositivity. Results 274 cases and 1340 controls were recruited. Cases were more likely than controls to have a low socioeconomic status, no education, to be divorced/separated or widowed. An association was found between the following variables and HIV seropositivity: having a poor HIV knowledge (adjusted OR=2.79; 95% CI 1.43 to 5.45), not knowing a virus is the cause of AIDS (adjusted OR=2.03; 95% CI 1.38 to 2.98) and reporting more than three HIV-transmission-related misconceptions (adjusted OR=3.30; 95% CI 1.64 to 6.64), such as thinking an HIV-positive person cannot look healthy and that HIV is transmitted by sorcery, God’s punishment, a kiss on the mouth, mosquitoes, coughs/sneezes or undercooked food. Conclusions Despite having access to healthcare services, there are still many people in Kinshasa that have HIV-related misconceptions that increase their HIV risk. Our findings underscore the need for a culturally adapted and gender-orientated basic HIV information into Congolese HIV prevention programmes.

Summary Background & aims Gestational diabetes mellitus (GDM) prevalence is increasing worldwide. To the best of our knowledge the specific evaluation of soft drink consumption as a risk factor for developing GDM has only been conducted in the Nurses' Health Study II. Objective To investigate the incidence of GDM according to soft drink consumption in the SUN project. Design The “Seguimiento Universidad de Navarra” (SUN) project is a prospective and dynamic cohort which included data of 3396 women who notified at least one pregnancy between December 1999 and March 2012. A validated 136-item semi-quantitative food frequency questionnaire was used to assess soft drink consumption. Four categories of sugar-sweetened soft drink (SSSD) and diet soft drink (DSD) consumption (servings) were established: rarely or never ( 3/month and ≤1/week) and high (≥2/week). Potential confounders were adjusted through non-conditional logistic regression models. Results During the follow-up, we identified 172 incident cases of GDM. After adjusting for age, baseline body mass index, family history of diabetes, smoking, total energy intake, physical activity, parity, fast-food consumption, adherence to Mediterranean dietary pattern, alcohol intake, multiple pregnancy, cardiovascular disease/hypertension at baseline, fiber intake, following special diet and snacking, SSSD consumption was significantly associated with an increased risk of incident GDM, with multivariable adjusted odds ratios (OR) of 2.03 (95% confidence interval [CI]: 1.25–3.31) and 1.67 (95% CI: 1.01–2.77) for the highest and intermediate categories, respectively, versus the lowest category ( p for linear trend: 0.006). Conversely, DSD consumption was not associated with GDM incidence (adjusted OR: 0.82; 95% CI: 0.52–1.31) for the highest versus the lowest category (p for linear trend: 0.258). Additional sensitivity analyses did not change the results. Conclusion Higher consumption of SSSDs before pregnancy was an independent risk factor for GDM, however, no association was observed between DSD consumption and GDM risk.

Background: Considering the high percentage of couples in which one or both members are HIV negative, the frequency of transmission among non-regular partners and the probabilities of non-disclosure, attention should be paid to people getting a negative HIV test at the Voluntary Counseling and Testing (VCT). Research has shown that a negative HIV test may be followed by a change in sexual behaviours. In Sub-Saharan Africa, where most HIV infections occur, there are few studies that have analysed the factors associated with changes in sexual risk behaviours after a negative HIV test at the VCT clinic. The aim of this project is to evaluate the specific factors associated with changes in sexual behaviours, three months after a negative result in an HIV test, and to analyse the effect of counseling and testing on HIV-related knowledge of participants in an outpatient centre of Kinshasa (Democratic Republic of Congo). Methods and design: Prospective cohort study from December 2014 until March 2016. People 15-60 year old that received VCT at Monkole Hospital (Kinshasa) were followed three months after they got a negative HIV test. In a face-to-face interview, participants replied to a baseline and a follow-up research questionnaire on HIV-related knowledge, attitudes and behaviours. At follow-up respondents were also offered a new HIV test and additional HIV counseling. Four hundred and fifteen participants completed the baseline questionnaire and 363 (87 %) came back for their 3-month follow up. Discussion: This is the first longitudinal study in the DRC that evaluates the factors associated with changes in sexual behaviours after a negative HIV test at the VCT. Participants attending the VCT services within a clinical setting are a good study population as they can be good transmitters of preventive information for other people with no access to health facilities.

OBJETIVO: El objetivo de este estudio es comprobar cómo influyen en el inicio de la actividad sexual de los jóvenes salvadoreños los mensajes que reciben sobre cuestiones de sexualidad, afectividad y ocio a través de la familia, los amigos y los medios de comunicación. MÉTODOS: Estudio transversal a partir de una muestra representativa de 2 615 estudiantes (de 13 a 19 años) de El Salvador. Se utilizó un muestreo sistemático aleatorio para seleccionar 30 colegios. Se recogieron aspectos sociodemográficos, estilos de vida y fuentes de información sobre sexualidad y amor utilizadas por los jóvenes. RESULTADOS: La edad media de los jóvenes fue de 15 años (DE = 1,8). En total 638 (24,4%) jóvenes afirmaron haber tenido relaciones sexuales. Los siguientes factores se asociaron con una mayor probabilidad de haber tenido relaciones sexuales: percibir que los hermanos (OR = 1,8, IC 95%: 1,2-2,7) o los amigos (OR = 1,7, IC 95%: 1,3-2,2) apoyan que se tengan relaciones sexuales. Como factores protectores se encontraron la supervisión de los padres (OR = 0,5, IC 95%: 0,4-0,7); recibir mensajes que apoyan la abstinencia por parte de amigos (OR = 0,7, IC 95%: 0,6-1,0) o hermanos (OR = 0,7, IC 95%: 0,5-0,8) y recibir mensajes favorables al matrimonio por parte de los padres (OR = 0,4, IC 95%: 0,3-0,6). CONCLUSIONES: Los mensajes de la familia y amigos son factores que parecen influir en el inicio de las relaciones sexuales de los jóvenes. Los programas de promoción de la salud sexual en El Salvador deberían tener en cuenta estos factores.OBJECTIVE: The objective of this study is to verify the influence of messages Salvadorian youth receive about sexuality, affection, and leisure from family, friends, and the media on the initiation of sexual activity. METHODS: Cross-sectional study based on a representative sample of 2 615 students (from 13 to 19 years of age) in El Salvador. A random systematic sampling was used to select 30 schools. Sociodemographic aspects, lifestyles, and sources of information on sexuality and love used by the young people were collected. RESULTS: The average age of the young people studied was 15 (SD = 1.8). In all, 638 (24.4%) of the young people stated that they had had sexual relations. The following factors are associated with a greater probability of having had sexual relations: a perception that siblings (OR = 1.8, CI 95%: 1.2-2.7) or friends (OR = 1.7, CI 95%: 1.3-2.2) encourage them to have sex. Protective factors were found to be the supervision of parents (OR = 0.5, CI 95%: 0.4-0.7); messages received from friends that encourage abstinence (OR = 0.7, CI 95%: 0.6-1.0) or from siblings (OR = 0.7, CI 95%: 0.5-0.8); and favorable messages related to marriage received from parents (OR = 0.4, CI 95%: 0.3-0.6). CONCLUSIONS: Messages from family and friends are factors that seem to influence the initiation of sexual activity by young people. Sexual health promotion programs in El Salvador should take these factors into account.

Background Adequate knowledge is essential for making informed decisions. We attempted to determine the level of knowledge about mechanisms of action of birth control methods in five representative samples of European women. Study Design Randomly selected women, aged 18–49 years, completed an anonymous survey in Germany, France, the UK, Sweden and Romania (N=1137). Participants were asked about how contraceptive methods work and if providers should inform them about this issue. Multiple linear regression was used to evaluate women's characteristics associated with their knowledge of mechanisms of action. Results The majority of women identified the unequivocal mode of action of condoms, sterilization and abortion. Fewer than 2% identified all possible mechanisms of action of hormonal contraceptives and intrauterine devices. Highly educated women correctly identified the mechanism or mechanisms of action of more methods than less educated women (β=0.22, 95% confidence interval 0.01–0.43). Regardless of their sociodemographic characteristics and their belief about when human life begins, most women (75%) stated that the provider should inform them about possible postfertilization effects. Conclusions European women have low knowledge about mechanisms of action of several contraceptive methods. The majority want to be informed about possible postfertilization effects. Since adequate knowledge is essential for making informed decisions, providers are encouraged to inform women about all possible mechanisms of action of contraceptives.

ObjectiveWhereas the relationship between some components of diet, such as n-3 fatty acids and B-vitamins, and depression risk has been extensively studied, the role of fast-food or processed pastries consumption has received little attention.DesignConsumption of fast food (hamburgers, sausages, pizza) and processed pastries (muffins, doughnuts, croissants) was assessed at baseline through a validated semi-quantitative FFQ. Participants were classified as incident cases of depression if they reported a physician diagnosis of depression or the use of antidepressant medication in at least one of the follow-up questionnaires. Cox regression models were fit to assess the relationship between consumption of fast food and commercial baked goods and the incidence of depression.SettingThe SUN (Seguimiento Universidad de Navarra – University of Navarra Follow-up) Project, Spain.SubjectsParticipants (n 8964) from a Spanish cohort.ResultsAfter a median follow-up of 6·2 years, 493 cases of depression were reported. A higher risk of depression was associated with consumption of fast food (fifth (Q5) v. first quintile (Q1): hazard ratio (HR) = 1·36; 95 % CI 1·02, 1·81; P trend = 0·003). The results did not change after adjustment for the consumption of other food items. No linear relationship was found between the consumption of commercial baked goods and depression. Participants belonging to consumption quintiles Q2–Q5 showed an increased risk of depression compared with those belonging to the lowest level of consumption (Q1; HR = 1·38; 95 % CI 1·06, 1·80).ConclusionsFast-food and commercial baked goods consumption may have a detrimental effect on depression risk.

Research on the risk of motor vehicle injuries and their relationship with the amount of travel has been only partially analyzed. The few individual exposure assessments are related to very specific subsets of the driving and traveling populations. This study analyzes the relationship between kilometers traveled and hospitalization due to motor vehicle injuries. Twelve thousand three hundred and sixty nine Spanish university graduates from the Seguimiento Universidad de Navarra multipurpose cohort study were evaluated. They had not been hospitalized due to motor vehicle injuries at baseline and were followed up to eight years. Biannual questionnaires allowed for self-reporting of kilometers traveled in motor vehicles, together with incidence of hospitalization. Covariates in the Cox regression models included age and gender and baseline use of safety belt while driving, driving a vehicle with driver-side airbag, driving a motorcycle, and drinking and driving. There were 49,766 participant-years with an average yearly travel of 7,828 km per person-year. Thirty-six subjects reported a first hospitalization event during this time. The adjusted hazard ratio per additional kilometer traveled was 1.00005 (95% confidence interval 1.000013 to 1.000086). Even the smallest of reductions in the amount of kilometers traveled (from an average of 3,250 km per year to 1,000) has a statistically significant protective effect on the likelihood of sustaining hospitalization due to motor vehicle injury (aHR 0.9, 95% CI 0.78 to 0.98). In light of current policies aimed to reduce motorized traffic due to environmental concerns, it may be appropriate to consider the additional health benefit related to reductions in injuries.

Objective: Some methods of family planning, such as oral contraceptives, emergency pill or intrauterine device, may occasionally work after fertilization. These effects may be important to some women. We explored Spanish women’s attitudes towards contraceptive choices that may have occasional postfertilization mechanisms of action. Study design: Cross-sectional study in a Spanish representative sample of 848 potentially fertile women, aged 18–49. Data were collected using a 30-item questionnaire about family planning. Logistic regression was used to identify variables associated with women’s attitudes towards post-fertilization effects. Results: The majority of women were married, had completed high school and had at least one child. Forty-five percent of women would not consider using a method that may work after fertilization and 57% would not consider using one that may work after implantation. Forty-eight percent of the sample would stop using a method if they learned that it sometimes works after fertilization, increasing to 63% when referring to a method that sometimes works after implantation. Women who believe that human life begins at fertilization, those who believe it is important to distinguish between spontaneous and induced embryo losses and women who report having a religion were less likely to consider the use of a method with some post-fertilization effects. Conclusion: The possibility of post-fertilization effects may influence Spanish women’s choice of a family planning method. Information about mechanisms of action of birth control methods should be disclosed to women so that they can make informed choices.

No hay duda de que la aplicacion sistematica y universal decalendarios vacunales en la infancia ha sido uno de los ma-yores exitos sanitarios en la historia de la humanidad. El usoapropiado de las vacunas es probablemente la intervencionmas eficiente en salud publica, con logros del calibre de laerradicacion de la viruela y grandes avances frente a la po-liomielitis

We evaluated the prognostic value of prealbumin (transthyretin) levels in patients with acute kidney injury (AKI).This was a longitudinal, single-center, observational cohort study.The setting was a university-affiliated hospital.One hundred and sixty-one consecutive patients with AKI matched at least one of the Risk, Injury, Failure, Loss, End Stage (RIFLE) criteria for increased serum creatinine, and had requested a nephrology consultation between April 2000 and March 2006.We conducted a computer-assisted review of all cases of AKI seen by a nephrologist between April 2000 and March 2006. We used Cox proportional hazards models to estimate the risk of in-hospital mortality associated with serum prealbumin level at the beginning of the nephrology consultation.Clinicopathologic variables were compared between patients with a serum prealbumin level11 mg/dL (the exposed group; cutoff point, median) and patients with a serum prealbumin levelor =11 mg/dL (the control group). In-hospital mortality rates associated with prealbumin levels were 45.0% for11 mg/dL, and 19.8% foror =11 mg/dL (P = .001). After adjusted analysis, the presence of a serum prealbumin level11 mg/dL was significantly associated with increased in-hospital mortality (hazard ratio, 2.10; 95% confidence interval, 1.08 to 4.08), compared with patients with the same Liano scoring, the same RIFLE classes, and the same treatment for AKI, but with a serum prealbumin levelor =11 mg/dL. In addition, each increment of 5 mg/dL of serum prealbumin was associated with an adjusted 29% decrease of in-hospital mortality (hazard ratio, 0.71; 95% confidence interval, 0.52 to 0.96).Serum prealbumin levels11 mg/dL were strongly associated with a higher risk of death, independent of AKI severity, comorbid illnesses, serum C-reactive protein levels, and other possible confounders. The measurement of serum prealbumin levels may be an inexpensive and useful tool in the evaluation of the risk profiles of AKI patients.

Fundamento y objetivo Validar un punto de corte alternativo de la version espanola del Eating Attitudes Test (EAT-40) para el cribado de casos de trastornos de la conducta alimentaria en la poblacion general. Sujetos y metodo Se administro el cuestionario traducido a una muestra representativa de 2.734 mujeres estudiantes de entre 13 y 22 anos de edad. Se entrevisto a las participantes cuya puntuacion en el cuestionario fue superior a 21 y a una muestra aleatoria del resto. Se estimaron los parametros de validez interna y externa obtenidos con puntos de corte distintos de 30, que es el utilizado habitualmente en el EAT. Resultados La mejor prediccion diagnostica se obtuvo con 21 puntos (sensibilidad del 73,3% y especificidad del 85,1%). El valor predictivo positivo fue del 20% y el valor predictivo negativo, del 98,4%. Conclusiones La mejor prediccion diagnostica del EAT-40 en un entorno no clinico se obtiene con un punto de corte de 21 puntos, algo inferior al recomendado por los autores del cuestionario.

Fundamento y objetivo Numerosos estudios, en su mayoria transversales, han analizado la asociacion entre habito tabaquico y depresion, pero hasta el momento no hay evidencias suficientes para establecer el sentido de esta posible asociacion. El objetivo de este trabajo ha sido realizar un analisis prospectivo de la asociacion entre habito tabaquico e incidencia de depresion en la cohorte SUN (Seguimiento Universidad de Navarra). Sujetos y metodo Se ha realizado un estudio de cohortes dinamico (reclutamiento permanentemente abierto), basado en 8.556 participantes universitarios, en quienes se valoro la incidencia de depresion en un periodo de 6 anos de seguimiento prospectivo. La depresion se definio por el diagnostico medico y/o consumo de antidepresivos referidos por el propio participante en al menos uno de los cuestionarios de seguimiento realizados a los 2, 4 y 6 anos. La asociacion entre el habito tabaquico y la incidencia de depresion se estimo calculando los cocientes de riesgos (hazard ratios [HR]) y sus intervalos de confianza (IC) del 95% mediante modelos de regresion de Cox (riesgos proporcionales). Resultados El tiempo medio de seguimiento de los participantes fue de 47,4 meses. Durante el seguimiento 190 participantes inicialmente exentos de depresion refirieron un diagnostico medico de depresion. Se encontro un riesgo significativamente superior en fumadores (HR = 1,39; IC del 95%, 1,00-1,93) comparados con no fumadores, mientras que la relacion era inversa en exfumadores que hacia mas de 10 anos que habian dejado el tabaco (HR = 0,42; IC del 95%, 0,19-0,94). Conclusiones Este estudio indica una relacion directa entre el consumo de tabaco y la incidencia de depresion.

The role of alcohol on fertility remains unclear. We aimed to investigate the association between alcohol and specific alcoholic beverages consumption and the risk of difficulty getting pregnant. We used a case-control study nested within the Seguimiento Universidad de Navarra (SUN) cohort, a prospective, dynamic and multipurpose cohort of 21,705 Spanish university graduates, followed biennially with mailed questionnaires. We identified 686 case-control pairs, matched for age and time in the cohort. Cases were women reporting difficulty getting pregnant. Controls did not consult due to difficulty conceiving and had at least one child during follow-up. After adjustment for potential confounders, we found no association between self-reported difficulty getting pregnant and the number of alcoholic beverages consumed per week, (Odds Ratio [OR] &gt, 5 drinks/week vs. none = 1.04, 95% Confidence Interval [CI] = 0.72–1.51). No association between types of alcoholic beverage and difficulty conceiving (OR &gt, 5 drinks of wine/week vs. none = 1.16, 95% CI = 0.72–1.88, OR &gt, 5 drinks of beer/week vs. none = 1.06, 95% CI = 0.82–1.37, 5 drinks of spirits/week vs. none = 1.24, 95% CI = 0.84–1.64) was observed. In conclusion, we found no association between alcohol intake and risk of consulting a physician due to difficulty conceiving. More studies are needed to clearly elucidate the effects of alcohol intake on women’s fertility. In the meantime, recommendations about alcohol intake to couples trying to conceive have to be given cautiously.

Sodium intake is a potential environmental factor for immune-mediated inflammatory diseases. The aim of this study is to investigate the association of sodium intake with rheumatoid arthritis. We performed a cross-sectional study nested in a highly educated cohort investigating dietary habits as determinants of disease. Daily sodium intake in grams per day was estimated from a validated food frequency questionnaire. We identified prevalent self-reported cases of rheumatoid arthritis. Logistic regression models were used to estimate the odds ratio for rheumatoid arthritis by sodium intake adjusting for confounders. Linear trend tests and interactions between variables were explored. Sensitivity analyses included age- and sex-matched case–control study, logistic multivariate model adjusted by residuals, and analysis excluding individuals with prevalent diabetes or cardiovascular disease. The effective sample size was 18,555 individuals (mean age 38-years old, 60% women) including 392 self-reported rheumatoid arthritis. Median daily sodium intake (estimated from foods plus added salt) was 3.47 (P25–75: 2.63–4.55) grams. Total sodium intake in the fourth quartile showed a significant association with rheumatoid arthritis (fully adjusted odds ratio 1.5; 95% CI 1.1–2.1, P for trend = 0.02). Never smokers with high sodium intake had higher association than ever smokers with high sodium intake (P for interaction = 0.007). Dose-dependent association was replicated in the case–control study. High sodium intake may be associated with a diagnosis of rheumatoid arthritis. This confirms previous clinical and experimental research. SUN project is supported by the Spanish Government (Instituto de Salud Carlos III, Fondode InvestigacionesSanitarias; grants PI10/02658, PI10/02293, RD06/0045, G03/140, and 87/2010), the Navarra Regional Government (project PI 45/2011), and the University of Navarra SI

Objectives: This study intends to evaluate whether the belief that condoms are 100% effective in protecting against HIV infection is associated with sexual risk behaviours among youth. Methods: A cross-sectional study was performed in representative samples of high-school students in the Philippines, El Salvador and Peru. Participants completed a self-administered questionnaire. Students were asked about the risk of HIV transmission if one has sex using condoms. They were also asked to indicate whether they had ever had sexual relations and whether they used a condom in their first sexual relation. The sample was composed of 8994 students, aged 13–18. Results: One out of seven adolescents believed condoms are 100% effective (safe-sex believers). Those adolescents were 82% more likely to have had sex than those without such belief, after adjusting for confounders (OR=1.82; 95% CI 1.51 to 2.21). On the contrary, no association was found between risk perception and condom use. Subgroup and sensitivity analyses produced similar results. Conclusions: This is, to the best of our knowledge, the first study conducted specifically to evaluate this phenomenon and that has used the same questionnaire and the same data collection protocol in three different developing countries from Asia, Central and South America. These results reasonably suggest that there could be an association between safe sex beliefs and sexual initiation. Longitudinal studies are needed to better understand this possible association as it could influence how to better promote sexual health.

Resumen Objetivo Investigar el conocimiento de las mujeres sobre los mecanismos de accion de los metodos de planificacion familiar (PF), especialmente de los que pueden actuar despues de la fecundacion. Identificar si las mujeres quieren mas informacion al respecto. Metodos Estudio descriptivo transversal en una muestra de 725 mujeres fertiles de centros de salud de Pamplona, mediante la autocumplimentacion de un cuestionario anonimo con 30 preguntas sobre PF. Se realizaron analisis estadisticos univariantes y regresiones logisticas multivariantes. Resultados Menos del 5% de las mujeres conoce todos los mecanismos de accion de los anticonceptivos orales y el dispositivo intrauterino y solo el 7% los de la pildora poscoital. El 91% opina que el medico deberia explicarles si un metodo tiene mecanismos posfecundacion, independientemente de sus creencias. Conclusiones Es necesario informar a las mujeres acerca de todos los mecanismos de accion de los metodos de PF, para garantizar su derecho a elegir libremente.