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BACKGROUND: Although an important secondary prevention trial reported an impressive protection by a Mediterranean dietary pattern on reinfarction and cardiovascular death, scarce direct epidemiologic evidence is currently available regarding the role of the Mediterranean diet in the aetiology of coronary heart disease. AIMS: The aim of the study was to quantify the risk reduction of incident myocardial infarction provided by a Mediterranean dietary pattern. METHODS: We included 342 subjects (171 patients who suffered their first acute myocardial infarction and 171 matched controls) in a case-control study. A validated semi-quantitative food frequency questionnaire (136 items) was used. We defined an a priori Mediterranean dietary pattern. We assessed six food items that we considered protective: 1) olive oil, 2) fiber, 3) fruits, 4)vegetables, 5) fish and 6) alcohol. For each of these six dietary factors, we calculated the distribution according to quintiles within the study and assigned each participant a score of 1 to 5 corresponding to the quintile of intake, with 1 representing the lowest and 5 representing the highest quintile. We also estimated the quintiles of two other elements assumed to be associated with a higher risk: 7) meat/meat products and 8) some items with high glycaemic load (white bread, pasta and rice). For these two elements we inversely ranked the score, with 1 representing the highest and 5 representing the lowest quintile. Finally, we summed up the eight quintile values for each participant.A second score ( post hoc pattern) was built using only a single cut-off point for these eight elements. The cut-off points for each element in this post hoc pattern were decided according to the dose-response relationships between the consumption of each food item and the risk of myocardial infarction observed in the analyses that used quintiles of each food item. RESULTS: For both patterns, we found that the higher the score, the lower the odds ratio of myocardial infarction. A significant linear trend was apparent after adjustment for the main cardiovascular risk factors. For each additional point in the a priori Mediterranean pattern (observed range: 9-38) the odds ratio (95 % confidence intervals) was 0.92 (0.86-0.98). This estimate was 0.55 (0.42-0.73) when we used the post hoc pattern (range: 0-8). CONCLUSIONS: Our data support the hypothesis that a Mediterranean diet (that emphasizes olive oil, fiber, fruits, vegetables, fish and alcohol and reduces meat/meat products) can be an effective measure for reducing the risk of myocardial infarction. However, our results support the exclusion of refined cereals with a high glycaemic load as healthy elements of this pattern. [ABSTRACT FROM AUTHOR]

Background: A major component of disability is related to chronic disease, but the study of self-reported causes of disability could add new aspects in understanding this process. The main objective of this work was to determine the associations between chronic diseases and disability and to describe the pattern of self-reported causes of the disabilities present in older persons.Methods: We carried out a survey in a probabilistic sample of people aged 65 and older of the city of Madrid. The initial sample size was 1001. Subjects were interviewed in their homes. We asked about the presence of 14 chronic conditions. Self-reported difficulty and dependence in 9 noninstrumental activities of daily living (ADLs) were ascertained. Subjects were asked to report the main cause responsible for the disability. Multivariate logistic regression models were constructed to estimate the association of each chronic condition with the probability of having disability.Results: Final sample size was 772 people (overall response rate 77.0%). Interviews answered by proxies were 7.5%. Only 4.5% declared no chronic condition. Osteoarthitis/rheumatism was the most prevalent condition (56.8%). In addition, 63.2% were independent, 21.3% were independent with difficulty (in at least one ADL), and 15.5% were dependent (in at least one ADL). Subjects attributed to osteoarthitis and to aging 41.8% and 17.1% of all disabilities, respectively. Chronic conditions strongly associated with disability were cerebrovascular disease (adjusted odds ratio [OR]: 3.51 [95% confidence interval: 1.44-8.60]), depression/anxiety disorders (OR: 2.72 [1.83-4.05]), and diabetes (OR: 2.18 [1.24-3.83]).Conclusions: Cerebrovascular diseases, depression/anxiety disorders, and diabetes were the conditions more clearly related to disability. On the other hand, a large proportion of subjects attribute their disabilities to osteoarthritis and old age. [ABSTRACT FROM AUTHOR]

Background: The acquisition of healthy lifestyle habits by adolescents is largely influenced by close interpersonal relationships including their parents and teachers., Methods: A cross-sectional survey regarding tobacco use was conducted among 304 parents and 41 teachers of secondary school adolescents (12-17 years of age) enrolled in the first, second, and third grades of compulsory secondary education at the largest high school in Sueca, Valencia, Spain., Results: The prevalence of smoking was 36.2% among parents (occasional smokers 75.4%) and 19.5% among teachers (occasional smokers 62.5%). Most parents (89.8%) did not believe that their child smoked and 95.7% viewed it negatively if they did. Also, 75.2% of parents agreed that tobacco consumption encourages adolescents to use cannabis or other drugs. Friends who smoke and additives added to cigarettes were considered very influential factors for starting smoking. Most teachers (90.2%) reported having given a recommendation to their students to quit smoking. Cannabis and cigarette smoking were rated as harmful to health. Most respondents believed that cigarette smoking may favor the consumption of cannabis., Conclusions: The use of e-cigarettes was also considered a risk factor for starting smoking. It would be advantageous incorporating parents and teachers as role models in multidisciplinary interventions addressing smoking behavior in secondary school students.

Young health advocates have the legitimate aspiration to be masters of their future and are increasingly contributing to public health research and practice worldwide, yet their potential to contribute to the documentation and communication of outputs from public health conferences has not been fully realised. This short communication highlights the Youth Committee of the 2023 European Conference on Tobacco or Health as an example of youth involvement in a major public health conference focused on tobacco control. The authors explore the benefits, practicalities and challenges of incorporating young professionals into conference workflow, including creativity, networking and engagement with broader public health challenges within their communities. This article emphasises the active participation of Youth Committees in public health fora as a model for future conferences and underscores a commitment to achieving a tobacco-free generation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Novel findings indicate links between unhealthy lifestyles and depression based on active inflammatory processes. Thus, identifying participants with poor habits could reveal differences in trends of incident depression. This study aimed to examine the association between an objective lifestyle assessment, as measured by the Lifestyle and Well-Being Index (LWB-I), and incident depression in healthy participants of a Spanish cohort., Study Design: This was a longitudinal analysis of a subsample of 10,063 participants from the Seguimiento Universidad de Navarra cohort study., Methods: Group comparisons and Cox proportional hazard models were conducted using the LWB-I, which categorizes the sample into groups with healthy and unhealthy lifestyles and well-being. The main outcome was incident depression as well as secondary outcomes., Results: Those classified to the transition category of LWB-I were associated with a hazard ratio of 0.67 (95% confidence interval: 0.52-0.87), and those in the excellent category showed a hazard ratio of 0.44 (95% confidence interval: 0.33-0.58), which in both groups reflects a significantly lower risk of incident depression compared with the group including those classified in the poor LWB-I level. Moreover, the available sensitivity analyses concerning time of depression diagnosis or antidepressant treatment further supported the role of nutrition and physical activity on incident depression. Interestingly, throughout the follow-up, incident depression was inversely related to healthier daily habits as measured by the LWB-I., Conclusions: A global assessment of lifestyles such as the LWB-I provides valuable insight into the complex relationship between lifestyle factors and their link to depression risk., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The WHO has defined international targets toward the elimination of hepatitis C by 2030. Most countries cannot be on track to achieve this goal unless many challenges are surpassed. The Let's End HepC (LEHC) tool aims to contribute to the control of hepatitis C. The innovation of this tool combines the modelling of public health policies (PHP) focused on hepatitis C with epidemiological modelling of the disease, obtaining a unique result that allows to forecast the impact of policy outcomes. The model was applied to several countries, including Spain. Methods: To address the stated objective, we applied the "Adaptive Conjoint Analysis" for PHP decision-making and Markov Chains in the LEHC modelling tool. The tool also aims to be used as an element of health literacy for patient advocacy through gamification mechanisms and country comparability. The LEHC project has been conducted in several countries, including Spain. The population segments comprised in the project are: People Who Inject Drugs (PWID), prisoners, blood products, remnant population. Results: A total of 24 PHP related to hepatitis C were included in the LEHC project. It was identified that Spain had fully implemented 14 of those policies to control hepatitis C. According to LEHC's model forecast, the WHO's Hepatitis C elimination goal on reducing the number of patients living with Hepatitis C to 10% can be achieved in Spain by 2026 if current policies are maintained. The model estimates that the total population in Spain, by 2026, is expected to comprise 26,367 individuals living with hepatitis C. Moreover, if the 24 PHP considered for this study are fully implemented in Spain, the elimination goal may be achieved in 2024, with 29,615 individuals living with hepatitis C by that year. Conclusion: The findings corroborate the view that Spain has set great efforts in directing PHP toward Hepatitis C Virus (HCV) elimination by 2030. However, there is still room for improvement, namely in further implementing 10 of the 24 PHP considered for the LEHC project. By maintaining the 14 PHP in force, the LEHC model estimates the HCV elimination in the country by 2026, and by 2024 if further measures are employed to control the disease., Competing Interests: This study received funding from Gilead Sciences Europe Ltd. The funder had the following involvement with the study: financial support for the national data collection part of the modelling, web design, and IT of the LEHC project. Article authorship, national advisory board, and scientific/academic work are not sponsored. All authors declare no other competing interests., (Copyright © 2022 Lopes, Baptista-Leite, Franco, Serra, Escudero and Martín-Moreno.)

The COVID-19 pandemic has hit Spain particularly hard, despite being a country with a developed economy and being praised for the robustness of its national health system. In order to understand what happened and to identify how to improve the response, we believe that an independent multi-disciplinary evaluation of the health, political and socio-economic spheres is essential. In this piece we propose objectives, principles, methodology and dimensions to be evaluated, as well as outlining the type of results and conclusions expected. Inspired by the requirements formulated by the WHO Independent Panel for Pandemic Preparedness and Response and by experiences in other countries, we detail the multidimensional aspects to be evaluated. The goal is to understand key aspects in the studied areas and their scope for improvement in terms of preparedness, governance, regulatory framework, national health system structures (primary care, hospital, and public health), education sector, social protection schemes, minimization of economic impact, and labour framework and reforms for a more resilient society. We seek to ensure that this exercise serves not only at present, but also that in the future we are better prepared and more agile in terms of our ability to recover from any pandemic threats that may arise., (Copyright © 2020 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

The COVID-19 epidemic has been a great challenge to health systems and especially hospitals. A prospective observational epidemiological study was planned as of February 26, 2020 in a tertiary hospital in the Valencia region. The total number of patients followed up with complete information during the first year was 2,448. Among other variables, the comorbidities of the patients were collected (and grouped in the Charson index), the stay in the intensive care unit (ICU), the co-infections, and the colonizations. Data on nosocomial infections due to said virus were also collected. The median days from the onset of symptoms to diagnosis were 4 + 4.6, while an additional 4.4 days had to pass for the patients to be admitted to the ICU. The factors associated with a higher risk of death were those with coinfection, especially with Candida auris [odds ratio (OR): 4.6], a situation that also occurred in the ICU (OR: 3.18). Charlson Index comorbidity and C. auris colonization were also very important both in general hospitalization and in the ICU., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Alfonso-Sanchez, Agurto-Ramirez, Chong-Valbuena, De-Jesús-María, Julián-Paches, López-Cerrillo, Piedrahita-Valdés, Giménez-Azagra and Martín-Moreno.)

Dairy products might influence breast cancer (BC) risk. However, evidence is inconsistent. We sought to examine the association between dairy product consumption-and their subtypes-and incident BC in a Mediterranean cohort. The SUN ("Seguimiento Universidad de Navarra") Project is a Spanish dynamic ongoing cohort of university graduates. Dairy product consumption was estimated through a previously validated 136-item food frequency questionnaire (FFQ). Incident BC was reported in biennial follow-up questionnaires and confirmed with revision of medical records and consultation of the National Death Index. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated with Cox regression models. Among 123,297 women-years of follow-up (10,930 women, median follow-up 12.1 years), we confirmed 119 incident BC cases. We found a nonlinear association between total dairy product consumption and BC incidence ( p nonlinear = 0.048) and a significant inverse association for women with moderate total dairy product consumption (HR Q2vs.Q1 = 0.49 (95% CI 0.28-0.84); HR Q3vs.Q1 = 0.49 (95% CI 0.29-0.84) p trend = 0.623) and with moderate low-fat dairy product consumption (HR Q2vs.Q1 = 0.58 (95% CI 0.35-0.97); HR Q3vs.Q1 = 0.55 (95% CI 0.32-0.92), p trend = 0.136). In stratified analyses, we found a significant inverse association between intermediate low-fat dairy product consumption and premenopausal BC and between medium total dairy product consumption and postmenopausal BC. Thus, dairy products, especially low-fat dairy products, may be considered within overall prudent dietary patterns.

Objective: The aim of this study was to assess body shape trajectories in childhood and midlife in relation to subsequent risk of breast cancer (BC) in a Mediterranean cohort., Design: The 'Seguimiento Universidad de Navarra' (SUN) Project is a dynamic prospective cohort study of university graduates initiated in 1999. With a group-based modelling approach, we assessed body shape trajectories from age 5 to 40 years. Multivariable Cox regression models were used to estimate the hazard ratio (HR) for BC after the age of 40 years according to the body shape trajectory., Setting: City of Pamplona, in the North of Spain., Participants: 6498 women with a mean age of 40 years (sd 9)., Results: We identified four distinct body shape trajectories ('childhood lean-midlife increase' (19·9 %), 'childhood medium-midlife stable' (53 %), 'childhood heavy-midlife stable' (21 %) and 'childhood heavy-midlife increase' (6·1 %)). Among 54 978 women-years of follow-up, we confirmed eighty-two incident cases of BC. Women in the 'childhood lean-midlife increase' group showed a higher risk of BC (HR = 1·84, 95 % CI 1·11, 3·04) compared with women in the 'childhood medium-midlife stable' category. This association was stronger for postmenopausal BC (HR = 2·42, 95 % CI 1·07, 5·48)., Conclusions: Our results suggest a role for lifetime adiposity in breast carcinogenesis.

Background: Sugar-sweetened beverages (SSB) and artificially-sweetened beverages (ASB) have been inconsistently associated with declines in cognitive function. Because of their low caloric content and replacement of sugar, ASB are often seen as 'healthy' alternatives to SSB. Objective: We longitudinally assessed the association between the consumption of SSB or ASB and cognitive function. Design: A subsample of the 'Seguimiento Universidad de Navarra' (SUN) cohort of university graduates aged over 55 years old was evaluated with the Spanish Telephone Interview for Cognitive Status (STICS-m) at two-time points, separated by 6 years. Consumption of SSB and ASB was appraised using a validated food-frequency questionnaire. Linear regression models were fitted, adjusting for potential confounders, including cardiometabolic variables, with the change in the STICS-m score at year 6 as the dependent variable. Results: A significant association between the consumption of SSB and changes in cognitive function as measured by the STICS-m was observed in the total sample, with a change of -0.43 (95% CI -0.85, -0.02, p  = 0.04) in those that consumed >1 beverage/month compared to never/seldom consumers. The association was not significant for the consumption of ASB, but point estimates showed negative values, suggesting declines in cognition. Conclusions: Only the consumption of SSB, but not ASB, was significantly associated with a decline in cognitive function after 6 years. Further longitudinal studies are needed to explore the relationship between these beverages and cognitive function and the potential mechanisms through which they might be harmful.

Objective: To assess the association between a comprehensive smoking ban and hospitalization rates for acute myocardial infarction (AMI)., Methods: An observational study was conducted to assess changes in hospital admission rates for AMI in the Autonomous Community of Valencia, Spain (population 5 million), during the period 1995-2013. Law 28/2005 prohibited smoking in all enclosed spaces (public and private), and Law 42/2010 extended the ban to bars and restaurants as well as children's playgrounds and access areas of schools and hospitals. Data on hospital admissions were obtained from the Hospital Discharge Database (CMBD) of the Autonomous Community. Annual hospital admission rates per 100000 population for AMI (ICD-9-CM code 410) for men and women were calculated., Results: Adjusted hospital admission rates per 100000 population for AMI decreased markedly from 141.1 in 2005 to 119.2 in 2007, with a further reduction to 102.9 in 2013. Reductions in hospital admission were recorded in both men and women, but the downward trends were stronger in women., Conclusion: The Spanish comprehensive smoking ban was associated with a marked reduction in the adjusted rate of hospital admissions due to AMI in the Autonomous Community of Valencia. This decrease in the number of persons requiring in-patient care due to AMI is important from both a health care and a societal perspective., (Copyright © 2020 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The use of oral contraceptives (OC) has been suggested to represent a potential risk factor for the development of obesity. However, the available literature assessing the relationship between OC use and the development of obesity is still scarce and characterised by controversial heterogeneity. We prospectively evaluated the association between the use of OC and the development of obesity in female participants of a middle-aged and free-living cohort., Methods: The study population included 4920 female Spanish university graduates, initially nonobese women, with mean age (standard deviation) 28.2 (5.4) years. The study population was followed up for a mean of 8.6 (3.7) years. Self-reported use of OC and body mass index were assessed at baseline and biennially during follow-up. We used generalized estimating equation models to evaluate the association between exposure to OC and the development of obesity., Results: After adjusting for potential confounders, baseline OC use was associated with higher odds of new-onset obesity during the full follow-up period (multivariable-adjusted odds ratio [OR] = 1.78; 95% Confidence Interval [CI]: 1.01-3.15). The continued use of OC for periods of time longer than 2 years was significantly associated with a higher risk of developing obesity (OR = 2.82, 95% CI: 1.17-6.82)., Conclusions: According to our prospective cohort study, OC use is significantly associated with higher odds of obesity development, especially when the use of OC is steady and extends over periods of more than 2 years.

Background: the association between pain characteristics and frailty risk is uncertain., Objective: to investigate the separate impact of the frequency, intensity and location of pain on frailty risk and its possible mechanisms., Methods: prospective cohort of 1505 individuals ≥63 years followed between 2012 and 2015 in Spain. In 2012, pain was classified into: lowest pain (Score 0), middle pain (Score 1-4) and highest pain (Score 5-6). Incident frailty was assessed in 2015 as having ≥3 Fried criteria or a Frailty Index (FI) ≥0.30., Results: in multivariate analyses, the risk of frailty (measured with the Fried criteria or the FI) increased progressively with the frequency of pain, its intensity and the number of pain locations. Compared with those having the lowest pain score, the odds ratio (95% confidence interval) of Fried-based frailty was 1.24 (0.56-2.75) in the middle score and 2.39 (1.34-4.27; P-trend <0.01) in the highest score. Corresponding values for frailty as FI ≥0.30 were 1.39 (0.80-2.42) and 2.77 (1.81-4.24; P-trend <0.01). Odds ratios did not change after adjustment for alcohol intake, Mediterranean diet adherence or sedentary time, but were reduced with adjustment for pain-associated chronic diseases (cardiovascular disease, diabetes, chronic lung disease, osteomuscular disease and depression). A higher pain score was linked to higher risk of exhaustion and low physical activity (two out of five Fried criteria) and to a worse score in all FI domains., Conclusion: frequency, intensity and location of pain were associated with higher risk of frailty. Study associations were partly explained by pain-associated morbidity.

Through the application of science to public health practice, National Cancer Control Programmes provide the framework for the development of policies on cancer control, with the ultimate goal of reducing cancer morbidity and mortality, and improving quality of life. In the last decade, a substantial number of Member States in the European Union (EU) have formulated and/or updated their National Cancer Control Programmes, Plans or Strategies including primary prevention (health promotion and environmental protection), secondary prevention (screening and early detection), integrated care and organization of services, and palliative care as main elements. Although tobacco control and population-based screening policies are examples of best practices that are gradually being implemented in most of the EU countries, there are still large regional differences in cancer burden arising from the wide variety of social determinants and other epidemiological factors, along with gaps in the policy and practical articulation of cancer control within the health systems. On the other hand, few quantitative assessments are available with regard to evaluating the success or failure of the implementation of these programmes, especially in terms of reducing cancer incidence or mortality. An EU framework to better assess of the effectiveness of cancer prevention policies and the factors triggering shortfall in best practices implementation seems imperative.

Background: The relation of coffee consumption with total mortality is controversial, because the available evidence is still inconsistent., Objective: This study aimed to assess this association in a highly educated, middle-aged Mediterranean cohort., Design: We analyzed data from 201,055 person-years of follow-up arising from 19,888 participants. Coffee consumption was obtained at baseline with the use of a previously validated semiquantitative food-frequency questionnaire. Information on mortality was ascertained by permanent contact with the "Seguimiento Universidad de Navarra" (SUN) participants and their families, postal authorities, and consultation of the National Death Index. We used Cox regression models to estimate HRs and 95% CIs for mortality according to baseline total coffee consumption adjusted for potential confounders. Sex, age, and baseline adherence to the Mediterranean diet were considered as potential effect modifiers., Results: Among the 19,888 participants, 337 died. Overall, in the multivariable adjusted analysis, we found a 22% lower risk of all-cause mortality for each 2 additional cups of total coffee per day (HR: 0.78; 95% CI: 0.66, 0.93). This association was stronger for participants aged ≥55 y (HR: 0.67; 95% CI: 0.52, 0.86) than for younger participants, who showed no significant association (P-interaction = 0.002)., Conclusion: In a Mediterranean cohort, we found an inverse linear association between total coffee consumption and the risk of all-cause mortality that was strongest among participants older than 54 y.

The International Health Regulations (IHR) 2005, as the overarching instrument for global health security, are designed to prevent and cope with major international public health threats. But poor implementation in countries hampers their effectiveness. In the wake of a number of major international health crises, such as the 2014 Ebola and 2016 Zika outbreaks, and the findings of a number of high-level assessments of the global response to these crises, it has become clear that there is a need for more joined-up thinking between health system strengthening activities and health security efforts for prevention, alert and response. WHO is working directly with its Member States to promote this approach, more specifically around how to better embed the IHR (2005) core capacities into the main health system functions. This paper looks at how and where the intersections between the IHR and the health system can be best leveraged towards developing greater health system resilience. This merging of approaches is a key component in pursuit of Universal Health Coverage and strengthened global health security as two mutually reinforcing agendas., Competing Interests: Competing interests: HK, NE, GR, EK, MV and GP work for WHO. JMM is a consultant and advisor to the WHO Regional Office for Europe on public health.

Background: Addressing surgical site infection (SSI) is accomplished, in part, through studies that attempt to clarify the nature of many essential factors in the control of SSI. We sought to examine the link between multiple risk factors, including environmental factors, and SSI for prevention management., Methods: We conducted a longitudinal prospective study to identify SSIs in all patients who underwent interventions in 2014 in 8 selected hospitals on the Mediterranean coast of Spain. Risk factors related to the operating theatre included level of fungi and bacterial contamination, temperature and humidity, air renewal and differential air pressure. Patient-related variables included age, sex, comorbidity, nutrition level and transfusion. Other factors were antibiotic prophylaxis, electric versus manual shaving, American Society of Anaesthesiologists physical status classification, type of intervention, duration of the intervention and preoperative stay., Results: Superficial SSI was most often associated with environmental factors, such as environmental contamination by fungi (from 2 colony-forming units) and bacteria as well as surface contamination. When there was no contamination in the operating room, no SSI was detected. Factors that determined deep and organ/space SSI were more often associated with patient characteristics (age, sex, transfusion, nasogastric feeding and nutrition, as measured by the level of albumin in the blood), type of intervention and preoperative stay. Antibiotic prophylaxis and shaving with electric razor were protective factors for both types of infection, whereas the duration of the intervention and the classification of the intervention as "dirty" were shared risk factors., Conclusion: Our results suggest the importance of environmental and surface contamination control to prevent SSI.

The influence of diet on inflammation in children remains unclear. We aimed to analyze the influence of diet on high-sensitivity C-reactive protein (hs-CRP) levels in a pre-pubertal population free of other influences that may affect hs-CRP levels. We determined hs-CRP levels in 571 six- to eight-year-old children using an hs-CRP ELISA kit. Information on food and nutrient intake was obtained through a food-frequency questionnaire. Overall dietary quality was assessed using the Healthy Eating Index (HEI). We found that girls in the highest tertile of hs-CRP levels had a higher intake of saturated fatty acid, and lower intakes of fiber and vitamin E and a lower HEI score when compared to those in tertiles 1 and 2. We also observed a significant decrease in fruit and vegetable intakes by hs-CRP tertile. Factor analysis showed that a dietary pattern that was loaded most strongly with vegetable, fruit, fiber and vitamin A and E intakes correlated negatively (-0.132, p < 0.05) with hs-CRP. No such association was found in boys. In conclusion, our data show that girls with a poorer quality diet show higher hs-CRP levels already at a pre-pubertal age.

Background: leptin resistance, which may develop during the ageing process, stimulates the production of pro-inflammatory cytokines and insulin resistance that could impair the muscle function. However, the role of leptin on physical functioning among older adults has not yet been elucidated., Objective: to examine the association between serum leptin levels and physical function impairment in older adults., Design and Setting: prospective study of 1,556 individuals 60 years and older from the Seniors-ENRICA cohort, who were free of physical function limitation at baseline., Main Outcome Measure: serum leptin was measured in 2008-10, and incident functional limitation was assessed through 2012. Self-reported limitations in agility and mobility were assessed with the Rosow and Breslau scale, limitation in the lower extremity function was measured with the Short Physical Performance Battery, and impairment in the overall physical performance with the physical component summary of the SF-12., Results: after adjustment for potential confounders and compared to individuals in the lowest quartile of leptin concentration, those in the highest quartile showed increased risk of impaired physical function; the odds ratio (95% confidence interval) and P-trend was: 1.95 (1.11-3.43), P = 0.006 for self-reported impaired mobility; 1.76 (1.08-2.87), P = 0.02 for self-reported impaired agility; 1.48 (1.02-2.15), P = 0.04 for limitation in the lower extremity function; and 1.97 (1.20-3.22), P = 0.01, for decreased overall physical performance. These associations were only modestly explained by C-reactive protein and insulin resistance. Moreover, the associations held across groups with varying health status and were independent of estimated total body fat., Conclusions: higher leptin concentration was associated with increased risk of impaired physical function. Preserving metabolic function during the old age could help delaying physical function decline., (© The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Indications for linezolid use are nosocomial or community-acquired pneumonia and skin infections or soft tissue infection caused by gram-positive microorganisms, but new recommendations may emerge. It is important to balance benefits with risks because severe adverse events have been described in patients taking linezolid treatment. Accordingly, we evaluated the suitability of linezolid prescription according to approval of indication by evaluating the presence of drug-related problems (DRP) in a University hospital. DRP were identified in 36 patients (50.0%). In most cases, they were related to known or established indications (15 patients, 20.8%), to safety (5 patients, 6.9%), and to both in others (16 patients, 22.2%). No DRP were recorded, which modified linezolid efficacy. DRP were significantly higher in the patients treated by an approved indication in Spain (63.3%) than in those treated by an unapproved indication in Spain (28.6%). We concluded that new studies about extending linezolid indications may be necessary.

Background: Clinical inertia has been defined as mistakes by the physician in starting or intensifying treatment when indicated. Inertia, therefore, can affect other stages in the healthcare process, like diagnosis. The diagnosis of dyslipidemia requires ≥2 high lipid values, but inappropriate behavior in the diagnosis of dyslipidemia has only previously been analyzed using just total cholesterol (TC)., Objectives: To determine clinical inertia in the dyslipidemia diagnosis using both TC and high-density lipoprotein cholesterol (HDL-c) and its associated factors., Design: Cross-sectional., Setting: All health center visits in the second half of 2010 in the Valencian Community (Spain)., Patients: 11,386 nondyslipidemic individuals aged ≥20 years with ≥2 lipid determinations., Measurement Variables: Gender, atrial fibrillation, hypertension, diabetes, cardiovascular disease, age, and ESCARVAL training course. Lipid groups: normal (TC<5.17 mmol/L and normal HDL-c [≥1.03 mmol/L in men and ≥1.29 mmol/L in women], TC inertia (TC≥5.17 mmol/L and normal HDL-c), HDL-c inertia (TC<5.17 mmol/L and low HDL-c), and combined inertia (TC≥5.17 mmol/L and low HDL-c)., Results: TC inertia: 38.0% (95% CI: 37.2-38.9%); HDL-c inertia: 17.7% (95% CI: 17.0-18.4%); and combined inertia: 9.6% (95% CI: 9.1-10.2%). The profile associated with TC inertia was: female, no cardiovascular risk factors, no cardiovascular disease, middle or advanced age; for HDL-c inertia: female, cardiovascular risk factors and cardiovascular disease; and for combined inertia: female, hypertension and middle age., Limitations: Cross-sectional study, under-reporting, no analysis of some cardiovascular risk factors or other lipid parameters., Conclusions: A more proactive attitude should be adopted, focusing on the full diagnosis of dyslipidemia in clinical practice. Special emphasis should be placed on patients with low HDL-c levels and an increased cardiovascular risk.

Objectives: The Program for Prevention and Health Promotion (PPHP) of the Spanish Society of Family and Community Medicine was launched at the end of the 1980s and its main objective is to integrate preventive and health promotion activities in daily clinical practice in primary care. The aim of the present study was to determine the level of compliance with the preventive activities of the PPHP., Methods: We performed a comprehensive literature search of PPHP publications to assess the implementation and impact of the program., Results: The distinct evaluations carried out since the beginning of the program show that both compliance and registration of preventive activities have improved over time. The PPHP has been positively evaluated by both health professionals and patients. Family physicians in Spain carry out preventive activities more often than other European family physicians., Conclusions: The PHPPS continues to operate 24 years after its initiation. However, some adaptations are needed since the Spanish health system is changing. Proposed modifications are related to accessibility and to providing a more effective response to users. In elderly patients, life expectancy should be assessed and priorities for preventive interventions should be set accordingly., (Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objectives: No study that analyzes how the investigators who work in the Spanish hospitals perceived and evaluate the current research system has been performed. This work, carried out by the Scientific Forum of the Lilly Foundation, aims to improve the level of information on the research activity performed in the hospitals., Subjects and Methods: By means of a «self-administered» interview made up of 34 items and aimed at physicians and other research professionals who work in the Spanish hospitals (272 surveyed), 3 questions were analyzed: a) general situation of biomedical research in Spain; b) administration of available resources: need for better resources, and c) evaluation and giving priority to biomedical research., Results: The use of the data has shown strengths in the system such as the initiatives to promote research through contracts with FIS and post-residency (7.6/10 points); the beneficial effects of research and care quality (7.3/10); or support of the pharmaceutical industry through the sponsoring of clinical trials (6.9/10). However, it has also shown that there are some weaknesses in the organization of the centers, as for example, those referring to the differentiated allocation of the care cost of the research activity (5.1/10); to the coordination between them and the health care centers (2.8/10); to the integration and organization among care, teaching and research (3.6/10); and to decide the priorities (5.2/10) and evaluation (5.2/10) of the research activities. Furthermore, the value of the research as a fundamental activity of the hospitals is emphasized (4.7/10)., Conclusions: The investigators surveyed consider that biomedical research in recent decades in the hospital setting has significantly improved and has had a positive effect in the number of publications. The subjects surveyed consider that research should have greater institutional support and recognition, and a more translational orientation, which would be translated into better quality of life of the citizens and registry of patents., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Background and Objective: This study estimates smoking-attributable mortality in Spain in 2006., Population and Method: Source data included 1) smoking prevalence in Spain; 2) deaths occurred in Spain; and 3) relative risks of mortality by tobacco-caused diseases drawn from the Cancer Prevention Study II. All data corresponded to individuals aged 35 years and older., Results: In 2006, 53,155 smoking-attributable deaths were estimated (14.7% of all deaths occurred in individuals≥35 years; 25.1% in men and 3.4% in women). Almost 90% (47,174) of these attributable deaths corresponded to men, and 11.3% (5,981) to women. The most frequent attributable deaths were: cancer (24,058), specially lung cancer (16,482), cardiovascular disease (17,560), specially ischemic heart disease (6,263) and stroke (4,283), and respiratory disease (11,537), specially chronic obstructive lung disease (9,886). Since 2001, a decrease in smoking-attributable mortality was observed in men and an increase in women., Conclusions: About one out of 7 deaths occurring annually in individuals≥35 years in Spain is attributable to smoking (one in 4 in men and one in 29 in women). Despite a decreasing trend in the number of smoking-attributable deaths over time (except in women, where they increase), the toll of estimated attributable deaths is still very high., (Copyright © 2010. Published by Elsevier Espana.)

This paper concentrates on the port folio of public health services in the National Health System, with an inventory of those provided by the central level of government in the currently decentralized context of Spain. There is an important activity in public health, with some dispersion among different bodies and organisations. Most of the current activities of the central level of government concentrate in monitoring health levels and their determinants, managing information systems and health alerts and warnings, but with an involvement in policy development, both as a counterpart of the European Union and as an active agent with both regional levels of government and other organisations influencing public health. Besides, this level of government assures some essential services with little visibility for the general population as they are mostly delivered to other public administrations or to professional groups.

Objectives: The objective of the present study was to quantify both diagnostic and therapeutic inertia in hypertension and to identify patient-associated variables., Patients and Methods: Cross-sectional, multicenter study of 35 424 subjects carried out in 428 health centers and/or primary care clinics in the Valencian Community, Spain, in a preventive activity conducted during 2003 and 2004. Diagnostic inertia was identified when a patient without known hypertension had high blood pressure (BP) but was labeled "normal" by the medical staff, and therapeutic inertia when treatment was not modified for a hypertensive patient on the presence of high BP values. Bivariate and multivariate statistical analyses were performed to identify patient's characteristics associated with inertia., Results: Diagnostic inertia was present in 32.5% (95% CI 31.4-33.6) and therapeutic inertia in 37.0% (95% CI 35.6-38.5) of the cases. Both were more frequent in cases of isolated systolic or diastolic high BP. In the multivariate models, the factors associated with diagnostic inertia were type-2 diabetes (p=0.041), non-smoking (p=0.004), previous coronary heart disease (p=0.001), BP values (p<0.001) and body mass index (p=0.031), whereas for therapeutic inertia they were type-2 diabetes (p=0.003), previous coronary heart disease (p=0.016) or stroke (p<0.001) and BP values (p<0.001)., Conclusions: Clinical inertia, either diagnostic or therapeutic, was present in one of every three cases of high BP. The most frequent factors associated with clinical inertia were the presence of associated conditions, which requires lower BP goals and the BP values.

Objective: The objective of the present study was to determine the dietary patterns of a Mediterranean cohort and relate them to the observed patterns of beverage consumption., Design: Prospective cohort study. Dietary habits were assessed with a semi-quantitative FFQ validated in Spain. A principal components factor analysis was used to identify dietary patterns and to classify subjects according to their adherence to these patterns. The association between adherence to each dietary pattern and beverage consumption was assessed cross-sectionally. In a longitudinal analysis (2-year follow-up), the relationship between adherence to the baseline dietary patterns and the likelihood of changing alcohol consumption was ascertained., Setting: The SUN (Seguimiento Universidad de Navarra) study is conducted in Spain., Subjects: In total, 15 073 university graduates were included in the analyses., Results: Two major dietary patterns were identified. We labelled them as 'Western dietary pattern' (WDP) and 'Mediterranean dietary pattern' (MDP). Higher adherence to the WDP was associated with higher consumption of carbonated beverages and whole-fat milk (P for trend <0.001), while higher adherence to the MDP was associated with higher consumption of decaffeinated coffee, orange juice, other natural juices, diet carbonated drinks, low-fat milk and bottled water (P for trend <0.001). Participants with higher adherence to the WDP were less likely to decrease their alcohol consumption during follow-up (OR between extreme quintiles = 0.68; 95 % CI 0.56, 0.84). By contrast, participants with higher adherence to the MDP were less likely to increase their alcohol consumption (OR = 0.66, 95 % CI 0.46, 0.95)., Conclusion: In this cohort of university graduates, a healthier dietary pattern was associated with a healthier pattern of beverage consumption.

The development of the modern methodology necessary to accurately characterize dietary intake in individuals and population only dates back two decades, when nutritional epidemiology first emerged. The reason for the recentness of this discipline lies in the fact that dietary assessment at the population level presents complex challenges which are only being overcome as we investigate and improve the available methodological instruments. In this paper, alternative methods to estimate food and nutritional intake are reviewed. Following a succinct description of direct and indirect methods to evaluate dietary consumption, including a brief reference to biomarkers and mixed techniques such as "total diet" studies, the article focuses on direct methods of quantifying dietary intake through questionnaires. The basis, advantages, and limitations of alternative options are considered, and subsequently the article summarizes the development of new survey designs and analytical/statistical techniques which aim to optimize the available methodology. The article finally concludes by affirming that the approximations indicated by the complementary introduction of biomarkers, together with the optimized use of combined methods with questionnaires, are potentially the most precise and trustworthy estimations of dietary intake at the population level. In light of both the advances achieved and the pending challenges, it is clear that there is a strong necessity to foster research which will lead to improvement in the methodology in this field.

The purpose of this study was to evaluate exposure conditions and acute health effects in subjects participating in the Prestige oil spill cleanup activities and the association between these and the nature of the work and use of protection devices in the regions of Asturias and Cantabria (Spain). The sample comprised 400 subjects in each region, selected from a random sampling of all persons involved in cleanup activities, stratified by type of worker and number of working days. Data were obtained via a structured questionnaire and included information on specific tasks, number of working days, use of protective materials, and acute health effects. These effects were classified into two broad groups: injuries and toxic effects. Data analysis was performed using complex survey methods. Significant differences between groups were evaluated using Pearson's chi(2) test. Unconditional logistic regression was used to compute odds ratios and 95% confidence intervals. Bird cleaners accounted for the highest prevalence of injuries (19% presented with lesions). Working more than 20 days in highly polluted areas was associated with increased risk of injury in all workers. Occurrence of toxic effects was higher among seamen, possibly due to higher exposure to fuel oil and its components. Toxic effects were more frequent among those working longer than 20 days in highly polluted areas, performing three or more different cleaning activities, having skin contact with fuel oil on head/neck or upper limbs, and eating while in contact with fuel or perceiving disturbing odors. No severe disorders were identified among individuals who performed these tasks. However, potential health impact should be considered when organizing cleanup activities in similar environmental disasters.

Chromium intake may increase insulin sensitivity, glucose tolerance, and the ratio of high density lipoprotein cholesterol to low density lipoprotein cholesterol. However, the epidemiologic evidence on the association between chromium and cardiovascular disease is very limited. To determine whether low toenail chromium concentrations were associated with risk of nonfatal myocardial infarction, the authors conducted an incident, population-based, case-control study in eight European countries and Israel in 1991-1992. Cases (n = 684) were men with a first diagnosis of myocardial infarction recruited from the coronary units of participating hospitals. Controls (n = 724) were men selected randomly from population registers (five study centers) or through other sources, such as hospitalized patients (three centers), general practitioners' practices (one center), or relatives or friends of cases (one center). Toenail chromium concentration was assessed by neutron activation analysis. Average toenail chromium concentrations were 1.10 mug/g in cases (95% confidence interval: 1.01, 1.18) and 1.30 mug/g in controls (95% CI: 1.21, 1.40). Multivariate odds ratios for quintiles 2-5 were 0.82 (95% CI: 0.52, 1.31), 0.68 (95% CI: 0.43, 1.08), 0.60 (95% CI: 0.37, 0.97), and 0.59 (95% CI: 0.37, 0.95). Toenail chromium concentration was inversely associated with the risk of a first myocardial infarction in men. These results add to an increasing body of evidence that points to the importance of chromium for cardiovascular health.

Objectives: Epidemiologic studies on probabilistic samples of the institutionalized elderly in Spain are very scarce. The aim of this study was to describe the health and functional status of a population of older people living in nursing homes., Subjects and Method: A cross-sectional epidemiologic study was carried out. A sample of 800 subjects living in 19 public and 26 private nursing homes in Madrid was obtained through a stratified cluster method. Residents, main caregivers, doctors and nurses were interviewed. Cognitive status, perceived health, depression, pain, functional capacity, chronic illnesses, pressure ulcers, urinary and fecal incontinence, drug consumption and hospitalizations were assessed., Results: Seventy-five percent of the sample were women. The mean age was 83.4 (standard deviation, 7.3) years. Forty-four percent had some degree of cognitive impairment. Forty-six percent were independent or mildly dependent in basic activities of daily living. Fifty-five percent reported very good or good perceived health. Thirty percent had depressive symptoms. Thirty-one percent had experienced daily pain in the previous 7 days. Three percent had pressure ulcers. The most prevalent illnesses were hypertension (45%), osteoarthritis (34%), dementia (33%) and anxiety (27%). The prevalence of Alzheimer's disease was 14%. Fifty-three percent had urinary incontinence and 26% had fecal incontinence. Twenty-six percent had been transferred to an emergency unit in the previous year., Conclusions: The estimates of the main variables, such as cognitive impairment and functional status, were in general more favorable than those in other populations of nursing home residents in Europe and North America. This is partly explained by the greater proportion of persons with a low need for care in the nursing homes in Madrid.