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(1) Background: The social determinants that maintain health inequalities are organized in the physical, social, and economic contexts of neighborhoods and municipalities. Their characteristics influence the behaviors and choices of the people living in them, with an impact on their health and well-being. In recent years, several local applications and urban development tools have been designed to learn how to promote the development of health and wellness environments. Aim: The purpose was to test the properties of the Spanish adaptation of the Place Standard Tool through its implementation in a Valencian community municipality. (2) Methods: Metric properties were analyzed from a sample of 242 participants. Descriptive statistics were used to analyze the sociodemographic data and to describe item responses. Cronbach's alpha was used to provide a measure of the internal consistency, whereas the Kaiser-Meyer Olkin test was relied upon to study the relationship between different variables. (3) Results: The questionnaire showed an internal consistency index of 0.849 and a KMO of 0.842, with a single factor variance of 81.50%. (4) Conclusions: The Spanish adaptation of the Place Standard Tool is a valid tool for assessing neighborhoods and municipalities with a focus on social determinants of health and equity.

[ES] El enfoque de aprendizaje de los estudiantes es variable dependiendo de factores personales y situacionales del estudiante. Aunque hay distintas clasificaciones, los enfoques profundo y superficial aparecen como los más comunes. En el presente estudio se ha utilizado el cuestionario R-SPQ-2F en alumnos de una asignatura de segundo curso de máster durante tres cursos académicos consecutivos. El resultado muestra que los alumnos manifiestan un mayor enfoque profundo que superficial y el cuestionario es valido en el contexto educativo realizado. El género de los estudiantes no fue un factor diferencial, pero sí el curso analizado indciando que había variabilidad entre los estudiantes participantes entre cursos. La motivación intrínseca de los estudiantes y la metodología usada en la asignatura parecen los factores más influyentes en favorecer el aprendizaje profundo de los estudiantes., [EN] Students' approach to learning is variable depending on the student's personal and situational factors. Although there are different classifications, deep and superficial approaches appear as the most common. In this study, the R-SPQ-2F questionnaire has been used in students of a second master's year for three consecutive academic courses. The result showed that students present a greater deep approach than superficial and the questionnaire is valid in the educational context conducted. The gender of the students was not a differential factor, but the course analyzed indicated that there was variability among participating students between courses. The intrinsic motivation of the students and the methodology used in the subject seemed the most influential factors in promoting the deep learning of the students.

Background: Exposure to trihalomethanes (THMs) in drinking water has consistently been associated with an increased risk of bladder cancer, but evidence on other cancers including the breast is very limited. Objectives: We assessed long-term exposure to THMs to evaluate the association with female breast cancer (BC) risk. Methods: A multi case-control study was conducted in Spain from 2008 to 2013. We included 1003 incident BC cases (women 20-85 years old) recruited from 14 hospitals and 1458 population controls. Subjects were interviewed to ascertain residential histories and major recognized risk factors for BC. Mean residential levels of chloroform, brominated THMs (Br-THMs) and the sum of both as total THM (TTHMs) during the adult-lifetime were calculated. Results: Mean adult-lifetime residential levels ranged from 0.8 to 145.7 mu g/L for TTHM (median= 30.8), from 0.2 to 62.4 mu g/L for chloroform (median = 19.7) and from 0.3 to 126.0 mu g/L for Br-THMs (median= 9.7). Adult-lifetime residential chloroform was associated with BC (adjusted OR = 1.47; 95% CI = 1.05, 2.06 for the highest (> 24 mu g/L) vs. lowest (< 8 mu g/L) quartile; p-trend = 0.024). No association was detected for residential Br-THMs (OR= 0.91; 95% CI = 0.68, 1.23 for> 31 mu g/L vs.< 6 mu g/L) or TTHMs (OR = 1.14; 95% CI = 0.83, 1.57 for> 48 mu g/L vs.< 22 mu g/L). Conclusions: At common levels in Europe, long-term residential total THMs were not related to female breast cancer. A moderate association with chloroform was suggested at the highest exposure category. This large epidemiological study with extensive exposure assessment overcomes several limitations of previous studies but further studies are needed to confirm these results.

Background Evidence for a protective role of physical activity against development of stomach cancer is yet inconclusive. We studied the association of domain-specific physical activity and the risk of gastric adenocarcinoma (GAC), by site and histology, in the MCC-Spain case-control study. Methods 428 histologically confirmed GAC cases (67% men) including the gastro-esophageal region and 3225 controls were included. Cases were recruited in hospitals from 10 different Spanish regions, whereas population controls were randomly selected within the respective hospitals' catchment areas. A physical activity (PA) questionnaire was used to gather information on household and recreational activities, allowing estimation of PA volume (in metabolic equivalents (MET)-min/week). Participants also reported the intensity of working PA and daily sitting time. Questionnaire data on diet, lifestyles and clinical variables including Helicobacter pylori serology were available. Adjusted odds ratios (OR) of GAC were estimated for domains of physical activity, stratifying by sex, site (cardia vs. non-cardia), and Lauren classification (intestinal vs. diffuse). Results Household physical activity (HPA) showed a strong inverse association with GAC, observed for both cardia and non-cardia tumours. Risk of overall gastric cancer was 50% lower risk among participants in the highest HPA category (OR = 0.50, 95`)Cl: 0.38, 0.66). Recreational physical activity (RPA) was also associated with lower overall GAC risk (OR = 0.68, 95% CI: 0.52, 0.88), particularly at moderate levels of intensity such as walking (OR = 0.61, 95% CI: 0.46, 0.79). The protective effect of RPA was strongest for non-cardia tumours. Sedentary time was not related to GAC risk (p-trend = 0.392), but the potential protective effect of RPA was restricted to non -sedentary participants. Conclusions Both household and recreational physical activities were independently related to lower GAC risk in the MCC-Spain study.

This field note presents the conclusions and recommendations made at the meeting 'How to reduce social inequalities in cancer screening programmes?' held at the XXVI School of Public Health of Mahon (Menorca, Spain). Participants developed recommendations based on experiences of population-based screening programmes (breast and colorectal) and opportunistic screening (cervical). The conclusions and recommendations focused on four main areas (information systems, evaluation and quality, research, and interventions): the inclusion of social variables at an individual level in health information systems; the establishment of minimum standards for gathering information regarding inequalities in access to preventive services; the performance of actions in vulnerable populations; and the promotion of the exchange of experiences and best practices through the Cancer Screening Programmes Network and working groups of the scientific societies. (C) 2016 SESPAS. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Epidemiologic and animal data indicate that night shift work might increase the risk for breast cancer. We evaluated the association of night work with different clinical types of breast cancer in a population based case-control study (MCC-Spain study) taking into account chronotype, an individual characteristic that may relate to night shift work adaptation. Lifetime occupational history was assessed by face-to-face interviews and shift work information was available for 1708 breast cancer cases and 1778 population controls from 10 Spanish regions, enrolled from 2008 to 2013. We evaluated three shift work domains, including shift work type (permanent vs rotating), lifetime cumulative duration and frequency. We estimated odds ratios (OR) for night work compared to day work using unconditional logistic regression models adjusting for confounders. Having ever worked permanent or rotating night shift was associated with an increased risk for breast cancer compared to day workers [odds ratio (OR) 1.18; 95 % CI 0.97, 1.43]. Chronotype was differentially associated with breast cancer depending on the duration of night shift work. Risk was higher in women with invasive tumors (OR 1.23; 95 % CI 1.00, 1.51) and for estrogen and progestagen positive tumors among premenopausal women (OR 1.44; 95 % CI 1.05, 1.99). Having ever performed night shift was associated with a small increased risk for breast cancer and especially in subgroups of women with particular hormone related characteristics.

Introduction: We present the protocol of a large population-based case-control study of 5 common tumors in Spain (MCC-Spain) that evaluates environmental exposures and genetic factors. Methods: Between 2008-2013, 10,183 persons aged 20-85 years were enrolled in 23 hospitals and primary care centres in 12 Spanish provinces including 1,115 cases of a new diagnosis of prostate cancer, 1,750 of breast cancer, 2,171 of colorectal cancer, 492 of gastro-oesophageal cancer, 554 cases of chronic lymphocytic leukaemia (CLL) and 4,101 population-based controls matched by frequency to cases by age, sex and region of residence. Participation rates ranged from 57% (stomach cancer) to 87% (CLL cases) and from 30% to 77% in controls. Participants completed a face-to-face computerized interview on sociodemographic factors, environmental exposures, occupation, medication, lifestyle, and personal and family medical history. In addition, participants completed a self-administered food-frequency questionnaire and telephone interviews. Blood samples were collected from 76% of participants while saliva samples were collected in CLL cases and participants refusing blood extractions. Clinical information was recorded for cases and paraffin blocks and/or fresh tumor samples are available in most collaborating hospitals. Genotyping was done through an exome array enriched with genetic markers in specific pathways. Multiple analyses are planned to assess the association of environmental, personal and genetic risk factors for each tumor and to identify pleiotropic effects. Discussion: This study, conducted within the Spanish Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), is a unique initiative to evaluate etiological factors for common cancers and will promote cancer research and prevention in Spain. (C) 2014 SESPAS. Published by Elsevier Espana, S.L.U. All rights reserved.

Night shift work has been classified as a probable human carcinogen based on experimental studies and limited human evidence on breast cancer. Evidence on other common cancers, such as prostate cancer, is scarce. Chronotype is an individual characteristic that may relate to night work adaptation. We evaluated night shift work with relation to prostate cancer, taking into account chronotype and disease severity in a population based case-control study in Spain. We included 1,095 prostate cancer cases and 1,388 randomly selected population controls. We collected detailed information on shift schedules (permanent vs. rotating, time schedules, duration, frequency), using lifetime occupational history. Sociodemographic and lifestyle factors were assessed by face-to-face interviews and chronotype through a validated questionnaire. We used unconditional logistic regression analysis adjusting for potential confounders. Subjects who had worked at least for one year in night shift work had a slightly higher prostate cancer risk [Odds Ratio (OR) 1.14; 95%CI 0.94, 1.37] compared with never night workers; this risk increased with longer duration of exposure (28 years: OR 1.37; 95%CI 1.05, 1.81; p-trend=0.047). Risks were more pronounced for high risk tumors [D'Amico classification, Relative Risk Ratio (RRR) 1.40; 95%CI 1.05, 1.86], particularly among subjects with longer duration of exposure (28 years: RRR 1.63; 95%CI 1.08, 2.45; p-trend=0.027). Overall risk was higher among subjects with an evening chronotype, but also increased in morning chronotypes after long-term night work. In this large population based study, we found an association between night shift work and prostate cancer particularly for tumors with worse prognosis. What's new? Up to 20% of workers do night-shift work, which may increase the risk of some cancers. In this study, the authors found that long-term night-shift work was associated with an increased risk of prostate cancer and decreased survival. Overall risk was higher among workers with an evening chronotype (i.e., a preference for working in the evening vs. in the morning), but risk also increased for morning chronotypes if the duration of night-shift work increased. These results may improve our understanding of prostate cancer etiology and potential prevention strategies.

El cáncer es uno de los principales problemas de salud. Engloba a un conjunto de enfermedades que tienen un origen multicausal. Los tumores con mayor impacto en la salud son pulmón, próstata y colorrectal en los hombres y mama y colorrectal en las mujeres. Las mejores estrategias para evitar el cáncer son las basadas en la prevención primaria y en el diagnóstico precoz. Se estima que entre el 80-90% de los canceres son prevenibles. Respecto a la prevención primaria hay fuerte evidencia que no fumar, realizar ejercicio físico regular, y una dieta rica en frutas y verduras junto con el control de algunos factores de riesgo ambientales y laborales, puede disminuir la incidencia del cáncer. Está recomendado el diagnóstico precoz de cáncer de mama, cuello de útero y de cáncer colorrectal en algunos grupos de población en el contexto de programas organizados con la adecuada garantía de calidad. Cancer is one of the main health problems. It includes a set of diseases with multi-causal origins. The tumours with the greatest impact on the health of men are lung, prostate and colorectal cancers, while for women they are breast and colorectal tumours. The best strategies for preventing cancer are ones based on primary prevention and early diagnosis. It is estimated that about to 80-90% of cancers are preventable. As regards primary prevention, there is considerable evidence to suggest that not smoking, regular physical exercise and a diet rich in fruit and vegetables, along with the control of some environmental and occupational risk factors can reduce the incidence of cancer. The early diagnosis of breast, colorectal and cervical cancer is recommended for some groups of the population in a context of organised programs with adequate quality guarantees.

In November 2008, at the request of the Directorate General of Public Health of the Ministry of Health and Social Policy, the Commission to Reduce Social Inequalities in Health in Spain was established with a mandate to develop a proposal for interventions to reduce health inequalities. This article aims to present the work carried out and the documents prepared by the Commission. The Commission, consisting of 18 members, conducted a situational analysis of health inequalities and of the policies to reduce them, reviewed international documents and consulted 56 experts from distinct fields to develop a proposal for recommendations to reduce health inequalities. In May 2010, the Commission presented the document " Moving toward equity: a proposal for policies and interventions to reduce social inequalities in health in Spain" The document listed a total of 166 recommendations, divided into 14 areas and ordered by priority. These recommendations highlight that health inequalities cannot be reduced without a commitment to promote health and equity in all policies and to move toward a fairer society. © 2011 SESPAS.

Objectives. We assessed the effectiveness of the penalty points system (PPS) introduced in Spain in July 2006 in reducing traffic injuries. Methods. We performed an evaluation study with an interrupted time-series design. We stratified dependent variables-numbers of drivers involved in injury collisions and people injured in traffic collisions in Spain from 2000 to 2007 (police data)-by age, injury severity, type of road user, road type, and time of collision, and analyzed variables separately by gender. The explanatory variable (the PPS) compared the postintervention period (July 2006 to December 2007) with the preintervention period (January 2000 to June 2006). We used quasi- Poisson regression, controlling for time trend and seasonality. Results. Among men, we observed a significant risk reduction in the postintervention period for seriously injured drivers (relative risk [RR]=0.89) and seriously injured people (RR=0.89). The RRs among women were 0.91 (P=.095) and 0.88 (P

The objective of this work was to analyze 3 functional candidate genes for reproduction in 2 lines of rabbits divergently selected by uterine capacity. Both lines were selected for 10 generations. The selection was then relaxed until the 17th generation, when it was compounded by 61 and 63 does of the High and Low lines, respectively. We sequenced the SCGB1A1 gene, which encodes the main protein secreted by the rabbit in the uterus and seems to play an important role in implantation. We found 6 SNP in the promoter region cosegregating in 2 haplotypes in both lines with similar frequency. We also analyzed IGF1 mRNA because of its effects on embryo development, but we did not find any polymorphism between individuals of the 2 lines. The third gene analyzed was the TIMP1, which encodes a protein involved in many biological processes related to reproduction. We determined the sequence of its promoter region and found 1 SNP (g.1423A>G) segregating with different frequencies in both lines (0.60 for allele A in the High line and 0.82 for allele G in the Low line). The association study performed in an F2 population (n = 598) generated by the cross of the 2 lines of rabbits revealed that the AA genotype had 0.88 embryos more than the GG genotype at 72 h of gestation. The difference increased to 2.23 embryos at implantation, but no difference was found between genotypes at birth. These results suggest that TIMP1 could be a candidate gene for embryo implantation and embryo survival., This study was funded by projects by the Comisión Interministerial de Ciencia y Tecnología AGL2001-3068 and AGL2005-07624. M. Merchán acknowledges an Formación de Personal Investigador (FPI) grant from the Ministerio de Ciencia y Tecnología and R. Peiró an FPI grant from Oficina de Ciencia y Tecnología de la Generalitat Valenciana.

An association study was performed in rabbits between early embryo survival and development, and the nonconservative SNP 12944C>G located in exon 11 and the triallellic microsatellite [(GT)15T(G)5, (GT)14T(G)5, and (GT)11T(G)7)] located in the promoter region of the oviductal glycoprotein 1 (OVGP1) gene. We analyzed an F2 cross of 2 lines of rabbits divergently selected for uterine capacity. A total of 172 and 159 females were slaughtered at 48 and 72 h of gestation, respectively, to determine whether OVGP1 influences ovulation rate, fertilization rate, early embryo survival, and embryonic stage of development. The results of the SNP indicated that all genotypes showed similar early embryo survival and a similar embryonic stage of development at 48 h of gestation. However, at 72 h of gestation, the GG genotype showed greater early embryo survival than the CC genotype (0.56 embryos) and their embryos presented less embryonic development. Analysis of the microsatellite was performed to ascertain the presence or absence of the allele (GT)14T(G)5. At both stages of gestation, the (GT)14T(G)5/(GT)14T(G)5 genotype showed greater early embryo survival (0.94 and 1.54 embryos at 48 and 72 h of gestation, respectively) and less embryonic development than the homozygous genotypes without the allele (GT)14T(G)5., This study was supported by Comisión Interministerial de Ciencia y Tecnología (CICYT) grants CICYT-AGL2001-3068-C03 and CICYT-AGL2005-07624-C03

Motor road transport has increased exponentially in the last few years. To a large extent, mobility is an essential element in the organization of society, but, until recently, the implications of chosen forms of transport for health and the environment have not been considered. In this chapter we review the negative impact of current forms of transport on health in terms of traffic injuries, climate change, atmospheric contamination, noise, and interference with daily activities and exercise, such as impediments to walking or cycling. Some possible interventions related to the instruments available in public health and other fields are proposed. Issues deserving further research are highlighted. Some examples in Spain and other countries are described. Recommendations are made on the need to reduce the use of private cars and to develop segmented routes and areas of quiet traffic connected in the cities and among nearby towns to promote walking are cycling. One major goal in current public policies should be to develop and maintain a public transport system that is safe, cheap and faster and less polluting than private transport. These interventions would help to achieve a change in current modes of transport and would lead to a healthier population and a more sustainable environment.

Se describen las líneas de trabajo priorizadas y algunos resultados obtenidos en la implantación del programa de prevención y reducción de lesiones por accidentes de tráfico en un área de salud. A partir de 1999 el Centro de Salud Pública priorizó la identificación y búsqueda de aliados en otros sectores (Asociación de policías locales y educación), la construcción de la capacidad de trabajo conjunta y la formación de un grupo intersectorial. Se llevaron a cabo actividades docentes y jornadas. Se formó una red de personas en 17 de un total de 39 ayuntamientos que participan con actividades en el grupo intersectorial. Un total de 10 de estos ayuntamientos participaron con actividades educativas y siete, además, exigieron al cumplimiento de la legislación. El grupo intersectorial potenció la visibilidad de sus actividades a través de los medios de comunicación local. Estas actividades no están dirigidas a reducir las lesiones por tráfico, sino a crear un marco de trabajo para la movilización de los sectores implicados. Se pretende potenciar más el compromiso entre los niveles políticos, técnicos y civiles incidiendo en valores sociales de respeto para una vida más saludable. We describe priority issues and some of the results obtained from the implementation of the «Prevention and Reduction of Traffic Accident Injuries» program in a health area. Since 1999 the public health center has made a priority of identifying and recruiting partners from other sectors (the local police association and the local education authority), increasing its capacity for working together, and setting up an intersectorial working group. Teaching activities and meetings were held. A network of people was created from 17 of a total of 39 town halls that participate in activities supported by the intersectorial group. Ten are involved in educational activities and a further seven focus on ensuring compliance with the law. The intersectorial group promoted their visibility through the local media. These activities are not aimed at reducing injuries from road traffic accidents, but rather at creating an action framework through which all the sectors involved can be mobilized. The aim is to strengthen commitment among political, technical and civil sectors by focussing on social values of respect for a healthier life.