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Lopes H, Baptista-Leite R, Franco D, Serra MA, Escudero A, Martín-Moreno JM. Let's End HepC: Modelling Public Health Epidemiological Policies Applied to Hepatitis C in Spain. Front Public Health 2022; 9:735572. [PMID: 35071151 PMCID: PMC8777247 DOI: 10.3389/fpubh.2021.735572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Henrique Lopes
- Institute of Health Sciences, Catholic University of Portugal, Lisbon, Portugal
| | - Ricardo Baptista-Leite
- Institute of Health Sciences, Catholic University of Portugal, Lisbon, Portugal.,Faculty of Health, Medicine and Life Sciences, Department of International Health, Care and Public Health Research Institute - CAPHRI, Maastricht University, Maastricht, Netherlands
| | - Diogo Franco
- Institute of Health Sciences, Catholic University of Portugal, Lisbon, Portugal
| | - Miguel A Serra
- Digestive Medicine Service, University of Valencia, Valencia, Spain
| | - Amparo Escudero
- Department of Medicine, University of Valencia, Valencia, Spain
| | - José M Martín-Moreno
- Department of Preventive Medicine and Public Health and INCLIVA, University of Valencia, Valencia, Spain
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Martín-Moreno JM, Arenas A, Bengoa R, Borrell C, Franco M, García-Basteiro AL, Gestal J, González López-Valcárcel B, Hernández Aguado I, Legido-Quigley H, March JC, Minué S, Muntaner C, Vives-Cases C. [Insight on how to assess and improve the response to the COVID-19 pandemic]. Gac Sanit 2022; 36:32-36. [PMID: 33518411 PMCID: PMC7834448 DOI: 10.1016/j.gaceta.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- José M. Martín-Moreno
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina e INCLIVA, Universitat de València, Valencia, España,Autor para correspondencia
| | - Alex Arenas
- Departament d’Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, España
| | | | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, España,CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Manuel Franco
- Grupo de Investigación en Epidemiología y Salud Pública, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Alcalá de Henares, Madrid, España,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alberto L. García-Basteiro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, España,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Juan Gestal
- Universidad de Santiago de Compostela, España
| | | | | | - Helena Legido-Quigley
- London School of Hygiene and Tropical Medicine and Saw Swee Hock School of Public Health, University of Singapore
| | | | - Sergio Minué
- Escuela Andaluza de Salud Pública, Granada, España
| | - Carles Muntaner
- University of Toronto y Center for Urban Health Solucions, Li Ka Shing Knowledge Institute, Canadá
| | - Carmen Vives-Cases
- CIBER de Epidemiología y Salud Pública (CIBERESP), España,Universidad de Alicante, España
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Carrión-Valero F, Quiles-Izquierdo J, González-Monte C, Taberner-Alberola F, Lluch-Rodrigo JA, Chorro FJ, Martín-Moreno JM. Association between a comprehensive smoking ban and hospitalization for acute myocardial infarction: An observational study in the Autonomous Community of Valencia, Spain. Revista Portuguesa de Cardiologia (English Edition) 2020. [DOI: 10.1016/j.repce.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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4
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San-Juan-Rodriguez A, Bes-Rastrollo M, Martinez-Gonzalez MA, Martín-Moreno JM, Rico-Campà A, Gea A. Oral contraceptives use and development of obesity in a Mediterranean cohort: the SUN (Seguimiento Universidad de Navarra) Project. Int J Obes (Lond) 2019; 44:320-329. [PMID: 31467420 DOI: 10.1038/s41366-019-0442-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/01/2019] [Accepted: 07/15/2019] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Alvaro San-Juan-Rodriguez
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,CIBERobn, Instituto de Salud Carlos III, Madrid, Spain.,Navarra's Health Research Institute (IdiSNA), Pamplona, Spain
| | - Miguel A Martinez-Gonzalez
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,CIBERobn, Instituto de Salud Carlos III, Madrid, Spain.,Navarra's Health Research Institute (IdiSNA), Pamplona, Spain.,Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - José M Martín-Moreno
- Department of Preventive Medicine & INCLIVA, University of Valencia, Valencia, Spain
| | - Anaïs Rico-Campà
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,CIBERobn, Instituto de Salud Carlos III, Madrid, Spain
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain. .,CIBERobn, Instituto de Salud Carlos III, Madrid, Spain. .,Navarra's Health Research Institute (IdiSNA), Pamplona, Spain.
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Muñoz-García MI, Martínez-González MA, Martín-Moreno JM, Razquin C, Cervantes S, Guillén-Grima F, Toledo E. Sugar-sweetened and artificially-sweetened beverages and changes in cognitive function in the SUN project. Nutr Neurosci 2019; 23:946-954. [DOI: 10.1080/1028415x.2019.1580919] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Mariana I. Muñoz-García
- Department of Preventive Medicine and Public Health, School of Medicine and University of Navarra Clinic, University of Navarra, Pamplona, Spain
| | - Miguel A. Martínez-González
- Department of Preventive Medicine and Public Health, School of Medicine and University of Navarra Clinic, University of Navarra, Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology and Public Health, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - José M Martín-Moreno
- Department of Preventive Medicine and Public Health and INCLIVA, University of Valencia, Valencia, Spain
| | - Cristina Razquin
- Department of Preventive Medicine and Public Health, School of Medicine and University of Navarra Clinic, University of Navarra, Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Epidemiology and Public Health, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Sebastián Cervantes
- Department of Preventive Medicine and Public Health, School of Medicine and University of Navarra Clinic, University of Navarra, Pamplona, Spain
- Department of Radiology, Complejo Hospitalario de Navarra, Osasunbidea-Servicio Navarro de Salud, Pamplona, Spain
| | - Francisco Guillén-Grima
- Department of Preventive Medicine and Public Health, School of Medicine and University of Navarra Clinic, University of Navarra, Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Epidemiology and Public Health, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Estefanía Toledo
- Department of Preventive Medicine and Public Health, School of Medicine and University of Navarra Clinic, University of Navarra, Pamplona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Epidemiology and Public Health, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
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6
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Navarro AM, Martinez-Gonzalez MÁ, Gea A, Grosso G, Martín-Moreno JM, Lopez-Garcia E, Martin-Calvo N, Toledo E. Coffee consumption and total mortality in a Mediterranean prospective cohort. Am J Clin Nutr 2018; 108:1113-1120. [PMID: 30475964 DOI: 10.1093/ajcn/nqy198] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/23/2018] [Indexed: 12/26/2022] Open
Abstract
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.
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Affiliation(s)
- Adela M Navarro
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.,Department of Cardiology, Complejo Hospitalario de Navarra, Servicio Navarro de Salud Osasunbidea, Pamplona, Spain
| | - Miguel Á Martinez-Gonzalez
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - Giuseppe Grosso
- Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliera Policlinico-Universitaria "Vittorio Emanuele," Catania, Italy.,The Need for Nutrition Education/Innovation Programme (NNEdPro), University of Cambridge, Cambridge, United Kingdom
| | - José M Martín-Moreno
- Department of Preventive Medicine and Public Health & INCLIVA, Universidad de Valencia, Valencia, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.,IdiPAZ (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Nerea Martin-Calvo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - Estefanía Toledo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.,Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
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7
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Navarro P, de Dios O, Jois A, Gavela-Pérez T, Gorgojo L, Martín-Moreno JM, Soriano-Guillen L, Garcés C. Vegetable and Fruit Intakes Are Associated with hs-CRP Levels in Pre-Pubertal Girls. Nutrients 2017; 9:nu9030224. [PMID: 28257085 PMCID: PMC5372887 DOI: 10.3390/nu9030224] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/20/2017] [Accepted: 02/27/2017] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Pilar Navarro
- Lipid Laboratory, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain.
| | - Olaya de Dios
- Lipid Laboratory, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain.
| | - Asha Jois
- Lipid Laboratory, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain.
| | - Teresa Gavela-Pérez
- Lipid Laboratory, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain.
- Department of Pediatrics, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain.
| | - Lydia Gorgojo
- Department of Preventive Medicine and Public Health and INCLIVA-Clinical Hospital, University of Valencia, 46010 Valencia, Spain.
| | - José M Martín-Moreno
- Department of Preventive Medicine and Public Health and INCLIVA-Clinical Hospital, University of Valencia, 46010 Valencia, Spain.
| | - Leandro Soriano-Guillen
- Lipid Laboratory, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain.
- Department of Pediatrics, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain.
| | - Carmen Garcés
- Lipid Laboratory, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain.
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8
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Vila-Candel R, Soriano-Vidal FJ, Navarro-Illana P, Murillo-Llorente MT, Martín-Moreno JM. [Relationship between maternal body mass index, gestational weight gain and birth weight; prospective study in a health department]. NUTR HOSP 2015; 31:1551-7. [PMID: 25795940 DOI: 10.3305/nh.2015.31.4.8495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To ascertain the relationship between maternal weight gain and birth weight, in every pre-gestational body mass index (BMI) category. MATERIAL AND METHODS A two-stage sampling observational and descriptive study was carried out in the health department of La Ribera (Valencia, Spain). The sample was divided into four groups according to pre-gestational BMI. FINDINGS 140 pregnant women were studied. We observed rising pre-gestational weight gain (PWG) and trimestral gradients. There was a higher increase from the first to the second trimester than from the second to the third trimester in every pre-gestational BMI category. According to the international recommendations of Institute of Medicine, 16.4% of women had an inferior gestational weight gain (GWG), 38.6% were within the recommendations and 45% were above them. The pre-gestational BMI, categorized by the WHO, is related to the birth weight, showing a statistical significance (F=6.636 and and p<0.001). Obese mothers with a higher weight gain than the recommended have newborns with higher birth weight (4,353 ± 821.924 g) and, underweight mothers with a lower weight gain than the recommended, have newborns with lower birth weights (2,900 ± 381.83 g) than the rest of the groups. CONCLUSIONS The absolute gestational weight gain did not show a statistical significance compared to the birthweight in any of the pre-gestational BMI categories and, as an isolated indicator, is not an added value to the prenatal quality control.
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Affiliation(s)
- Rafael Vila-Candel
- Hospital Universitario de la Ribera. Director of Department of Nursing, Universidad Católica de Valencia, Spain..
| | | | - Pedro Navarro-Illana
- PhD, Nursing. Dean of the Faculty of Nursing at Universidad Católica de Valencia, Spain..
| | | | - José M Martín-Moreno
- MD, PhD, DrPH is a Full Professor at the Department of Preventive Medicine and Public Health, Universitat de Valencia, Spain. Director, Programme Management World Health Organization, Spain..
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Llinás G, Mira JJ, Quirós T, Martín-Moreno JM. [Walking the talk: Quality in the Information Technology era, within the 31st SECA Congress]. Rev Calid Asist 2014; 29:183-184. [PMID: 24679551 DOI: 10.1016/j.cali.2014.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 02/25/2014] [Indexed: 06/03/2023]
Affiliation(s)
- G Llinás
- Unidad Central de Calidad, Departamento de salud de Valencia-Clínico-Malvarrosa, Área de Medicina Preventiva y Salud Pública, Universitat de València, Valencia, España.
| | - J J Mira
- Departamento de salud de Alicante-Sant Joan, Universidad Miguel Hernández, Elche, España
| | - T Quirós
- Unidad de Organización Asistencial y Calidad, Departamento de Salud de la Ribera, Alzira, Valencia, España
| | - J M Martín-Moreno
- Unidad Central de Calidad, Departamento de salud de Valencia-Clínico-Malvarrosa, Área de Medicina Preventiva y Salud Pública, Universitat de València, Valencia, España
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10
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Palazón-Bru A, Gil-Guillén VF, Orozco-Beltrán D, Pallarés-Carratalá V, Valls-Roca F, Sanchís-Domenech C, Martín-Moreno JM, Redón J, Navarro-Pérez J, Fernández-Giménez A, Pérez-Navarro AM, Trillo JL, Usó R, Ruiz E. Is the physician's behavior in dyslipidemia diagnosis in accordance with guidelines? Cross-sectional ESCARVAL study. PLoS One 2014; 9:e91567. [PMID: 24626597 PMCID: PMC3953440 DOI: 10.1371/journal.pone.0091567] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 02/12/2014] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
| | | | | | - Vicente Pallarés-Carratalá
- Health Surveillance Department, Mutual Society of Castellón, Castellón, Spain
- Department of Medicine, Jaume I University, Castellón, Spain
| | | | | | | | - Josep Redón
- School of Medicine, University of Valencia, Valencia, Spain
| | | | | | - Ana M. Pérez-Navarro
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Generalitat Valenciana, Valencia, Spain
| | - José L. Trillo
- Conselleria de Sanitat, Generalitat Valenciana, Valencia, Spain
| | - Ruth Usó
- Conselleria de Sanitat, Generalitat Valenciana, Valencia, Spain
| | - Elías Ruiz
- Conselleria de Sanitat, Generalitat Valenciana, Valencia, Spain
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Banegas JR, Díez-Gañán L, Bañuelos-Marco B, González-Enríquez J, Villar-Álvarez F, Martín-Moreno JM, Córdoba-García R, Pérez-Trullén A, Jiménez-Ruiz C. Mortalidad atribuible al consumo de tabaco en España en 2006. Med Clin (Barc) 2011; 136:97-102. [DOI: 10.1016/j.medcli.2010.03.039] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Revised: 03/12/2010] [Accepted: 03/16/2010] [Indexed: 10/18/2022]
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Villalbí JR, Carreras F, Martín-Moreno JM, Hernández-Aguado I. La cartera de servicios de salud pública en el Sistema Nacional de Salud: la aportación de la administración general del Estado. Rev Esp Salud Publica 2010; 84:247-54. [DOI: 10.1590/s1135-57272010000300003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Martín-Moreno JM, Gorgojo L. [Assessment of dietary intake at the population level through individual questionnaires: methodological shadows and lights]. Rev Esp Salud Publica 2008; 81:507-18. [PMID: 18274354 DOI: 10.1590/s1135-57272007000500007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Royo-Bordonada MA, Garcés C, Gorgojo L, Martín-Moreno JM, Lasunción MA, Rodríguez-Artalejo F, Fernández O, de Oya M. Saturated fat in the diet of Spanish children: relationship with anthropometric, alimentary, nutritional and lipid profiles. Public Health Nutr 2007; 9:429-35. [PMID: 16870014 DOI: 10.1079/phn2005870] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjectiveTo compare the anthropometric, alimentary, nutritional and lipid profiles and global diet quality of Spanish children according to saturated fat intake.DesignThis was a cross-sectional study. Food data were collected using a food-frequency questionnaire.Subjects and methodsThe sample included 1112 children of both sexes, aged between 6 and 7 years, selected by means of random cluster sampling in schools. The plasma lipid profile included measurements of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, apolipoprotein A1 (apoA1) and apolipoprotein B (apoB). Global diet quality was evaluated by the Dietary Variety Index (DVI) and the Healthy Eating Index (HEI).ResultsEnergy intake, DVI and HEI of children from the lower quartile of saturated fat intake (LL) were higher (P < 001) than in the remaining children (UL). However, there were no significant differences in average height or weight between groups. The UL children had lower intakes of meat, fish, vegetables, fruits and olive oil and a higher intake of dairy products (P < 0.001). The intakes of fibre, vitamins C, D, B6, E and folic acid were higher in the LL children, who had lower intakes of vitamin A and calcium. The ratios LDL-C/HDL-C and apoB/apoA1 were lower (P = 0.04) in the LL children (1.87 and 0.52, respectively) than in the UL children (2.02 and 0.54, respectively).ConclusionsThe growth rate of children does not seem to be affected by the level of saturated fat intake. Furthermore, at the levels of intake observed in this study, diets with less saturated fat are associated with better alimentary, nutritional and plasma lipid profiles.
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Affiliation(s)
- M A Royo-Bordonada
- Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo, Madrid, Spain.
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Suárez B, Lope V, Pérez-Gómez B, Aragonés N, Rodríguez-Artalejo F, Marqués F, Guzmán A, Viloria LJ, Carrasco JM, Martín-Moreno JM, López-Abente G, Pollán M. Acute health problems among subjects involved in the cleanup operation following the Prestige oil spill in Asturias and Cantabria (Spain). Environ Res 2005; 99:413-24. [PMID: 16307984 DOI: 10.1016/j.envres.2004.12.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Revised: 12/07/2004] [Accepted: 12/13/2004] [Indexed: 05/05/2023]
Abstract
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.
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Affiliation(s)
- B Suárez
- National Centre for Epidemiology, Carlos III Institute of Public Health, Madrid 28039, Spain
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Guallar E, Jiménez FJ, van 't Veer P, Bode P, Riemersma RA, Gómez-Aracena J, Kark JD, Arab L, Kok FJ, Martín-Moreno JM. Low toenail chromium concentration and increased risk of nonfatal myocardial infarction. Am J Epidemiol 2005; 162:157-64. [PMID: 15972934 DOI: 10.1093/aje/kwi180] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Eliseo Guallar
- Department of Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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Royo-Bordonada MA, Gorgojo L, Ortega H, Martín-Moreno JM, Lasunción MA, Garcés C, Gil A, Rodríguez-Artalejo F, de Oya M. Greater dietary variety is associated with better biochemical nutritional status in Spanish children: the Four Provinces Study. Nutr Metab Cardiovasc Dis 2003; 13:357-364. [PMID: 14979682 DOI: 10.1016/s0939-4753(03)80004-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Although dietary variety has been associated with a better nutritional profile, its possible role in obesity raises doubts about its overall health benefits. In this study, we examined the association between dietary variety and anthropometric variables, food intake and various food intake biomarkers in Spanish children. METHODS AND RESULTS This was a cross-sectional study of 1112 children aged 6-7 years from Cadiz, Murcia, Orense and Madrid, who were selected by means of the random cluster-sampling of schools. Information concerning food and nutrient intake was obtained using a food frequency questionnaire, and a dietary variety index (DVI) was calculated on the basis of the number of different foods consumed more than once a month. The anthropometric variables (weight and height), and plasma lipid and vitamin levels were determined using standardised methods. Our results show that the body mass index (BMI) did not vary substantially as a function of DVI: it was 16.9 in the lowest DVI tertile and 17.2 in the highest (p=0.20). Unlike BMI, the DVI positively correlated (p<0.05) with the plasma levels of alpha and beta-carotene, lycopene, retinol, alpha-tocopherol and vitamin E, with energy intake, and with most of the foods, particularly vegetables, fruit and sausages (respective correlation coefficients of 0.43, 0.26 and 0.23). CONCLUSIONS Dietary variety is associated with a better food and nutritional profile in Spanish children. Nevertheless, the presence of a positive association between the DVI and energy intake, and the consumption of sausages and pre-cooked products calls for the recommendation of a varied diet of healthy foods, such as cereals (especially whole grains), fruits and vegetables.
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Affiliation(s)
- M A Royo-Bordonada
- Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo, Madrid, Spain.
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Iñigo J, Arce A, Martín-Moreno JM, Herruzo R, Palenque E, Chaves F. Recent transmission of tuberculosis in Madrid: application of capture–recapture analysis to conventional and molecular epidemiology. Int J Epidemiol 2003; 32:763-9. [PMID: 14559746 DOI: 10.1093/ije/dyg098] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Population-based studies using a combination of molecular techniques and conventional epidemiological methods have been used to study the dynamics of tuberculosis (TB) transmission but the relative utility of each technique has not yet been established. METHODS A prospective population-based molecular and epidemiological study of patients diagnosed with TB was conducted in three urban districts of Madrid (Spain) during 1997-1999. Analysis was performed using the capture-recapture method including covariates in which conventional epidemiological data and the information on clustered cases obtained by DNA fingerprinting were regarded as independent and complementary procedures. RESULTS The estimate obtained by molecular analysis alone, that 31.6% of TB cases were due to recent transmission, was revised to 44.8% (95% CI: 31.4-58.2) using the capture-recapture method. The estimated completeness of the combined databases for identification of recent transmission was 59.2%. Underestimation of the true prevalence of recent transmission was higher with conventional epidemiology than molecular analysis, particularly for patients <35 years old and those with a history of imprisonment. CONCLUSIONS In this study, use of the capture-recapture technique allowed us to combine epidemiological information obtained by conventional and molecular methods to quantify the number of cases of recently transmitted TB in the community and identify specific populations at high risk of disease. This information is clearly important because such groups are a prime target for improved TB control measures. In the long term, this combination of techniques may contribute significantly to control the spread of TB.
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Affiliation(s)
- J Iñigo
- Dirección General de Salud Pública, Consejería de Sanidad de la Comunidad de Madrid, Aduana 29, 28013 Madrid, Spain.
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Royo-Bordonada MA, Gorgojo L, Martín-Moreno JM, Garcés C, Rodríguez-Artalejo F, Benavente M, Mangas A, de Oya M. Spanish children's diet: compliance with nutrient and food intake guidelines. Eur J Clin Nutr 2003; 57:930-9. [PMID: 12879087 DOI: 10.1038/sj.ejcn.1601627] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare the diet of Spanish children against the nutrient and food intake guidelines. To calculate an index of overall diet quality and check its validity against nutrient intake. DESIGN AND SETTING Cross-sectional study in four cities in Spain, where information on food and nutrient intake was obtained from schoolchildren through a food frequency questionnaire. PARTICIPANTS The sample included 1112 children (overall response rate of 85%) attending public and private schools and aged 6-7 y. Children were selected through random cluster sampling in schools, and stratified by sex and socioeconomic level. MAIN OUTCOME MEASURES Mean nutrient intake, number of food servings, and the percentage of children who meet recommended nutrient and food-serving intake levels. The overall dietary quality was assessed using the Healthy Eating Index (HEI). RESULTS Mean micronutrient intake exceeded 100% of the recommended dietary allowances, except for vitamin B6, which registered a mean intake of 77.1%. For almost all children, intake of saturated fat was above, and that of carbohydrate below, the recommended level, in contrast to the relatively high compliance with the recommendations for poly- and monounsaturated fatty acid, salt and fiber intake (69.7, 43.7, 40.7, and 30.1%, respectively). Consumption of food servings for each of the five American pyramid food groups came close to or exceeded USDA guidelines, with the exception of cereals, with 5.4 servings per day. The mean score obtained in the HEI was 64.6. Children who complied with all the food guide pyramid recommendations registered a higher dietary variety and a healthier nutritional profile. CONCLUSIONS Children aged 6-7 y show scant compliance with the macronutrient goals for healthy eating. Micronutrient intake is adequate in general, yet there are small groups of children with risk of deficient intake of vitamins B6 and D. While Spanish children's eating habits are reasonably in line with American food guide pyramid guidelines, consumptions of cereals and fruit should be improved.
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Affiliation(s)
- M A Royo-Bordonada
- Carlos III Institute of Public Health, Ministerio de Sanidad y Consumo, Madrid, Spain.
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Royo-Bordonada MA, Gorgojo L, de Oya M, Garcés C, Rodríguez-Artalejo F, Rubio R, del Barrio JL, Martín-Moreno JM. Food sources of nutrients in the diet of Spanish children: the Four Provinces Study. Br J Nutr 2003; 89:105-14. [PMID: 12568670 DOI: 10.1079/bjn2002754] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of the present study was to assess the principal food sources of energy and nutrients among Spanish children. We used a cross-sectional study design, based on results obtained from a food-frequency questionnaire. The sample included 1112 children, aged 6-7 years, from Cadiz, Madrid, Orense and Murcia, Spain. Children were selected through random cluster-sampling in schools. We analysed the percentage contributed by each food item to total energy and nutrient intake. The most important food sources were: white bread in the case of carbohydrate (13.4 %); olive oil in the case of total lipids (18.3 %) and monounsaturated fatty acids (29.2 %); whole milk in the case of protein (10.2 %) and saturated fatty acids (14.9 %); chips (French fried potatoes) in the case of polyunsaturated fatty acids (30.4 %). The greatest proportion of Na, consumed in excess, came from salt added to meals. Ham ranked second as a source of saturated fats. Fruits and green leafy vegetables proved to have great relevance as sources of fibre and vitamins, though with regard to the latter, it was observed that fortified foods (breakfast cereals, dairy products, fruit juices, etc.) had come to play a relevant role in many cases. In conclusion, the nutritional profile of Spanish school-aged children aged 6-7 years could be improved by nutritional policies targeted at limiting their consumption of ham (cured or cooked) and of salt added to meals, replacing whole milk with semi-skimmed milk, encouraging the consumption of products rich in complex carbohydrates already present in children's diets (bread, pasta, rice) and promoting less fatty ways of cooking food.
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Affiliation(s)
- M A Royo-Bordonada
- Institute of Health Carlos III, Ministry of Health & Consumer Affairs, Madrid, Spain.
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Martínez-González MA, Fernández-Jarne E, Serrano-Martínez M, Marti A, Martinez JA, Martín-Moreno JM. Mediterranean diet and reduction in the risk of a first acute myocardial infarction: an operational healthy dietary score. Eur J Nutr 2002; 41:153-60. [PMID: 12242583 DOI: 10.1007/s00394-002-0370-6] [Citation(s) in RCA: 171] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Miguel A Martínez-González
- Epidemiología y Salud Pública, Facultad de Medicina, Universidad de Navarra, Irunlarrea 1, 31080 Pamplona, Spain.
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Guallar E, Sanz-Gallardo MI, van't Veer P, Bode P, Aro A, Gómez-Aracena J, Kark JD, Riemersma RA, Martín-Moreno JM, Kok FJ. Mercury, fish oils, and the risk of myocardial infarction. N Engl J Med 2002; 347:1747-54. [PMID: 12456850 DOI: 10.1056/nejmoa020157] [Citation(s) in RCA: 451] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND It has been suggested that mercury, a highly reactive heavy metal with no known physiologic activity, increases the risk of cardiovascular disease. Because fish intake is a major source of exposure to mercury, the mercury content of fish may counteract the beneficial effects of its n-3 fatty acids. METHODS In a case-control study conducted in eight European countries and Israel, we evaluated the joint association of mercury levels in toenail clippings and docosahexaenoic acid (C22:6n-3, or DHA) levels in adipose tissue with the risk of a first myocardial infarction among men. The patients were 684 men with a first diagnosis of myocardial infarction. The controls were 724 men selected to be representative of the same populations. RESULTS The average toenail mercury level in controls was 0.25 microg per gram. After adjustment for the DHA level and coronary risk factors, the mercury levels in the patients were 15 percent higher than those in controls (95 percent confidence interval, 5 to 25 percent). The risk-factor-adjusted odds ratio for myocardial infarction associated with the highest as compared with the lowest quintile of mercury was 2.16 (95 percent confidence interval, 1.09 to 4.29; P for trend=0.006). After adjustment for the mercury level, the DHA level was inversely associated with the risk of myocardial infarction (odds ratio for the highest vs. the lowest quintile, 0.59; 95 percent confidence interval, 0.30 to 1.19; P for trend=0.02). CONCLUSIONS The toenail mercury level was directly associated with the risk of myocardial infarction, and the adipose-tissue DHA level was inversely associated with the risk. High mercury content may diminish the cardioprotective effect of fish intake.
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Affiliation(s)
- Eliseo Guallar
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD 21205-2223, USA.
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Valderrama-Gama E, Damián J, Ruigómez A, Martín-Moreno JM. Chronic disease, functional status, and self-ascribed causes of disabilities among noninstitutionalized older people in Spain. J Gerontol A Biol Sci Med Sci 2002; 57:M716-21. [PMID: 12403799 DOI: 10.1093/gerona/57.11.m716] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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von Below GC, Boer A, Conde-Olasagasti JL, Dillon A, Gibis B, Grilli R, Hardy C, Liaropoulos L, Martín-Moreno JM, Roine R, Scherstén T, Søreide O, Züllig M. Health technology assessment in policy and practice. Working group 6 report. Int J Technol Assess Health Care 2002; 18:447-55. [PMID: 12053429 DOI: 10.1017/s0266462302000302] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
According to the HTA-Europe report, health technology assessment (HTA) has the potential to influence health policy in the fields of research and development, regulation of pharmaceuticals, devices, and services, quality assurance, reimbursement, education and training of healthcare providers, and consumer education (1). To identify and bridge the gaps between HTA production and implementation, the goal of Working Group 6 was to approach the use of HTA in policy and practice on the aggregate policy level as well as in the local context, such as in hospitals. Members of Working Group 6 included both users (e.g., members of decision-making bodies) and producers (e.g., members of HTA agencies) of HTA reports. The aim of the working group was to identify three types of information on HTA implementation and impact. These included identifying successful examples of the implementation of HTA results, examples of structures that require HTA information as part of the decision-making process, and finally, identifying groups and persons who use HTA frequently and are willing to share their experiences with other HTA users and producers.
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Amate JM, González Enríquez J, Sarría A, Martín-Moreno JM. [Evaluation of health technologies and benefits entitlement in advanced social systems]. An Sist Sanit Navar 2002; 25:131-46. [PMID: 12861291 DOI: 10.23938/assn.0794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the present study, health is considered a subject of insurance whose protection has become a Fundamental Right. In the same line, health care has acquired a contractual character whose "nature" has evolved from individual to collective, expressed in terms of "health care insurance", public or private. In such context, outcome measurement becomes necessary to be able to define the variables of the System and, subsequently, the contracting conditions. Having an understanding of the economic impact is required to analyze the costs and, in consequence, the financial necessities of the System; as well as the clinical results in order for the insured to have some realistic expectations of the benefits that can be expected from the health care that is offered. In turn, the vertiginous rhythm of technological innovation that characterizes the modern medicine forces to the continuous revision of the state of the art framed in a health sector whose multifactorial profile confers it growing complexity. In conclusion, health technology assessment becomes indispensable to identify health care effectiveness, to facilitate its efficient management, to define responsibilities and to offer guarantees to the users; all which is already part of an ethical body that, day by day with more clarity, is being configured by the legislation and that, in turn, guarantees the survival of the Health Care System.
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Affiliation(s)
- J M Amate
- Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Madrid.
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Rodríguez-Artalejo F, Garcés C, Gorgojo L, López García E, Martín-Moreno JM, Benavente M, del Barrio JL, Rubio R, Ortega H, Fernández O, de Oya M. Dietary patterns among children aged 6-7 y in four Spanish cities with widely differing cardiovascular mortality. Eur J Clin Nutr 2002; 56:141-8. [PMID: 11857047 DOI: 10.1038/sj.ejcn.1601296] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2001] [Revised: 06/22/2001] [Accepted: 06/25/2001] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Classic cardiovascular risk factors, such as smoking, arterial hypertension and hypercholesterolaemia, cannot explain a substantial part of the geographic differences in cardiovascular mortality. Anthropometric and nutritional factors in early stages of life may contribute to adult cardiovascular disease. Therefore, this work examines certain anthropometric variables and diet among children aged 6-7 y, living in four Spanish cities with widely differing ischaemic heart disease (IHD) mortality. DESIGN AND SETTING Cross-sectional anthropometric and dietary survey in four cities in Spain. SUBJECTS A total of 1112 children (50.1% males, 49.9% females) attending public and private schools in Cadiz and Murcia, cities with a relatively high IHD mortality, and Madrid and Orense, cities with a relatively low IHD mortality. A standardized method was used to measure anthropometric variables, and a food-frequency questionnaire completed by subjects' mothers, to measure diet. OUTCOME MEASURES Body mass index (BMI), overweight (BMI>17.6 kg/m(2)), obesity (BMI>20.1 kg/m(2)) and intake of food and nutrients. RESULTS Children in the four cities showed a high prevalence of overweight (range across cities, 28.9-34.5%) and obesity (8.5-15.7%). They also had a moderately hypercaloric diet (range, 2078-2218 kcal/day), marked by an excessive intake of lipids (45.0-47.3% kcal), particularly saturated fats (16.6-16.9% kcal), proteins (17.0-17.3% kcal), sugars (20.0-21.9% kcal) and cholesterol (161.6-182.9 mg/1000 kcal/day), and a low intake of complex carbohydrates (17.5-18.1% kcal) and fibre (19.6-19.9 g/day). Compared with children in the two low-IHD-mortality cities, those in the two high-IHD-mortality cities had a greater BMI (mean difference, 0.61 kg/m(2); P=0.0001) and ponderal index (0.58 kg/m(3); P=0.0001) and a higher intake of energy (104 kcal/day; P=0.007), cholesterol (16.00 mg/1000 kcal/day; P=0.0001) and sodium (321 mg/day; P=0.0001). Inter-city differences in anthropometric variables remained after adjustment for birthweight. CONCLUSIONS Intake of fats, especially saturated fats, and cholesterol should be reduced among Spanish children. It could contribute to a needed reduction of the high prevalence of overweight and obesity in children. If the differences in anthropometric variables and diet between children from the cities with high and low coronary mortality are maintained in future or continue into adulthood, this could contribute to consolidate or even increase the IHD mortality gradient across cities. The finding that differences in anthropometric variables are independent of birthweight suggests that the childhood, rather than intrauterine environment, is involved in the development of such differences. SPONSORSHIP This study was partly funded by grants from the International Olive Oil Board (Consejo Oleícola Internacional), Comunidad Autónoma de Madrid, Fundación Pedro Barrié de la Maza, and Fundación Eugenio Rodríguez Pascual.
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Affiliation(s)
- F Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain.
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Inmaculada Sanz-Gallardo M, Guallar E, van Tveer P, Longnecker MP, Strain JJ, Martin BC, Kardinaal AF, Fernández-Crehuet J, Thamm M, Kohlmeier L, Kok FJ, Martín-Moreno JM. Determinants of p,p-dichlorodiphenyldichloroethane (DDE) concentration in adipose tissue in women from five European cities. Arch Environ Health 1999; 54:277-83. [PMID: 10433187 DOI: 10.1080/00039899909602486] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To identify the determinants of p,p'-dichlorodiphenyldichloroethane (p,p'-DDE) in adipose tissue in subjects who participated in a cross-sectional study, we analyzed fatty acids, antioxidants, and p,p'-DDE in aspirates of adipose tissue of 328 postmenopausal women from 5 European countries. The overall mean of p,p'-DDE concentration was 1.66 microg/g of fatty acids (95% confidence interval = 1.46, 1.88). In a multiple-regression analysis, the main predictors of log10(p,p'DDE) were center of recruitment (p < .0001), adipose arachidic acid (p = .001), and adipose retinol (p = .04). These factors explained 14.9% of the overall variability of log10(p,p'-DDE). In our subjects, adipose tissue p,p'DDE concentrations were only weakly related with biomarkers reflecting intake of fish and other foods. This result is consistent with the notion that p,p'-DDE exists in different foods and, given the widespread contamination of the food chain, is relatively evenly distributed among foods.
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Affiliation(s)
- M Inmaculada Sanz-Gallardo
- Department of Epidemiology and Biostatistics, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
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28
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Guallar E, Aro A, Jiménez FJ, Martín-Moreno JM, Salminen I, van't Veer P, Kardinaal AF, Gómez-Aracena J, Martin BC, Kohlmeier L, Kark JD, Mazaev VP, Ringstad J, Guillén J, Riemersma RA, Huttunen JK, Thamm M, Kok FJ. Omega-3 fatty acids in adipose tissue and risk of myocardial infarction: the EURAMIC study. Arterioscler Thromb Vasc Biol 1999; 19:1111-8. [PMID: 10195943 DOI: 10.1161/01.atv.19.4.1111] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Omega-3 fatty acids have potential antiatherogenic, antithrombotic, and antiarrhythmic properties, but their role in coronary heart disease remains controversial. To evaluate the association of omega-3 fatty acids in adipose tissue with the risk of myocardial infarction in men, a case-control study was conducted in eight European countries and Israel. Cases (n=639) included patients with a first myocardial infarction admitted to coronary care units within 24 hours from the onset of symptoms. Controls (n=700) were selected to represent the populations originating the cases. Adipose tissue levels of fatty acids were determined by capillary gas chromatography. The mean (+/-SD) proportion of alpha-linolenic acid was 0.77% (+/-0.19) of fatty acids in cases and 0.80% (+/-0.19) of fatty acids in controls (P=0.01). The relative risk for the highest quintile of alpha-linolenic acid compared with the lowest was 0.42 (95% confidence interval [CI] 0.22 to 0.81, P-trend=0.02). After adjusting for classical risk factors, the relative risk for the highest quintile was 0.68 (95% CI 0.31 to 1.49, P-trend=0.38). The mean proportion of docosahexaenoic acid was 0.24% (+/-0.13) of fatty acids in cases and 0.25% (+/-0.13) of fatty acids in controls (P=0. 14), with no evidence of association with risk of myocardial infarction. In this large case-control study we could not detect a protective effect of docosahexaenoic acid on the risk of myocardial infarction. The protective effect of alpha-linolenic acid was attenuated after adjusting for classical risk factors (mainly smoking), but it deserves further research.
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Affiliation(s)
- E Guallar
- Department of Epidemiology and Biostatistics, National School of Public Health, "Instituto de Salud Carlos III", Madrid, Spain
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29
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Gorgojo L, Guallar E, Martín-Moreno JM, López-Nomdedeu C, Vázquez C, Martí-Henneberg C, Serrano-Ríos M. [Nutrition surveys of Spanish school-age children: analysis of the period 1984-1994]. Med Clin (Barc) 1999; 112:368-74. [PMID: 10227016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE To review available data on the usual dietary intake of school-age Spanish children, by analyzing the nutritional surveys carried out during the period 1984-1994. METHODS Systematic and comprehensive search of surveys with dietary data in Spanish children aged 6 to 16 years collected during the period 1984-1994 and published after January 1997. The search of bibliographic databases (MEDLINE, IME, ISBN and Teseo), was completed with an extensive search of the gray literature and of unpublished studies through contact with public and private institutions which may fund such studies. The quality of the original surveys was assessed, and the data of the studies fulfilling pre-established quality requirements were summarized and tabulated. RESULTS We located 65 nutritional surveys in children and adolescents performed between 1984 and 1994, which generated 91 documents. Most surveys (76.9%) were local, while 18.5% of them studied provinces or regions and 3.1% studied more than one region. Only 4 studies (6.2%) met the quality requirements, but the methods or the presentation of the results of these surveys were too heterogeneous. In spite of that, the available data tends to show a certain lack of balance of macronutrient intakes in relation to the usual dietary recommendations. CONCLUSIONS Available data on nutritional intake of Spanish school-age children during 1984-1994 were too heterogeneous to be comparable, even if the analysis was restricted to high-quality surveys. Furthermore, there are no repeated surveys monitoring changes in intake in representative samples of children performed during the study period. This should be taken into account in future research endeavours which should contemplate a well defined sampling framework and the appropriate methodology to assure the proper interpretation of the eventual results.
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Affiliation(s)
- L Gorgojo
- Departamento de Epidemiología, Escuela Nacional de Sanidad, Madrid.
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30
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Damián J, Martín-Moreno JM, Lobo F, Bonache J, Cerviño J, Redondo-Márquez L, Martínez-Agulló E. Prevalence of urinary incontinence among Spanish older people living at home. Eur Urol 1998; 34:333-8. [PMID: 9748681 DOI: 10.1159/000019750] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To estimate the prevalence and characteristics of urinary incontinence (UI) in the noninstitutionalized elderly population of Madrid, Spain. METHODS We carried out a cross-sectional study in a representative sample of all community-dwelling people aged 65 or over. Subjects were interviewed in their homes. The question: Do you currently experience any difficulty in controlling your urine? . In other words, does your urine escape involuntarily? was used to identify UI. Type of UI, use of absorbents and specific drugs were also assessed, as well as consultation behavior. RESULTS 589 persons were interviewed (response rate: 71.2%). The prevalence of UI was 15.5%. No significant difference was observed between men and women. Urge UI was the main type for men and mixed UI for women. Use of pads was referred by 20.2%. A total of 34.3% of subjects never went to the doctor for their problem (25.2% of men and 39.4% of women). CONCLUSION Compared to other populations the overall prevalence of UI in Spanish elders living at home is relatively high. A very small difference by gender was found, although a lower response rate in women could in part explain this unexpected finding.
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Affiliation(s)
- J Damián
- Department of Epidemiology and Biostatistics, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain.
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31
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Royo-Bordonada MA, Martín-Moreno JM, Guallar E, Gorgojo L, van't Veer P, Mendez M, Huttunen JK, Martin BC, Kardinaal AF, Fernández-Crehuet J, Thamm M, Strain JJ, Kok FJ, Kohlmeier L. Alcohol intake and risk of breast cancer: the euramic study. Neoplasma 1997; 44:150-6. [PMID: 9372855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To evaluate the association of alcohol intake with the risk of breast cancer in post-menopausal women, we analyzed the data from an international case-control study conducted in five European countries (FRG, Switzerland, Northern Ireland, the Netherlands and Spain). Information on alcohol intake was available in 315 cases and 364 controls. Medians for the tertiles of alcohol intake among current drinkers were 1.7, 6.0, and 20.0 g/day. Adjusted relative risks (and 95% confidence intervals) of breast cancer for each tertile of intake in current drinkers, compared to never drinkers, were 1.00 (0.60-1.67), 1.01 (0.60-1.73), and 1.18 (0.69-2.03). The adjusted relative risk for ex-drinkers was 1.73 (1.07-2.79). Among both current drinkers and ex-drinkers, the relative risk was higher for those with body mass index above the median compared to those with body mass index below the median. These results do not support a dose-response effect of alcohol on breast cancer risk, although consumption levels were too low to exclude increased risk with high regular intake. Further research is necessary to evaluate the risk of developing breast cancer among ex-drinkers and the potential interaction between body mass index and alcohol drinking.
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Affiliation(s)
- M A Royo-Bordonada
- Department of Epidemiology and Biostatistics, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
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32
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van't Veer P, Lobbezoo IE, Martín-Moreno JM, Guallar E, Gómez-Aracena J, Kardinaal AF, Kohlmeier L, Martin BC, Strain JJ, Thamm M, van Zoonen P, Baumann BA, Huttunen JK, Kok FJ. DDT (dicophane) and postmenopausal breast cancer in Europe: case-control study. BMJ 1997; 315:81-5. [PMID: 9240045 PMCID: PMC2127062 DOI: 10.1136/bmj.315.7100.81] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine any possible links between exposure to DDE (1,1-dichloro-2,2-bis (p-chlorophenyl)ethylene), the persistent metabolite of the pesticide dicophane (DDT), and breast cancer. DESIGN Multicentre study of exposure to DDE by measurement of adipose tissue aspirated from the buttocks. Laboratory measurements were conducted in a single laboratory. Additional data on risk factors for breast cancer were obtained by standard questionnaires. SETTING Centres in Germany, the Netherlands, Northern Ireland, Switzerland, and Spain. SUBJECTS 265 postmenopausal women with breast cancer and 341 controls matched for age and centre. MAIN OUTCOME MEASURE Adipose DDE concentrations. RESULTS Women with breast cancer had adipose DDE concentrations 9.2% lower than control women. No increased risk of breast cancer was found at higher concentrations. The odds ratio of breast cancer, adjusted for age and centre, for the highest versus the lowest fourth of DDE distribution was 0.73 (95% confidence interval 0.44 to 1.21) and decreased to 0.48 (0.25 to 0.95; P for trend = 0.02) after adjustment for body mass index, age at first birth, and current alcohol drinking. Adjustment for other risk factors did not materially affect these estimates. CONCLUSIONS The lower DDE concentrations observed among the women with breast cancer may be secondary to disease inception. This study does not support the hypothesis that DDE increases risk of breast cancer in postmenopausal women in Europe.
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Abstract
Over the last 20 years, the development of meta-analysis has been aimed at obtaining objective synthesis of the available results on specific research questions. The main achievements of meta-analysis include the application of techniques to perform systematic literature searches and to obtain unbiased selection of studies, data extraction and pooled estimates of effect. This paper discusses the methodologic steps to follow when conducting a meta-analysis, with emphasis on study selections, data collection and statistical methods to combine the results from individual studies. We also present a set of guided questions as an aid to critically evaluate the conclusions of published meta-analyses. The application of meta-analytic techniques to cardiology is illustrated using a meta-analysis of the randomized controlled trials of angioplasty versus bypass surgery in the management of patients with ischemic heart disease.
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Affiliation(s)
- E Guallar
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid
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34
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Guallar E, Conde J, de la Cal MA, Martín-Moreno JM. [Guideline for the evaluation of health science research projects. Group of Evaluation of the Activities of the Fund for Health Research from 1988 to 1995]. Med Clin (Barc) 1997; 108:460-71. [PMID: 9235417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- E Guallar
- Departamento de Epidemiología y Bioestadística, Escuela Nacional de Sanidad, Instituto de Salud Carlos III
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35
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Martín-Moreno JM, Banegas JR. [Translation of the English term odds ratio as oportunidad relativa]. Salud Publica Mex 1997; 39:72-4. [PMID: 9092101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
In the present work we argue for the translation of the English term odds ratio, a term of formal anti-natural esthetics for the Spanish-speaking and with added phonetic difficulties, for oportunidad relativa. These words respect the English abbreviation OR facilitating the expression of consistent formulations which may be directly translated, as well as communication between users, since the linguistic confusion due to the present abundance of terms used in Spanish, is reduced to one. Our justifications are mainly syntactic and semantic and reflect reasonable comparability between the terms odds ratio and oportunidad relativa. Reviews of some of the most prestigious dictionaries of the English and the Spanish languages lend additional support to our proposition.
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Affiliation(s)
- J M Martín-Moreno
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España
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36
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Rodríguez Artalejo F, Graciani MA, Banegas JR, Martín-Moreno JM, Sabaté J, Rey Calero J. [Food and nutrient consumption in Spain in 1940-1988 (and II). Comparative study of the main sources of information on food consumption]. Med Clin (Barc) 1996; 107:446-52. [PMID: 9036252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND This paper has two objectives. The first is to examine the consistency of the main nutritional studies carried out in Spain over the last fifty years. The second is to use these studies to describe the changes in the Spanish diet over this period and to characterize the present dietary pattern. MATERIAL AND METHODS We have used three types of studies. First, food balance sheets elaborated by Barbancho, FAO, OECD and the Department of Agriculture. Second, surveys on the foods purchased by population groups, in particular the household budget surveys, and the "panel de consumo alimentario" from the Department of Agriculture. Third, food consumption surveys from Catalonia, Vasque Country, Murcia, Madrid, and Reus. RESULTS Protein, lipid and total caloric intake have increased over the last fifty years. Carbohydrate intake has been stable. Caloric intake from lipids has increased, caloric intake from protein has been stable and that from carbohydrates has decreased. All studies are consistent in that, from 1980 onwards, caloric intake from protein has been 12.5-16.7%, caloric intake from carbohydrates has been 39.3-48.1%, and that from lipids has been 36.6-46.0%. The monounsaturated/saturated ratio has been 1.2-1.7 and the polyunsaturated/saturated ratio 0.4-0.7. All data sources show a high consumption of foods typical of the Mediterranean diet, in particular fruit, vegetables, fish and vegetable oil, rich in unsaturated fats. Consistency among data sources is higher when data are expressed as percentage of total caloric intake than when they are expelled in absolute quantities. CONCLUSIONS All data sources suggest that the Spanish diet has changed with the economic development, but it still keeps most of the characteristics of the Mediterranean diet.
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Affiliation(s)
- F Rodríguez Artalejo
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid
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37
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Martín-Moreno JM. [Epidemiology and the respect for the confidentiality of personal data: apropos a proposed European directive]. Gac Sanit 1994; 8:317-20. [PMID: 7706003 DOI: 10.1016/s0213-9111(94)71209-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- J M Martín-Moreno
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid
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38
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Guallar E, Banegas JR, Martín-Moreno JM, del Río A. [Meta-analysis: its role in clinical decision making in cardiology]. Rev Esp Cardiol 1994; 47:509-17. [PMID: 7973011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Clinical decision-making in cardiology requires accurate estimates of the efficacy of diagnostic and therapeutic procedures. Defined as the quantitative integration of results from different studies on the same scientific question, meta-analyses are well-suited to summarize the evidence on the efficacy of clinical interventions. Meta-analyses aim at obtaining combined estimates of effect using all relevant information in a systematic fashion, complementing narrative reviews and expert committee reports. In this paper, the advantages and limitations of meta-analyses and their usefulness in clinical decision making in cardiology are illustrated using three recent examples in the literature--i.e., use of beta-blockers in secondary prevention of ischemic heart disease, intravenous streptokinase in acute myocardial infarction and fish intake in primary prevention of cardiovascular mortality. The steps to follow when conducting a meta-analysis are also discussed. Finally, a list of the most important meta-analyses in cardiology published to date is included for easy reference.
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Affiliation(s)
- E Guallar
- Departamento de Epidemiología y Bioestadística, Escuela Nacional de Sanidad, Madrid
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39
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Banegas Banegas JR, Rodríguez Artalejo F, Martín-Moreno JM, González Enríquez J, Villar Alvarez F, Guasch Aguilar A. [Projections of the impact of the smoking habit on the health of the Spanish population and on the potential benefits from its control]. Med Clin (Barc) 1993; 101:644-9. [PMID: 8289508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Smoking continues to be an important public health problem in Spain. With the aim to know some of the health care consequences derived from the evolution of this habit in the Spanish population and to anticipate the health care benefits which would be a result of intervention on the same the estimations of mortality related with smoking and its control in the next few decades were predicted. METHODS Mathematic models of simulation of the effects derived from changes in the prevalence of smoking based on the techniques of attributable risk, the multiplicity of the diseases involved and the time of reversal of the risk of death following health care intervention were used. RESULTS In absence of intervention on smoking the number of total deaths by the causes under consideration will, in general, increase, from 1987 to 2020. The reduction of 40% in the prevalence of smoking in adult Spanish smokers over a period of 8 years (1992-2000) would potentially decrease the number of cardiovascular deaths by 6,035, deaths by COPD by 394 and the deaths by malignant tumors studied in the year 2020 by 5,237. By the year 2020 the effects of intervention would, in general, be completely manifest. A part of this reduction of mortality would translate in a gaining of 57,323 real years of life in the year 2020. These benefits are also appreciable, although lesser, in the previous years from the beginning of intervention. CONCLUSIONS Smoking will continue to be an important public health problem in Spain in the future. The health care benefits which may be derived from correct application of effective control programs of the same would be appreciable.
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Affiliation(s)
- J R Banegas Banegas
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid
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40
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Guallar Castillón E, Jiménez Jiménez FJ, Tafalla García M, Martín-Moreno JM. [Fish consumption and coronary mortality in the general population: a meta-analysis of cohort studies]. Gac Sanit 1993; 7:228-36. [PMID: 8225789 DOI: 10.1016/s0213-9111(93)71155-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In order to estimate the effect of fish intake on ischemic heart disease mortality in the general population, we performed a meta-analysis of the epidemiologic studies involving participants free of disease at baseline published on the topic. All of the 7 studies published to date were cohort studies; however, only 5 of them reported the results with enough detail to be used in a formal meta-analysis. The total number of participants in these studies was 27,656, with an average follow-up in each study between 7.5 and 25 years and a total of 1,731 coronary deaths. The combined estimate of the relative risk for an intake of 30 g/day of fish compared to no intake was 0.96 (95% CI: 0.93-1.00; P = 0.058). Due to the presence of statistically significant heterogeneity among the studies, unexplained by a priori factors, we combined the studies assuming a random effects model, obtaining a relative risk estimate of 0.92 (95% CI: 0.84-1.01; P = 0.090). These results, together with the results of the only clinical trial of fish intake performed in post-myocardial infarction patients, in which an intake of 200-400 g/week of fatty fish reduced total mortality by 29% (relative risk of intake compared to no intake 0.71; 95% CI: 0.54-0.93), suggest a moderate beneficial effect of fish intake on coronary mortality.
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Affiliation(s)
- E Guallar Castillón
- Departamento de Epidemiología y Bioestadística, Escuela Nacional de Sanidad, Madrid
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