Principales resultados del programa de cribado de cáncer colorrectal en el País Vasco

Objective

To describe the procedures of the colorectal cancer screening program in the Basque Country (Spain), and the main results of the first rounds in 2009-2011.

Method

We carried out a retrospective study of invitations to attend screening between 2009 and 2011. Participation rates and the number of positive results of the fecal occult blood test (FOBT) were analyzed by sex and age group.

Results

There were 235.371 valid invitations (sent to the correct addresses), with an average participation rate of 64.3% (95%CI: 64.1-64.5%). Significant differences were found (p < 0,001) between women (67.1%; 95%CI: 66.9-67.4) and men (61.4%; 95%CI: 61.1-61.7). The rate of positive FOBT results was higher (p < 0,001) among men (9.1%; 95%CI: 8.9-9.2) than among women (4.8%; 95%CI: 4.7-4.9).

Conclusions

Participation rates were adequate compared with those in the reviewed literature. These rates were probably affected by the invitation strategy and by cultural and social factors.     

Validación en población catalana del cuestionario internacional de actividad física

Objectives

To validate the short form of the International Physical Activity Questionnaire in the population of Catalonia (Spain).

Methods

A convenience sample wore a uniaxial accelerometer (MTI Actigraph, Computer Science and Application's Inc.) for 7 days and completed the questionnaire, translated to Catalan. The sensitivity and specificity of the questionnaire in measuring adherence to physical activity recommendations were also tested.

Results

Valid data were obtained from 55 participants (29 women). The mean age was 40.5 years. Moderate correlations were found for total physical activity (r = 0.27; p < 0.05) and the time spent in vigorous activity (r = 0.38; p < 0.01). Sensitivity was 75% and specificity was 75% (κ = 0.33).

Conclusion

The short Catalan version of the International Physical Activity Questionnaire had acceptable validity for the measurement of total and vigorous physical activity. This questionnaire can be used to identify adherence to physical activity recommendations in the Catalan population.     

El estado de salud de las personas mayores que sufren insomnio

Objectives

To evaluate the perceived health status of elderly patients with insomnia, whether primary, secondary to a medical illness, or associated with another mental disorder.

Methods

We conducted a cross-sectional study in a representative sample of 926 persons aged over 65 years. A psychiatric interview was used to verify the presence of insomnia (DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders, fourth ed., revised text). Interviews were conducted by health professionals to assess perceived health status (EuroQol-5D), health problems, and socio-demographic characteristics.

Results

The prevalence of primary insomnia was 8.9% (95% CI: 7.1-11.0), that of insomnia associated with another mental disorder was 9.3% (95% CI: 7.5-11.4) and that of insomnia secondary to medical illness was 7.0% (95% CI: 5.4-8.9). Patients with insomnia who used hypnotics/sedatives scored lower in self-reported health (57.6; 95% CI: 53.7-61.4), significantly lower (p < 0.05) than participants with insomnia not taking these drugs (65.1; 95% CI: 53.7-61.4). The mean health status score in individuals without insomnia was 0.87 and was significantly lower (p < 0.05) in persons with any type of insomnia: 0.80 in primary insomnia, 0.73 in insomnia secondary to a mental disorder and 0.76 in insomnia associated with medical illness.

Conclusions

Health status was worse in older people with insomnia, whether primary, secondary to other mental illnesses or organic, and when the elderly patients consumed hypnotics/sedatives. Limitations were less severe in primary insomnia.     

Influencia del criterio de selección de pacientes para la toma de frotis en la estimación de la efectividad de la vacuna antigripal

Objective

To estimate the effectiveness of the influenza vaccine under different criteria for selecting patients for swabbing.

Method

A case-control study was performed of laboratory-confirmed cases (n = 909) and negative controls for influenza (n = 732) in the 2010-2011 to 2012-2013 seasons in Navarre (Spain). The adjusted vaccine effectiveness was estimated by including all swabs from patients with influenza-like-illness and selecting only the first two cases per physician and week.

Results

The first two patients per physician and week were less frequently vaccinated against influenza (7.9% vs. 12.5%, p = 0.021) and less often received confirmation of influenza (53.6% vs. 66.4%, p <0.001) than subsequent patients. These differences decreased after adjustment for covariates. The effectiveness of the influenza vaccine was 49% (95% CI: 23-66%) when all swabs were included and was 55% (95% CI: 27-72%) when we selected the first two swabs per week and physician.

Conclusion

The selection of the first two patients per physician and week may bias assessment of the effectiveness of the influenza vaccine, although this bias was small in the seasons analyzed.     

Prevalencia de síndrome metabólico según las nuevas recomendaciones de la OMS. Estudio HERMEX

Objectives

The unification of criteria for the diagnosis of metabolic syndrome, together with the subsequent World Health Organization (WHO) proposal to eliminate diabetes and cardiovascular diseases from the diagnostic criteria, will change estimates of the known prevalence of this syndrome. The aim of this study was to determine the prevalence of metabolic syndrome in a health area of Badajoz (Spain) using the latest consensus criteria and eliminating diabetes and cardiovascular disease.

Methods

We performed a cross-sectional population-wide study of randomly selected individuals aged between 25 and 79 years old in a health area of Badajoz. In all patients, data on their history of cardiovascular risk factors were gathered, waist circumference and blood pressure were measured and a fasting blood sample was collected. The prevalence of metabolic syndrome, following recent criteria, was compared by age and gender.

Results

We recruited 2,833 individuals (46.5% men). The mean age was 51.2 years The prevalence of metabolic syndrome was 33.6% and was significantly higher in men (36.7% vs 30.9%; p < 0.001). The prevalence of metabolic syndrome fell significantly after exclusion of patients with diabetes or cardiovascular disease (20.8%; p < 0.001). The difference in prevalence between the distinct criteria was significant for the whole population and by sex (p < 0.000). A significant difference in prevalence between genders was observed from the age of 45-54 years in men and 55-64 years in women

Conclusions

The prevalence of metabolic syndrome in a health area of Badajoz is among the highest reported in population-based studies in Spain. Although estimates of the prevalence are decreased by the new international recommendations, a considerable proportion of the young population requires preventive measures.     

Derivación a las consultas de gastroenterología desde atención primaria: evaluación de dos programas

Objectives

To analyze the effect of implementing a high-resolution clinic (HRC) and an increasing resolution capacity program in primary care (IRCPPC) for referrals to a gastroenterology outpatient clinic from primary care and the resources used.

Methods

A retrospective and observational study based on a review of referral sheets and databases was performed. We analyzed the number and reason for referrals, delay times and resource consumption in two periods: before (first 4 months of 2007) and after (first 4 months of 2009) the launch of the IRCPPC and HRC.

Results

In the first and second periods, 881 and 1076 patients, respectively, referred from primary health care were evaluated in the gastroenterology clinic, with a decrease in the delay time in the second period (80.8 ± 64.34 days vs 36.1 ± 29.12 days, p < 0.001). The most frequent reasons for referral were dyspepsia (27.7%), high-risk of colorectal cancer (17.1%), disturbance of bowel rhythm (18.2%), abdominal pain (16%), and gastroesophageal reflux (11.2%), with no differences between the two periods. Although delay times until the first visit (10.8 ± 9.03 days vs 42.8 ± 28.67 days, p < 0.001) and until discharge (39.6 ± 80.65 days vs 128.6 ± 135.34 days, p < 0.001) were lower in referrals to the HRC, the number of visits (3.6 ± 2.20 vs 3.2 ± 1.95, p = 0.015) and the cost of referrals (592.7 ± 421.50 € vs 486.0 ± 309.66 €, p < 0.001) was higher.

Conclusions

In the study period the number of referrals increased, while the delay time decreased. Although the HRC reduces delay times, it is associated with an increase in health resource use.     

Prevalencia de consumo de tabaco en vehículos privados

Objective

To determine the prevalence of smoking among drivers of private vehicles in the city of Lleida (Spain).

Methods

A random sample of 1600 cars passing through six intersections regulated by traffic lights were selected. The variables were age, sex, smoking driver, adult passengers, intersection (urban/interurban), day (working day/weekend), hour (morning/evening) and simultaneous smokers. We calculated the prevalence of smoking drivers and the corresponding odds ratios (ORs), adjusted for the potential confounding variables, as well as their 95% confidence intervals (95% CI).

Results

The prevalence was 6.0% (95% CI: 4.9-7.3) and was higher in men (6.4%), in the group aged 41 to 60 years (6.9%), and in unaccompanied drivers (6.5%). The probability of the driver smoking increased if there was a smoking passenger (aOR = 10.8; 95% CI: 3.6-32.5). The frequency of smoking drivers was higher on working days (aOR = 1.7; 95% CI: 1.0-2.8) and in the morning (aOR = 1.6; 95% CI: 1.0-2.4).

Conclusions

The prevalence of smoking drivers can be considered dangerously high. We recommend avoiding smoking while driving.     

School-based mindfulness instruction for urban male youth: A small randomized controlled trial

Objectives

Mindfulness-based stress reduction (MBSR) has been shown to improve mental health and reduce stress in a variety of adult populations. Here, we explore the effects of a school-based MBSR program for young urban males.

Participants and methods

In fall 2009, 7th and 8th graders at a small school for low-income urban boys were randomly assigned to 12-session programs of MBSR or health education (Healthy Topics—HT). Data were collected at baseline, post-program, and three-month follow-up on psychological functioning; sleep; and salivary cortisol, a physiologic measure of stress.

Results

Forty-one (22 MBSR and 19 HT) of the 42 eligible boys participated, of whom 95% were African American, with a mean age of 12.5 years. Following the programs, MBSR boys had less anxiety (p = 0.01), less rumination (p = 0.02), and showed a trend for less negative coping (p = 0.06) than HT boys. Comparing baseline with post-program, cortisol levels increased during the academic terms for HT participants at a trend level (p = 0.07) but remained constant for MBSR participants (p = 0.33).

Conclusions

In this study, MBSR participants showed less anxiety, improved coping, and a possible attenuation of cortisol response to academic stress, when compared with HT participants. These results suggest that MBSR improves psychological functioning among urban male youth.     

Estudio de contactos según círculos concéntricos en un caso de tuberculosis laríngea

Objective

To describe the census and contact investigation in a case of laryngeal tuberculosis.

Methods

Based on a patient with laryngeal tuberculosis and through interviews and ocular inspection, we established three circles of contacts. The tuberculin test was performed (positive ≥5 mm). Persons testing positive were invited to undergo a chest x-ray. The association of the infection was calculated with the odds ratio. The exposure-response relationship was determined with the linear trend χ2 test.

Results

The overall prevalence of infection was 39.9% (67/168). The prevalence among coworkers was 60.0% (24/40), that among frequenters of the town bar was 43.3% (13/30) and the conversions rate was 12.9%. There was a relationship with the degree of exposure (p <0.0001).

Conclusions

Laryngeal tuberculosis involved high transmission to coworkers and frequenters of the town bar. In-depth studies through concentric circles and good communication with exposed individuals should be carried out.     

Características sociodemográficas de la interrupción voluntaria del embarazo en Andalucía: diferencias entre población autóctona y extranjera

Objectives

To describe the variables associated with induced abortions in Andalusia (Spain) and the differences between native and foreign populations.

Material and methods

A cross-sectional population-based study was carried out. The files on deliveries and induced abortions were combined to create a single file for the period 2007-2010. A binary logistic regression model was employed. The dependent variable was whether the pregnancy ended in delivery or induced abortion. The independent variables were the year, province of residence, number of previous children, schooling, cohabitation and nationality. The raw and adjusted odds ratios and the 95% confidence intervals were calculated for native and foreign women.

Results

Of 460,716 pregnancies, 17% ended in an induced abortion and 83% in delivery. The variables most closely associated with the risk of an induced abortion among native and foreign women in Andalusia were having three or more previous children (OR = 23.06), being under 25 years old (OR = 19.53), living alone (OR = 10.04) and being an immigrant (OR = 3.95), especially in African women. The rates of abortions, fecundity and fertility were higher in foreigners than in native women, with an increase in abortions and a decrease in fertility and fecundity.

Conclusions

The women at greatest risk of having an abortion in Andalusia are young foreign women, especially those from Africa, who live alone, have previous children and secondary education and reside in the province of Huelva.     

Evolución temporal en el conocimiento y el posicionamiento de los pacientes con enfermedades crónicas respecto al testamento vital

Objective

To describe patients’ degree of knowledge about their diseases and advance directives, as well as their willingness to write these documents, among patients with chronic diseases seen in the emergency department.

Methods

We performed a prospective, comparative, cross-sectional study, without intervention and with consecutive patient inclusion in two periods (2003 and 2008). Demographic and clinical data were recorded. An anonymous interview about patients’ knowledge and opinions about their illness and their awareness of advance directives was performed. Previous awareness of advance directives and the predisposition to write these documents were taken as dependent variables, and factors associated with these variables were analyzed.

Results

In both periods, 381 patients with similar characteristics were included (191 in 2003 and 190 in 2008). Patients showed greater knowledge of their disease (74% vs 55%, p < 0,001), a greater predisposition to take part in medical decisions (62% vs 42%, p < 0,001), and higher participation in such decisions (48% vs 35%, p = 0.01) in 2008 than in 2003. However, awareness of advance directives was slightly lower (18% vs 23%, p = NS), and willingness to write these documents was unchanged (50% vs 50%, p = NS). Awareness of advance directives was associated with age less than 75 years and having completed secondary school. The predisposition to write advance directives was associated with previous awareness of these documents, considering oneself to be well informed, and wanting greater participation in medical decisions.

Conclusions

Patients with chronic diseases showed greater understanding of their disease in the second period but awareness of advance directives and willingness to write these documents remained low. Information on these issues should be improved as an essential part of the physician-patient relationship.     

Impacto de la nueva legislación sobre tabaquismo (Ley 42/2010) en los niveles de humo ambiental de tabaco en locales de hostelería

Objective

To evaluate pollution by second-hand smoke in a sample of hospitality venues before and after the implementation of smoke-free legislation.

Methods

A cross sectional, before-after study was conducted in 2008 and 2011 after the total ban. A SidePack Aerosol monitor was used both inside and outside the hospitality venues to measure fine breathable particles (PM_2.5). A total of 43 places with pre- and post-legislation measurements were included.

Results

The median indoor pollution in hospitality venues was 204.2 μg/m³ in 2008 and 18.82 μg/m³ in 2011; the average outdoor PM_2.5 concentration was 47.04 μg/m³ in 2008 and 18.82 μg/m³ in 2011. Pollution was higher in bars and cafeterias, followed by pubs and discos. Before the law was implemented, pollution was 4.34 times higher indoors than outdoors; in 2011 the average indoor PM_2.5 concentration decreased by 90.88%.

Conclusions

Only a complete ban is able to protect workers and customers against the health risks of second-hand smoke exposure     

Asociación entre las características del entorno de residencia y la actividad física

Objective

To assess the relationship between the physical and social attributes of the neighborhood environment and levels of total physical activity (PA), leisure time PA, and active commuting PA in adults.

Methods

The present cross-sectional study comprised 1500 adults (51.1% women) aged 15-74 years from the Autonomous Region of Madrid (Spain). Data were collected through a structured telephone interview. PA was assessed using the Global Physical Activity Questionnaire, version 2. Neighborhood attributes were assessed with the Environmental Module of the International Physical Activity Prevalence Study.

Results

The factors associated with a higher probability of achieving moderate to high levels of total PA and active commuting PA were living in high density residential areas, the presence of shops close to the residential area, public transport stops 10-15 minutes away from the home, and the existence of sidewalks in most of the neighborhood's streets (all p <0,05). The factors associated with moderate to high leisure time PA levels were the presence of active people in the residential area and the presence of low-cost recreational facilities (both p <0,05).

Conclusions

Our findings suggest that most of the physical and social attributes of the neighborhood environment examined in this study are associated with total and active commuting PA, whereas only certain neighborhood attributes seem to be associated with leisure time PA.     

Primary prevention of metabolic syndrome in the community using an evidence-based exercise program

Objectives

The purpose of the present study was to examine the effectiveness of a community-based exercise program to lower metabolic syndrome (MetS) risk factors.

Methods

MetS components were retrospectively analyzed in 332 adults (190 women, 142 men) before and after a 14-week supervised community exercise program between January 2007 and May 2012 at the University of Wisconsin-Eau Claire.

Results

Except for total cholesterol, all health outcome variables, including the 5 MetS components, improved following community exercise. Individuals having MetS decreased from 22.3% before participation to 13.5% at end (p < 0.05), while prevalence of participants with no MetS components increased 56% (from 65 to 102; p < 0.05). Compared to the lowest quartile of relative energy expenditure, participants with the highest quartile were 6.4 (95% CI 1.8–23.2; p < 0.05), 7 (95% CI 2.5–20.0; p < 0.05) and 9.3 (95% CI 2.6–34.0; p < 0.05) times more likely to eliminate low-HDL cholesterol, impaired fasting glucose, and low cardiorespiratory fitness as MetS risk factors, respectively.

Conclusion

A community exercise program is an effective method to reduce cardiovascular risk in adults by substantially decreasing the prevalence of MetS and its components. Greater volumes of exercise may increase the likelihood of MetS risk factor elimination.     

Consumo de tabaco de los adolescentes en Barcelona y tendencias a lo largo de 20 años

Objectives

Smoking is a preventable cause of early death and the habit starts in adolescence. The aim of this study was to describe tobacco consumption in secondary school students in 2008 and trends in the last 20 years in Barcelona.

Material and methods

We analyzed the trend in tobacco consumption by comparing data from 8 surveys carried out between 1987 and 2008 in the 8 th (2 nd year of Compulsory Secondary Education), 10th (4 th year of Compulsory Secondary Education) and 12th (2 nd year of Compulsory Secondary Education) years of secondary school. The FRESC questionnaire was used. Data on regular and daily consumption and associated factors in 2008 were gathered and compared with those corresponding to the previous studies. Percentages of annual change were calculated with Joinpoint regression and data were stratified by sex and year of education.

Results

In 2008, 6.1% of boys and 4.5% of girls in the 8 th year, 15.8% and 20.4% of those in the 10th year, respectively, and 26.1% and 33.1% of those in the 12th year, respectively, were regular smokers. A strong association was noted between regular smoking and cannabis consumption in three school years, as well as with having friends who were smokers and poor school performance. At 15-16 years old, the average annual decrease from 1996 to 2008 was 6.8% in girls and 6.1% in boys.

Conclusions

Adolescent smoking has been decreasing in the last few years in Barcelona. There is a strong association between tobacco use and cannabis consumption.     

American adults eligible for the Supplemental Nutritional Assistance Program consume more sugary beverages than ineligible adults

Background

There is considerable debate about whether sugar-sweetened beverages (SSBs) should be allowable purchases with benefits from the Supplemental Nutrition Assistance Program (SNAP).

Purpose

To examine national patterns in adult consumption of SSBs by SNAP eligibility.

Methods

Cross-sectional analysis of 24-hour dietary recall data obtained from the National Health and Nutrition Examination Survey 2003–2010 (N = 17,198), analyzed in 2013.

Results

In 2003–2010, 65% of adults receiving SNAP consumed SSBs, averaging 307 cal daily, and 74 g of sugar. Compared to adults ineligible for SNAP, adults receiving SNAP consumed a higher percentage of SSBs (65% vs. 59%, p < 0.001), more calories from SSB per capita (210 kcal vs. 175 kcal, p = 0.001), and more daily calories from SSBs among drinkers (307 kcal vs. 278 kcal, p = 0.008). Overall, per capita consumption from SSBs was highest among adults receiving SNAP (210 kcal, 9% total daily intake), followed by adults eligible but not participating in SNAP (192 kcal, 8% total daily intake) — both of which had significantly higher SSB consumption than ineligible adults (175 kcal, 8% total daily intake) (p < 0.05).

Conclusion

Adults eligible for SNAP benefits consume more SSBs than ineligible adults.     

Asociación entre horas de televisión,actividad física,horas de sueño y exceso de peso en población adulta joven

Objective

To explore the association between excess weight or body mass index (BMI) and the time spent watching television, self-reported physical activity and sleep duration in a young adult population.

Methods

We analyzed cross-sectional baseline data of 1,135 participants (17-35 years old) from the project Dieta, salud y antropometría en población universitaria (Diet, Health and Anthrompmetric Variables in Univeristy Students). Information about time spent watching television, sleep duration, self-reported physical activity and self-reported height and weight was provided by a baseline questionnaire. BMI was calculated as kg/m² and excess of weight was defined as ≥25. We used multiple logistic regression to explore the association between excess weight (no/yes) and independent variables, and multiple linear regression for BMI.

Results

The prevalence of excess weight was 13.7% (11.2% were overweight and 2.5% were obese). A significant positive association was found between excess weight and a greater amount of time spent watching television. Participants who reported watching television >2 h a day had a higher risk of excess weight than those who watched television ≤1 h a day (OR = 2.13; 95%CI: 1.37-3.36; p-trend: 0.002). A lower level of physical activity was associated with an increased risk of excess weight, although the association was statistically significant only in multiple linear regression (p = 0.037). No association was observed with sleep duration.

Conclusion

A greater number of hours spent watching television and lower physical activity were significantly associated with a higher BMI in young adults. Both factors are potentially modifiable with preventive strategies.     

Cumplimiento de las recomendaciones sobre actividad física en personas hipertensas asistidas en atención primaria

Objective

To determine the prevalence of adherence to physical activity recommendations in the hypertensive population of Lerida (Spain) attended in primary care and to identify related factors.

Methods

A cross sectional study was carried out in hypertensive adults. The dependent variable was adherence to physical activity recommendations measured with the Minnesota Questionnaire. The independent variables were sociodemographic factors, the information received, and attitudes to physical activity.

Results

A total of 786 hypertensive patients participated in this study; 53.9% were women and the mean age was 66.0 ± 10.2 years. Adherence to recommendations was found in 64.3% (95% CI: 60.9-67.6); this percentage was 65.2% in men (95% CI: 60.2-70.0) and 63.4% in women (95% CI: 58.8-67.9). Greater adherence was associated with age in men and with residence in a rural area in women. In both genders, greater adherence was associated with unpaid work and with having a favorable attitude to physical activity. No association was observed with the number of recommendations received in the last 6 months.

Conclusions

More than half the hypertensive population adhered to physical activity recommendations. To improve physical activity levels, recommendations can be tailored to the attitudes of individual patients.