Carmen Cabezas

Trends in dietary habits and food consumption in Catalonia, Spain (1992–2003)

OBJECTIVE To analyse trends in food habits and food consumption from 1992 to 2003. DESIGN Two consecutive cross-sectional nutrition surveys were carried out on random samples of the Catalan population (Evaluation of Nutritional Status in Catalonia (ENCAT) 1992-93 and ENCAT 2002-03). Dietary intake was assessed by means of two 24-hour recalls on non-consecutive days and a food frequency questionnaire was used to ascertain tendencies in the frequency of food consumption. SETTING Catalonia region, Northeastern Spain. SUBJECTS Analysis is based on a total of 4701 individuals: 2641 from ENCAT 1992-93 (1210 men and 1431 women) and 2060 from ENCAT 2002-03 (954 men and 1106 women), aged 10-75 years. RESULTS The trends from 1992 to 2003 showed an increase in eating between meals and outside the home. There was also an upsurge in consumers for fast food, especially among young adults. Notable decreases in fruit consumption (from 301 to 224 g day(-1)) as well as in vegetables, potatoes, meat (red meat and chicken), fish (whitefish and seafood) and offals were observed. In contrast, there was an increase in dairy product consumption, in general (from 255 to 312 g day(-1)), as well as low fat and skim milk derivatives. Fruit juice, nuts and olive oil consumption also increased, the latter being consumed daily by 96% of the population. Little variation was observed for the rest of the food groups in the period studied. Overall, Catalonia is characterised by a model of consumption that is quite favourable, inherent to Mediterranean countries but with important differences according to age. CONCLUSION Based on the food consumption trends observed in Catalonia, an increase in the consumption of fruits and vegetables, as well as whole grain cereals and fish, should be promoted, along with a reduction in the consumption of meat and sausages.

Large Outbreak of Measles in a Community with High Vaccination Coverage: Implications for the Vaccination Schedule

BACKGROUND Attempts to eliminate measles from a country or region may be disrupted by an imported case that affects indigenous persons. The objective of this study was to analyze epidemiological and clinical characteristics of a measles outbreak in Catalonia, Spain, in 2006. METHODS Data on cases of measles reported to the Department of Health, Generalitat of Catalonia, during the period 28 August 2006 through 8 July 2007 were collected. Suspected cases were confirmed by determination of measles-specific immunoglobulin M antibodies and/or detection of virus genome. Incidences were calculated using the estimated population of Catalonia for 2006, and 95% confidence intervals were determined assuming a Poisson distribution. The association between proportions was determined using the chi(2) test and Fishers exact test. The level of statistical significance was set at alpha = .05. RESULTS A total of 381 cases were confirmed, for an incidence of 6.6 cases per 100,000 persons. A total of 89.5% of cases occurred in nonvaccinated persons, mainly those aged < or =15 months (incidence, 278.2 cases per 100,000 persons; mean age of patients, 12 months). Indigenous subjects accounted for 89.8% of cases, and laboratory confirmation of results was obtained for 87.1%. Measles genotype D4 was identified in all sequenced samples. CONCLUSIONS The age distribution of cases of measles among children aged <15 months suggests that the first dose of vaccine should be routinely administered at the age of 12 months.

Rendimiento de la estimación del riesgo cardiovascular en España mediante la utilización de distintas funciones

Introduccion y objetivos A pesar de que presentan una baja incidencia, las enfermedades cardiovasculares son la causa mas frecuente de morbimortalidad en Espana. Se dispone de diversas funciones para calcular el riesgo cardiovascular en la prevencion primaria, cuya capacidad para identificar a los pacientes que desarrollaran acontecimientos cardiovasculares es poco conocida. Comparamos el rendimiento de las funciones de Framingham original, adaptada de REGICOR (Registre Gironi del Cor) y SCORE (Systematic COronary Risk Evaluation) para paises de bajo riesgo. Metodos Se registraron todos los acontecimientos cardiovasculares en un seguimiento de 5 anos de una cohorte sin enfermedad coronaria en 9 comunidades autonomas. Se midieron los factores de riesgo cardiovascular entre 1995 y 1998. Se considero que el riesgo era elevado a los 10 anos en ≥ 20% para Framingham, ≥ 10, ≥ 15 y ≥ 20% para REGICOR y ≥ 5% para SCORE. Resultados Se produjeron 180 (3,1%) acontecimientos coronarios (112 en varones y 68 en mujeres) en las 5.732 personas (57,3% de mujeres) en las que se realizo el seguimiento. Se produjo muerte cerebrovascular en 43 personas, asi como 24 acontecimientos vasculares no coronarios. Con la funcion REGICOR se obtuvo el mayor valor predictivo positivo para enfermedad coronaria y cardiovascular a cualquier edad, y, tomando un limite de 10% de riesgo a los 10 anos, se clasifico a menos poblacion de alto riesgo de 35-74 anos (12,4%) que con la funcion de Framingham (22,4%). SCORE y Framingham clasificaron al 8,4 y al 16,6% de la poblacion de 35-64 anos como de alto riesgo cardiovascular y REGICOR, al 7,5%. Conclusiones La funcion adaptada de REGICOR es la opcion aplicable hasta los 74 anos que muestra el mejor equilibrio en la capacidad de clasificacion de riesgo de acontecimientos cardiovasculares. Su aplicacion permite la clasificacion de alto riesgo a individuos con un perfil mas adecuado para ser candidatos a tratamiento hipolipemiante.

Trends in physical activity status in Catalonia, Spain (1992-2003)

AIM The promotion of a healthy and active lifestyle among the population is essential for the prevention of numerous chronic diseases. Physical activity measurement and surveillance is crucial for understanding and evaluating campaigns to promote its practice. OBJECTIVE To evaluate the 10-year trends in physical activity habits in the Catalan population. DESIGN Two cross-sectional nutritional surveys were carried out within a 10-year interval in the population of Catalonia. Data on physical activity include leisure-time physical activity, occupational physical activity and walking activity and regular stair climbing. SubjectIn all, 2344 individuals participated in the ENCAT 1992-93 study and 2055 individuals in the ENCAT 2002-03 survey, aged 10 to 75 years. RESULTS Inactivity related to occupation increased (from 53% in 1992-93 to 56% in 2002-03 of the Catalan population having sedentary work-related activities). In both genders, the percentage of people who walked to work at least 30 min decreased (from 19% to 16% in men and from 25% to 19% in women). There was a decrease in the percentage of people who were completely sedentary during leisure time (from 59% to 56%), and an increase in the percentage of people who did at least 2 days of vigorous activity (from 39% to 46% in men and from 26% to 32% in women). CONCLUSIONS The physical activity related to work and transportation has decreased during the period observed. Although a slight improvement has been noted, the percentage of people who are sedentary during leisure time is still high among both men and women.

Effectiveness of a stepped primary care smoking cessation intervention: cluster randomized clinical trial (ISTAPS study)

AIM To evaluate the effectiveness in primary care of a stepped smoking cessation intervention based on the transtheoretical model of change. DESIGN Cluster randomized trial; unit of randomization: basic care unit (family physician and nurse who care for the same group of patients); and intention-to-treat analysis. SETTING All interested basic care units (n = 176) that worked in 82 primary care centres belonging to the Spanish Preventive Services and Health Promotion Research Network in 13 regions of Spain. PARTICIPANTS A total of 2,827 smokers (aged 14-85 years) who consulted a primary care centre for any reason, provided written informed consent and had valid interviews. MEASUREMENTS The outcome variable was the 1-year continuous abstinence rate at the 2-year follow-up. The main variable was the study group (intervention/control). Intervention involved 6-month implementation of recommendations from a Clinical Practice Guideline which included brief motivational interviews for smokers at the precontemplation-contemplation stage, brief intervention for smokers in preparation-action who do not want help, intensive intervention with pharmacotherapy for smokers in preparation-action who want help and reinforcing intervention in the maintenance stage. Control group involved usual care. Among others, characteristics of tobacco use and motivation to quit variables were also collected. FINDINGS The 1-year continuous abstinence rate at the 2-year follow-up was 8.1% in the intervention group and 5.8% in the control group (P = 0.014). In the multivariate logistic regression, the odds of quitting of the intervention versus control group was 1.50 (95% confidence interval = 1.05-2.14). CONCLUSIONS A stepped smoking cessation intervention based on the transtheoretical model significantly increased smoking abstinence at a 2-year follow-up among smokers visiting primary care centres.

Compliance with dietary guidelines in the Catalan population: basis for a nutrition policy at the regional level (the PAAS strategy)

OBJECTIVE To analyse the degree of compliance with the nutrition objectives and population-based food guides and to indicate possible recommendations for their development within the framework of a Nutrition and Health Policy in Catalonia. DESIGN Using data derived from the latest Catalan Nutrition Survey (ENCAT 2002-03) conducted by the Department of Health, compliance was analysed with respect to the recommendations derived as a result of a previously conducted Survey. In addition, compliance to the recommendations elaborated by the Spanish Society of Community Nutrition (SENC) was also evaluated. SETTING Catalonian region located in the Northeast of Spain. SUBJECTS Analysis is based on a total of 2160 individuals (996 males and 1164 females) aged 10-80 years interviewed in 2002-03. RESULTS The analysis of compliance with the recommendations established in 1995 showed: (a) recommendation to maintain and increase consumption of fruits and vegetables was not achieved; (b) continued use of olive oil as the dietary fat of choice was met; (c) incomplete compliance with maintaining the Mediterranean diet traditions, especially in the younger cohorts; (d) compliance with the recommendation to decrease consumption of red meat and sausages, but non-compliance with guidance to maintain or increase fish consumption and (e) compliance with partially substituting whole milk and dairy for low-fat products. Compliance with the SENC Healthy Eating Guide revealed that those food groups with the worst results were meat and sausages (excessive), pulses (below recommendations) and fruits and vegetables (below recommendations). CONCLUSIONS Compliance with dietary guidelines is low in Catalonia, and reflects the need for an effective nutrition policy in the region defined by the Autonomous Government as the Plan for the Promotion of Physical Activity and Healthy Eating (PAAS).

The extension of smoke-free areas and acute myocardial infarction mortality: before and after study

Objectives Recent studies suggest that comprehensive smoking regulations to decrease exposure to second-hand smoke reduce the rates of acute myocardial infarction (AMI). The objective of this paper is to analyse if deaths due to AMI in Spain declined after smoking prevention legislation came into force in January 2006. Design Information was collected on deaths registered by the Instituto Nacional de Estadística for 2004–2007. Age- and sex-specific annual AMI mortality rates with 95% CIs were estimated, as well as age-adjusted annual AMI mortality rates by sex. Annual relative risks of death from AMI were estimated with an age-standardised Poisson regression model. Results Adjusted AMI mortality rates in 2004 and 2005 are similar, but in 2006 they show a 9% decline for men and a 8.7% decline for women, especially among those over 64 years of age. In 2007 there is a slower rate of decline, which reaches statistical significance for men (−4.8%) but not for women (−4%). The annual relative risk of AMI death decreased in both sexes (p<0.001) from 1 to 0.90 in 2006, and to 0.86 in 2007. Conclusion The extension of smoke-free regulations in Spain was associated with a reduction in AMI mortality, especially among the elderly. Although other factors may have played a role, this pattern suggests a likely influence of the reduction in population exposure to second-hand smoke on AMI deaths.

The role of gender in a smoking cessation intervention: a cluster randomized clinical trial

BackgroundThe prevalence of smoking in Spain is high in both men and women. The aim of our study was to evaluate the role of gender in the effectiveness of a specific smoking cessation intervention conducted in Spain.MethodsThis study was a secondary analysis of a cluster randomized clinical trial in which the randomization unit was the Basic Care Unit (family physician and nurse who care for the same group of patients). The intervention consisted of a six-month period of implementing the recommendations of a Clinical Practice Guideline. A total of 2,937 current smokers at 82 Primary Care Centers in 13 different regions of Spain were included (2003-2005). The success rate was measured by a six-month continued abstinence rate at the one-year follow-up. A logistic mixed-effects regression model, taking Basic Care Units as random-effect parameter, was performed in order to analyze gender as a predictor of smoking cessation.ResultsAt the one-year follow-up, the six-month continuous abstinence quit rate was 9.4% in men and 8.5% in women (p = 0.400). The logistic mixed-effects regression model showed that women did not have a higher odds of being an ex-smoker than men after the analysis was adjusted for confounders (OR adjusted = 0.9, 95% CI = 0.7-1.2).ConclusionsGender does not appear to be a predictor of smoking cessation at the one-year follow-up in individuals presenting at Primary Care Centers.ClinicalTrials.gov IdentifierNCT00125905.

Effectiveness of a stepped primary care smoking cessation intervention (ISTAPS study): design of a cluster randomised trial

BackgroundThere is a considerable body of evidence on the effectiveness of specific interventions in individuals who wish to quit smoking. However, there are no large-scale studies testing the whole range of interventions currently recommended for helping people to give up smoking; specifically those interventions that include motivational interviews for individuals who are not interested in quitting smoking in the immediate to short term. Furthermore, many of the published studies were undertaken in specialized units or by a small group of motivated primary care centres.The objective of the study is to evaluate the effectiveness of a stepped smoking cessation intervention based on a trans-theoretical model of change, applied to an extensive group of Primary Care Centres (PCC).Methods/DesignCluster randomised clinical trial. Unit of randomization: basic unit of care consisting of a family physician and a nurse, both of whom care for the same population (aprox. 2000 people). Intention to treat analysis.Study population: Smokers (n = 3024) aged 14 to 75 years consulting for any reason to PCC and who provided written informed consent to participate in the trial.Intervention: 6-month implementation of recommendations of a Clinical Practice Guideline which includes brief motivational interviews for smokers at the precontemplation – contemplation stage, brief intervention for smokers in preparation-action who do not want help, intensive intervention with pharmacotherapy for smokers in preparation-action who want help, and reinforcing intervention in the maintenance stage.Control group: usual care.Outcome measures: Self-reported abstinence confirmed by exhaled air carbon monoxide concentration of ≤ 10 parts per million. Points of assessment: end of intervention period and 1 and 2 years post-intervention; continuous abstinence rate for 1 year; change in smoking cessation stage; health status measured by SF-36.DiscussionThe application of a stepped intervention based on the stages of a change model is possible under real and diverse clinical practice conditions, and improves the smoking cessation success rate in smokers, besides of their intention or not to give up smoking at baseline.Trial RegistrationClinical Trials.gov Identifier: NCT00125905

Prioridades en promoción de la salud según los profesionales de atención primaria: un estudio Delphi

Objetivos Conocer las opiniones de los profesionales de atencion primaria sobre las actividades preventivas en la practica clinica, asi como los obstaculos percibidos por los profesionales para realizarlas y las posibles formas de superarlos. Participantes En total participaron 129 profesionales, entre los que se incluian medicos de atencion primaria, profesionales de enfermeria, tecnicos y responsables de gestion de servicios de atencion primaria, y profesionales de salud publica. Diseno Cuestionario Delphi enviado por correo electronico. Emplazamiento Atencion primaria en Cataluna. Mediciones y resultados principales Se realizaron dos rondas en las que se obtuvieron tasas de respuesta del 48,9 y el 67,4%, respectivamente. Tras la segunda ronda se obtuvo una convergencia superior al 40% en todas las preguntas. Los principales problemas para la prevencion en la practica fueron la falta de tiempo, la falta de formacion y las propias actitudes de los profesionales hacia la prevencion. Para mejorar la implementacion de la prevencion en la practica, los profesionales senalaron la formacion en habilidades de comunicacion, metodologia del consejo y la utilizacion de guias de practica clinica. Conclusiones Los profesionales apuntan algunas necesidades especificas en la formacion que pueden contribuir a mejorar la integracion de las actividades preventivas. Por otro lado, se detecta la necesidad de mejorar las actitudes de los propios profesionales hacia la prevencion.