Cristina Lopez-del Burgo

The Mediterranean Diet Is Associated with a Reduction in Premature Mortality among Middle-Aged Adults

The available large prospective studies supporting an inverse association between better adherence to the Mediterranean diet and lower mortality have mainly included older adults. It is not clear whether this inverse association is also present among younger individuals at lower mortality risk. Our aim was to assess the association between adherence to the Mediterranean diet and total mortality in middle-aged adults from the Seguimiento Universidad de Navarra (SUN) Project. We followed 15,535 Spanish university graduates for a mean of 6.8 y. Their mean age was 38 ± 12 y, 59.6% were females, and all were initially free of cardiovascular disease, cancer, and diabetes. A validated FFQ was used to assess dietary habits. Adherence to the Mediterranean diet was categorized into 3 groups according to the Mediterranean Diet Score (low, 0-2 points; moderate, 3-5 points; and high, 6-9 points). The outcome variable was total mortality. Cox proportional hazards models were used to estimate HR and 95% CI. We adjusted the estimates for sex, age, years of university education, BMI, smoking, physical activity, television watching, history of depression and baseline hypertension, and hypercholesterolemia. We observed 125 deaths during 105,980 person-years of follow-up. The fully adjusted HR for moderate and high adherence were 0.58 (95% CI: 0.34, 0.99; P = 0.05) and 0.38 (95% CI: 0.21, 0.70; P = 0.002), respectively. For each 2-point increment in the Mediterranean Diet Score, the HR of death was 0.72 (95% CI: 0.58, 0.91; P = 0.006). Among highly educated, middle-aged adults, adherence to the traditional Mediterranean diet was associated with reduced risk of death.

Choice of birth control methods among European women and the role of partners and providers

BACKGROUND The choice of a birth control method is influenced by sociocultural and personal factors. We explored the perceived influences in womens choice of a birth control method in five European countries (Germany, France, the UK, Romania and Sweden), where contraception is widely used. STUDY DESIGN This is a cross-sectional study of 1137 randomly selected women aged 18-49 years. An anonymous, 31-item questionnaire related to birth control methods was used. Logistic regression was used to identify variables associated with partner participation in choice of a contraceptive. RESULTS Oral contraceptives were mainly used in Germany (54.3%), France (50.5%) and Sweden (34.6%) and condoms in the UK (29.6%) and Romania (22.9%). Sweden showed the highest use of intrauterine devices (IUD, 19%). Romania had the lowest use of contraception. Oral contraceptives and IUDs use were frequently suggested by providers instead of by women. Choosing the method with the partner was associated with age [odds ratio (OR)=0.97, 95% confidence interval (CI) 0.94-0.99], being a university graduate (OR=1.59, 95% CI 1.01-2.29), married (OR=1.52, 95% CI 1.01-2.29) and with using a method that requires partners cooperation (OR=8.18, 95% CI 5.46-12.27). CONCLUSIONS Hormonal contraceptives and IUDs are commonly recommended by providers rather than requested by women. Partner preferences are taken into account when his cooperation in the use of the method is needed. As fertility care is a male and female issue, there is still more room for actively involving both women and men in their choice of a birth control method.

Dietary fat intake and quality of life: the SUN project

BackgroundFew studies have related nutritional factors with quality of life in healthy populations. The purpose of the study was to assess whether dietary fat intake is associated to mental and physical quality of life.MethodsThis analysis included 8,430 participants from the SUN (Seguimiento Universidad de Navarra) Project. The intake of saturated fatty acids (SFA), polyunsaturated fatty acids (PUFA), trans unsaturated fatty acids (TFA), and monounsaturated fatty acids (MUFA) was assessed through a 136-item food frequency questionnaire at baseline. Quality of life was measured with the SF-36 Health Survey after 4 years of follow-up. Generalized Linear Models were fitted to assess the regression coefficients (b) and their 95% confidence intervals (95% CI) for the 8 domains of the SF-36 according to successive quintiles of each kind of fatty acids intake.ResultsThe multivariate-adjusted models revealed a significant inverse association for SFA intake (in quintiles) and two of the physical domains (physical functioning and general health). E.g. for general health domain: (highest quintile of intake (Q5) vs. lowest quintile (Q1), b = -1.6; 95% CI = -3.1, -0.1. General health also showed a dose-response relationship (p for trend < 0.05). For TFA intake (in quintiles), a significant inverse association was found for most of the mental domains (vitality, social functioning and role emotional). E.g. for vitality domain (Q5) vs. (Q1), b = -2.0, 95% CI = -3.4 to -0.6. We also found an inverse association between TFA intake and the bodily pain domain: (Q5 vs. Q1), b = -2.6; 95% CI = -4.4 to -0.8, with a statistically significant dose-response relationship (p for trend < 0.05). Except for TFA intake and the mental domains, the rest of the associations were attenuated when we repeated the analysis adjusting for adherence to the Mediterranean diet.ConclusionsA detrimental relationship between TFA intake at baseline and most of the SF-36 mental domains measured 4 years later were found, whereas weak inverse associations were found for SFA intake and some physical domains.

Observational research with adolescents: a framework for the management of the parental permission

BackgroundWaiving parent permission can be an option in some epidemiological and social research with adolescents. However, exemptions have not been uniformly considered or applied. Our aim is to critically assess the different factors that could be taken into account when making decisions about waiving active parental permission in observational research with adolescents.DiscussionIn some cases alternatives to parental permission could be applied to protect the rights of both adolescents and parents and also to assure the benefits to adolescents as a group that can come from appropriately conducted studies. However, the criteria of ensuring minimal risk can be difficult to define and apply and a distinction between harm and discomfort is reviewed. Waiving active parental permission could be acceptable when the risk of harm is minimal; when the research questions are related to an activity for which adolescents are not legally considered to be children; when the risk of harm or discomfort may increase if parental permission is required; and when risk of discomfort is low because the questionnaire is not potentially offensive for some adolescents and/or for some parents.SummaryStringent rules concerning parental permission in some studies could be detrimental to adolescents. A framework and a decision tree guide are proposed to help researchers and Research Ethics Committees in their decisions on whether active parental permission must be obtained.

Women's attitudes towards mechanisms of action of family planning methods: survey in primary health centres in Pamplona, Spain

BackgroundInformed consent in family planning includes knowledge of mechanism of action. Some methods of family planning occasionally work after fertilization. Knowing about postfertilization effects may be important to some women before choosing a certain family planning method. The objective of this survey is to explore womens attitudes towards postfertilization effects of family planning methods, and beliefs and characteristics possibly associated with those attitudes.MethodsCross-sectional survey in a sample of 755 potentially fertile women, aged 18–49, from Primary Care Health Centres in Pamplona, Spain. Participants were given a 30-item, self-administered, anonymous questionnaire about family planning methods and medical and surgical abortion. Logistic regression was used to identify variables associated with womens attitudes towards postfertilization effects.ResultsThe response rate was 80%. The majority of women were married, held an academic degree and had no children. Forty percent of women would not consider using a method that may work after fertilization but before implantation and 57% would not consider using one that may work after implantation. While 35.3% of the sample would stop using a method if they learned that it sometimes works after fertilization, this percentage increased to 56.3% when referring to a method that sometimes works after implantation. Women who believe that human life begins at fertilization and those who consider it is important to distinguish between natural and induced embryo loss were less likely to consider the use of a method with postfertilization effects.ConclusionInformation about potential postfertilization effects of family planning methods may influence womens acceptance and choice of a particular family planning method. Additional studies in other populations are necessary to evaluate whether these beliefs are important to those populations.

Familia, amigos y otras fuentes de información asociadas al inicio de las relaciones sexuales en adolescentes de El Salvador

OBJETIVO: El objetivo de este estudio es comprobar como influyen en el inicio de la actividad sexual de los jovenes salvadorenos los mensajes que reciben sobre cuestiones de sexualidad, afectividad y ocio a traves de la familia, los amigos y los medios de comunicacion. METODOS: Estudio transversal a partir de una muestra representativa de 2 615 estudiantes (de 13 a 19 anos) de El Salvador. Se utilizo un muestreo sistematico aleatorio para seleccionar 30 colegios. Se recogieron aspectos sociodemograficos, estilos de vida y fuentes de informacion sobre sexualidad y amor utilizadas por los jovenes. RESULTADOS: La edad media de los jovenes fue de 15 anos (DE = 1,8). En total 638 (24,4%) jovenes afirmaron haber tenido relaciones sexuales. Los siguientes factores se asociaron con una mayor probabilidad de haber tenido relaciones sexuales: percibir que los hermanos (OR = 1,8, IC 95%: 1,2-2,7) o los amigos (OR = 1,7, IC 95%: 1,3-2,2) apoyan que se tengan relaciones sexuales. Como factores protectores se encontraron la supervision de los padres (OR = 0,5, IC 95%: 0,4-0,7); recibir mensajes que apoyan la abstinencia por parte de amigos (OR = 0,7, IC 95%: 0,6-1,0) o hermanos (OR = 0,7, IC 95%: 0,5-0,8) y recibir mensajes favorables al matrimonio por parte de los padres (OR = 0,4, IC 95%: 0,3-0,6). CONCLUSIONES: Los mensajes de la familia y amigos son factores que parecen influir en el inicio de las relaciones sexuales de los jovenes. Los programas de promocion de la salud sexual en El Salvador deberian tener en cuenta estos factores.

Knowledge and beliefs about mechanism of action of birth control methods among European women

BACKGROUND Adequate knowledge is essential for making informed decisions. We attempted to determine the level of knowledge about mechanisms of action of birth control methods in five representative samples of European women. STUDY DESIGN Randomly selected women, aged 18-49 years, completed an anonymous survey in Germany, France, the UK, Sweden and Romania (N=1137). Participants were asked about how contraceptive methods work and if providers should inform them about this issue. Multiple linear regression was used to evaluate womens characteristics associated with their knowledge of mechanisms of action. RESULTS The majority of women identified the unequivocal mode of action of condoms, sterilization and abortion. Fewer than 2% identified all possible mechanisms of action of hormonal contraceptives and intrauterine devices. Highly educated women correctly identified the mechanism or mechanisms of action of more methods than less educated women (β=0.22, 95% confidence interval 0.01-0.43). Regardless of their sociodemographic characteristics and their belief about when human life begins, most women (75%) stated that the provider should inform them about possible postfertilization effects. CONCLUSIONS European women have low knowledge about mechanisms of action of several contraceptive methods. The majority want to be informed about possible postfertilization effects. Since adequate knowledge is essential for making informed decisions, providers are encouraged to inform women about all possible mechanisms of action of contraceptives.

Primary prevention of gestational diabetes mellitus through nutritional factors: a systematic review

BackgroundGestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset during pregnancy, is increasing worldwide, mostly because obesity among women of reproductive age is continuously escalating. GDM is associated with adverse maternal and fetal outcomes. The aim of this article was to systematically review literature on the effectiveness of nutritional factors before or during pregnancy to prevent GDM.MethodsWe assessed the primary prevention of GDM through nutritional factors, as diet and supplements. We searched on PubMed, Cochrane Databases and ClinicalTrials.gov from inception to June 2016. Clinical trials and adjusted prospective cohort studies were included.ResultsEight clinical trials and twenty observational studies assessing the association between dietary factors and primary prevention of GDM were included. Furthermore, six clinical trials and two observational studies related to supplements were also added. Only two nutritional interventions were found to significantly reduce the incidence of GDM, besides the supplements. However, the observational studies showed that a higher adherence to a healthier dietary pattern can prevent the incidence of GDM, especially in high risk population before getting pregnant.ConclusionsThe results indicate that there may be some benefits of some nutritional factors to prevent GDM. However, better-designed studies are required to generate higher quality evidence. At the moment, no strong conclusions can be drawn with regard to the best intervention for the prevention of GDM.

Safe-sex belief and sexual risk behaviours among adolescents from three developing countries: a cross-sectional study

Objectives This study intends to evaluate whether the belief that condoms are 100% effective in protecting against HIV infection is associated with sexual risk behaviours among youth. Methods A cross-sectional study was performed in representative samples of high-school students in the Philippines, El Salvador and Peru. Participants completed a self-administered questionnaire. Students were asked about the risk of HIV transmission if one has sex using condoms. They were also asked to indicate whether they had ever had sexual relations and whether they used a condom in their first sexual relation. The sample was composed of 8994 students, aged 13–18. Results One out of seven adolescents believed condoms are 100% effective (safe-sex believers). Those adolescents were 82% more likely to have had sex than those without such belief, after adjusting for confounders (OR=1.82; 95% CI 1.51 to 2.21). On the contrary, no association was found between risk perception and condom use. Subgroup and sensitivity analyses produced similar results. Conclusions This is, to the best of our knowledge, the first study conducted specifically to evaluate this phenomenon and that has used the same questionnaire and the same data collection protocol in three different developing countries from Asia, Central and South America. These results reasonably suggest that there could be an association between safe sex beliefs and sexual initiation. Longitudinal studies are needed to better understand this possible association as it could influence how to better promote sexual health.

Spanish women's attitudes towards post-fertilization effects of birth control methods

OBJECTIVE Some methods of family planning, such as oral contraceptives, emergency pill or intrauterine device, may occasionally work after fertilization. These effects may be important to some women. We explored Spanish womens attitudes towards contraceptive choices that may have occasional post-fertilization mechanisms of action. STUDY DESIGN Cross-sectional study in a Spanish representative sample of 848 potentially fertile women, aged 18-49. Data were collected using a 30-item questionnaire about family planning. Logistic regression was used to identify variables associated with womens attitudes towards post-fertilization effects. RESULTS The majority of women were married, had completed high school and had at least one child. Forty-five percent of women would not consider using a method that may work after fertilization and 57% would not consider using one that may work after implantation. Forty-eight percent of the sample would stop using a method if they learned that it sometimes works after fertilization, increasing to 63% when referring to a method that sometimes works after implantation. Women who believe that human life begins at fertilization, those who believe it is important to distinguish between spontaneous and induced embryo losses and women who report having a religion were less likely to consider the use of a method with some post-fertilization effects. CONCLUSION The possibility of post-fertilization effects may influence Spanish womens choice of a family planning method. Information about mechanisms of action of birth control methods should be disclosed to women so that they can make informed choices.