Silvia Carlos

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.

Association between Sleeping Hours and Siesta and the Risk of Obesity: The SUN Mediterranean Cohort

Objectives: Our aim was to investigate the association between sleeping hours at night and during the siesta and the incidence of obesity in a Mediterranean cohort. Methods: After a median of 6.5 years of follow-up, we included 10,532 or 9,470 participants without chronic disease or obesity at baseline for analyzing the association between the incidence of obesity and nocturnal sleep duration or having siesta. Sleeping hours and siesta were assessed at baseline. Weight was recorded at baseline and every 2 years during the follow-up. The outcome was the incidence of obesity during follow-up among participants with initial BMI <30 kg/m2. Results: During follow-up we observed 446 new cases of obesity in the analysis of nocturnal sleep duration. Sleeping less than 5 h at night was associated with a higher risk of becoming obese compared to sleeping between 7 and <8 h (HR 1.94; 95% CI 1.19-3.18; p for quadratic trend = 0.06) after adjusting for potential confounders. During follow-up, we observed 396 incident cases of obesity in the analysis of siesta. Those who took a siesta for 30 min/day had a 33% lower risk of becoming obese (HR 0.67; 95% CI 0.46-0.96; p for quadratic trend = 0.13) compared to those who did not take siesta. Conclusion: Our results suggest that short nocturnal sleep duration could be a modifiable risk factor for obesity. It is possible that this association may be stronger among men and subjects who experienced previous weight gain. Additionally, siesta might be a novel and independent protective factor for obesity; however, confirmatory studies are needed.

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.

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.

Association between dietary intakes of PCBs and the risk of obesity: the SUN project

Background Polychlorinated biphenyls (PCB) are persistent organic pollutants (POP) that are consumed because of their bioaccumulation through the food chain. Recent studies have suggested the implication of POPs in the development of metabolic diseases such as type 2 diabetes and obesity. However, this relationship is not entirely consistent, and has not been investigated in longitudinal studies. The purpose of this study was to prospectively examine the association between dietary intake of PCBs and the incidence of obesity in the Seguimiento Universidad de Navarra (SUN) Project. Methods Our study included 12 313 participants without obesity at baseline, who were followed-up for a median of 8.1 years. Dietary intakes of PCBs, expressed as WHO toxic equivalents, were assessed at baseline through a 136-item semiquantitative food-frequency questionnaire. The published concentration levels of PCBs measured in samples of food consumed in Spain were used to estimate intakes. Multivariable Cox regression models were fitted to estimate HRs and 95% CI for incident obesity. Results During follow-up, we observed 621 incident cases of obesity. After adjustment for total energy intake and additional adjustment for potential confounders, participants in the fifth quintile of PCBs intake were at higher risk of becoming obese (adjusted HR: 1.58; (95% CI 1.21 to 2.06)) compared to those in the first quintile. The linear trend test was statistically significant (p<0.001). Conclusions Dietary intake of PCBs as estimated using a food frequency questionnaire was associated with a higher incidence of obesity. Nevertheless, further longitudinal studies are needed to confirm our results.

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.

Vacuna contra el virus del papiloma humano: razones para el optimismo y razones para la prudencia

No hay duda de que la aplicacion sistematica y universal decalendarios vacunales en la infancia ha sido uno de los ma-yores exitos sanitarios en la historia de la humanidad. El usoapropiado de las vacunas es probablemente la intervencionmas eficiente en salud publica, con logros del calibre de laerradicacion de la viruela y grandes avances frente a la po-liomielitis

Mediterranean diet and heart rate: The PREDIMED randomised trial

This study was funded by the Spanish Ministry of Health (ISCIII), CIBEROBN, PI1001407, PI11/02505, G03/140, RD06/0045, the Autonomous Government of Catalonia, Caixa Tarragona (10-1343) and by the Generalitat Valenciana (ACOMP/2013/165). The Fundacion Patrimonio Comunal Olivarero and Hojiblanca SA (Malaga, Spain), California Walnut Commission (Sacramento, CA), Borges SA (Reus, Spain) and Morella Nuts SA (Reus, Spain) donated the olive oil, walnuts, almonds and hazelnuts, respectively. None of the funding sources played a role in the design, collection, analysis, interpretation or publication of the data. ET is supported by a Rio Hortega fellowship (ISCIII, Spanish Government).

The use of expensive technologies instead of simple, sound and effective lifestyle interventions: a perpetual delusion

A dangerous distortion of priorities seems to be currently apparent in the dominant approaches to major public health problems, including cardiovascular disease, diabetes, obesity, cancer and some infectious diseases. Relevant examples suggest an apparently inappropriate tendency to prioritise technocratic, partial solutions rather than confronting their true behavioural and structural determinants. Technically oriented preventive medicine often takes excessive precedence over simpler, more sensible approaches to modify lifestyles, the environment and the social structure. Structural factors (social, cultural, financial, familiar, educational, political or ideological factors) that act as determinants of individual behaviours should be effectively addressed to confront the essential causes of the most prevalent and important health problems. Some consumer-directed commercial forces seem to be increasingly driving many aspects of the current sociocultural environment, and may eventually compromise the main pursuits of public health. Population-wide strategies are needed to create a healthy sociocultural environment and to empower individuals and make themselves resistant to these adverse environmental and structural pressures. Otherwise most public health interventions will most likely end in failures.