The Determinants of Tourist Satisfaction in Religious Destinations: the case of Montserrat (Spain)

In the last few years, the historic region of Bages in Catalonia (Spain) has developed the tourism advantage it enjoys because of the medieval relics of the monastery of Montserrat that it treasures, to the point of becoming a major resort area. Montserrat is an example of synergies between religious heritage and tourism. On the mountain of Montserrat, religious devotion, regional identity, cultural heritage and linguistic tradition, landscape, and the nearness of Barcelona join together to create a tourist product of great importance. This working paper shows how religious tourism is an expression of the commercialisation of culture and religion. Heritage, images, shrines, beliefs and devotion are all related to culture, identity, religious feeling and faith, but also to the consumption of a tourism product. The findings suggest that identification with religious identity, promoted for tourism, should be considered as the main determinant of tourists’ attitudes towards the selection of this destination

The social relations and the motivations to assist to the Festival of Music of Peralada

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Las relaciones sociales y las motivaciones para asistir al Festival de Música de Peralada

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Validación del índice de masa corporal auto-referido en la Encuesta Nacional de Salud

Objective. To assess the validity of self-reported body mass index in the National Health Survey. 120 participants were selected and questioned about their weight and height with exactly the same questions that the National Health Survey uses. Afterwards, and once informed consent was obtained, participants were weighed and measured, and this data was used as the gold standard. On average, participants underestimated their weight by 1.39 kg, overestimated their height by 0.55 cm and underestimated their body mass index by 0.71 kg/m2. The sensitivity of self-reported self reported body mass index (BMI) to detect overweight was 77%, the specificity was 97%, the positive predictive value was 0.95 and the negative predictive value was 0.86. The Kappa index was 0.76 and the quadratically weighted Kappa index was 0.85. The correlation coefficient between self-reported and measured BMI was 0.96 and the intraclass correlation coefficient was 0.97. Self-reported data is an efficient way of obtaining information about BMI, although with limitations, because self-reported data tends to underestimate weight and overestimate height, thus underestimating BMI and the proportion of participants with elevated BMI

A novel nonsense mutation in the melanocortin-4 receptor associated with obesity in a Spanish population

BACKGROUND: In recent years, several groups have reported dominant inheritance of obesity conferred by missense, nonsense and frameshift mutations in the melanocortin 4 receptor gene (MC4R). Hence, MC4R is involved in the most common monogenic form of human obesity described so far. OBJECTIVES: In this context, we screened a Spanish population, composed of obese subjects and normal weight controls, for mutations in the MC4-R by single-strand conformational polymorphism (SSCP). SUBJECTS AND METHODS: Overall 313 individuals, 159 obese subjects (body mass index: BMI: 37.6 kg/m2, 95% CI: 36.7–38.5 kg/m2) and 154 normal weight control subjects (BMI: 22.3 kg/m2, 95% CI: 22.0–22.6 kg/m2) were screened for MC4-R mutations. RESULTS: We detected a novel nonsense mutation at codon 16 of the MC4-R in an obese female (BMI: 30.0 kg/m2) and a previously described missense mutation (Val-253-Ile) located within the sixth trans-membrane domain of the MC4-R in a normal weight individual (BMI: 19.0 kg/m2). The polymorphism Val-103-Ile was detected in one obese individual, while four subjects (two cases and two controls) with the polymorphism Ile-251-Leu were found. CONCLUSIONS: We have identified a novel nonsense mutation (Trp-16-Stop) that, based on previously described frameshift and nonsense mutations, most likely results in dominantly inherited obesity. Within this Spanish population, the frequency of the Ile-251-Leu polymorphism of the MC4R was similar in obese and control subjects (about 1.3%), while the polymorphism Val-103-Ile was only detected in an obese individual (0.6%)

Influencia del polimorfismo -3826 A Æ G en el gen de la UCP1 sobre los componentes del síndrome metabólico

Fundamento. La proteína desacoplante UCP1 se ha relacionado con el desarrollo y/o mantenimiento de la obesidad a través de su implicación en la regulación del balance energético. El papel de esta proteína mitocondrial en humanos es incierto por la escasa presencia del tejido adiposo pardo en el individuo adulto. El polimorfismo -3826 A/G de la UCP1 solo o conjuntamente con la mutación Trp64Arg del receptor adrenérgico β3 se ha asociado con obesidad, diabetes mellitus y enfermedades relacionadas aunque con resultados contradictorios. Con objeto de conocer la influencia del polimorfismo -3826 A/G de la UCP1 sobre los componentes clásicos del síndrome metabólico en nuestra población, se han estudiado 159 individuos obesos y 154 en normopeso, con un diseño de casos y controles. A todos ellos se les ha determinado IMC, índice cintura/cadera, % de grasa corporal, TA, perfil lipídico, leptina, glucemia e insulinemia basales. Asimismo se les ha analizado la presencia de la mencionada mutación en el gen de la UCP1. Resultados. Se obtuvieron diferencias significativas en todas las variables estudiadas entre obesos (casos) y normopeso (controles) Dentro del grupo de obesos, el polimorfismo –3826 A/G del gen de la UCP1 (n=53) se asoció con un mayor IMC (p=0,03), mayor % de grasa corporal (p=0,04) y TA más elevada tanto sistólica (p=0,009) como diastólica (p=0,02) No hubo diferencias estadísticamente significativas en ninguno de los demás índices evaluados. Conclusión. El factor fundamental que influye sobre los componentes del síndrome metabólico es la obesidad. No obstante, el polimorfismo –3826 A/G del gen de la UCP1 se asocia con un mayor grado de obesidad y unas cifras más elevadas de TA

Obesity risk is associated with carbohydrate intake in women carrying the Gln27Glu beta2-adrenoceptor polymorphism.

Interindividual differences in the response to dietary intake are, in some cases, genotype dependent. Moreover, genotype-environment interactions may appear when the impact of lifestyle factors (e.g., diet) on a phenotype (e.g., BMI > 30 kg/m2) differs by genotype. A case-control study (obese subjects vs. normal weight controls) was conducted to assess a possible effect modification on obesity risk of the Gln27Glu polymorphism for the ß2-adrenoceptor gene depending on dietary intake. The sample included 159 subjects with BMI > 30 kg/m2 and 154 controls with BMI 49% energy (E)] had a higher obesity risk (OR = 2.56, P = 0.051). The product-term introduced in the logistic model to assess effect modification revealed a marginally significant interaction (P = 0.058) between both factors. Furthermore, a high intake of CHO (E > 49%) was associated with higher insulin levels among women carrying the Gln27Glu polymorphism (P < 0.01). This gene-nutrient interaction emphasizes the importance of examining the outcome of some obesity-related mutations depending on lifestyle (including diet) and may explain the heterogeneity of findings from previous studies

Effect of smoking on body weight: longitudinal analysis of the SUN cohort

Our aim was to investigate prospectively the association between two major cardiovascular risk factors: smoking and weight gain. METHODS: We prospectively evaluated 7565 individuals taking part in a dynamic cohort study over a median follow-up period of 50 months. Self-reported weight and physical activity levels had been validated previously. The adjusted mean difference in weight gain relative to never-smokers (the reference group) was estimated for different levels of tobacco exposure. RESULTS: After adjusting for age, baseline body mass index, sedentary lifestyle, changes in physical activity level, total energy intake, fiber intake, food consumption between meals, and sugary soft drink, fast food and alcohol consumption, it was found that individuals who stopped smoking during follow-up had a greater relative weight gain: men 1.63 kg (95% confidence interval [CI], 1.07-2.19 kg), and women 1.51 kg (95% CI, 1.11-1.91 kg). In addition, active smokers had a greater weight gain than never-smokers: men 0.49 kg (95% CI, 0.11-0.87 kg), and women 0.36 kg (95% CI, 0.07-0.65 kg). CONCLUSIONS: Individuals who stopped smoking during follow-up and active smokers both experienced significantly greater weight gains than never-smokers. This association between cardiovascular risk factors should be taken into account when developing prevention programs

Effects of a Mediterranean Eating Plan on the Need for Glucose-Lowering Medications in Participants With Type 2 Diabetes: A Subgroup Analysis of the PREDIMED Trial

[Objective]: To examine the effects of two Mediterranean eating plans (Med-EatPlans) versus a low-fat eating plan on the need for glucose-lowering medications. [Research design and methods]: From the Prevención con Dieta Mediterránea (PREDIMED) trial, we selected 3,230 participants with type 2 diabetes at baseline. These participants were randomly assigned to one of three eating plans: Med-EatPlan supplemented with extra-virgin olive oil (EVOO), Med-EatPlan supplemented with mixed nuts, or a low-fat eating plan (control). In a subgroup (15%), the allocation was done in small clusters instead of using individual randomization, and the clustering effect was taken into account in the statistical analysis. In multivariable time-to-event survival models, we assessed two outcomes: 1) introduction of the first glucose-lowering medication (oral or injectable) among participants on lifestyle management at enrollment and 2) insulin initiation. [Results]: After a median follow-up of 3.2 years, in multivariable analyses adjusting for baseline characteristics and propensity scores, the hazard ratios (HRs) of starting a first glucose-lowering medication were 0.78 (95% CI 0.62–0.98) for Med-EatPlan + EVOO and 0.89 (0.71–1.12) for Med-EatPlan + nuts, compared with the control eating plan. After a median follow-up of 5.1 years, the adjusted HRs of starting insulin treatment were 0.87 (0.68–1.11) for Med-EatPlan + EVOO and 0.89 (0.69–1.14) for Med-EatPlan + nuts compared with the control eating plan. [Conclusions]: Among participants with type 2 diabetes, a Med-EatPlan + EVOO may delay the introduction of new-onset glucose-lowering medications. The Med-EatPlan did not result in a significantly lower need for insulin

The natural history of classic galactosemia: lessons from the GalNet registry.

BACKGROUND Classic galactosemia is a rare inborn error of carbohydrate metabolism, caused by a severe deficiency of the enzyme galactose-1-phosphate uridylyltransferase (GALT). A galactose-restricted diet has proven to be very effective to treat the neonatal life-threatening manifestations and has been the cornerstone of treatment for this severe disease. However, burdensome complications occur despite a lifelong diet. For rare diseases, a patient disease specific registry is fundamental to monitor the lifespan pathology and to evaluate the safety and efficacy of potential therapies. In 2014, the international Galactosemias Network (GalNet) developed a web-based patient registry for this disease, the GalNet Registry. The aim was to delineate the natural history of classic galactosemia based on a large dataset of patients. METHODS Observational data derived from 15 countries and 32 centers including 509 patients were acquired between December 2014 and July 2018. RESULTS Most affected patients experienced neonatal manifestations (79.8%) and despite following a diet developed brain impairments (85.0%), primary ovarian insufficiency (79.7%) and a diminished bone mineral density (26.5%). Newborn screening, age at onset of dietary treatment, strictness of the galactose-restricted diet, p.Gln188Arg mutation and GALT enzyme activity influenced the clinical picture. Detection by newborn screening and commencement of diet in the first week of life were associated with a more favorable outcome. A homozygous p.Gln188Arg mutation, GALT enzyme activity of ≤ 1% and strict galactose restriction were associated with a less favorable outcome. CONCLUSION This study describes the natural history of classic galactosemia based on the hitherto largest data set