Evaluación de la Estrategia Nacional sobre Drogas 2000-2008: elaboración de una propuesta metodológica

La Estrategia Nacional sobre Drogas 2000-2008 planteaba entre sus objetivos el de ser evaluada. Con este fin se presenta una propuesta metodológica sencilla y basada en los últimos avances metodológicos realizados en materia de evaluación de políticas públicas. La propuesta responde a cuestiones relevantes como quién debe realizar dicha evaluación, a qué preguntas debe responder y cuál es el diseño metodológico más apropiado para llevarla a cabo

Hypertension control: population surveys vs clinical studies

Editorial commentary on Manuscript Number: JHH-14-0356. “Blood pressure levels and control in Italy: comprehensive analysis of clinical data from 2000-2005 and 2005-2010 hypertension surveys”.This work has been partially funded by FIS grant PI13/02321, and Cátedra de la Universidad Autónoma de Madrid de Epidemiología y Control del Riesgo Cardiovascular, Madrid, Spai

Etiquetado frontal Nutri-Score: el aceite de oliva y otros alimentos cuya clasificación se debería mejorar

Se estudia el etiquetado frontal Nutri-Score, la problemática, los beneficios, las diferencias con las guías alimentarias y se plantean posibles mejoras en los sistemas de etiquetado e información.N

Sitting time and mortality in older adults with disability: A national cohort study

The progressive aging of the population has increased the number of older adults with disabilities. Regular physical activity has shown to improve health among these individuals, but the effects of sedentary behavior are mostly unknown. Thus, this study examined the association between sitting time and mortality in older adults with disability. Methods Prospective cohort of 2470 people aged ≥60 years. In 2000–2011, the study participants reported their sitting time and physical activity levels and were subsequently followed up through 2011 to ascertain mortality. Results During an average follow-up of 8.7 years, 982 deaths occurred. Compared with people who spent seated <4 hours/d, the hazard ratio (95% confidence interval) of mortality was 1.27 (1.07–1.51) in those seated during 4–6 hours/d and 1.55 (1.29–1.87) in those seated for >6 hours/d. Each increment of 1 hour/day in sitting time was linked to a 7% increase in mortality. Compared with active individuals who spent seated <4 hours/day, those who were inactive and spent seated >6 hours/d showed the highest mortality (hazard ratio 1.82, 95% confidence interval 1.37–2.42). Conclusions Sitting time is associated with higher mortality in older people with disability. Interventions combining the reduction of sedentary behavior with increased physical activity should be developed and evaluated in this group of populationThis work was supported by FIS grant 12/1166 (Instituto de Salud Carlos IIII and FEDER/FSE), MINECO I+D+i grant DEP2013-47786-R, FP7-HEALTH-2012-Proposal No. 305483-2 (FRAILOMIC Initiative), and by the Catedra UAM de Epidemiología y Control del Riesgo Cardiovascula

Dietary micronutrients intake and plasma fibrinogen levels in the general adult population.

Plasma fibrinogen predicts cardiovascular and nonvascular mortality. However, there is limited population-based evidence on the association between fibrinogen levels and dietary intakes of micronutrients possibly associated with inflammation status. Data were taken from the ENRICA study, conducted with 10,808 individuals representative of the population of Spain aged ≥ 18 years. Nutrient intake (vitamin A, carotenoids, vitamin B6, vitamin C, vitamin D, vitamin E, magnesium, selenium, zinc and iron) was estimated with a validated diet history, and plasma fibrinogen was measured under appropriate quality checks. Statistical analyses were performed with linear regression and adjusted for main confounders. The geometric means of fibrinogen (g/L) across increasing quintiles of nutrient intake were 3.22, 3.22, 3.22, 3.16, and 3.19 (p-trend = 0.030) for vitamin E; 3.23, 3.22, 3.20, 3.19, and 3.19 (p-trend = 0.047) for magnesium; and 3.24, 3.22, 3.19, 3.21, and 3.19 (p-trend = 0.050) for iron. These inverse associations were more marked in participants with abdominal obesity and aged ≥ 60 years, but lost statistical significance after adjustment for other nutrients. Although dietary intakes of vitamin E, magnesium and iron were inversely associated with fibrinogen levels, clinical implications of these findings are uncertain since these results were of very small magnitude and mostly explained by intake levels of other nutrients.This work has been funded by State Secretary of R + D + I and FEDER/FSE FIS grants (F.R.A., grant 16/609 and 19/319; E.L.G., grant 16/1512); and the JPI HDHL-SALAMANDER project (F.R.A., grant APCIN 2016-145). The funders had no role in the design, analysis or writing of this workS

Patterns of alcohol consumption and health-related quality of life in older adults

This is the peer reviewed version of the following article: Drug and Alcohol Dependence 159 (2016): 166-173, which has been published in final form at http://dx.doi.org/10.1016/j.drugalcdep.2015.12.012 Eliminar seleccionadoBackground: Health-related quality of life (HRQOL) is a more powerful predictor of health services use and mortality than many objective measures of health. However, in older adults the association between main alcohol drinking patterns and HRQOL is uncertain. Methods: A prospective cohort with 2163 community-dwelling individuals aged ≥60 years was recruited in Spain in 2008-2010 and followed-up through 2012. At baseline, participants reported alcohol consumption. HRQOL was measured with the SF-12 questionnaire, at baseline and in 2012. Results: In cross-sectional analyses at baseline, compared to non-drinkers, better scores on the physical component summary (PCS) of the SF-12 were reported in moderate (β=1.59 [95% confidence interval 0.61 to 2.58]) and heavy drinkers (β=2.18 [0.57 to 3.79]). Better scores on the PCS were also reported by drinkers who adhered to the Mediterranean drinking pattern (MDP) (β=1.43 [0.30 to 2.56]) as well as those who did not (β=1.89 [0.79 to 2.99]). However, no association was observed between average alcohol consumption or the MDP and the mental component summary (MCS) of the SF-12; or between beverage preference or drinking with meals and either the PCS or MCS scores. In prospective analyses, women who reportedly drank exclusively with meals showed better scores on the PCS than women who drank only outside of meals (β=3.64 [0.79 to 6.50]). Conclusions: The small association between alcohol consumption and better physical HRQOL found at baseline was not apparent after a few years of follow-up. Medical advice on alcohol consumption cannot be grounded on its effects on HRQOLThis work was mainly supported by grant no. 02/2014 from the Plan Nacional sobre Drogas (Ministry of Health of Spain). Additional funding was obtained from FIS grant no. 12/1166 (Instituto de Salud Carlos III, State Secretary of R + D + I and FEDER/FSE), the FRAILOMIC Initiative (FP7-HEALTH-2012-Proposal no. 305483-2) and the ATHLOS project (EU H2020- Project ID: 635316)

Evaluation of food and beverage television advertising during children's viewing time in Spain using the UK nutrient profile model

OBJECTIVE: To evaluate the nutritional quality of products advertised on television (TV) during children’s viewing time in Spain, applying the UK nutrient profile model (UKNPM). DESIGN: We recorded 80 h of four general TV station broadcasts during children’s time in May and June 2008, and identified all advertisements for foods and beverages. Nutritional information was obtained from the product labels or websites and from food composition tables. Each product was classified as healthy (e.g. gazpacho, a vegetable juice) or less healthy (e.g. potato crisp snacks) according to the UKNPM criteria. SETTING: Four free-of-charge TV channels in Spain: two national channels and two regional ones. SUBJECTS: TV commercials of food and beverages. RESULTS: A total of 486 commercials were broadcast for ninety-six different products, with a mean frequency of 5?1 advertisements per product. Some 61?5% of the ninety-six products were less healthy, and the percentage was higher for foods (74?1 %). All (100 %) of the breakfast cereals and 80% of the non-alcoholic drinks and soft drinks were less healthy. Of the total sample of commercials, 59?7% were for less healthy products, a percentage that rose to 71?2% during children’s reinforced protection viewing time. CONCLUSIONS: Over half the commercials were for less healthy products, a proportion that rose to over two-thirds during the hours of special protection for children. This suggests that applying the UKNPM to regulate food advertising during this slot would entail the withdrawal of most food commercials in Spain. TV advertising of products with low nutritional quality should be restricted.S

Compliance with self-regulation of television food and beverage advertising aimed at children in Spain

OBJECTIVE: To evaluate the level of compliance with the PAOS Code (Publicidad, Actividad, Obesidad y Salud), which establishes standards for the self-regulation of food marketing aimed at minors, in television advertising by food and beverage companies that have agreed to abide by the Code. DESIGN: The study sample consisted of food and beverage advertisements targeting children during 80 h of programming by four Spanish television networks. The level of compliance with each standard of the PAOS Code was classified into three categories: 'compliance', 'non-compliance' and 'uncertain compliance'. Overall, an advertisement was considered compliant with the PAOS Code if it met all the standards; non-compliant if it contravened one or more standards; and uncertain in all other cases. RESULTS: Of a total of 203 television advertisements from companies that agreed to the PAOS Code, the overall prevalence of non-compliance was 49.3% (v. 50.8% among those that did not agree to the code), with 20.7% of advertisements considered of uncertain compliance. Non-compliance was more frequent on Saturdays, in longer advertisements, in advertisements containing promotions or dairy products, and for advertisements from companies of French or US origin. CONCLUSIONS: Non-compliance with the PAOS Code was very high and was similar for companies that did and did not agree to the Code, casting doubt on the Code's effectiveness and oversight system. It seems the time has come to commit to statutory regulations that reduce the negative impact of advertising on children's diets, as demanded by public health experts and consumer associations.The authors declare that they have not received any typeof funding for conducting the study and there is noconflict of interest. M.M.R.-F. took part in the design of thestudy, bibliographical research, interpretation of results,editing every part of the manuscript and checking it. Shedid the fieldwork collecting the data and analysed thedata in collaboration with M.A.R.-B., being the first eva-luator. M.A.R.-B. took part in the design of the study,bibliographical research, interpretation of results, editingevery part of the manuscript and checking it. He analysedthe data in collaboration with M.M.R.-F. and he was thesecond evaluator in cases of doubt. F.R.-A. took part inthe design of the study, bibliographical research, inter-pretation of results, manuscript editing and checking it.S

Association of lead and cadmium exposure with frailty in US older adults

This is the prepint version of a work that was accepted for publication in Enviromental Research A definitive version was subsequently published in Enviromental Research 137(2015) DOI: 10.1016/j.envres.2015.01.013BACKGROUND: Environmental lead and cadmium exposure is associated with higher risk of several age-related chronic diseases, including cardiovascular disease, chronic kidney disease and osteoporosis. These diseases may lead to frailty, a geriatric syndrome characterized by diminished physiologic reserve in multiple systems with decreased ability to cope with acute stressors. However, no previous study has evaluated the association between lead or cadmium exposure and frailty. METHODS: Cross-sectional study among individuals aged ≥ 60 years who participated in the third U.S. National Health and Nutrition Examination Survey and had either blood lead (N=5272) or urine cadmium (N=4887) determinations. Frailty was ascertained with a slight modification of the Fried criteria, so that individuals meeting ≥ 3 of 5 pre-defined criteria (exhaustion, low body weight, low physical activity, weakness and slow walking speed), were considered as frail. The association between lead and cadmium with frailty was evaluated using logistic regression with adjustment for relevant confounders. RESULTS: Median (intertertile range) concentrations of blood lead and urine cadmium were 3.9 µg/dl (2.9-4.9) and 0.62 µg/l (0.41-0.91), respectively. The prevalence of frailty was 7.1%. The adjusted odds ratios (95% confidence interval) of frailty comparing the second and third to the lowest tertile of blood lead were, respectively, 1.40 (0.96-2.04) and 1.75 (1.33-2.31). Lead concentrations were also associated with the frequency of exhaustion, weakness and slowness. The corresponding odds ratios (95% confidence interval) for cadmium were, respectively, 0.97 (0.68-1.39) and 1.55 (1.03-2.32), but this association did not hold after excluding participants with reduced glomerular filtration rate: 0.70 (0.43-1.14) and 1.09 (0.56-2.11), respectively. CONCLUSIONS: In the US older adult population, blood lead but not urine cadmium concentrations showed a direct dose-response relationship with frailty. These findings support that lead exposure increases frailty in older adultsThis work has been supported by grants from the Instituto de Salud Carlos III, Ministry of Health of Spain (PI12/1166) and from the European Commission (FRAILOMIC Initiative FP7-HEALTH-2012-Proposal No: 305483-2)