Percepción del personal médico de atención primaria de salud acerca de sus funciones, formación y conocimientos en materia de salud laboral

ObjetivosEvaluar la percepción que el profesional médico de atención primaria de salud (PMAPS) tiene sobre sus funciones en prevención de riesgos laborales (PRL), así como sus conocimientos y habilidades en materia de salud laboral (SL).DiseñoEstudio descriptivo, transversal.EmplazamientoDepartamento de Salud 20 de la provincia de Alicante.ParticipantesTodos los PMAPS (n=104), con una participación del 80% (n=83).Mediciones principalesLos participantes autocumplimentaron un cuestionario específicamente desarrollado para el estudio. Se establecieron 16 cuestiones que abarcaban funciones en PRL y capacitación para desarrollarlas, así como cantidad y utilidad de formación recibidas en materia de SL.ResultadosEl PMAPS no percibe que tenga funciones en materia de PRL (mediana [Me], 2; rango intercuartílico [RI], 1-3). En mayor medida se consideró capacitado para identificar el origen laboral o no de una enfermedad atendida en su consulta (Me, 3; RI, 3-4). La formación en SL durante la licenciatura de medicina junto con la vía MIR se han identificado como las de menor cuantía (el 55,4 y el 60% de los entrevistados puntuaron en el valor 1 del cuestionario). EL PMAPS claramente ha considerado que una mayor formación en SL le ayudaría en su actividad diaria profesional; se obtuvieron puntuaciones de tipo alto (opciones de respuesta mayores o iguales a 4) en más del 70% de los entrevistados.ConclusionesEs necesario que se fomente la formación en SL para que el PMAPS se sienta parte integrante del personal sanitario con funciones en PRL y pueda adquirir los conocimientos y habilidades necesarios en materia de SL para su práctica médica habitual.ObjectivesTo evaluate the perception of primary health care medical staff (PHCMS) have on their functions in occupational risk prevention (ORP), as well as their knowledge and skills on the subject of occupational health (OH).DesignDescriptive cross-sectional study.SettingHealth Department 20 of Alicante province, Spain.ParticipantsAll PHCMS (N=104), with a participation of 80% (N=83).Primary MeasurementsThe participants self-completed a questionnaire specifically developed for the study. Sixteen questions were established and covered functions in ORP and skills for developing them, as well as the amount and usefulness of training received on the subject of OH.ResultsThe PHCMS did not perceive that they had functions as regards ORP (median [Me], 2; interquartile range [IR], 1-3). To a greater extent they considered themselves capable of identifying whether an illness seen in their clinic was of work origin or not (Me, 3; IR, 3-4).Training in OH as a medical student and in their medical internship (MIR) was identified as of minor importance (55.4% and 60%, respectively, of those surveyed scored a value of 1 in the questionnaire). The PHCMS obviously considered that better training in OH would help them in their daily professional activity. High scores were obtained for this (response options greater than or equal to 4) in more than 70% of the interviewees.ConclusionsTraining in OH must be encouraged so that PHCMS are seen to be health personnel with functions in ORP and are able to acquire the necessary knowledge and skills in OH for their routine medical practice

Dietary intake in pregnant women in a Spanish Mediterranean area: as good as it is supposed to be?

Objective To assess food and nutrient intakes and compliance with nutritional recommendations in pregnant women according to selected sociodemographic characteristics. Design Cross-sectional study based on data from the INMA-Valencia cohort (Spain), which recruited pregnant women between 2004 and 2005. Information on maternal sociodemographics and anthropometry was collected. Dietary intake was assessed through an FFQ. Intakes of foods were compared with Spanish food-based dietary guidelines. Intake inadequacy for nutrients was assessed using the Dietary Reference Intakes of the US Institute of Medicine. Setting Valencia, Spain. Subjects We studied 822 pregnant women who had information on dietary intake during their first trimester of pregnancy. Results More than 50 % of pregnant women did not meet the guidelines for cereals and legumes; reported intakes of carbohydrates, n-3 and n-6 fatty acids were below recommendations and exceeded the total fat intake according to dietary references. Dietary inadequacy for folate, Fe and vitamin E ranged from 99 % to 68 %. Vegetable intake was related to age only. Younger and less educated women showed lower intakes of protein and n-3 fatty acids and higher intakes of trans-fatty acids as well as greater inadequacy for micronutrients. Spanish women reported lower intakes of fruit and carbohydrates and higher intakes of protein, total fat, SFA, MUFA and n-3 fatty acids compared with their foreign-born counterparts. Conclusions Women in the studied area have inadequate intakes of several nutrients relevant during pregnancy. Age, education and country of origin are factors significantly related to dietary intake and adequacy

Families of symmetric periodic orbits in the three body problem and the figure eight

Ejemplar dedicado a: Actas de las VI Jornadas de Mecánica CelesteIn this paper we show a technique for the continuation of symmetric periodic orbits in systems with time-reversal symmetries. The geometric idea of this technique allows us to generalize the “cylinder” theorem for this kind of systems. We state the main theoretical result without proof (to be published elsewhere). We focus on the application of this scheme to the three body problem (TBP), taking as starting point the figure eight orbit [3] to find families of symmetric periodic orbits.DGYCIT/ Junta de Andalucía DGES PB98-1152DGYCIT/ Junta de Andalucía BFM-2003-0033

Pro‑vegetarian food patterns and cardiometabolic risk in the PREDIMED‑Plus study: a cross‑sectional baseline analysis

Purpose We explored the cross-sectional association between the adherence to three diferent provegetarian (PVG) food patterns defned as general (gPVG), healthful (hPVG) and unhealthful (uPVG), and the cardiometabolic risk in adults with metabolic syndrome (MetS) of the PREDIMED-Plus randomized intervention study. Methods We performed a cross-sectional analysis of baseline data from 6439 participants of the PREDIMED-Plus rand omized intervention study. The gPVG food pattern was built by positively scoring plant foods (vegetables/fruits/legumes/ grains/potatoes/nuts/olive oil) and negatively scoring, animal foods (meat and meat products/animal fats/eggs/fsh and seafood/dairy products). The hPVG and uPVG were generated from the gPVG by adding four new food groups (tea and cof fee/fruit juices/sugar-sweetened beverages/sweets and desserts), splitting grains and potatoes and scoring them diferently. Multivariable-adjusted robust linear regression using MM-type estimator was used to assess the association between PVG food patterns and the standardized Metabolic Syndrome score (MetS z-score), a composed index that has been previously used to ascertain the cardiometabolic risk, adjusting for potential confounders. Results A higher adherence to the gPVG and hPVG was associated with lower cardiometabolic risk in multivariable models. The regression coefcients for 5th vs. 1st quintile were − 0.16 (95% CI: − 0.33 to 0.01) for gPVG (p trend: 0.015), and − 0.23 (95% CI: − 0.41 to − 0.05) for hPVG (p trend: 0.016). In contrast, a higher adherence to the uPVG was associated with higher cardiometabolic risk, 0.21 (95% CI: 0.04 to 0.38) (p trend: 0.019). Conclusion Higher adherence to gPVG and hPVG food patterns was generally associated with lower cardiovascular risk, whereas higher adherence to uPVG was associated to higher cardiovascular risk

Coffee Consumption and All-Cause, Cardiovascular, and Cancer Mortality in an Adult Mediterranean Population

We assessed the association between usual coffee consumption and all-cause, cardiovascular (CV), and cancer mortality in an adult population in Spain, taking into account both the amount and type of coffee consumed. We used baseline data on coffee consumption and other personal variables, and the number of deaths during an 18-year follow-up period, for 1567 participants aged 20 years and older from the Valencia Nutrition Study in Spain. Total, caffeinated, and decaffeinated coffee consumption was assessed using a validated food frequency questionnaire. Cox regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). During the 18-year follow-up period, 317 died; 115 due to CV disease and 82 due to cancer. Compared with no-consumption, the consumption of 1 cup per day and >1 cup per day of coffee was associated with a lower risk of all-cause mortality, HR = 0.73 (95% CI: 0.56–0.97) and HR 0.56 (95% CI: 0.41–0.77), respectively. A lower cancer mortality was observed among drinkers of more than 1 cup per day compared with nondrinkers, HR 0.41 (95% CI 0.20–0.86). Regarding the type of coffee, only the overall consumption of caffeinated coffee was associated with lower all-cause mortality at 12 and 18 years of follow-up, HR = 0.66 (95% CI:0.46–0.94) and HR = 0.59 (95% CI: 0.44–0.79), respectively. In conclusion, this study suggests that the moderate consumption of coffee, particularly caffeinated coffee (range 1–6.5 cups per day), is associated with a lower all-cause and cancer mortality after a long follow-up period. No significant association was found between coffee consumption and CVD mortality

Pro-vegetarian food patterns and cardiometabolic risk in the PREDIMED-Plus study: a cross-sectional baseline analysis

Purpose We explored the cross-sectional association between the adherence to three different provegetarian (PVG) food patterns defined as general (gPVG), healthful (hPVG) and unhealthful (uPVG), and the cardiometabolic risk in adults with metabolic syndrome (MetS) of the PREDIMED-Plus randomized intervention study. Methods We performed a cross-sectional analysis of baseline data from 6439 participants of the PREDIMED-Plus randomized intervention study. The gPVG food pattern was built by positively scoring plant foods (vegetables/fruits/legumes/grains/potatoes/nuts/olive oil) and negatively scoring, animal foods (meat and meat products/animal fats/eggs/fish and seafood/dairy products). The hPVG and uPVG were generated from the gPVG by adding four new food groups (tea and coffee/fruit juices/sugar-sweetened beverages/sweets and desserts), splitting grains and potatoes and scoring them differently. Multivariable-adjusted robust linear regression using MM-type estimator was used to assess the association between PVG food patterns and the standardized Metabolic Syndrome score (MetS z-score), a composed index that has been previously used to ascertain the cardiometabolic risk, adjusting for potential confounders. Results A higher adherence to the gPVG and hPVG was associated with lower cardiometabolic risk in multivariable models. The regression coefficients for 5th vs. 1st quintile were − 0.16 (95% CI: − 0.33 to 0.01) for gPVG (p trend: 0.015), and − 0.23 (95% CI: − 0.41 to − 0.05) for hPVG (p trend: 0.016). In contrast, a higher adherence to the uPVG was associated with higher cardiometabolic risk, 0.21 (95% CI: 0.04 to 0.38) (p trend: 0.019). Conclusion Higher adherence to gPVG and hPVG food patterns was generally associated with lower cardiovascular risk, whereas higher adherence to uPVG was associated to higher cardiovascular risk

Adherence to Pro-Vegetarian Food Patterns and Risk of Oesophagus, Stomach, and Pancreas Cancers: A Multi Case–Control Study (The PANESOES Study)

We aimed to evaluate the association between three previously defined pro-vegetarian (PVG) food patterns and the cancers of the oesophagus, stomach, and pancreas in a multi case-control study. We analyzed data from a multi-case hospital-based study carried out in two Mediterranean provinces in Spain. A total of 1233 participants were included in the analyses: 778 incident cancer cases, histologically confirmed (199 oesophagus, 414 stomach, and 165 pancreas) and 455 controls. A dietary assessment was performed using a validated food frequency questionnaire (FFQ). Three PVG food patterns (general, healthful, and unhealthful) were estimated using 12 food groups for the general PVG (gPVG), scoring positive plant-based foods and negative animal-based foods, and 18 food groups, for the healthful (hPVG) and unhealthful (uPVG) food patterns. Multinomial logistic regression was used to estimate relative risk ratios (RRR) and confidence intervals (95% CI) for quintiles of adherence to PVG patterns and as a continuous variable. The RRR (95% CI) for the highest vs. the lowest quintile of gPVG were, RRR = 0.37 (0.32, 0.42) for the oesophagus, RRR = 0.34 (0.27, 0.43) for the stomach, and RRR = 0.43 (0.35, 0.52) for pancreas cancer. For the hPVG, the RRR were RRR = 0.72 (0.58, 0.90) for the oesophagus, RRR = 0.42 (0.34, 0.52) for the stomach, and RRR = 0.74 (0.59, 0.92) for pancreas cancer. The uPVG was associated with a higher risk of stomach cancer RRR = 1.76 (1.42, 2.18). Higher adherence to gPVG and hPVG food patterns is associated with a lower risk of oesophageal, stomach, and pancreas cancers, while a higher adherence to a uPVG food pattern is associated with a higher risk of stomach cancer.Funding: This work was supported by the Spanish Ministry of Health (FIS 91/0435, RCESP C03/09), the Generalitat Valenciana (EVES 030/2005, CTGCA/2002/06, G03/136), CIBERESP

Reproducibility and validity of a food frequency questionnaire designed to assess diet in children aged 4-5 years

Background The food frequency questionnaire (FFQ) is the most efficient and cost-effective method to investigate the relationship between usual diet and disease in epidemiologic studies. Although FFQs have been validated in many adult populations worldwide, the number of valid FFQ in preschool children is very scarce. The aim of this study was to evaluate the reproducibility and validity of a semi-quantitative FFQ designed for children aged 4 to 5 years. Materials and methods In this study, we have included 169 children aged 4–5 years from the INMA project in Valencia, a population-based prospective cohort study of mothers and children in Spain. The 105- items FFQ was administered twice to the parents or care-givers of children over a 9-month period. Reproducibility was explored by comparing intake of nutrients by the FFQs, while validity was examined by comparing the nutrient values from the FFQs with the average nutrient values of three 24 hour dietary recall (24hDR) taken in the period, and also, with the concentration in blood specimens for several vitamins (carotenoids, folate, vitamin B12, vitamin C and α-tocopherol). Pearson correlation coefficients and de-attenuated correlation coefficients were calculated and we also evaluated misclassification by quintile distribution. Results All correlation coefficients for reproducibility for nutrients and major food groups were statistically significant; the average correlation coefficients for daily intake were 0.43 for food groups and 0.41 for nutrients. The average correlation coefficients for validity for daily intakes against 24hDR was r = 0.30, and the average for de-attenuated correlation coefficients was r = 0.44. When evaluating validity against the blood concentration of vitamins, statistically significant correlations were observed for vitamin C (0.35), lycopene (0.31), β-Cryptoxantin (0.40), and vitamin E (0.29); the average of correlation coefficients was r = 0.21. Conclusion Despite some low to moderate correlations for reproducibility and validity, overall this study suggests that the FFQ may be a good method for assessing a wide range of food groups and nutrients intake in children aged 4–5 years.This work was supported by Instituto Salud Carlos III (Red INMA G03/176 CB06/02/ 0041), Ministerio Sanidad y Fondos FEDER (FIS 03/1615; 04/1509; 04/1436; 05/1079; 06/1213; 06/ 0867; 07/0314; 11/01007), Conselleria Sanitat, Generalitat Valenciana (ACOMP/2010/115; 084/ 2010)

Identification of a Novel Variant in EARS2 Associated with a Severe Clinical Phenotype Expands the Clinical Spectrum of LTBL

The EARS2 nuclear gene encodes mitochondrial glutamyl-tRNA synthetase, a member of the class I family of aminoacyl-tRNA synthetases (aaRSs) that plays a crucial role in mitochondrial protein biosynthesis by catalyzing the charging of glutamate to mitochondrial tRNA(Glu). Pathogenic EARS2 variants have been associated with a rare mitochondrial disorder known as leukoencephalopathy with thalamus and brainstem involvement and high lactate (LTBL). The targeted sequencing of 150 nuclear genes encoding respiratory chain complex subunits and proteins implicated in the oxidative phosphorylation (OXPHOS) function was performed. The oxygen consumption rate (OCR), and the extracellular acidification rate (ECAR), were measured. The enzymatic activities of Complexes I-V were analyzed spectrophotometrically. We describe a patient carrying two heterozygous EARS2 variants, c.376C>T (p.Gln126*) and c.670G>A (p.Gly224Ser), with infantile-onset disease and a severe clinical presentation. We demonstrate a clear defect in mitochondrial function in the patient’s fibroblasts, suggesting the molecular mechanism underlying the pathogenicity of these EARS2 variants. Experimental validation using patient-derived fibroblasts allowed an accurate characterization of the disease-causing variants, and by comparing our patient’s clinical presentation with that of previously reported cases, new clinical and radiological features of LTBL were identified, expanding the clinical spectrum of this diseaseThis study was supported with a competitive PhD grant from a pre-Doctoral scholarship for research groups of the Health Research Institute of Santiago (IDIS)S

Reproducibility and validity of a food frequency questionnaire among pregnant women in a Mediterranean area

Background: Studies exploring the role of diet during pregnancy are still scarce, in part due to the complexity of measuring diet and to the lack of valid instruments. The aim of this study was to examine the reproducibility and validity (against biochemical biomarkers) of a semi-quantitative food frequency questionnaire (FFQ) in pregnant women. Methods: Participants were 740 pregnant women from a population-based birth cohort study in Valencia (INMA Study). We compared nutrient and food intakes from FFQs estimated for two periods of pregnancy (reproducibility), and compared energy-adjusted intake of several carotenoids, folate, vitamin B12, vitamin C and α-tocopherol of the FFQ in the first trimester with their concentration in blood specimens (validity). Results: Significant correlations for reproducibility were found for major food groups and nutrients but not for lycopene (r=0.06); the average correlation coefficients for daily intake were 0.51 for food groups and 0.61 for nutrients. For validity, statistically significant correlations were observed for vitamin C (0.18), α-carotene (0.32), β-carotene (0.22), lutein-zeaxantin (0.29) and β-cryptoxantin(0.26); non-significant correlations were observed for retinol, lycopene, α-tocopherol, vitamin B12 and folate (r≤0.12). When dietary supplement use was considered, correlations were substantially improved for folate (0.53) and to a lesser extent for vitamin B12 (0.12) and vitamin C (0.20). Conclusion: This study supports that the FFQ has a good reproducibility for nutrient and food intake, and can provide a valid estimate of several important nutrients during pregnanc