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Objective. Pregabalin group (PGB) is an antiepileptic used to treat neuropathic pain. We evaluated analgesic efficacy and safety for postoperative/ chronic pain, disability, and sleep quality in patients who underwent spine surgery administered with PGB, or not, during the presurgical and postsurgical periods. Design. Retrospective cohort study of 60 patients (two groups with 30 patients) with full information on 50 (29 with PGB and 21 without PGB). Ten patients were dismissed as information was lacking. The PGB group (P) (29 patients) received 75 mg/12 hours before surgery, 150 mg 10 hours after surgery, and 150 mg/12 hours 3 days after surgery. The control group (C; 21 patients) took no PGB. Methods. Neuropathic pain was assessed before surgery, and 2 and 6 months later using visual analog scales (VAS), DN4, disability (Oswestry), and sleep quality. No serious adverse events occurred with PGB. Results. The median VAS pain score at rest was lower in the PGB group at 2 months postsurgery (1 vs 2, P=0.032), as was the median DN4 score (0 vs 3, P=0.032) and the median Oswestry disability index (ODI: 12 vs 18, P=0.001). At 6 months postsurgery, pain scores were also lower in the PGB group for VAS (0 vs 4, P=0.001), DN4 score (0 vs 4, P=0.001) and the ODI (10 vs 24, P=0.001). Improvement in the functionality and sleep quality of the PGB group was noteworthy (P=0.018). Conclusions. PGB has analgesic/antihyperalgesic effects on postoperative neuropathic pain after surgery for lumbar disc hernia. Our findings show that this benefit increases with time. [ABSTRACT FROM AUTHOR]

Background: The role of immunization with bacillus Calmette-Guérin (BCG) in the prevalence of asthma, hay fever and atopic dermatitis is not definitely established and seems to be influenced by ethnic background. The aim of this study was to analyze the relationship between this immunization and the prevalence of those diseases in a homogeneous population of Spanish schoolchildren. Methods: The International Study of Asthma and Allergies in Childhood (ISAAC) core and environmental questionnaires were used in four different centers of the Spanish North Atlantic coast. Bilbao, San Sebastián and Asturias have a universal BCG immunization policy during the first days of life, whereas La Coruña discontinued this practice in 1989. Except for this center, immunization coverage was above 90%. A random sample of schools of Asturias or all schools in the city district (rest of centers) with children 6 and 7 years old was surveyed. Results: The participation rate was above 70%. After excluding those children born outside Spain, the numbers were 6,762 immunized and 2,828 nonimmunized. After adjusting for gender, age, smoking habits of the father and mother, truck traffic near the household, older and younger siblings and having a cat or a dog during the first year of the child’s life, the adjusted ORs of the BCG-immunized children suffering from asthma, hay fever and atopic dermatitis were respectively 0.87 (95% CI 0.76–1.00), 0.87 (0.75–1.01) and 0.89 (0.76–1.05). Conclusions: BCG immunization offers a weak but significant protection against asthma and hay fever in Spanish schoolchildren. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the possible impact of the COVID-19 pandemic on prevalence rates and self-reported changes in patterns of alcohol use among first-year university students in Spain, considering the risk of problematic alcohol use. A serial cross-sectional study based on the uniHcos project was carried out. Data from 10 518 first-year university students (73.3% female, mean age 19 (SD = 1.6)) collected between 2012 and 2022 were analysed. The evolution of the pooled prevalence rates during the time series was analysed and the risk of problematic alcohol consumption was assessed using the AUDIT. Also, self-reported changes in alcohol use patterns during the pandemic were assessed. According to the results, during the COVID-19 pandemic, the prevalence of alcohol use in the past 30-days was reduced (76.3% in 2019 vs. 63.7% in COVID-19) increasing again in the New Normal period. Thus, a similar pattern in the practice of binge drinking was observed. Regarding the AUDIT score, 21.7% (95%CI 20.9, 22.6) of the students had harmful alcohol consumption, with a higher proportion among males. In the multivariable logistic models, a higher AUDIT score was significantly associated (p-value < 0.001) with being male and living with roommates. According to self-reported changes in consumption patterns during the COVID-19 pandemic, a higher proportion of participants with harmful use reported an increase in alcohol consumption compared to those at low-risk (43% vs 19%). Finally, despite the overall reduction in drinking prevalence during COVID-19, changes were not equal for all students and depended on their previous level of problematic drinking, highlighting that this should be considered in the development of strategies against alcohol use in this population., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

The aims of this research were to evaluate the current nutritional status, dietary intake, and level of physical activity and assess the need for intervention. This was a cross-sectional study with 2724 participating children aged 6-9 years old. Nutritional status was assessed using nutrimetry, dietary intake with a 3-day food-recall questionnaire and physical activity with an ad hoc questionnaire. The nutricode with the highest prevalence was healthy weight/normal stature, with 51.3% of the sample. For the BMI for age Z-score, those in the overweight/obesity category represented 37.5% of the sample, while the thinness category included 7.6%. Intake of calories, proteins, sugar, lipids, SFA, MUFA, and cholesterol were significantly higher than recommended. The thinness groups consumed a significantly higher amount of excess calories while the overweight/obesity groups had the lowest mean excess calorie intake. Children in the thinness category presented the highest rates at both ends of the spectrum for sedentary activities. This study showed the high prevalence of malnutrition in schoolchildren. The results for the risk of thinness and overweight/obesity according to individual nutrient intake should be carefully interpreted. Lifestyle is a fundamental aspect to consider when combating malnutrition, especially at the level of dietary and physical activity habits, to combine various methods of intervention to improve nutritional status.

The objective of this cross-sectional study was to explore sleep patterns and the potential relationship between sleep and tryptophan intake among Spanish university students. A total of 11,485 students self-reported their sleep and dietary patterns and habits. Tryptophan intake was calculated using a food intake matrix and results were presented as quartiles of total intake. Short sleep duration prevalence was 51.0%, with males exhibiting a significantly higher frequency. A total of 55.0% of participants presented inadequate sleep efficiency, with males again presenting a higher rate. Median tryptophan intake was 692.16 ± 246.61 mg/day, 731.84 ± 246.86 mg/day in males and 677.24 ± 244.87 mg/day in females ( p = 0.001). Dietary tryptophan intake below the first quartile (<526.43 mg/day) was associated with a higher risk of short sleep duration in males (1.26; 95%CI: 1.02-1.55) and females (1.19; 95%CI: 1.05-1.34) and with the Athens Insomnia Scale insomnia in males (2.56; 95%CI: 1.36-4.82) and females (1.47; 95%CI: 1.10-2.05). Regarding academic specializations, females in the humanities field showed a higher risk of Athens Insomnia Scale insomnia due to low tryptophan intake (Q1: 3.15; 95% CI: 1.04-9.55 and Q2: 3.41; 95%CI: 1.01-11.5). In summary, lower tryptophan consumption appears to be associated with poorer sleep quality in Spanish university students; however, other social factors affecting students may also influence sleep quality. These findings have important implications for nutritional recommendations aimed at enhancing tryptophan intake to improve sleep quality.

Objective: Hypertension and smoking during pregnancy have been linked to various adverse maternal and fetal outcomes. The objective of this work is to study how the smoking influences the development of hypertension, its effects on the pregnant woman, and on the newborn., Materials and Methods: An observational study in two phases was carried out: the descriptive first phase allows characterization of the sample and the analytical second phase is a case-control nested in a retrospective cohort corresponding to pregnancy., Results: A total of 712 women were included in the study. Of the 672 (94.4%) non-hypertensive women, 533 (79.3%) were non-smoking and 139 (20.7%) smoking. For the 40 (5.6%) hypertensive women, 30 (75.0%) were non-smoking and 10 (25.0%) smoking. The prevalence of hypertension was of 5.6%. Women who quit smoking before pregnancy saw a reduced risk of hypertension. For women who smoke during pregnancy, those of younger ages, with a normal body mass index, who are primiparous, employed and with a low-medium level of education have higher risk of hypertension. The risk of hypertension according to the level of physical activity during leisure time follows a "U" shape, with those who perform light physical activity at the lowest risk of hypertension. Hypertensive women have a higher risk of small for gestational age newborns. Smoking does not pose an additional risk for adverse outcomes once hypertension is diagnosed., Conclusions: Future studies should aim to determine the role of smoking habit in the appearance of hypertension in pregnancy in order to establish adequate intervention guidelines that may aid in reducing the prevalence of hypertension., (Copyright © 2023 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

The therapeutic approach of bladder cancer strongly determines its prognosis. We describe the treatments and outcomes for a Spanish cohort of patients with bladder cancer for the first 12 months after diagnosis and identify the factors that influenced the decision to undergo the treatment received. We conducted a multicenter, prospective, cohort study including primary bladder cancer patients during the first 12 months after diagnosis. The clinical outcomes were performance status (ECOG), adverse events and any cause of mortality. We stratified the analysis by factors that might influence the treatments received. We conducted univariate and multivariable logistic regression models to assess which patient and tumor characteristics were associated with receiving adjuvant treatment in the subgroup of noninvasive bladder cancer patients. In total, 314 patients were included (85% men; 53.8% >70 years) in 7 tertiary Spanish hospitals; 82.2% had a noninvasive urothelial bladder cancer (NMIBC). Patients received mostly surgery plus adjuvant therapy (67.7%). BCG (32.8% patients) was the most frequently administered adjuvant therapy, followed by intravesical chemotherapy (17.8% patients) and radiotherapy (10.8%). The variability of administered treatments among hospitals was low. Patients with NMIBC were more likely to receive adjuvant therapy if they had a higher educational level, some comorbidities and a high-grade tumor. The number of fully active patients (ECOG 0) significantly decreased during the first year of follow-up from 58% to 36 % (OR: 2.41, 95%CI 1.82-3.20); at 12-month follow-up 10.8% patients had died from any cause. In conclusion, most of the patients had a NMIBC. Surgery alone or plus adjuvant therapy were the commonest curative options of bladder cancer. BCG therapy was the adjuvant therapy most frequently administered. Higher educational level, presence of comorbidities and a high-grade tumor were associated with adjuvant therapy. Patient performance status was worsening over time. Almost 1 of 10 patients died during the first year of follow-up., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract: The therapeutic approach is crucial to prostate cancer prognosis. We describe treatments and outcomes for a Spanish cohort of patients with prostate cancer during the first 12 months after diagnosis and identify the factors that influenced the treatment they received.This multicenter prospective cohort study included patients with prostate cancer followed up for 12 months after diagnosis. Treatment was stratified by factors such as hospital, age group (<70 and ≥70 years), and D'Amico cancer risk classification. The outcomes were Eastern Cooperative Oncology Group (ECOG) performance status, adverse events (AEs), and mortality. The patient characteristics associated with the different treatment modalities were analyzed using multivariate logistic regression.We included 470 men from 7 Spanish tertiary hospitals (mean (standard deviation) age 67.8 (7.6) years), 373 (79.4%) of which received treatment (alone or in combination) as follows: surgery (n = 163; 34.7%); radiotherapy (RT) (n = 149; 31.7%); and hormone therapy (HT) (n = 142; 30.2%). The remaining patients (n = 97) were allocated to no treatment, that is, watchful waiting (14.0%) or active surveillance (5.7%). HT was the most frequently administered treatment during follow-up and RT plus HT was the most common therapeutic combination. Surgery was more frequent in patients aged <70, with lower histologic tumor grades, Gleason scores <7, and lower prostate-specific antigen levels; while RT was more frequent in patients aged ≥70 with histologic tumor grade 4, and higher ECOG scores. HT was more frequent in patients aged ≥70, with histologic tumor grades 3 to 4, Gleason score ≥8, ECOG ≥1, and higher prostate-specific antigen levels. The number of fully active patients (ECOG score 0) decreased significantly during follow-up, from 75.3% at diagnosis to 65.1% at 12 months (P < .001); 230 (48.9%) patients had at least 1 AE, and 12 (2.6%) patients died.Surgery or RT were the main curative options. A fifth of the patients received no treatment. Palliative HT was more frequently administered to older patients with higher tumor grades and higher Gleason scores. Close to half of the patients experienced an AE related to their treatment., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: Discrimination during vital moments, such as the university period, can generate a high impact on people's behavior and health. The aim of this study was to analyze the possible association of discrimination with perceived health and with different risk behaviors, as well as to describe gender differences in Spanish university students. Discrimination during vital moments, such as college, can have a high impact on people's behavior and health., Methods: A cross-sectional study was carried out with data from first-year university students from 11 Spanish universities (n=9,862). Discrimination, perceived health, alcohol consumption, smoking, consumption of illegal substances, leisure time connected to the Internet, risky sexual relations, family function, risk of mental health problems and risk of eating disorders were assessed. Prevalences with their 95% confidence intervals were obtained and for quantitative variables the mean and standard deviation were calculated. Odds ratios with 95% confidence intervals were calculated to determine the relationship between discrimination and the other variables., Results: An association was found between discrimination and fair or poor perceived health (OR: 1.7; p=0.0001), consumption of illegal substances (OR: 1.3; p=0.002), problematic internet use (OR: 1.3; p=0.004), family dysfunction (OR: 1.8; p=0.0001), risk of mental health problems (OR: 1.9; p=0.0001) and eating disorders (OR: 1.5; p=0.0001). Regarding gender differences, higher prevalence of discrimination was observed in men with health status perceived as fair or worse (OR: 2.2; p=0.0001), family dysfunction (OR: 1.8; p=0.0001), risk of mental health problems (OR: 2.2; p=0.0001) and eating disorders (OR: 1.9; p=0.002). Women, apart from the previous variables, presented association of discrimination with consumption of illegal substances (OR: 1.3; p=0.005) and problematic internet use (OR: 1.4; p=0.002)., Conclusions: The study findings underline that there is an association between discrimination and risk behaviors among Spanish university students. In turn, discrimination was associated with poor or fair perceived health, this relationship being similar in both men and women., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Pulses such as peas, beans or lentils are one of the most complete foods at the nutritional level; however, they are one of the most often neglected foods in the diets of university students. Entrance to university translates into a major lifestyle change for many young people, and the habits acquired or cemented at this time will remain into adulthood. The objective of this study is to analyse the association between personal/sociodemographic factors, dietary intake of other food groups and the consumption of pulses in first-year university students. This cross-sectional study is part of the UniHcos project, a multicentre study of multipurpose prospective cohorts in eleven Spanish universities. Data from 9862 university students were collected through an online self-questionnaire completed by all students who met the selection criteria and agreed to participate in the project during the 2011-2018 academic years. Of students, 75·8 % presented an inadequate (≤2 times/week) consumption of pulses. Living outside the family home in either a student residence (OR 0·76; 95 % CI 0·69, 0·84) or rental (OR 0·81; 95 % CI 0·70, 0·95) decreased the compliance with recommendations on the consumption of pulses. Low consumption of pulses is seemingly not restricted to a specific profile or dietary pattern among university students, and no specific focus group for intervention can be identified. Policies promoting the consumption of pulses among the university population as a whole are necessary to increase compliance rates with the dietary recommendations.

The set of measures to contain the diffusion of COVID-19 instituted by the European governments gave an unparalleled opportunity to improve our understanding of the transport and industrial sectors' contribution to urban air pollution. The purpose of this study was to assess the impacts of the lockdown measures on air quality and pollutant emissions in Valencia, Spain. For this reason, we determined if there was a significant difference in the concentration levels of different particulate matter (PM) sizes, PM 10 , PM 2.5 , and NO x , NO 2 , NO, and O 3, between the period of restrictions in 2020 and the same period in 2019. Our findings indicated that PM pollutant levels during the lockdown period were significantly different from the same period of the previous year, even if there is variability in the different local areas. The highest variations reduction in the PM 10 and PM 2.5 levels were observed for the València Centre, València Avd Francia, and València Pista de Silla (all of the urban traffic type) in which there was a reduction of 58%-42%, 56%-53%, and 60%-41% respectively. Moreover, consistent with recent studies, we observed a significant reduction in nitric oxide levels in all the air monitoring stations. In all seven monitoring stations, it was observed, in 2020, NO x , NO 2 , and NO concentrations decreased by 48.5%-49.8%-46.2%, 62.1%-67.4%-45.7%, 37.4%-35.7%-35.3%, 60.7%-67.7%-47.1%, 65.5%-65.8%-63.5%, 60.0%-64.5%-41.3%, and 60.4%-61.6%-52.5%, respectively. Lastly, overall O 3 levels decreased during the lockdown period, although this phenomenon was more closely related to weather conditions. Overall, no significant differences were observed between the meteorological conditions in 2019 and 2020. Our findings suggest that further studies on the effect of human activities on air quality are needed and encourage the adoption of a holistic approach to improve urban air quality.

Breast cancer is the most common tumor among women, representing the second cause of cancer deaths in women. Treatment with chemotherapy negatively interferes with nutritional status. The intake of vitamins before, during and after treatment in a pilot cohort of women with non-invasive breast cancer (type I, II) treated at the Valencian Institute of Oncology (IVO) is evaluated. A 3-day anthropometric and nutritional assessment was performed using the DIAL program. Nutritional intake is compared with the values of Estimated Average Requirements (EAR) and Dietary Reference Intake (DRI) provided by the United States Department of Agriculture (USDA) and the European Food Safety Authority (EFSA). There is an overall decrease in vitamin intake during treatment which worsens at the end of said treatment. The decrease is significant in the case of vitamins B 2 ( p = 0.006), B 3 ( p = 0.042), B 5 ( p = 0.001), and B 8 ( p = 0.021). The relative risk during and after treatment increases with respect to the reference timeframe, before treatment. Deficit risks are statistically significant in the case of vitamins B 5 ( p = 0.001), B 8 ( p = 0.001) and B 12 ( p = 0.001). Decreased vitamin intake during treatment suggests a negative change in the patients' dietary behaviors during this time. Nutritional intervention and support may be beneficial to optimize overall dietary intake and maintain compliance with EAR and DRI for patients during a time in which adequate nutrition is important.

Objective: The purpose of this study is to investigate the role of cervical radiography in the study of patients with vertigo and dizziness., Patients: This is a retrospective single-institution case series study of 493 patients suffering from vertigo and dizziness who were referred (from January 2011 to December 2012) to the hospital to study those symptoms., Methods: We studied cervical radiographies, CT and MRI of the cervical spine made in the sample and the radiological findings. We analyzed demographic characteristics, presence of psychiatric pathology and emergency assistance due to vertigo in patients who have undergone cervical study., Results: A total of 57% of patients had cervical radiography made; this was more frequent in women, Spanish people, with psychiatric pathology and who have gone to the emergency department for vertigo (p < 0.05). Degenerative changes were found in 74.1% of the patients with radiography made, more frequently at an older age, osteophytes in 49.5% and abnormal cervical lordosis in 37.1%., Conclusions: There are sociodemographic factors that influence in the request for cervical radiographs in patients with vertigo and dizziness. Given the suspicion of cervical vertigo, we do not consider that the findings in the radiographs help in the diagnosis. In our opinion, an excessive use of cervical radiography is made in patients with vertigo and dizziness.

Introduction: In Spain, one third of all children and two-thirds of adults suffer from excess weight, a condition that generates a direct excess medical cost of 2000 million Euros. Obesogenic food environments cause obesity by promoting the consumption of sugar-sweetened beverages and ultra-processed foods. Accordingly, we propose five priority policies capable of reversing the epidemic of obesity and related non-communicable diseases through the creation of healthy food environments., The Power (poder in Spanish) of Food Policies: Advertising (Publicidad): regulation of unhealthy food and drink advertisements carried by all media and targeted at children, and prohibition of sponsorships of congresses, conferences or sports events and endorsements by scientific associations or health professionals. Supply (Oferta): promotion of a 100% healthy supply of goods on sale in vending machines sited at educational, health and sports centres. Demand (Demanda): levying a tax of at least 20% on sugar-sweetened beverages, accompanied by subsidies or reduced taxes on healthy foods and availability of drinking water free of charge at all public venues and areas. Labelling (Etiquetado): effective application of the Nutri-Score through the use of incentives, regulation and public-tender mechanisms. Reformulation (Reformulación): revising and redrawing reformulation agreements with the industry, setting more ambitious goals and mandatory compliance., A Final Thought: These five proposed interventions, all of which have been successfully applied in other countries, will serve to raise population awareness and have a positive impact on health and the economy, through reducing the health care costs of obesity and enhancing work productivity. These measures should form part of a wide-ranging transformation of the food system, with agri-food policies that foster the sustainable production of healthy foods., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

The level of meat consumption is one of the main deviations from the Mediterranean diet pattern in Spanish university students. The objective of this cross-sectional descriptive study is to analyze the association between sociodemographic factors and the consumption of fresh and processed meat in Spanish university students. This study is part of a cohort of 11 Spanish universities with 9862 university students (UniHcos Project). A descriptive analysis and a chi2 test were carried out to assess differences between personal and sociodemographic variables and meat consumption, and binary logistic regression analysis to assess factors associated with consumption; 19.9% and 73.5% met the recommendations for meat-fresh and meat-processed consumption, respectively. Only 3.8% of students meet the recommendations for both fresh and processed meat. Statistically significant differences were found between sex, BMI, employment, housing, and coexistence regarding compliance with recommendations. Female employed students living in rental accommodations with a partner are more likely to meet the recommendations for fresh meats while male, normal weight, employed students living in rental accommodations with a partner are more likely to meet the recommendations for processed meats. There is a lack of compliance with the recommendations for consumption of fresh meat in Spanish university students, differences in compliance among students of differing regions and an association with sex, employment, housing, and coexistence regarding compliance., Competing Interests: The authors declare no conflict of interest.

Aims: the aim of this study was to examine the possible association between the type of hospital admission and subsequent survival of the patient, as well as the pathological features recorded in a large population of patients with colorectal cancer., Methods: the study included 1,079 patients diagnosed with colon or rectal cancer in the Hospital Costa del Sol (Marbella, Spain). The relationship between patient survival rate and type of first admission to the hospital (elective or emergency admission) was assessed. The following variables were studied: age, gender, tumor location, pathological stage, differentiation grade, chemotherapy before surgery and survival., Results: colon tumors are more common in patients admitted to hospital for the first time via the emergency service (63.7%) and the tumors tend to be poorly differentiated (64.2%) and metastatic (70%). These patients also present a more aggressive disease and a poorer prognosis than patients with an elective admission. With regard to patients from the Emergency Department, a Cox regression analysis showed a risk-ratio (RR) of 1.36 (confidence interval [CI] 95%: 1.11-1.66) for disease-free survival and of 1.41 (95% CI: 1.14-1.76) for overall survival., Conclusions: hospital admission via the Emergency Department is an indicator of aggressiveness and poorer prognosis compared to patients who enter via programmed routes.

Mental disorders are consistently and closely related to psychological distress. At the start of the university period, the relationship between a student's psychological distress, family support, and employment status is not well-known. The aims of this study were: To determine the prevalence of psychological distress in first-year university students and to analyze its relationship with family support and the student's employment status. Data from 4166 first-year university students from nine universities across Spain were considered. The prevalence of psychological distress was obtained using the GHQ-12, a valid and reliable screening tool to detect poor mental health. To analyze the relationship between psychological distress, family support, and employment status, logistic regression models were fitted. Regarding the prevalence found, 46.9% of men and 54.2% of women had psychological distress. In both genders, psychological distress levels increased as family support decreased. Among women, psychological distress was associated with their employment status. The prevalence of psychological distress among first-year university students in Spain is high. In addition, family support, and employment status for women, could be factors to take into account when developing psychological distress prevention strategies at the beginning of the university period.

Introduction: Introduction: recent studies warn of changes in dietary habits and an increase in overweight children as possible risk factors for early hypertension. Objectives: to know the prevalence of normotension, rehypertension and hypertension in the children studied, and to evaluate its possible association with diet and anthropometric indicators. Methods: a cross-sectional study was carried out within the Project "Anthropometry and Child Nutrition of Valencia" (ANIVA), where diet, blood pressure, and anthropometry were evaluated in 652 children between six and nine years old. The World Health Organization (WHO) criteria to identify normotensive, prehypertensive and hypertensive were applied. Results: there is a higher prevalence of normotensive (83.9%, p < 0.05). The prevalence of prehypertensive and hypertensive patients is 8.1% and 8.0%, respectively. Boys have higher levels of hypertension (8.4%), while girls have a higher prevalence of prehypertension (9.3%). In boys, significantly higher values are identified for the weight, height and hip circumference. Girls present significantly higher percentage of fat mass, bicipital fold, suprailiac fold, and heart rate. Significant correlations were found between the anthropometric indicators and blood pressure by sex, highlighting the waist circumference-blood pressure correlation in boys. Significant differences are observed between the nutrients ingested in the diet and blood pressure. Conclusions: a prevalence of hypertension of 8% in children aged 6-9 years of the province of Valencia is identified. The blood pressure values increase according to the body mass index, percentage of fat mass, waist circumference and the set of folds. A dietary pattern associated with hypertension in children is identified.

The analysis of perfluoroalkyl substances (PFASs) and organophosphate flame retardants (PFRs) in the different environmental compartments of a characteristic coastal wetland, the Albufera Natural Park (Valencia, Spain), is required for understanding the transport, accumulation and fate of these pollutants in an area under high anthropogenic pressure. Samples included 13 wastewater treatment plant influents, 13 effluents, 12 surface water, 19 sediment samples and 10 fish individuals from the Albufera Natural Park and the surrounding area. Tris(2-chloroisopropyl) phosphate (TCIPP) and perfluorooctane sulfonate (PFOS) were at the highest concentrations in water, 330.2 ng L -1 and 47.8 ng L -1 , respectively. In fish and sediment PFOS was also the most detected while perfluorooctanoic acid (PFOA) was in all types of water. Higher levels of target compounds (mainly PFASs) in wastewater effluents compared to influent suggested both, formation from precursors during treatment and poor removal efficiency. Mean levels of PFOS in water and fish were higher than the environmental quality standards (EQS) established by the European Union Directive 2013/39/EU. The influence of the metropolitan area of Valencia and its surrounding industrial belt could explain the significantly higher levels reported in the northern part (influenced by the Turia River)., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Iodine deficiency is one of the most important health problems in the world. It intervenes in the synthesis of thyroid hormones, which carry out important functions, so that a deficit of this mineral causes alterations of different kinds such as those related to growth. The objective of the present study was to know the prevalence of iodine deficit in the diet of Valencian children from 6 to 8 years old and their relationship with anthropometry. The analysis of the dietary intake was carried out through questionnaires. Thirteen schools participated in the study. The sample studied consists of 661 school children belonging to the Valencian Community, between 6 and 8 years of age: 298 boys and 363 girls. 79.12% of the children did not meet recommended daily iodine intakes. When comparing the groups of girls and boys with an inadequate intake, in general, girls show worse nutritional adequacy. When comparing the groups of girls and boys with sufficient iodine intake, no statistically significant differences were observed. No immediate effects of iodine deficiency on children's anthropometry were observed. Intake of dairy products, fish and iodized salt is recommended, since they can contribute to the diet the iodine required to avoid a deficiency.

Objective: To assess the daily intake of polychlorinated biphenyls not similar to dioxins (NDL-PCB) derived from fish consumption in Spain and compare it with tolerance limits in order to establish a safe threshold so that the nutritional benefits derived from fish consumption may be optimized., Design: Analysis of NDL-PCB in fish samples and ecological study of the estimated intake of NDL-PCB from fish consumption in different Spanish population groups., Subjects: National representative sample of the Spanish population., Results: The intake of NDL-PCB was estimated in two different scenarios: upper bound (UB) and lower bound (LB). Estimating intake using the average concentration of NDL-PCB found in the fish samples, the intake for 'other children' is estimated as: 1·80 (UB) and 5·33 (LB) ng/kg per d at the 50th percentile (P50); 7·39 (UB) and 21·94 (LB) ng/kg per d at the 95th percentile (P95) of fish consumption. Estimated NDL-PCB intake shoots up in the toddler group, reaching values of 30·43 (UB) and 90·37 (LB) ng/kg per d at P95. Estimated intake values are lower than those previously estimated in Europe, something expected since in previous studies intake was estimated through total diet. In adults, our estimated values are 1·59 (UB) and 4·72 (LB) ng/kg per d at P50; 4·95 (UB) and 14·72 (LB) ng/kg per d at P95., Conclusions: NDL-PCB concentration in fish is under the tolerance limits in most samples. However, daily intake in consumers of large quantities of fish should be monitored and special attention should be given to the youngest age groups due to their special vulnerability and higher exposure.

The Mediterranean diet (MD) is a dietary pattern with important benefits. The objectives of this study were to assess the adherence to the MD among pregnant women in Valencia (Spain) and characterize the pregnant women according to their level of adherence. Finally, we aimed to examine the role of MD adherence during pregnancy in the anthropometric development of the newborn. The study included 492 pregnant women who were followed at La Fe Hospital in 2017. The self-administered "Kidmed" questionnaire for data collection on dietary information evaluation was used and a clinical history review of mothers and newborns was performed. Two groups of mothers were identified: those with low adherence (LA) and optimal adherence (OA). The study revealed that 40.2% of the women showed LA to the MD. The newborns born to these women presented a higher risk of being small for gestational age (SGA) {adjusted odds ratio (aOR) = 1.68; 95% confidence interval (CI) 1.02⁻5.46} when adjusting for parental body mass index (BMI) and multiple gestation, but not when adjusting for all significant possible confounders (aOR = 2.32; 95% CI 0.69⁻7.78). The association between MD and SGA was not significantly affected by the use of iron and folic acid supplements (aOR = 2.65; 95% CI 0.66⁻10.65). The profile of the pregnant woman with LA is that of a young smoker, with a low level of education and a low daily intake of dairy products. These results suggest that LA to the MD is not associated with a higher risk of giving birth to a SGA newborn.

Influenza vaccination may limit the impact of influenza in the community. The aim of this study was to assess the effectiveness of influenza vaccination in preventing hospitalisation in individuals aged ≥ 65 years in Spain. A multicentre case-control study was conducted in 20 Spanish hospitals during 2013/14 and 2014/15. Patients aged ≥ 65 years who were hospitalised with laboratory-confirmed influenza were matched with controls according to sex, age and date of hospitalisation. Adjusted vaccine effectiveness (VE) was calculated by multivariate conditional logistic regression. A total of 728 cases and 1,826 matched controls were included in the study. Overall VE was 36% (95% confidence interval (CI): 22-47). VE was 51% (95% CI: 15-71) in patients without high-risk medical conditions and 30% (95% CI: 14-44) in patients with them. VE was 39% (95% CI: 20-53) in patients aged 65-79 years and 34% (95% CI: 11-51) in patients aged ≥ 80 years, and was greater against the influenza A(H1N1)pdm09 subtype than the A(H3N2) subtype. Influenza vaccination was effective in preventing hospitalisations of elderly individuals., (This article is copyright of The Authors, 2017.)

This case-control study investigated nutrient intake, healthy eating index with 10 items on foods and nutrients, on 3-day food diaries and anthropometric measurements in 105 children with autism spectrum disorder and 495 typically developing children (6-9 years) in Valencia (Spain). Children with autism spectrum disorder were at a higher risk for underweight, eating more legumes, vegetables, fiber, and some micronutrients (traditional Mediterranean diet) but fewer dairy and cereal products, and less iodine, sodium, and calcium than their typically developing peers. Differences existed in total energy intake but healthy eating index and food variety score differences were not significant. Autism spectrum disorder group failed to meet dietary recommendations for thiamin, riboflavin, vitamin C, or calcium. Risk of inadequate intake of fiber, vitamin E, and sodium was lower in children with autism spectrum disorder than typically developing children. Results suggest that (1) risk of inadequate intake of some micronutrients in children with autism spectrum disorder and (2) cultural patterns and environment may influence food intake and anthropometric characteristics in autism spectrum disorder. Primary care should include anthropometric and nutritional surveillance in this population to identify intervention on a case-by-case basis. Future research should explore dietary patterns and anthropometric characteristics in different autism spectrum disorder populations in other countries, enhancing our understanding of the disorder's impact.

The occurrence of 8 drugs of abuse and metabolites in the influent and effluent of the 3 Wastewater Treatment Plants (WWTP) that treat wastewater from Valencia was studied in 2011, 2012 and 2013. Target drugs except 6-monoacetylmorphine (6-ACMOR) were detected in 100% of the influents. The WWTPs eliminate cocaine (COC), amphetamine (AMP), methamphetamine (MAMP) and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH). Benzoylecgonine (BECG) was also efficiently eliminated (93-98%), whereas 3,4-methylenedioxymethamphetamine (MDMA) presented removal rates of 32-57% and ketamine (KET) was not eliminated. The most consumed illicit drugs, according to the estimated concentrations of each compound in the studied WWTPs, were cannabis and COC followed by KET, AMP, MAMP, MDMA and heroin. Environmental risk assessment was evaluated by calculating Risk Quotient (RQ). MDMA and KET could pose a medium risk and low risk, respectively, to the aquatic organisms. Although short-term environmental risk is not worrisome, long-term effects cannot be known exactly., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The aim of this study was to investigate the main characteristics of non-vaccinated pregnant women who were hospitalised for influenza A (H1N1) pdm09 pandemic versus pregnant women hospitalised for non-influenza-related reasons in Spain, and to characterise the clinical presentation of the disease in this population to facilitate early diagnosis and future action programmes. Understanding influenza infection during pregnancy is important as pregnant women are a high-risk population for increased morbidity from influenza infection. We investigated the socio-demographic and clinical features of 51 non-vaccinated, pregnant women infected with the pandemic influenza A (H1N1) virus in Spain (cases) and compared them to 114 controls (non-vaccinated and non-infected pregnant women) aged 15-44 years. Substantial and significant odd ratios (ORs) for pandemic influenza A (H1N1) were found for the pregnant women who were obese compared with controls (body mass index > 30) (OR 3.03; 95% confidence intervals 1.13-8.11). The more prevalent symptoms observed in pandemic influenza-infected pregnant women were high temperature, cough (82.4%), malaise (80.5%), myalgia (56.1%), and headaches (54.9%). Our results suggest that the initial symptoms and risk factors for infection of pregnant women with the influenza A (H1N1) pdm09 virus are similar to the symptoms and risk factors for seasonal influenza, which make early diagnosis difficult, and reinforces the need to identify and protect high-risk groups.

Non-melanoma skin cancer (NMSC) is the most frequent malignancy in organ transplant recipients. The aetiology of NMSC after transplant is multifactorial. The aim of this study was to determine the clinical and environmental factors involved in the development of NMSC in a Spanish kidney transplant population from the Mediterranean region. A total of 289 patients who had received a kidney transplant during the period January 1996 to December 2010 were included in the study. Both prospective and retrospective data were used. All patients underwent a structured interview and a complete examination of the skin. After a median follow-up of 72 months (range 12-180 months), 73 of the 289 patients (25.2%) developed 162 tumours. The ratio of basal cell carcinoma to squamous cell carcinoma was 2.21:1. The cumulative incidence of NMSC increased with the duration of immunosuppression, from 20.78% at 5 years, to 37.35% at 10 years to 53.08% at 15 years after transplantation. Age at the time of transplant, phototype and occupational sun exposure were associated with a higher risk of NMSC. NMSC is a significant clinical problem in kidney transplant recipients. This has implications for the development of prevention and surveillance strategies. Clinical and environmental factors may be used to identify those patients who are at risk for NMSC.

Sweet syndrome is the most characteristic of the neutrophilic dermatoses. We performed a retrospective study of patients with Sweet syndrome seen in our department between 2001 and 2009, inclusive; the aims were to define the patient profile and to evaluate the clinical and epidemiological differences between subgroups. There were 24 patients (13 women and 11 men). The age distribution was similar in both sexes and showed 2 peaks, one in the fourth decade and the other in the eighth decade. The etiology was predominantly infectious or inflammatory, followed by the idiopathic form. There were 4 cases of paraneoplastic disease, 2 of which involved solid-organ tumors. One case was associated with the administration of infliximab. Symptoms persisted longer in cases that were idiopathic or that developed in the context of neoplastic disease., (Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.)

With aging of the populations, the oral health and hygiene of elderly people has become an important public health issue. In this cross-sectional study we investigated the prevalence of tooth decay and other periodontal diseases in a representative cohort of 480 non-institutionalized adults ≥65 years from the province of Valencia, Spain. Using a World Health Organization standard for an adult oral survey methodology, we obtained data on remnant teeth with the decayed, missing and filled teeth (DMFT) index, a Community Periodontal Index of Treatment Needs (CPTIN), attachment loss, and temporo-mandibular articulation (TMA) status. The prevalence of these conditions were compared by age and gender, using the Chi-square, and Student's t-, and ANOVA statistical tests. The mean number of remaining teeth were 17.1 in the total sample, which was higher for women (17.9 versus 15.7 in men; p=0.04). This mean number decreased as age increased (p<0.05). The overall DMFT index was 19%, showing a persistent increase with age from 14% (65-69-year) to 23% (≥80-year) (p=0.118). Only 6% of participants had no periodontal pathology, while 26% had bleeding gums and 57% had calculus, while attachment loss was observed in 31%. TMA malfunction with a click was present in 6%, was painful in 5%, and was associated with reduced mouth-opening in 2%. The prevalence of oral health pathologies was high among these elderly people, who would benefit from optimal oral health care., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Objective: This study aimed to determine the prevalence of the use of medicines, particularly over-the-counter medicines (OTC medicines), and to analyse its association with different personal and lifestyle aspects., Setting: The study sample was an adolescent population in the Valencian Community (East Spain) aged 14-17 years., Method: A total of 23,349 adolescents from 229 schools completed a questionnaire (response rate 89.54%). We analysed adolescents who were taking prescribed medicines at the time of the questionnaire, and who were users of OTC medicines that had not been prescribed by a doctor for a particular illness. We estimated this association with several personal and lifestyle factors using simple and multivariate analyses and logistic regression., Results: A total of 15.18% of the participants reported that they were taking prescribed medicines when they answered the questionnaire, and 45.38% of the participants reported a frequent use of OTC medicines. Prescribed medicine use is more likely in older adolescents [Relative Prevalence Ratio adjusted by confounding factors (RPRa) 1.05, 95% CI:1.01-1.10], in those who had tried to lose weight by dieting in the last year (RPRa 1.23, 95% CI: 1.11-1.37), in current smokers (RPRa 1.13, 95% CI: 1.02-1.27), in those who had a serious emotional problem (RPRa 1.85, 95% CI:1.60-2.16) and in people who presented a chronic pathology (RPRa 8.24, 95% CI: 7.45-9.11). Respondents who reported a frequent use of OTC medicines were more likely to be older (RPRa 1.03, 95% CI: 1.00-1.06), have tried to lose weight by dieting in the last year (RPRa 1.15, 95% CI:1.06-1.24), be a current smoker (RPRa 1.19, 95% CI:1.10-1.28), have a serious emotional problem (RPRa 1.48,95% CI: 1.31-1.67), and watch TV (RPRa 1.24, 95% CI:1.16-1.32)., Conclusions: We noted an extensive use of medicines, especially OTC medicines, in adolescents, and an association with some personal and lifestyle factors. We conclude that prevention and early education of a responsible use of medicines should be a public health priority.

Objective: The objective of the study was to analyze the relationship between air pollutants and the prevalence of recent symptoms of asthma, allergic rhinitis, and atopic eczema in schoolchildren aged between 6 and 7 years., Patients and Methods: The prevalence of recent (previous 12 months) symptoms of allergic diseases was obtained by means of the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), Spain, with the participation of 7 centers (Asturias, Barcelona, Bilbao, Cartagena, La Coruña, Madrid, and Valencia) and 20 455 schoolchildren aged between 6 and 7 years, from 2002 to 2003. The pollutant detection systems of the aforementioned centers provided the mean annual concentrations of sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and total suspended particulate matter., Results: The annual average concentration of SO2 showed a significant association with a higher prevalence of recent severe asthma (adjusted odds ratio [aOR] between level-1 and level-3 pollution, 1.32; 95% confidence interval [CI], 1.01-1.73), rhinitis (aOR, 1.56; 95% CI, 1.39-1.75), and rhinoconjunctivitis (aOR, 1.70; 95% CI, 1.45-2.00). The annual average concentration of CO was associated with a higher prevalence of rhinitis (aOR, 1.65; 95% CI, 1.34-2.04), rhinoconjunctivitis (aOR, 1.76; 95% CI, 1.31-2.37), and eczema (aOR, 1.55; 95% CI, 1.17-2.04). The annual average concentration for NO2 and total suspended particulate matter showed inverse associations with the prevalence of nocturnal dry cough., Conclusions: Findings suggest that air pollutants such as SO2 and CO increase the risk of recent symptoms of asthma and allergic rhinitis in schoolchildren aged between 6 and 7 years in Spain.

There is a predominance of small and dense LDL cholesterol particles in familial combined hyperlipidemia (FCH). The lipoprotein lipase gene could exert an influence in these circumstances.To study the relationship of pattern B LDL and lipids with N291S polymorphism of lipoprotein lipase (LPL) in FCH patients.Lipid profile, apolipoproteins, diameter of LDL and N291S polymorphism were determined in 93 patients with FCH and 286 individuals from the general population.FCH patients with N291S polymorphism showed a lower mean diameter of LDL. FCH patients with pattern B LDL showed higher concentrations of triglycerides, VLDLc, non-HDLc and apo B100 and lower levels of HDLc than those with pattern A. Of FCH patients with polymorphism 87.5% presented pattern B and 12.5% pattern A, while patients without polymorphism presented pattern A in 69.2% cases and pattern B in 30.8% cases, with differences being statistically significant (p < 0.004). The prevalence of this mutation in our FCH patients was 9.7%.The prevalence of N291S mutation in our FCH patients was similar to the 9.3% described in Dutch FCHL patients but clearly higher than the 2-5% described for other Caucasian populations. No polymorphism was found in our general population sample. FCH patients with phenotype B of LDL possessed an atherogenic lipid profile. The relationship between small and dense LDL and the presence of the N291S mutation may identify patients with high cardiovascular risk.

Few studies have focused on the long-term influence of the climate on the prevalence of asthma. The aim of this study is to establish the influence of geo-climatic conditions on the prevalence of asthma symptoms both in adolescents and schoolchildren, and to discover if this influence is associated with their time trends. Eight centres in Spain performed both ISAAC phases I (1994) and III (2002) in children 13-14 years old. Six of them also surveyed children 6-7 years old. For each age group and phase, about 3,000 children were surveyed per centre. This study examines the prevalence of current wheeze and severe current wheeze in two different geo-climatic zones, coast and plateau, considering their relative humidity and temperature range. In both age groups, the mean asthma prevalence on the coast, for phase I and III, was significantly higher than on the plateau. Living on the plateau was an independent protective factor for current wheeze and severe current wheeze for the two age groups. Within the coastal centres, the increase of the annual relative humidity was a statistical significant risk factor for current wheeze, the same trend existing for current severe wheeze. These effects were independent of the sex and of the phase of the study. The prevalence of asthma and severe asthma symptoms is more frequent on the coast of Spain as compared to the inner plateau. This finding was repeated both in 1994 and in 2002.

Background and Aims: Atopic eczema (AE) is the most frequent inflammatory skin disease in childhood in the western world. Several studies have reported a significant increase of prevalence in recent decades and the environmental factors implicated in its aetiology, including environmental tobacco smoke. This study aims to investigate the possible association of AE prevalence in Spanish schoolchildren aged 6-7 and 13-14 years in relation to their parents' smoking habits., Methods: We conducted a cross-sectional population-based study with 6-7 year-old (n = 27805) and 13-14 year-old (n = 31235) schoolchildren from 10 Spanish centres. AE prevalence was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and the Spanish Academy of Dermatology criteria, used in Spain to diagnose AE., Results: An association was found in school-children aged 6-7 (adjusted for gender, presence of asthma, presence of rhinitis, siblings and mother's level of education) between AE being clinically diagnosed with the mother's smoking habit (RPRa 1.40, 1.10-1.78) and there being more than 2 smokers at home (RPRa 1.34, 1.01-1.78). Regarding the presence of itchy rash, an association was observed with fathers who smoke (RPRa 1.40, 1.13-1.72). Among the 13-14 year-olds, no association was observed in relation to either clinically diagnosed AE or the appearance of itchy rash with parents' smoking habit., Conclusions: Our results indicate the risk for children of being exposed to environmental tobacco smoke in terms of AE, especially when they are younger.

Background: The association between asthma and obesity in children, and the effect modification of allergy on this association have not been fully established. Aims The objective of the study was to know the effect modification of the severity of asthma and of the coexistence of rhinoconjunctivitis (RC) in the relationship between obesity and asthma., Methods: A cross-sectional study of 17 145 schoolchildren 6-7 years old from eight Spanish cities who had completed information on height and weight of the ISAAC phase III questionnaire, which also included questions about asthma and RC symptoms and on various risk factors. Body mass index (BMI) was used to define obesity according to international standards. Two different logistic regressions, using current occasional asthma (COA) and current severe asthma (CSA) as dependent variables, were made stratifying for gender and for the coexistence of RC and controlling for age, older and younger siblings, exercise, mother's education, truck traffic, cat/dog during the first year of life and smoking father or mother., Results: Obesity was a risk factor of CSA without RC, both for boys (1.92, CI 95% 1.13-3.25) and for girls (2.99, CI 95% 1.68-5.32). Every BMI unit increment increased by 6.7% the risk of CSA without RC in boys and by 12.4% in girls. Obesity was not a risk factor for CSA with RC. The association between COA and obesity was weaker and the coexistence of RC did not modify it greatly., Conclusions: Obese schoolchildren are more at risk of suffering from non-allergic asthma than the non-obese subjects.

Objective: To analyze geographic variations in the prevalence of symptoms related to asthma in Spanish children and adolescents., Population and Methods: In 2001 and 2002, the Spanish arm of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase 3 collected information on 28 445 children in the age bracket of 6-7 years in 10 metropolitan areas (A Coruña, Asturias, Barcelona, Bilbao, Cartagena, Castellón, Madrid, Pamplona, San Sebastián, and Valencia) and on 31 257 adolescents in the bracket 13-14 years in 11 areas (the previously named areas plus Valladolid). An asthma symptom questionnaire was filled in by parents or the adolescents themselves. Differences in symptoms between geographic areas were analyzed by fitting a logistic regression model. The relationship between symptoms and age was analyzed by linear correlation., Results: The prevalence of recent wheezing (last 12 months) ranged from 7.1% to 12.9% among 6-7-year-olds and from 7.1% to 15.3% among the 13-14-year-olds. The greatest risk of recent wheezing was observed for children in A Coruña (odds ratio [OR] =1.96 in comparison with the area of lowest prevalence; 95% confidence interval [CI], 1.65-2.33) and Bilbao (OR=1.83; 95% CI, 1.54-2.18) and for adolescents in A Coruña (OR=2.38; 95% CI, 2.04-2.79) and Asturias (OR=2.37; 95% CI, 2.03-2.77). A strong correlation (r=0.72) was observed between the prevalence of recent wheezing and age in each of the geographic areas., Conclusions: Considerable geographic variation in the prevalence of asthma symptoms can be seen in Spain even among young children. Symptoms are more frequent in children and adolescents who live on the Spain s northern Atlantic coast.

Background: Obesity and overweight have been described as factors associated with asthma. Our aim was to evaluate the role obesity plays on asthma in children. SCOPE AND SUBJECTs: A study carried out on children and teenagers between 8 and 15 years of age, chosen for a cluster-type random sampling from children who studied in 80 schools, which represents 30% of the schools in the city of Valencia., Material and Methods: The analysed data was organized into two groups, obese (from the Body Mass Index (Kg/m2)), showing children with a percentile over 85% of the measuring reference for the Spanish population) and non obese, when they did not fulfil this condition. The prevalence of the different parameters studied was calculated by an Interval of Confidence of 95%. The risk was calculated (Relative Risk) from those symptoms compatible with asthma among obese children compared to non obese children., Results: No significant relative risk (RR) was seen for obesity with regards to asthma in those percentiles of obesity over 85. Otherwise, an increase in the relative risk (RR) regarding the severity of asthma was seen in relation to obesity, mainly in the 85th percentile (RR = 1.51 of suffering between 4-12 wheezing attacks and RR = 1.86 of suffering more than 12 attacks in obese children as opposed to non obese children)., Conclusions: In this study, we did not identify a higher risk of asthma among obese children than among non obese children, although we did find there was a higher risk of severity of asthmatic symptoms. As far as the severity of the asthma is concerned, we saw a higher risk of wheezing and whistling attacks among obese children with the 85th and the 95th percentiles according to the Body Mass Index.

Background: Phase III of the International Study of Asthma and other Allergies in Childhood (ISAAC) was carried out in schoolchildren aged 6-7 years from eight areas of Spain to estimate time trends and geographic variations in the prevalence of symptoms of allergic rhinitis (AR)., Material and Method: A standard and validated questionnaire was used following ISAAC methodology and was completed by the schoolchildren's parents. The prevalence of symptoms of AR in Phase I (1993-1994) and Phase III (2001-2002) was compared. Eight centers participated: Asturias, Barcelona, Bilbao, Cartagena, Castellón, Madrid, Pamplona and Valencia. Poisson regression was used in the analysis., Results: A total of 25,113 schoolchildren were studied with a median participation of 81.7 %. In all centers, AR symptoms tended to increase, with a prevalence ratio of rhinoconjunctivitis in the previous year of 1.61 (95 % confidence interval: 1.48-1.76) when both phases, adjusted by gender, center, and seasonal variation, were compared. The prevalence of AR symptoms was higher in boys than in girls. Wide variations in the prevalence of AR were observed across centers with a higher prevalence in Asturias, Madrid, Cartagena and Bilbao. Lower prevalences were reported in Barcelona, Castellón and Pamplona., Conclusions: There seems to have been a general increase in AR symptoms. Substantial variations between centers suggested that there may be local differences in risk factors. Intense research will be required for satisfactory preventive actions.

Background and Objective: Our goal was to estimate the time trends in the prevalence of symptoms of allergic rhinitis (AR) and its geographic variations., Population and Method: During 2001-2002, the phase 3 of ISAAC study was carried out, and a comparison with the phase 1 (1993-1994) was done. This cross sectional study included 30,046 schoolchildren 13-14 years-old from 9 centers (Asturias, Barcelona, Bilbao, Cartagena, Castellon, Madrid, Pamplona, Valencia, and Valladolid). A questionnaire about rhinitis symptoms self-administered to schoolchildren was used at schools and institutes with a participation rate of 100% to 75.8%., Results: A divergent time trend of AR prevalence symptoms was observed with a decrease in Barcelona and Bilbao, a stabilization in Cartagena, Pamplona, and Valencia, and an increase in Castellon; Madrid and Valladolid; however, there was an overall increase in nasal allergy. The prevalence of rhinoconjunctivitis in the past year (Prevalence Ratio [PR] = 1,13; 95% Confidence Interval [CI], 1.07-1.19) and nasal allergy ever (PR = 1.22; 95% CI, 1.15-1.30) increased after adjusting for gender, center and season change. The prevalence of rhinoconjunctivitis and nasal allergy varied according to centres, Madrid, Asturias, Cartagena and Bilbao exhibiting the higher prevalence. Taken as a whole, these data indicate a middle prevalence of AR when compared with other countries following an ISAAC methodology., Conclusions: Two patterns of time trend of prevalence of symptoms of AR were observed. The investigation of risk factors at local level could be important in order to undertake preventive measures.

Objective: To define the clinical characteristics of patients with non-Hodgkin lymphoma (NHL) in general and by histological subtypes based on the REAL classification., Patients and Methods: From a total of 210 case histories of patients with NHL, 188 presenting a complete pathology report were selected. The latter was either based on the REAL classification or was converted to it by an expert. The clinical features of the patients at the time of diagnosis were also recorded., Results: Significant differences were observed in the distribution by sex among mantle cell lymphomas, with a predominance among males (p = 0.005). The youngest patients were diagnosed of Burkitt lymphoma and B lymphoblastic lymphoma. Patient status improved significantly (p = 0.0001), with a predominance of ECOG 0, and the stage of the patients studied was 74.1% (stage III/IV) versus 25.9% (stage I/II)., Conclusions: The different characteristics of patients with NHL suggest the need for a single classification with diagnosis by histological subtype.

Background: The ISAAC phase I results have supplied valuable information on the prevalence of asthma and allergy in childhood throughout the world., Objectives: To describe the implementation and participation rate of normal children in each test performed in phase II of the ISAAC in the four Spanish cities participating the study, and to establish the influence of type of school and geographical situation (in a polluted or unpolluted area) in Cartagena., Methods: The ISAAC phase II included a questionnaire on symptoms, risk factors and treatment, skin examination, skin-prick test, bronchial challenge test, total and specific IgE measurement, as well as mite and bacterial endotoxin determination in house dust. The questionnaire was distributed with a letter requesting authorization from the parents in primary schools (fourth and fifth grades) in sufficient number to achieve approximately 1,000 skin prick-test authorizations in each city., Results: The participation rate for the questionnaire, skin examination, skin-prick test, blood extraction, bronchial challenge test, and dust collection was, respectively, for each city: Cartagena: 58.9, 49.2, 43.2, 33.1, 39.9 and 29.8 %; Almería: 42.5, 40.6, 39.1, 39.1 and 37.6 %; Valencia: 43.7, 30.4, 23.5, 21.5, 20.1 and 17.1 %; Madrid: 53.2, 40.8, 38.6, 27.6, 30.6 and 21.1 %. In Cartagena, participation was significantly higher in private schools receiving a state subsidy and in those in unpolluted areas., Conclusions: The participation rate was highly variable and lower than that among the European centres that have already completed the study. The rate was significantly influenced by geographical area and type of school.

Background: The goal of this study was to know the prevalence of malnutrition in an institutionalized elderly population according to age and sex., Patients and Method: We studied 615 institutionalized patients, with a mean age (SD) of 79.33 (9.07) years. Anthropometric parameters included weight, height, knee-heel length, tricipital and subescapular skin folds, arm perimeter and fat mass. Biochemical parameters included: total cholesterol, triglycerides, albumin, prealbumin, transferrin,retinol-binding protein, C3 and lymphocyte count. Malnutrition prevalence was 26.87% (CI 95%, 23.15-30.86), 29.08% (CI 95%, 22.82-35.97) in men and 25.59% (CI 95%, 25.01-30.61) in women. Anthropometric parameters were found to be decreased in all malnourished patients. Significant decreases in albumin and retinol-binding protein concentrations were observed in some age groups of malnourished patients. We also found a decrease in the total cholesterol level in parallel to an age increase in both sexes, regardless of the nutritional status. Triglyceride levels were significantly decreased in both males and females with malnutrition., Conclusions: We detected a high prevalence of malnutrition, yet lower than reported in other studies with similar age groups.

Objectives: Given the great importance given at present to determining anthropometric measurements as an indicator of child health, and its general use in primary care, this study aimed to find how reliable the measurements by four nurses at a health centre were. The measurements' internal concordance, and thus the weight of the observer on the values found, was studied., Design: Analytical study of validation of infants' anthropometric measurements., Setting: Urban Health Centre, Valencia., Participants: 37 children, selected at random by a draw from those attending the programme for overseeing child development., Measurements and Results: Four nurses, using the methods of measurement normally followed at the Virgen de la Fuensanta Health Centre, consecutively determined weight, height and cephalic perimeter of the children. The analyses of variance of the anthropometric measurements for the observer showed no statistically significant differences. The calculation of the greatest discrepancy between observers regarding the mean of the values displayed no quantitatively important discrepancies, either., Conclusions: High consistency was found in the concordance of the somatometric measurements, as far as technique goes. This means that trained staff can find good indicators of child development and health, even when the staff taking the measurements alternate.

Background: A study is made of the pharmaco-epidemiology of antacid (ATC class A02A) and antiulcer (A02B) drug prescriptions during the year 1992., Methods: Prescription data were extracted from 1941 case histories of patients over 15 years old from four health care centers in the Valencian Community (Spain). Dosage and treatment duration were evaluated, along with the way in which morbidity, self-evaluated health, the demographic pattern and life-style characteristics influence drug prescription., Results: The proportion of drug prescriptions increased with age in both sexes (p < 0.01). Drug use depended mainly on chronic diseases. In prescribing antacids, the most influential diagnosis was gastritis (ICD 534, OR: 157), followed by duodenal ulcer (ICD 532, OR: 152) and gastric ulcer (ICD 531, OR: 122), other gastrointestinal disorders (ICD 66, OR: 54) and undefined diagnoses (OR: 15). In the prescription of antiulcer drugs, the most influential diagnoses were gastric and duodenal ulcer (OR: 380 and 342, respectively), and a significant relation was observed with the diagnosis of osteomuscular diseases (OR: 6). Lifestyle and demographic pattern were of marginal importance. The estimated duration of treatment was 85 days. No significant differences were observed in either treatment duration or administered doses of almagate, ranitidine and omeprazole with respect to sex, age or diagnosis., Conclusions: Prolonged treatment is common for acid suppression. The widespread use of peptic ulcer drugs is mostly due to excessive prescription for non-ulcer dyspepsia. At the same time, many patients consume these drugs on a long-term basis in the absence of a clear diagnosis. This observation supports the need for appropriate diagnostic and prescription protocols to secure increased economical savings and management results.

Various modifiable toxic risk factors for cancer of the larynx were evaluated in our geographic area in a retrospective epidemiological study of a sample of 373 patients diagnosed as cancer of the larynx chosen randomly at the La Fe Hospital of Valencia Spain over a 5-year period. A "z" test of the contrast of proportions of the laryngeal cancer series studied and the results of a National Health Survey showed significant differences between the two study populations (p < 0.05). Compared with the National Health Survey, smoking had an odds ratio (OR) of 72.21 (33.10 < OR < 166.31) (p < 0.05, Mantel-Haenszel test). The association between smoking and cancer of the larynx increased with the dose. Alcohol consumption had an OR: 1.52 (1.09 < OR < 2.11) (p < 0.05, Mantel-Haenszel test). Smoking carried a risk of 71.21 and had an etiological fraction of 98.61% (IC 95%: 65.17-100%), thus representing 98.61% of all etiological factors. Control of smoking could have prevented 65.17-100% of cases of cancer of the larynx (243 cases in our series). Alcohol consumption had a risk of 0.52 and etiological fraction of 34.21% (IC 95%: 2.38-100%). Control of alcohol use could have prevented cancer of the larynx in 2.38-100% of cases (9 cases in our series).

A descriptive study was made of the health indicators in 5 rural municipalities of the province of Castellón (Spain), with a total of 1428 inhabitants. This population is characterized by its aging, 36.9% of all individuals being older than 65 years. A retrospective evaluation was made of the annual mortality rates between 1940 and 1990, and of morbidity and medications consumption for the period between June 1991 and May 1992. An increase in general mortality was observed during the study period, though the rates also diminished in relation to age groups, sex and cause of death. In addition, 59.45% of the study population made use of health-care services in the course of one year, an average of 2.59 drugs being prescribed per inhabitant in that same period. Morbidity in decreasing order of importance was attributed to acute respiratory disease, osteomuscular disorders, hypertension, depression and gastric pathology. Medications for the common cold and coughing were the most frequently used drugs, along with pain-killers, cardioactive agents, psycholeptics and non-sterioidal anti-inflammatory drugs (NSAIDs). Aging causes the mortality variations recorded, despite the socio-sanitary improvements observed in the zone during the study period. Aging may also be related to the important use of healthcare services and of drugs noted in the study. The highest morbidity rates and drug consumption levels corresponded to chronic diseases that deteriorate patient quality of life without actually increasing mortality.