Search

Background/objectives: Food deserts are areas characterized by limited access to affordable and healthy food, often due to significant distances from supermarkets-exceeding 1.6 km in urban areas and 16 km in rural settings. These spatial limitations exacerbate health and socioeconomic disparities. This study aimed to assess diet quality and explore the barriers influencing dietary behaviors among individuals aged 60 and older residing in food deserts in Aragón, Spain., Methods: An exploratory qualitative study using a phenomenological approach was conducted, complemented by descriptive analyses of sociodemographic data and adherence to the Mediterranean diet, assessed through the PREDIMED questionnaire. Data were collected through in-depth interviews and a focus group with residents of food deserts., Results: Half of the participants showed high adherence to the Mediterranean diet, while the other half had moderate adherence. Despite the lack of access to supermarkets and higher food costs, many participants perceived their diet quality positively. Challenges, such as long distances to stores, limited public transport, and economic constraints, were mitigated through strategies like home gardening, hunting, and traditional cooking, which often reduced reliance on processed foods. However, participants also reported increased alcohol consumption as a means of socializing., Conclusions: Diet quality in Aragón's food deserts reflects a balance between significant access barriers and community-driven resources. While participants leveraged local strategies to maintain diet quality, systemic issues remain. Public policies should focus on improving transportation, enhancing local food systems, and fostering community-based initiatives to reduce inequalities in food access and promote healthier dietary habits in rural areas.

Purpose: Mental health is a global public health challenge, with mental disorders being a major cause of morbidity. Particularly, taxi drivers face unique challenges related to long working hours, economic instability, and hazardous working conditions. To summarise the existing scientific literature on mental disorders in taxi drivers and identify associated variables., Methods: PubMed, Scopus and Web of Science databases were examined from inception to April 2024 following the PRISMA guidelines. Two authors independently selected original studies. We included observational studies published in English or Spanish or Portuguese, which assessed the mental health of taxi drivers. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Heart, Lung, and Blood Institute (NHBLI) was used to assess the quality of the articles., Results: From an initial pool of 618 studies, eleven met the inclusion criteria and were included in the present systematic review. The findings indicate a considerable prevalence of mental health issues among taxi drivers in comparison to the general population. The prevalence of depression ranged from 14.3 to 60.5% and were driven by a number of factors, including perceived mental strain, lack of respect from operators, a stressful personal life, insufficient sleep, poor working conditions, work-family conflict and low work engagement. Anxiety was reported by 24.1-47% of drivers, with a lack of sufficient sleep being identified as a primary contributing factor. The prevalence of stress ranged from 19 to 55%, with key contributing factors including discrimination, smoking, limited language proficiency, sleep disorders and younger age. Furthermore, 33% of drivers displayed elevated levels of psychological distress, frequently linked to traumatic experiences and occupational hazards., Conclusions: Rates of depression, anxiety, stress and psychological distress are higher in taxi drivers than in general population, therefore prevention strategies should target this group., Systematic Review Registration: PROSPERO registration no. CRD42023360073., (© 2024. The Author(s).)

Background: Occupational medicine (OM) faces considerable challenges today, one of them related to the university training of future physicians considered suboptimal at a global level as it has been pointed out in many studies. The aim of this study is to update the state of OM medical education in European universities., Methods: Between March and August 2022, an e-mail survey regarding OM training to undergraduate medical students was conducted among OM professors at European universities in 28 countries (n = 347)., Results: Of the 347 universities, 53 medical schools from 19 countries responded (response rate = 15.3%). In 89% of cases, OM was taught. The average number of hours per academic year was 24.3, with significant variation within the same country. Lectures were the most popular teaching technique (98%), with a considerable use of modern approaches such as problem-based learning (61%), and e-learning (57%). While occupational diseases and principles of prevention were covered, other subjects such as the environmental impact or collaboration with an OM physician were poorly represented in the educational program., Conclusion: According to data, several European medical schools may provide insufficient OM education and training to their students. The education of undergraduate occupational medicine students in European medical schools should be designed to equip them with the knowledge and skills required to meet today's challenges. It is critical that undergraduate OM education in European medical schools be enhanced, harmonized, and standardized., (© 2024. The Author(s).)

Objective: To validate a questionnaire to analyze the perception of users of primary care (PC) with telephone consultation (TC), and to study the satisfaction with TC by users of PC services., Design: A two-phase study was conducted. Firstly, a questionnaire on satisfaction with telemedicine services was validated. Secondly, a cross-sectional study on satisfaction with TC was conducted., Setting: PC., Participants: 405 users of PC services in Zaragoza (Spain)., Main Outcome Measure: Our main outcome was the satisfaction with telemedicine services PC services. Factor analysis was carried out using the exploratory factor analysis with Varimax rotation. The reliability of the dimensions obtained was analyzed using Cronbach's alpha. The inferential analysis was conducted using parametric tests., Results: The questionnaire was a valid and reliable tool (α>0.9) to assess the satisfaction of PC service users with telemedicine services. Before COVID-19, the satisfaction of the users with PC was adequate (mean=6111/10). However, during the COVID-19 the attention in PC centers became mostly telephone-based and satisfaction lowered as disappointing (mean=3555/10). Regarding the future of telemedicine, users considered it as unsatisfactory (mean=2977/10). Being a woman, being unemployed and belonging to an area of low vulnerability led to a worse perception of telemedicine., Conclusion: This questionnaire was a valid and reliable tool to assess the satisfaction of PC service users with telemedicine services. Perceptions of patient satisfaction decreased during COVID-19. Thus, TC seems to be a good option when the patients consider it to be a complementary rather than a substitute tool to follow-up their conditions., (Copyright © 2023 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Cognitive stimulation (CS) is a popular and cost-effective intervention, which applies different types of techniques focused on cognitive skills and can be administered by different professionals. CS can be defined as activities that involve cognitive processing usually conducted in a social context and often in a group. Therefore, CS can improve psychosocial functioning and quality of life (QoL), depression, anxiety and activities of daily living (ADLs) independent of the pharmacological treatment such as acetylcholinesterase inhibitors. The objective of this systematic review and meta-analysis was to evaluate the effects of CS on psychosocial outcomes in older adults (aged 65 years or over), with healthy cognitive ageing, mild cognitive impairment (MCI), and dementia., Methods: PubMed, Scopus and Web of Science databases were examined from inception to October 2021. A total of 1,997 studies were initially identified in these databases. After discarding studies that did not meet the inclusion criteria, 30 studies were finally included in the systematic review and the meta-analysis performed with robust variance estimator (RVE) due the inclusion of studies with repeated measurements. The quality assessment tools from the National Institutes of Health were used to evaluate the quality of the studies., Results: CS was significantly associated with a higher QoL in participants who received personalized/adapted CS (RVE = 0.11±0.19 [-0.76, 0.99], t(1.86) = 0.6, p = 0.61). ., Conclusion: Personalized/adapted CS seems to improve QoL in older adults., Competing Interests: Declaration of Competing Interest The Authors declare that there is no conflict of interest., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background and Aims: Evidence shows that migrant children have a higher risk of developing obesity than those with native parents. We aimed to investigate the association between parental migration background and cardiometabolic health in children and adolescents in Europe., Methods and Results: We included 8745 children aged 2-17 from the second follow-up of the European IDEFICS/I.Family cohort. Linear regression models were used to investigate the association between parental migration background (one or two migrant parent(s) vs native parents) and body mass index (BMI), metabolic syndrome (MetS) score and its individual components. Outcome variables were parametrized as age and sex-specific z-scores. We adjusted for age, sex, country, and parental education, and additionally for parental income, lifestyle including dietary factors, and maternal BMI. On average, children with two migrant parents had higher z-scores of BMI (+0.24 standard deviation (SD)) and MetS score (+0.30 SD) compared to those with native parents, whereas no significant differences were seen for children with one migrant parent. Associations were attenuated when controlling for maternal BMI and sports club activity. Parental education modified the associations with BMI and MetS z-scores such that they were more pronounced in children with low parental education., Conclusion: Children with two migrant parents were at higher risk for adverse cardiometabolic health compared to children with native parents, especially in families with low parental education. These associations were explained by lower physical activity and maternal body weight and encourages early intervention strategies by schools and communities., (© 2023. The Author(s).)

Acute leukemia commonly occurs in young children with peak incidence at the age of 2-5 years. However, the etiology is still unclear and many preventable risk factors still deserve to be reviewed. The focus of this systematic review and meta-analysis is to summarize the evidence concerning early life nourishment (breastfeeding, early life diet), neonatal vitamin K administration and the risk of acute leukemia. All epidemiological studies published up to June 2023 and assessing diet-related risk factors for childhood acute leukemia were identified in two electronic databases (PubMed and Web of Science), with no limits on publication year or language. A total of 38 studies (37 case-control studies and 1 study with pooled analysis) were included. The published risk estimates were combined into a meta-analysis using the Generic Inverse Variance method. The current evidence shows that breastfeeding (yes vs. no) has a protective effect against acute lymphoblastic leukemia (odds ratio = 0.85; 95% CI, 0.76-0.94). Evidence related to the role of other studied factors (foods and supplements) is inconclusive. Further research into the potential role of diet in early life and the risk of acute leukemia is needed to develop prevention strategies at population level. Review Registration: PROSPERO registration no. CRD42019128937.

The purpose of this systematic review and meta-analysis was to assess the short-, mid-, and long-term effectiveness of dry needling in improving pain and functional capacity of patients with chronic neck pain. Search strategy was performed on PubMed, Web of Science, Scopus, PEDro, and Cochrane Library Plus biomedical databases. The risk of bias was assessed using the RoB2 tool. Randomised controlled clinical trials in which at least 1 of the groups received dry needling were included. 662 studies were found; 14 clinical trials were selected for qualitative analysis and 13 for quantitative analysis. The quality of most of the studies included was "high." All the studies reported improvements in cervical pain and/or disability, regardless of the protocol followed and the muscles targeted. No serious adverse effects were reported. Dry needling showed to be more effective when compared with other therapies in both women and men, without differences by sex. When the analysis was carried out by age, patients over 40 years old benefitted more than those below 40 years old. Our meta-analysis supports the use of dry needling to improve pain and functional capacity in patients with chronic neck pain at short- and mid-term intervals., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2023 Mar Hernández-Secorún et al.)

Many studies have investigated the etiology of acute leukemia, one of the most common types of cancer in children; however, there is a lack of clarity regarding preventable risk factors. This systematic review and meta-analysis aimed to summarize the current evidence regarding the role of maternal dietary factors in the development of childhood leukemia. All epidemiological studies published until July 2022 that evaluated maternal dietary risk factors for childhood acute leukemia were identified in two electronic databases (PubMed and Web of Science) without limits of publication year or language. A total of 38 studies (1 prospective cohort study, 34 case-control studies and 3 studies with pooled analysis) were included. The published risk estimates were combined into a meta-analysis, using the Generic Inverse Variance method. The maternal consumption of fruits (two or more daily servings vs. less) was inversely associated with acute lymphoblastic leukemia (odds ratio = 0.71; 95% CI, 0.59-0.86), whereas maternal coffee intake (higher than two cups per day vs. no consumption) was associated with an increased risk of acute lymphoblastic leukemia (odds ratio = 1.45; 95% CI, 1.12-1.89). Despite these findings, more high-quality research from cohort studies and the identification of causal factors are needed to develop evidence-based and cost-effective prevention strategies applicable at the population level. Review Registration: PROSPERO registration no. CRD42019128937.

The Inventory of Problems-29 (IOP-29) is a 29-item self-administered symptom validity test (SVT) that assesses the credibility of clinical presentations related to posttraumatic stress disorder, depression/anxiety, psychosis, cognitive impairment and combination thereof. To date, no publications have summarized the classification accuracy of the IOP-29 using a bivariate meta-analytical approach that preserves the two-dimensional nature of the estimators. Our objective was to conduct a systematic review and bivariate diagnostic test accuracy meta-analysis of the IOP-29 according to the relevant guidelines. Twenty-one independent samples were included, with a total sample size of 4,163 participants. The results indicated that the IOP-29 is able to discriminate adequately between instructed simulators and healthy controls/clinical patients. Using the recommended cutoff (False Disorder Probability Score [FDS], ≥ .50), a sensitivity of 82% was achieved, maintaining specificity at 93% (false positive rate of 7%). The language of the test and the type of comparison group have been identified as possible sources of heterogeneity. Specificity decreases for the non-English version of the IOP-29, for the FDS ≥ .30, and also decreases for studies using clinical controls, for all three cutoff scores. In general, our findings support the usefulness of the IOP-29 as an SVT; however, most of the included studies use a simulation design and have been coauthored by the test authors. Likewise, about half of the studies did not include bona fide patient controls but only nonclinical controls. The results obtained are highly promising, but further research, especially that using the criterion group paradigm, is recommended. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Several studies have identified the main barriers and facilitators that breast cancer survivors experience in the return to work (RTW). The authors conducted a qualitative study using focus group discussions with a group of female non-metastatic breast cancer survivors (n = 6), a group of health professionals from different medical specialties (n = 8), and a third group of company managers mainly composed of human resources managers (n = 7). The study was carried out between March and December 2021 in Zaragoza (Spain). Transcripts were analyzed using inductive content analysis to identify work-related barriers and facilitators and coded by the research team. Barriers identified included physical and cognitive symptoms, psychosocial problems, lack of knowledge and coordination (health professional, patients, and managers), legal vacuum, physical change, time constraints, work characteristics (lower skilled jobs), unsupportive supervisors and coworkers, family problems and self-demand. Facilitators included family and work support, physical activity and rehabilitation, personalized attention, interdisciplinary collaboration, legal advice for workers, knowledge about breast cancer in companies, positive aspects of work, elaboration of protocols for RTW in women with breast cancer. RTW in working women with breast cancer requires a personalized and holistic view that includes the perspectives of patients, healthcare professionals and company managers.

Background and Purpose: The lack of cognitive activity accelerates age cognitive decline. Cognitive stimulation (CS) tries to enhance cognitive functioning. The purpose of this systematic review and meta-analysis was to evaluate the effects of CS on cognitive outcomes (general cognitive functioning and specific cognitive domains) in older adults (aged 65 years or older, cognitively healthy participants, or with mild cognitive impairment, or dementia)., Methods: PubMed, Scopus and Web of Science databases were examined from inception to October 2021. A total of 1,997 studies were identified in these databases, and. 33 studies were finally included in the systematic review and the meta-analysis. Raw means and standard deviations were used for continuous outcomes. Publication bias was examined by Egger's Regression Test for Funnel Plot Asymmetry and the quality assessment tools from the National Institutes of Health., Results: CS significantly improves general cognitive functioning (mean difference=MD = 1.536, 95%CI, 0.832 to 2.240), memory (MD = 0.365, 95%CI, 0.300 to 0.430), orientation (MD = 0.428, 95%CI, 0.306 to 0.550), praxis (MD = 0.278, 95%CI, 0.094 to 0.462) and calculation (MD = 0.228, 95%CI, 0.112 to 0.343)., Conclusion: CS seems to increase general cognitive functioning, memory, orientation, praxis, and calculation in older adults., Competing Interests: Declaration of Competing Interest The Authors declare that there is no conflict of interest., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

Cost has been reported as the main barrier to healthy eating in vulnerable groups. We aimed to evaluate the effect of a nutrition education intervention on adherence to Mediterranean Diet and health when providing food vouchers. This pilot study has a randomized control trial design. We included 66 vulnerable users from the Red Cross of Zaragoza (Spain). Intervention and control group individuals received 120 euros/month of food vouchers over 3 months to be spent in supermarkets (60 euros/month if under 12 y) plus a 10-week nutrition education program for the intervention group. Family food purchases were assessed using electronically recorded supermarket-obtained transactions. During and at the end of the intervention the percentage of healthy food was higher in the intervention than in the control group. Once the nutrition education was over, differences between groups dissipated. In the intervention group, health parameters improved, particularly weight-status, lipids, and liver enzymes. Control participants gained weight, although lipid and liver enzymes improved. Blood pressure and HbA1c did not improve in either the intervention or the control group. In conclusion, providing unrestricted food vouchers to vulnerable groups to increase healthy food consumption appears to be insufficient and should be accompanied by medium-long term nutrition education.

Objective: To know the characteristics of the studies that have paid attention to women who have sex with women (WSW) and to identify possible gaps in the interest of comprehensive sexual health in WSW., Method: A scoping review on sexual health on WSW was conducted from 2000 to 2019. Papers with lack of focus on sexual health on WSW were excluded and a web tool was used to guarantee blindness. Information was extracted on the key characteristics of the studies and the quality of the evidence. The sexual health categories were comprehensive sexual health, specification of sexual practices in WSW, and recommendations provided., Results: 39 studies were included, mostly cross-sectional. The gaps identified were the lack of evidence on sexual health, confusion about sexual orientation and sexual practices, lack of specific interest in comprehensive sexual health and the life cycle approach. Recommendations focused on WSW self-care; interventions aimed at clinical practice, research, education and prevention; and contributions of a feminist approach on sexual health of WSW., Conclusions: There are several gaps about in the knowledge about sexual health among WSW. Self-care improvement and specific strategies addressed to the unique characteristics of these women and their different and specific situation and health determinants are highlighted., (Copyright © 2022 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

The infections and deaths resulting from Coronavirus Disease 2019 (COVID-19) triggered the need for some governments to make COVID-19 vaccines mandatory. The present study aims to analyze the position of 3026 adults in Colombia, El Salvador, and Spain regarding the possibility of making COVID-19 vaccine mandatory and the intention to be vaccinated with the booster or possible successive doses. Data from an online survey conducted from August to December 2021 among a non-representative sample of Spanish-speaking countries were collected. Multinomial Logistic Regression Models were used. A total of 77.4% of Colombians were in favor of mandatory vaccination compared to 71.5% of Salvadorians and 65.4% of Spaniards (p < 0.000). Women and people over 65 years of age were the groups most in favor of making the vaccine mandatory (p < 0.000). A total of 79.4% said they had received a third dose or would intend to receive the third dose or future doses, if necessary, compared with 9.4% who expressed doubts and 9.9% who refused to be vaccinated or did not intend to be vaccinated. Among the measures that could be taken to motivate vaccination, 63.0% and 60.6% were in favor of requiring a negative test to enter any place of leisure or work, respectively, compared to 16.2% in favor of suspension from work without pay. The acceptance of mandatory vaccination and of third or future doses varies greatly according to sociodemographic characteristics and work environment. As such, it is recommended that policy makers adapt public health strategies accordingly.

The prevalence of pediatric respiratory diseases in Spain is 23%. Inhalation is the preferred route of administration but there are frequent errors in the performance of the inhalation technique leading a poor control of the disease. The aim of this research was to detect errors in the execution of the inhalation technique at a Pediatric Pulmonology Unit in a hospital of Aragón (Spain). In order to improve the administration of inhaled medication, an educational intervention for 1 year by nursing was conducted. This interventional study, including children aged 1 to 15 years with an inhalation therapy and who attended the Pediatric Pulmonology Unit, was conducted between September 2017 and September 2018. Logistic Regression models were conducted in SPSS. This study involved 393 children (61.1% boys). Before the intervention, 39.4% achieved a correct inhalation technique increasing up to 62.1% after the intervention. Those who had their first visit to the Unit, young children and girls had a higher risk of incorrect performance than those with subsequent visits, older children, and boys, respectively. The most common errors in the inhalation technique were not performing adequate apnoea after inhaling and not rinsing the mouth at the end of the procedure. The education given by nurses to pediatric patients improved the inhalation technique, achieving better control of the disease and use of the health system.

Medical students generally express a low interest in Occupational Medicine. We aimed to assess the attitudes and changes in attitudes of students towards this area after completing a course on Occupational Medicine in two Medical Universities in Spain (Zaragoza and Castilla-La Mancha). The teaching method included blended learning as a model that used online virtual patient platforms (CASUS) and/or EMUTOM, as well as traditional methods such as face-to-face teaching. A total of 526 students (98 of whom attended the University of Castilla-La Mancha) participated during three academic years (2015-2016, 2016-2017 and 2017-2018). The validation of the questionnaire was carried out using reliability, exploratory and confirmatory factor analysis. For the analysis of internal consistency and discrimination, Cronbach's alpha was used. The adequacy of the factor analysis was measured by means of KMO, and a correlation matrix was examined by means of Bartlett's test of sphericity. To identify differences between students before and after completing the course, the Mann-Whitney U-test for independent samples was used. Our results show that despite a negative or neutral attitude towards Occupational Medicine, the acquisition of competences and skills in this area and their training were recognized as fundamental for their future professional performance as doctors in any specialty.

Background and Aims: This study aimed to expand the European Prospective Investigation into Cancer and Nutrition (EPIC) nutrient database (ENDB) by adding amino acid (AA) values, using the U.S. nutrient database (USNDB). Additionally, we aimed to evaluate these new protein and AA intake estimates from the EPIC dietary questionnaires (DQ) and 24-h dietary recalls (24-HDR) using different matching procedures., Methods and Results: Dietary energy, protein and AA intakes were assessed via DQ and 24-HDR by matching with the USNDB food composition table. Energy and protein intakes calculated using USNDB matching were compared with those calculated using ENDB, that uses country specific food composition tables. Pearson correlations, Cohen's weighted kappa statistic and Bland-Altman plots were used to compare data resulting from USNDB matching with our reference from ENDB matching. Very high correlations were found when comparing daily energy (r = 0.99) and dietary protein intakes (r = 0.97) assessed via USNDB with those obtained via ENDB (matching for DQ and 24-HDR). Significant positive correlations were also found with energy and protein intakes acquired via 24-HDRs in the EPIC calibration sample., Conclusion: Very high correlations between total energy and protein intake obtained via the USDA matching and those available in ENDB suggest accuracy in the food matching. Individual AA have been included in the extended EPIC Nutrient database that will allow important analyses on AA disease prospective associations in the EPIC study., Competing Interests: Declaration of competing interest No authors report conflicts of interest., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

COVID-19 vaccines have shown high efficacy, with most side effects being mild-moderate and more frequently reported by females and people at younger ages. Since no studies have assessed the impact that weight status could have on the reported adverse reactions, we aim to study the association between weight status and reported side effects. We included data on 2136 adults from an online survey conducted from 6 May to 9 June 2021. The questionnaire was filled in by participants over Google forms. Generalized Linear Mixed Models were used. A higher risk of presenting fever ≥38°, vomiting, diarrhea and chills was found in those with a non-overweight status compared to those overweight after adjusting for age, sex, education, medication to prevent/relieve post-vaccination effects and vaccine administered. When adjusting, most of the significant effects, in the association between side effects of the COVID-19 vaccine and weight status, did not remain significant. In conclusion, a non-overweight status was associated with a higher risk of presenting fever ≥38°, vomiting, diarrhea and chills compared to those overweight. Nevertheless, most of the reported side effects to COVID-19 vaccine were not associated with a higher risk of presenting more adverse effects, and individual differences were determined by sex and age.

Background: To achieve herd immunity, the acceptance of the COVID-19 vaccine by the population, especially healthcare professionals, plays a key role. The objective of the present paper is to address the differences in attitudes among Spanish healthcare professionals compared with the general population regarding COVID-19 vaccination. Methods: This cross-sectional study included data from 2,136 adults ( n = 664 healthcare professionals) from an online survey conducted from May 6 to June 9, 2021. The Vaccination attitudes examination scale was used to measure the negative attitudes toward vaccines. Four subscales: mistrust of vaccine benefit, worries about the unforeseen future effect, concerns about commercial profiteering, and preference for natural immunity were calculated. Generalized linear mixed models were conducted to study these associations. Results: Between 10.2 and 22.6% of the subjects showed high levels of negative attitudes toward vaccines. However, only 1.5% of our sample (2.1% among healthcare professionals) refused to get the COVID-19 vaccine when it was offered because they chose otherwise. Retired people showed the lowest concerns and the highest trust in vaccines. No statistically significant effects were found between working in a healthcare field and having higher positive attitudes toward vaccines. Conclusion: Low levels of rejection against the COVID-19 vaccine were identified in the present sample. However, despite being at a higher risk, health care professionals did not show higher positive attitudes toward vaccines. Furthermore, refusal percentage to vaccination was higher among healthcare professionals compared with non-healthcare professionals. Developing a strategy to increase positive attitudes against the COVID-19 vaccine should be an objective for public health policy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Iguacel, Luna Maldonado, Luna Ruiz-Cabello, Samatán, Alarcón, Ángeles Orte, Santodomingo Mateos and Martínez-Jarreta.)

Context: Vegetarian and vegan diets are increasing in popularity. Although they provide beneficial health effects, they may also lead to nutritional deficiencies. Cognitive impairment and mental health disorders have a high economic burden., Objective: A meta-analysis was conducted to examine the relationship between vegan or vegetarian diets and cognitive and mental health., Data Sources: PubMed, Scopus, ScienceDirect, and Proquest databases were examined from inception to July 2018., Study Selection: Original observational or interventional human studies of vegan/vegetarian diets were selected independently by 2 authors., Data Extraction: Raw means and standard deviations were used as continuous outcomes, while numbers of events were used as categorical outcomes., Results: Of 1249 publications identified, 13 were included, with 17 809 individuals in total. No significant association was found between diet and the continuous depression score, stress, well-being, or cognitive impairment. Vegans/vegetarians were at increased risk for depression (odds ratio = 2.142; 95%CI, 1.105-4.148) and had lower anxiety scores (mean difference = -0.847; 95%CI, -1.677 to -0.018). Heterogeneity was large, and thus subgroup analyses showed numerous differences., Conclusions: Vegan or vegetarian diets were related to a higher risk of depression and lower anxiety scores, but no differences for other outcomes were found. Subgroup analyses of anxiety showed a higher risk of anxiety, mainly in participants under 26 years of age and in studies with a higher quality. More studies with better overall quality are needed to make clear positive or negative associations., Systematic Review Registration: PROSPERO registration no. CRD42018097204., (© The Author(s) 2020. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Large socioeconomic, gender, and ethnic inequalities exist in terms of childhood obesity worldwide. Children from low socioeconomic status families are more likely to have overweight/obesity and related cardiometabolic problems and future cancer risk. A wider concept are social vulnerabilities defined as social or economic characteristics or experiences negatively affecting children through behavioral, biological factors, or mental health. Social vulnerabilities include also therefore low subjective perceptions of social position., Objective: This study aims to identify social vulnerabilities and to summarize their impact as obesity development risk factor. Preventive programs implemented targeting these vulnerable groups and their effectiveness are also discussed., Methods: Literature review based on the experience of the authors social vulnerabilities identified as risk factors for childhood obesity were children whose parents lack of a social network, low support from formal and informal sources, parental unemployment, belonging to a minority group or having migrant background, adverse childhood experiences including household dysfunction, violence and childhood maltreatment and other traumatic experiences, gender inequalities and being part of nontraditional families., Results: The impact of social vulnerabilities on childhood obesity is independent of SES; however, SES exacerbates or buffer the effect social vulnerabilities have on different lifestyles and stress. Behavioral, biological, and mental health mechanisms may explain the association between social vulnerabilities and childhood obesity., Conclusions: Behaviors such as dietary intake, physical activity, sedentary behaviors, and sleep are negatively affected by the stress and low levels of mental health derived from social vulnerabilities. It seems that high energy intakes rather than low physical activity levels might be the main driving force behind the obesity epidemic in vulnerable groups. Most of the prevention programs identified did not take into account social vulnerabilities and inequalities making them ineffective in most vulnerable groups. Interventions conducted in children from socially vulnerable group suggest modest but promising effects.

Purpose: Psychosocial stressors derived from socioeconomic disadvantages in adolescents can result in higher risk of metabolic syndrome (MetS). We aimed to examine whether socioeconomic disadvantages were associated with MetS independent of lifestyle and whether there was a dose-response relationship between the number of cumulated socioeconomic disadvantages and risk of MetS., Methods: This study included 1,037 European adolescents (aged 12.5-17.5 years). Sociodemographic variables and lifestyle were assessed by self-reported questionnaires. Disadvantaged groups included adolescents with low-educated parents, low family affluence, migrant origin, unemployed parents, and nontraditional families. MetS risk score was calculated as the sum of sex- and age-specific z-scores of waist circumference, blood pressure, lipids, and insulin resistance. Linear mixed-effects models adjusted for sex, age, pubertal status, and lifestyle were used to study the association between social disadvantages and MetS risk score., Results: Adolescents with low-educated mothers showed a higher MetS score (.54 [.09-.98]; β estimate and 99% confidence interval) compared to those with high-educated mothers. Adolescents who accumulated more than three disadvantages (.69 [.08-1.31]) or with missing information on disadvantages (.72 [.04-1.40]) had a higher MetS risk score compared to nonsocioeconomically disadvantaged groups. Stronger associations between socioeconomic disadvantages and MetS were found in male than in female adolescents., Conclusions: Adolescents with low-educated mothers or with more than three socioeconomic disadvantages had a higher MetS risk, independent of lifestyle, potentially due to higher psychosocial stress exposure. Policy makers should focus on improving low-educated familiesa and more disadvantaged families' knowledge on nutrition and physical activity to help them cope better with stress., (Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

We aimed to study growth patterns according to rapid weight gain (RWG) and infant feeding practices during the first 120 days and whether infant feeding practices mediated the association between RWG in the first semester of life and subsequent body mass index (BMI) z-score in children from age 1 to 6. (1) Methods: 862 children from the Growth and Feeding during Lactation and Early Childhood in Children of Aragon study (CALINA in Spanish) were examined. Repeated-measures ANOVA analyses were conducted to assess growth trajectories according to RWG and type of feeding practice. The product of coefficients mediation method was used to assess the potential contribution of infant feeding practices to the association between RWG and BMI z-score. Mediation models were conducted using IBM SPSS-PROCESS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. (2) Results: BMI and weight z-score trajectories were significantly higher in the RWG group and the formula-fed group. No significant differences were found regarding height. Infant feeding practices did not mediate the association between RWG and BMI z-score but were associated with BMI at 6 years. (3) Conclusions: Infant feeding practices and RWG determine different growth trajectories of BMI and weight during childhood. Although infant feeding practices did not mediate the association between early RWG and BMI later in life, formula feeding is independently related to higher BMI growth patterns later in childhood.

The microbiome has been hypothesized to play a role in cancer development. Because of the diversity of published data, an overview of available epidemiologic evidence linking the microbiome with cancer is now needed. We conducted a systematic review using a tailored search strategy in Medline and EMBASE databases to identify and summarize the current epidemiologic literature on the relationship between the microbiome and different cancer outcomes published until December 2019. We identified 124 eligible articles. The large diversity of parameters used to describe microbial composition made it impossible to harmonize the different studies in a way that would allow meta-analysis, therefore only a qualitative description of results could be performed. Fifty studies reported differences in the gut microbiome between patients with colorectal cancer and various control groups. The most consistent findings were for Fusobacterium, Porphyromonas , and Peptostreptococcus being significantly enriched in fecal and mucosal samples from patients with colorectal cancer. For the oral microbiome, significantly increased and decreased abundance was reported for Fusobacterium and Streptococcus , respectively, in patients with oral cancer compared with controls. Overall, although there was a large amount of evidence for some of these alterations, most require validation in high-quality, preferably prospective, epidemiologic studies., (©2020 American Association for Cancer Research.)

Objective: Research examining aspects of positive mental health as potential predictors of cardiometabolic health in young populations is scarce. We investigated the associations between psychosocial well-being and waist circumference (WAIST), blood pressure (BP), the homeostasis model assessment for insulin resistance, triglycerides, and high-density lipoprotein cholesterol considering life-style factors as mediators., Methods: Data of European children and adolescents participating in the baseline (2007/2008), first follow-up (FU1; 2009/2010) and second follow-up (FU2; 2013/2014) examinations of the IDEFICS/I.Family study were used (ncross-sectional = 6519; nlongitudinal = 1393). A psychosocial well-being score was calculated from 16 items on emotional well-being, self-esteem, and social relationships (0-48 points). Cardiometabolic markers were transformed to age- and sex-specific and, in case of BP, also height-specific z scores. Life-style factors included diet, physical activity, sleep, and electronic media use. Applying path analysis, we obtained unstandardized estimates of direct and indirect effects of well-being on cardiometabolic markers., Results: Cross-sectionally, well-being score showed a negative direct and a negative indirect effect through life-style factors on WAIST z score (estimate per 4-point increase, -0.051 [p = .001] and -0.014 [p < .001], respectively). Longitudinally, positive changes in well-being score between baseline and FU1 and between FU1 and FU2, respectively, demonstrated negative indirect effects through life-style factorsFU2 on WAIST z scoreFU2. Both cross-sectionally and longitudinally, higher levels of well-being showed lowering indirect effects on homeostasis model assessment, BP, and triglyceride z scores and an increasing indirect effect on high-density lipoprotein cholesterol z score through both life-style factors and WAIST z score., Conclusions: These results supported our hypothesis that a healthier life-style may be one mechanism through which higher well-being is linked with lower abdominal obesity and fewer other cardiometabolic disorders in young populations., Trial Registration: Pan-European IDEFICS/I.Family children cohort, ISRCTN registry number: ISRCTN62310987 (http://www.isrctn.com/ISRCTN62310987).

Addressing social disadvantages that lead to obesity should be a public health priority. Obesity prevalence among children and adolescents has reached a plateau in countries with high income but it continues rising in low-income and middle-income countries. In high-income countries, an elevated prevalence of obesity is found among racial and ethnic minority groups and individuals from disadvantaged socioeconomic backgrounds. In addition to classic socioeconomic status (SES) factors, like income, parental education, and occupation, recent publications have linked parental social disadvantages, such as minimal social network, non-traditional family structure, migrant status and unemployment, with obesogenic behaviors and obesity among children. Socio-ecological models of obesity in children can explain the influence of classic SES factors, social disadvantages, culture, and genes on behaviors that could lead to obesity, contributing to the elevated prevalence of obesity. Obesity is a multifactorial disease in which multilevel interventions seem to be the most effective approach to prevent obesity in children, but previous meta-analyses have found that multilevel interventions had poor or inconsistent results. Despite these results, some multilevel interventions addressing specific disadvantaged social groups have shown beneficial effects on children's weight and energy balance-related behaviors, while other interventions have benefited children from both disadvantaged and non-disadvantaged backgrounds. Considering obesity as a worldwide problem, the World Health Organization, the European Commission, and the National Institutes of Health recommend the implementation of obesity prevention programs, but the implementation of such programs without taking into consideration social disadvantages may be an unsuccessful approach. Therefore, the present publication consists of a review of the pertinent literature related to social disadvantage and its consequences for behaviors that could lead to childhood obesity. In addition, we will discuss the relationship between social disadvantages and the socio-ecological model of obesity in children. Finally, we will summarize the relevant aspects of multilevel intervention programs aiming to prevent obesity in children and provide recommendations for future research and intervention approaches to improve weight status in children with social disadvantages., (Copyright © 2020 Ayala-Marín, Iguacel, Miguel-Etayo and Moreno.)

Background: Obesity has been proposed as a risk factor for prostate cancer (PCa). In obesity, serum levels of the appetite-regulating hormones-leptin, adiponectin, and ghrelin-become deregulated., Objective: To explore whether serum levels of appetite-regulating hormones associate with the incidence of PCa, the incidence of advanced disease, or PCa-specific mortality., Methods: PRISMA guidelines were followed. A systematic search for relevant articles published until March 2019 was performed using the databases PubMed, EMBASE, and Web of Science. Observational studies with data on serum levels of leptin, adiponectin, or ghrelin and PCa outcome were included. Meta-analysis was used to combine risk estimates. Meta-relative risks (mRRs) were calculated using random effects models. When available, raw data was pooled. Publication bias was assessed by funnel plot and Begg's test., Results: Thirty-five studies were eligible for inclusion. The qualitative analysis indicated that leptin was not consistently associated with any PCa outcome, although several cohorts reported decreased adiponectin levels in men who later developed advanced PCa. Based on the meta-analysis, there was no significant effect of leptin on PCa incidence (mRR = 0.93 (95% CI 0.75-1.16), p = 0.52) or advanced PCa (mRR = 0.90 (95% CI 0.74-1.10), p = 0.30). There were insufficient studies to estimate the mRR of PCa incidence for men with the highest levels of adiponectin. The combined risk of advanced PCa for men with the highest levels of adiponectin was reduced but did not reach significance (mRR = 0.81 (95% CI 0.61-1.08), p = 0.15)., Conclusions: The current evidence does not suggest an association between leptin and PCa outcome. However, there may be an inverse association between adiponectin and the incidence of advanced PCa that should be investigated by further studies. Serum ghrelin has not been largely investigated.

Introduction: Introduction: several investigations have identified breastfeeding as a protective factor for rapid infant weight gain and childhood obesity while other studies have found that this protective effect could be the result of confounding factors. Objectives: to assess the associations between lactation practices (breast-fed vs formula-fed infants) during the introduction of complementary food period, as well as the following: a) patterns of food intake; and b) trajectories of growth at six, nine and 12 months (z-score of weight, height and body mass index [BMI] and changes in these z-scores from six to 12 months). Methods: two hundred and three infants randomly selected from Spanish Primary Health Centres were measured. Parents recorded all infant's food consumption for three days (g/day). Linear regression models were applied. Results: breast-fed infants had a lower intake of cereals, fruit baby food, vegetables with meat/fish and a total intake of food compared to formula-fed infants at nine months of age. After adjusting for sex, parental education and total food intake, breastfed children continued to have lower intake of cereals (-5.82, 95% CI: -9.22, -2.43), and lower total food intake (-301.23, 95% CI: -348.50, -253.96). Breast-fed infants had a lower change in z-score of weight, height and BMI from six to 12 months of age and these differences remained when adjusting for all confounders. Conclusions: formula-fed infants during the complementary feeding period have a higher food intake and show higher rates of rapid infant weight gain compared to breast-fed infants. These differences in growth trajectories depending on breastfeeding maintenance and food intake during early life must be considered in adiposity risk evaluation.

Objective: To find out whether use of nutritional supplements (NUS) differs between children and adolescents with attention-deficit/hyperactivity disorder (ADHD; medicated or unmedicated), compared with those without the disorder., Methods: We used cross-sectional data from the population-based I.Family study conducted between 2013 and 2014 in eight European countries. Parents completed questionnaires and participated in interviews, for example, on health and medical history of their child. Data from 5067 children and adolescents aged 5-17 years were included. Exposures were medicated (with ADHD-approved medication) and unmedicated ADHD. The outcome was the use of NUS, measured by use of any or multiple different NUS. Multivariable logistic regression adjusted for sociodemographics and health determinants was used to find ADHD-depending differences., Results: The study sample comprised 4490 children and adolescents without ADHD and 51 medicated and 76 unmedicated subjects with ADHD. Regarding the use of any NUS, no statistically significant differences were found between children and adolescents without ADHD (18%) and those with medicated (18%) or unmedicated ADHD (22%). However, discrepancies appear when considering multiple use of NUS, not reported for any medicated ADHD subject but remarkably often for unmedicated ADHD subjects (13%), resulting in an adjusted odds ratio of 2.6 (95% confidence interval, 1.2-5.6) when compared with those without ADHD (5%)., Conclusion: Children and adolescents who were not using medication for treating ADHD potentially took NUS as oral remedies. Given the potential for a delay of indicated treatments and for use of those NUS which have no proven effectiveness, pediatricians should actively explore whether NUS have been used to treat ADHD core symptoms, and families should be informed that the average effect size has to be considered small.

Context: The numbers of vegans and vegetarians have increased in the last decades. However, the impact of these diets on bone health is still under debate., Objective: This systematic review and meta-analysis sought to study the impact of vegetarian and vegan diets on bone mineral density (BMD) and fracture risk., Data Sources: A systematic search was conducted of PubMed, Scopus, and Science Direct, covering the period from the respective start date of each database to November 2017., Data Extraction: Two investigators evaluated 275 studies against the inclusion criteria (original studies in humans, written in English or Spanish and including vegetarian or vegan diets and omnivorous diets as factors with BMD values for the whole body, lumbar spine, or femoral neck and/or the number of fractures as the outcome) and exclusion criteria (articles that did not include imaging or studies that included participants who had suffered a fracture before starting the vegetarian or vegan diet). The quality assessment tool for observational cohort and cross-sectional studies was used to assess the quality of the studies., Results: Twenty studies including 37 134 participants met the inclusion criteria. Compared with omnivores, vegetarians and vegans had lower BMD at the femoral neck and lumbar spine and vegans also had higher fracture rates., Conclusions: Vegetarian and vegan diets should be planned to avoid negative consequences on bone health., Systematic Review Registration: PROSPERO registration no. CRD42017055508.

Objective: The present study investigated the association between sugar and fat intake in childhood in relation to alcohol use in adolescence. We hypothesized that early exposure to diets high in fat and sugar may affect ingestive behaviours later in life, including alcohol use.Design/Setting/SubjectsChildren from the European IDEFICS/I.Family cohort study were examined at ages 5-9 years and followed up at ages 11-16 years. FFQ were completed by parents on behalf of children, and later by adolescents themselves. Complete data were available in 2263 participants. Children's propensities to consume foods high in fat and sugar were calculated and dichotomized at median values. Adolescents' use of alcohol was classified as at least weekly v. less frequent use. Log-binomial regression linked sugar and fat consumption in childhood to risk of alcohol use in adolescence, adjusted for relevant covariates., Results: Five per cent of adolescents reported weekly alcohol consumption. Children with high propensity to consume sugar and fat were at greater risk of later alcohol use, compared with children with low fat and low sugar propensity (relative risk=2·46; 95 % CI 1·47, 4·12), independent of age, sex and survey country. The association was not explained by parental income and education, strict parenting style or child's health-related quality of life and was only partly mediated by sustained consumption of sugar and fat into adolescence., Conclusions: Frequent consumption of foods high in fat and sugar in childhood predicted regular use of alcohol in adolescence.

Context: Dietary risks are leading contributors to global morbidity and mortality and disproportionately burden individuals of lower socioeconomic positions., Objective: The aim of this review is to understand, holistically, what factors are perceived to influence healthy eating and to determine whether perceived factors differ when comparing the general population with lower socioeconomic subgroups., Data Sources: Four academic databases (MEDLINE, CINAHL, PsycINFO, Cochrane Library) and 3 gray literature databases were searched systematically, along with reference lists., Study Selection: Studies were included if they were qualitative and were conducted with community-dwelling adults in high-income countries and if they focused specifically on healthy eating. Eligibility was determined through author consensus., Data Extraction: Thirty-nine eligible studies (of 11 641 records screened) were identified. Study characteristics were extracted using a standard template, and quality appraisal was conducted using the Critical Appraisal Skills Program tool. Data synthesis was conducted using meta-ethnography, with themes categorized according to the socioecological model., Results: Factors across the individual, social, lived, and food environments were perceived to influence healthy eating. Meta-ethnography revealed that multiple environmental and social factors were frequently reported as barriers to healthy eating. While factors were largely generalizable, diet affordability and the lower availability of stores offering healthy food appeared to be more salient barriers for lower socioeconomic groups., Conclusions: Actions to improve population diets should mitigate the barriers to healthy eating to create environments that support healthy eating across the socioeconomic gradient. Systematic Review Registration: PROSPERO registration number CRD42017065243.

Background: Previous research has examined the role of early-life risk factors on childhood weight gain.The extent to which these factors drive socioeconomic differences in weight is unclear. We aimed to quantify the influence of early-life risk factors on the development of socioeconomic inequalities in children's body mass index (BMI) z-score at 10-11 years., Methods: Overall, 2186 children from the Longitudinal Study of Australian Children were examined. Socioeconomic position (SEP) was measured as a continuous composite of parent's education, occupation and income. The Product of Coefficients mediation method was used to quantify the contribution of maternal smoking during pregnancy, gestational diabetes, prematurity, caesarean section, birthweight, not being breastfed, early introduction of solid food, maternal BMI and paternal BMI to the relationship between SEP and BMI z-score., Results: Each increasing decile of SEP (higher SEP) was associated with a 0.05 unit lower (95% CI: -0.06, -0.03) BMI z-score at 10-11 years. In total, 83.5% of these differences in BMI z-score could be explained by socioeconomic differences in maternal smoking during pregnancy (26.9%), maternal BMI (39.6%) and paternal BMI (17.0%)., Conclusions: Interventions to reduce socioeconomic inequalities in excess weight gain during childhood should support the attainment of a healthy parental weight and prevent smoking during pregnancy.

Objective: Socioeconomic disadvantages during childhood are hypothesised to have negative implications for health. We aimed to investigate the association between socioeconomic disadvantages and children's total metabolic syndrome (MetS) score at baseline and follow-up and the extent to which socioeconomic disadvantages over time and the accumulation of these socioeconomic disadvantages can affect children's MetS risk., Methods: The two-year longitudinal IDEFICS study included 2401 European children (aged 2.0-9.9) with complete information of the 16,229 participating at baseline. Sociodemographic variables, psychosocial factors and lifestyle were proxy-reported via questionnaires. Socioeconomically disadvantaged groups included children from families with low income, low education, migrant origin, unemployed parents, parents who lacked a social network, and from non-traditional families. MetS risk score was calculated as the sum of z-scores of waist circumference, blood pressure, lipids and insulin resistance. Linear mixed-effects models were used to study the association between social disadvantages and MetS risk. Models were adjusted for sex, age, well-being and lifestyle (fruit and vegetables consumption, physical activity, screen time)., Results: At both time points, children from low-income families (0.20 [0.03-0.37]); (β estimate and 99% confidence interval), children from non-traditional families (0.14 [0.02-0.26]), children whose parents were unemployed (0.31 [0.05-0.57]) and children who accumulated >3 disadvantages (0.21 [0.04-0.37]) showed a higher MetS score compared to non-socioeconomically disadvantaged groups., Conclusion: Children from socioeconomically disadvantaged families are at high metabolic risk independently of diet, physical activity, sedentary behaviours and well-being. Interventions focusing on these socioeconomically disadvantaged groups should be developed to tackle health disparities., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background/objectives: In high-income countries, childhood obesity follows a clear socioeconomic gradient with greater prevalence in children with lower socioeconomic status (SES). The extent to which the trend of other social vulnerabilities over time and the accumulation of these vulnerabilities can affect children's weight is still unknown., Subjects/methods: In the IDEFICS study, 8624 children aged 2.0-9.9 years from eight European countries were examined at baseline and after 2 years. Sociodemographic variables, maternal body mass index (BMI), and lifestyle were reported by parents. Children were measured and classified as thin, normal weight, and overweight/obese using the extended IOTF criteria. Four vulnerable groups were defined: children whose parents were migrants, children whose parents lack a social network, children from non-traditional families (children not living with both biological parents), and children with unemployed parents. Logistic mixed-effects models were used to study the association between vulnerabilities and children's weight at baseline and follow-up, temporal trends in vulnerabilities and children's weight and accumulation of vulnerabilities and children's weight. Models were adjusted for lifestyle, maternal BMI, parental education, and income., Results: Children whose parents lost their social support at follow-up were more likely to be thin than non-vulnerable children (OR = 1.69, 99% CI = 1.03-2.78). Children whose parents had a migrant background (OR = 1.30, 99% CI 1.04-1.62), children from non-traditional families at both time points (OR = 1.40, 99% CI 1.03-1.90) and whose parents were unemployed at baseline and follow-up (OR = 2.03, 99% CI 1.03-3.99) were more likely to be overweight/obese compared to non-vulnerable children. Cross-sectionally, we did not find an association between parental lack of network, non-traditional family structure, or employment and children's weight status., Conclusions: Policy actions are required to tackle inadequate weight loss and gain among vulnerable children (especially those exposed over the long term) since they are at a higher risk of thinness and overweight.