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Resumen Introduccion La heredabilidad de los trastornos de la conducta alimentaria, como la anorexia nerviosa y la bulimia nerviosa, se ha estimado alrededor del 22% al 62%. El objetivo del presente trabajo es determinar la influencia de los factores geneticos y ambientales que contribuyen en la expresion de los factores psicologicos medidos a traves del Eating Disorders Inventory , en funcion del sexo, en adolescentes de la Comunidad Valenciana (Espana). Material y metodos Quinientas ochenta y cuatro parejas de gemelos de 13 a 18 anos de edad. Para determinar la cigosidad los profesores rellenaron un cuestionario de similitud fisica. Se aplicaron las subescalas del Eating Disorders Inventory , impulso a la delgadez, insatisfaccion corporal, perfeccionismo e ineficacia. Se ha realizado una modelizacion de las mismas para establecer los componentes geneticos y ambientales (comunes y especificos) de su varianza. Resultados En las ninas las 4 variables mostraron un componente de heredabilidad, del 37,7% para la ineficacia, del 42,8% para el perfeccionismo, del 56,9% para el impulso a la delgadez y del 65,5% para la insatisfaccion corporal. En los ninos se descarta una influencia genetica para la insatisfaccion corporal, que aparece influenciada exclusivamente por factores ambientales. El resto de variables mostraron un componente heredable, pero en menor medida que en las ninas. Conclusiones A excepcion de la IC en ninos, las actitudes y comportamientos alimentarios muestran un patron parcialmente heredable, que varia en funcion del sexo.

Objectives The study aimed to examine whether dissociation and attitudes towards change were associated with the psychopathology in patients with eating disorders (EDs) at 1-year follow-up. Method The study included 110 females with anorexia nervosa and bulimia nervosa (48 and 62 respectively). At the beginning of the study and 1 year later, they were assessed by means of the following questionnaires: Dissociative Experiences Scale, Attitudes Towards Change (ACTA), State-Trait Anxiety Inventory, Rosenberg Self-Esteem Scale, Beck Depression Inventory, Eating Attitude Test, Bulimic Investigatory Test Edinburgh and Body Shape Questionnaire (BSQ). Results No statistically significant differences were found between both diagnostic groups regarding dissociation scores. The ACTA at baseline, specifically for patients in the contemplation stage, mediate the effect of dissociation on the psychopathological outcome. Discussion These findings suggest that dissociation might be a transdiagnostic feature related to the EDs outcome. The psychotherapeutic framework must take it into account, particularly in patients in the contemplation stage.

The aims of this study: (1) To evaluate the relative contributions of genetics and environment to perfectionism and it's two constructs: self-oriented, and socially prescribed perfectionism. (2) To clarify genetic and environmental common origins of both personal and social components. Methods: Participants were 258 pairs of adolescent Spanish twins. Socially prescribed and self-oriented perfectionism were assessed using the perfectionism subscale of the Eating Disorder Inventory. Statistics: univariate and bivariate twin models, according to sex. Results; Heritability of self-oriented perfectionism was 23% in boys and 30% in girls, and of socially prescribed perfectionism 39% in boys and 42% in girls. Bivariate analysis suggested a common genetic and environmental pathway model. The genetic correlation between both perfectionisms was 0.981 in boys and 0.704 in girls. The non-shared environmental correlation was 0.254 in boys and 0.259 in girls. Conclusions; genetic influences on perfectionism are moderate during adolescence. Our results point toward a shared genetic component underlying both kind of perfectionism. These findings generate doubts about the hypothesis of a leading role of genetics in the pathogenesis of Self-oriented perfectionism and of environment in socially prescribed. The high genetic correlation seems to indicate that self-oriented and socially prescribed are the same dimension of perfectionism.

Resumen Fundamento y objetivo Los estudios familiares y gemelares han demostrado que los factores geneticos son responsables del 47-90% de la variancia interindividual del indice de masa corporal (IMC). El objetivo de la presente investigacion fue evaluar los factores geneticos y ambientales que contribuyen a las diferencias en el IMC, y en funcion del sexo, en una muestra gemelar de escolares de la Comunidad Valenciana. Material y metodo Quinientas ochenta y cuatro parejas de gemelos de 13 a 18 anos de edad completaron el estudio: 82 parejas monocigoticas (MC) y 87 dicigoticas (DC) varones, 118 (MC) y 102 (DC) mujeres, y 195 parejas (DC) de sexo opuesto. Para determinar la cigosidad, los profesores rellenaron un cuestionario de similitud fisica y pesaron y tallaron a los participantes. Se calculo el IMC y se establecio el estado nutricional segun la edad. Se llevo a cabo una modelizacion del IMC que permitio establecer los componentes geneticos y ambientales (comunes y especificos) de su variancia. Resultados Se observo un 7,1% de sobrepeso y un 2,8% de obesidad. La heredabilidad del IMC se estimo en un 88% en ninos y en un 72,1% en ninas. Los factores ambientales especificos explicaron el resto de la variancia del IMC (en ninos el 12% y en ninas el 8,8%). Solo en las ninas aparecio una contribucion de los factores ambientales comunes. Conclusiones La influencia genetica sobre el IMC es intensa durante la adolescencia, con ligeras variaciones en funcion del sexo, siendo solo las ninas vulnerables a las influencias ambientales comunes.

Resumen Introduccion y objetivos Actualmente existe un aumento mundial de la incidencia de melanoma. Su pronostico depende entre otros factores de la existencia de metastasis en los ganglios linfaticos regionales. La realizacion de la biopsia del ganglio centinela persigue la identificacion de metastasis ganglionares subclinicas como factor pronostico de la enfermedad. El presente estudio tiene por objetivo estudiar las diferencias entre los pacientes con melanoma, positivos y negativos a la biopsia del ganglio centinela, y analizar el impacto de esta tecnica en su pronostico. Material y metodos Se realizo biopsia del ganglio centinela a los pacientes con melanomas de espesor Breslow ≥1 mm o con Breslow Ademas, se recogieron las siguientes variables: sexo, edad, fototipo, localizacion y tipo de melanoma, niveles Breslow y Clark, ulceracion, regresion, estadio inicial, TNM, cambio de estadio y fallecimiento por melanoma. Resultados El 19,44% de los pacientes presento ganglios positivos. Esta positividad se presento asociada con el melanoma nodular (odds ratio cruda [ORc]: 3,44; intervalo de confianza al 95% [IC 95%]: 1,33–8,90) con respecto al melanoma de extension superficial Breslow superior a 2,0 (nivel 2,1–4,0: ORc: 21,14; IC 95%: 2,60–172,03, nivel >4,0: ORc: 23,25; IC 95%: 2,44–221,73), nivel Clark IV (ORc: 8,73; IC 95% 1,03–74,12), ulceracion (ORc: 4,86; IC 95%: 1,58–14,90), estadios T3 y T4 (T3: ORc: 4,20; IC 95%: 1,52–11,63; T4: ORc: 4,67; IC 95% 1,27–17,15), cambio de estadio (ORc: 7,20; IC 95%: 2,25–22,99) y fallecimiento por melanoma (ORc: 8,67; IC 95%: 3,62–96,15). Conclusiones Estos resultados confirman la importancia pronostica de la biopsia del ganglio centinela, que permite identificar a los pacientes con mayor tendencia a la progresion de la enfermedad y fallecimiento por melanoma.

Water chlorination leads to the formation of trihalomethanes (THM). In this case study, the levels of THM during the chlorination process of the drinking water in Valencia (Spain) were determined over a 12-year period. Different control areas and points were strategically sampled and samples were analyzed by gas chromatography. Temporal tendencies, as well as spatial and seasonal variations, were established. The individual distribution of THM was also evaluated. Factors such as distances from chlorination points and inter-month seasonal distribution, including ambient temperature effect, were assessed. The range of total THM concentrations measured in the water network goes from 4 to 184 µg L−1. However, from the year 2000, coinciding with an improvement in the quality scheme of the analytical method, no more than one sample per year is above the limiting level of 100 µg L−1 and the annual data dispersion becomes lower. Although the levels of THM virtually do not exceed the limits established by law, the...

Introduction and objectives The incidence of melanoma is currently increasing worldwide. One of the factors influencing disease prognosis is the presence of regional lymph node metastases. Sentinel lymph node biopsy attempts to identify subclinical lymph node metastasis as a prognostic factor in the disease. The aim of this study was to analyze differences between patients with melanoma for whom positive or negative results were obtained in sentinel lymph node biopsy and to assess the impact of the technique on disease prognosis. Material and methods Sentinel lymph node biopsy was carried out in patients with melanoma of the following characteristics: Breslow thickness ≥1mm, Breslow thickness Results Positive sentinel node biopsies were recorded in 19.44% of patients. Positive results were associated with the following variables: nodular melanoma (crude odds ratio [ORc] compared with superficial spreading melanoma, 3.44; 95% confidence interval [CI], 1.33–8.90); Breslow thickness >2.0, for a thickness of 2.1–4.0 (ORc, 21.12; 95% CI, 2.60–172.03) and for a thickness >4.0 (ORc, 23.25; 95% CI, 2.44–221.73); Clark level IV (ORc, 8.73; 95% CI, 1.03–74.12); ulceration (ORc, 4.86; 95% CI, 1.58–14.90); T3 (ORc, 4.20; 95% CI, 1.52–11.63) and T4 (ORc, 4.67; 95% CI, 1.27–17.15) in the TNM classification; change in cancer stage during follow-up (ORc, 7.20; 95% CI, 2.25–22.99); and death due to melanoma (ORc, 8.67; 95% CI, 3.62–96.15). Conclusions These results confirm the prognostic importance of sentinel lymph node biopsy, which facilitates identification of patients with a greater tendency towards disease progression and death due to melanoma.

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.

Introduction: The heritability of eating disorders has been estimated to range from 22% to over 62%.The aim of this study is to determine the relative influence of genetics and environment that contribute to the drive for thinness, body dissatisfaction, perfectionism, and ineffectiveness, by evaluating sex differences in a sample of adolescent twins from Valencia, Spain. Material and methods: Five hundred eighty-four pairs of adolescent twins between 13 and 18 years of age completed the study. To determine zygosity, teachers responded to a questionnaire on physical similarity. Psychological traits of eating disorders were assessed with four sub-scales of the Eating Disorder Inventory (EDI); drive for thinness, body dissatisfaction, perfectionism, and ineffectiveness. Twin models were used to assess genetic and environmental (common and unique) factors affecting these four psychological traits. Results: All four traits showed significant genetic contributions among girls, with heritability estimates of 37.7% for ineffectiveness, 42.8% for perfectionism, 56.9% for drive for thinness, and 65.5% for body dissatisfaction. Among boys, body dissatisfaction showed no additive genetic contributions, indicating significant shared and individual specific environment effects. The three other traits in boys showed significant additive genetic contributions, but were lower than in girls. Conclusions: With the exception of body dissatisfaction in boys, psychological traits of eating disorders show heritability patterns that differ according to sex. (C) 2014 SEP y SEPB. Published by Elsevier Espana, S.L.U. All rights reserved.

Background and objective: Twin and family studies support large genetic influences on variability in body mass index (BMI), with heritability estimates ranging from 47% to over 90%. Our objective was to study the relative contributions of genetics and environment to BMI, evaluating sex differences, in an adolescent twin sample from Valencia, Spain. Material and methods: Five hundred eighty-four pairs of adolescent twins between 13 and 18 years of age completed the study (82 monozygotic [MZ] and 87 dizygotic [DZ] pairs of male twins, 118 MZ and 102 DZ pairs of female twins, and 195 opposite-sex pairs of DZ twins). To determine zygosity, teachers responded a questionnaire on physical similarity. They also measured the participant's height and weight. BMI was calculated and weight status was determined according to age. We used twin models to assess genetic and environmental (common and unique) factors affecting BMI. Results: There was a 7.1% frequency of overweight and 2.8% of obesity. The estimated heritability of BMI was 88.0% in boys and 72.1% in girls, with the remaining variance attributable to non-shared environment in boys (12.0%) and 8.8% in girls. It was only in girls that common environment had an effect on BMI. Conclusions: Genetics appears to play an important role in explaining the variability in BMI in the adolescence, with slight variations between boys and girls. Common environmental factors exert their influence on BMI only in girls. (C) 2014 Elsevier Espana, S.L.U. All rights reserved.

Atopic Eczema (AE) is a chronic inflammatory skin disease that affects children and adults, and alters quality of life with a high morbidity rate and severe economic burden. The objective of the present work was to analyse specific atmospheric pollutants (O3, NO, PM10 and SO2) affecting the prevalence of diagnosed AE and its symptoms among 6-7-year-old schoolchildren.The participants included 21311 schoolchildren aged 6-7 years from 8 Spanish regions, whose parents completed the ISAAC Phase III questionnaire to ascertain AE diagnosis and symptoms. The mean levels (µg/m3) of O3, NO, PM10 (particles 10 micrometers or less in diameter) and SO2 were determined in each geographical area. Participating in this study.According to these mean levels, three levels of exposure to each pollutant were considered: level 1 (percentiles 0-25); level 2 (percentiles 26-74); level 3 (percentiles 75-100). Exposure to O3 was associated with increased prevalence of rashes (exposure level 2, Odds Ratio (OR): 1.22, 95% Confidence Interval (95%CI): 1.02-1.45; level 3 OR: 1.33, 95%CI: 1.10-1.61) and diagnosed AE (level 2, OR: 1.27, 95%CI: 1.17-1.39; level 3 OR: 1.27, 95%CI: 1.15-1.41). An association was found between the level of NO and a drop in the prevalence of diagnosed AE (exposure level 2, OR: 0.88, 95%CI: 0.81-0.95; level 3 OR: 0.85, 95%CI: 0.74-0.97). There was also an association between the highest exposure level to PM10 and a reduced prevalence of rashes (level 3 OR: 0.42, 95%CI: 0.22-0.81) and diagnosed AE (level 3 OR: 0.53, 95%CI: 0.38-0.75). Future studies into exposure to O3 and its relationship with allergic diseases may be conducted in order to prevent this association.

Aims: To explore the relation between employment status, type of unemployment and pregnancy outcomes. Methods: A cohort study of 7,282 pregnancies of unemployed women and 56,014 pregnancies among women in paid jobs was performed within the Danish National Birth Cohort. Pregnancy outcomes were ascertained and information about lifestyle, occupational, medical, and obstetric factors was obtained. Logistic regression was used to calculate odds ratios (OR) for fetal loss, congenital anomalies, multiple births, sex ratio, preterm and very preterm birth and small for gestational age status, adjusting for lifestyle, medical and obstetric factors. Results: There were no differences in pregnancy outcomes between employed and unemployed women but women receiving unemployment benefit had an increased risk of preterm birth (adjusted OR (aOR) 1.16, 95% confidence interval (95% CI) 1.03—1.31) and having a small for gestational age child (aOR 1.08, 95% CI 1.00—1.19) compared with employed women. Women receiving sickness or maternity benefit had an increased risk of multiple birth (aOR 1.70, 95% CI 1.43—2.04), preterm (aOR 1.47, 95% CI 1.22—1.77) and very preterm birth (aOR 1.88, 95% CI 1.22—2.89), while those receiving an unreported type of support had an increased risk of preterm birth (aOR 1.40, 95% CI 1.02—1.93). Conclusions: We found no indication that being unemployed during pregnancy benefits or endangers the health of the child. Within the subgroups of unemployed women, we observed that women receiving unemployment and sickness or maternity benefits were at higher risk for some adverse pregnancy outcomes. © 2011, the Nordic Societies of Public Health. 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

Background An increase in the number of overweight and obese subjects in the general population has been observed. The aim of this study was to determine the prevalence of overweight and obese subjects in the general population and its association with undiagnosed pathologies, such as diabetes mellitus [DM] and hypertension [HT], by taking age, gender and place of residence [rural or urban] into account. Findings A cross-sectional population-based survey was conducted in Castellón, East Spain in 2005–2006. The sample included 2,062 participants aged 18–94 years. Weight, height, blood pressure and glycaemia values were recorded, and information about gender, age and place of residence was obtained. Overweight, obesity, and undiagnosed HT and DM prevalences were calculated. Multiple regression analyses were done to assess the association of overweight/obesity with undiagnosed HT and DM by adjusting for age, gender and place of residence. The overall overweight, obesity, and undiagnosed HT and DM prevalences were 39.9% [95% CI:37.3–42.0], 25.9% [95% CI:24.0–27.9], 9.0% [95% CI:7.8–10.4] and 12.6% [95% CI:11.2–14.1], respectively. We identified various independent risk factors; those relating to overweight were increasing age, male gender and rural residential area, while that relating to obesity was increasing age. Compared to normal weight adults, the Relative Prevalence Ratio (RPR) for subjects who were overweight and had HT was 2.00 [95% CI:1.21–3.32]; that for obesity and HT was 1.91 [95% CI:1.48–2.46], and it was 1.50 [95% CI:1.25–1.81] for obesity and DM. Conclusion Overweight and obesity prevalences, and their association with undiagnosed DM and HT, are high in our study population.