Breastfeeding during the first 6 months of life, adiposity rebound and overweight/obesity at 8 years of age.

BACKGROUND: The question of whether breastfeeding protects the child from obesity is a still debated issue; however, the relationship between early adiposity rebound and higher risk of obesity is well known. This study was aimed at evaluating whether breastfeeding (without formula supplement) during the first 6 months of life delays the time of adiposity rebound and consequently reduces the rates of obesity at the age of 8. METHODS: This retrospective cohort study included 1812 children born in Gran Canaria in 2004, with follow-up until they were 8 years of age. Anthropometrical data had been taken during routine visits to the doctor and were extracted from medical record databases. Only children with breastfeeding for the first 6 months of life (173 children) and children without breastfeeding (192 children) were included. Children with mixed feeding and children whose data were not available were excluded. RESULTS: No body mass index (BMI) differences were found between children with breastfeeding (17.7) or without breastfeeding (17.3) during the first 6 months of life. The percentages of children with normal weight, overweight and obesity were similar in both groups, as well as the age of adiposity rebound breastfeeding 3.61 years; formula 3.64 years). Early adiposity rebound was associated with increased BMI at the age of 8, both in male and female children. CONCLUSIONS: Breastfeeding during the first 6 months of life was not demonstrated to delay the age of the adiposity rebound, in our study.

Symbolic dynamics marker of heart rate variability combined with clinical variables enhance obstructive sleep apnea screening.

Many sleep centres try to perform a reduced portable test in order to decrease the number of overnight polysomnographies that are expensive, time-consuming, and disturbing. With some limitations, heart rate variability (HRV) has been useful in this task. The aim of this investigation was to evaluate if inclusion of symbolic dynamics variables to a logistic regression model integrating clinical and physical variables, can improve the detection of subjects for further polysomnographies. To our knowledge, this is the first contribution that innovates in that strategy. A group of 133 patients has been referred to the sleep center for suspected sleep apnea. Clinical assessment of the patients consisted of a sleep related questionnaire and a physical examination. The clinical variables related to apnea and selected in the statistical model were age (p < 10(-3)), neck circumference (p < 10(-3)), score on a questionnaire scale intended to quantify daytime sleepiness (p < 10(-3)), and intensity of snoring (p < 10(-3)). The validation of this model demonstrated an increase in classification performance when a variable based on non-linear dynamics of HRV (p < 0.01) was used additionally to the other variables. For diagnostic rule based only on clinical and physical variables, the corresponding area under the receiver operating characteristic (ROC) curve was 0.907 (95% confidence interval (CI) = 0.848, 0.967), (sensitivity 87.10% and specificity 80%). For the model including the average of a symbolic dynamic variable, the area under the ROC curve was increased to 0.941 (95% = 0.897, 0.985), (sensitivity 88.71% and specificity 82.86%). In conclusion, symbolic dynamics, coupled with significant clinical and physical variables can help to prioritize polysomnographies in patients with a high probability of apnea. In addition, the processing of the HRV is a well established low cost and robust technique.

Predictive factors of destination at discharge after spinal cord injury.

INTRODUCTION: One of the main goals of the rehabilitation of patients with spinal cord injury (SCI) is the reintegration of the individual to their family, social, and work setting. The objective of this study was to identify the factors that determine the discharge destination after a traumatic spinal cord injury. MATERIAL AND METHODS: We conducted a retrospective descriptive study of 305 patients with SCI who completed the rehabilitation treatment at the spinal injury unit of Hospital Insular de Gran Canaria between 2001 and 2018. RESULTS: During the study period, we observed an increase in the number of patients referred to long-term care centres, from 9.14% between 2001 and 2010 to 18.4% between 2011 and 2018 (P < .01). Of 20 variables that presented a significant association with destination at discharge in the univariate study, 7 presented a significant association in the multivariate study: age (OR: 1.05; 95% CI, 1.02-1.08), living with a partner (OR: 0.26; 95% CI, 0.09-0.76), residing on another island (OR: 3.57; 95% CI, 1.32-9.63), smoking (OR: 3.44; 95% CI, 1.26-9.44), diabetes (OR: 6.51; 95% CI, 1.46-29.02), history of psychiatric disorders (OR: 3.79; 95% CI, 1.31-10.93), and scores on the Spinal Cord Independence Measure-III (SCIM-III) (OR: 0.48; 95% CI, 0.33-0.69). CONCLUSIONS: Our findings identified advanced age, living on the island of Tenerife, not being married, smoking, type 2 diabetes mellitus, history of psychiatric disorders, and low SCIM-III scores as predictive factors of referral to a long-term care centre in patients with traumatic SCI in the Canary Islands.

Effect of obesity on fragility fractures, BMD and vitamin D levels in postmenopausal women. Influence of type 2 diabetes mellitus.

AIMS: To see the effects of obesity on risk fracture, bone density (BMD), and vitamin D levels in a group of postmenopausal women, and consider how comorbid type 2 diabetes mellitus (T2DM) modifies them. METHODS: 679 postmenopausal women were grouped into obese and non-obese. Obese women were grouped into those with T2DM and those without. 25(OH)-vitamin D, PTH and BMD were measured, and prevalent fragility fractures were gathered. RESULTS: Obese women had higher prevalence of T2DM, than non-obese women. Levels of 25(OH)-vitamin D were lower and those of PTH higher in obese women, BMD values were higher in obese women. Diabetic-obese women had a higher prevalence of non-vertebral fractures than non-diabetic-obese. Multivariate logistic regression model showed association of fragility fractures with age, total hip BMD, BMI and T2DM. Obese women have higher BMD and lower 25(OH)-vitamin D values (and higher PTH) than non-obese, without diabetes. CONCLUSIONS: T2DM confers an increased risk of non-vertebral fractures in postmenopausal obese women.

[Factors associated with functional improvement in patients with cervical spinal cord injuries]. / Factores asociados a la mejoría funcional en pacientes con lesión medular traumática cervical.

OBJECTIVE: To determine the factors influencing functional improvement of cervical spinal cord injuries during hospital admission. MATERIAL AND METHODS: We performed a retrospective study of patients with an acute cervical spinal cord injury who had completed a rehabilitation programme in the Spinal Cord Injuries Unit of the Canary Islands between 2001 and 2018. To measure functional improvement, we administered the Spinal Cord Independence Measure III (SCIM III) on admission and at discharge. RESULTS: Of the 141 patients in our sample, 88% were men. Worse functional results were observed in older patients, those with a history of alcohol consumption, complete lesions and those with more severe lesions on the ASIA scale. Factors significantly associated with functional improvement were the interval between injury and admission to the unit, length of hospital stay, and the interval between injury and hospital discharge. CONCLUSIONS: Older patients, as well as those with a history of alcohol intake, complete lesions and greater severity on the ASIA scale, had worse functional outcomes. In contrast, early admission was crucial to obtain better functional outcomes and was associated with shorter hospital stays.

Hyperuricaemia as a prognostic factor for acute ischaemic stroke. / Uricemia como factor pronóstico del ictus isquémico agudo.

INTRODUCTION: Recent studies on uric acid as a biomarker for the prognosis of acute stroke have found conflicting results. METHODS: We collected blood samples from 600 consecutively admitted patients at our tertiary hospital and analysed the relationship between uric acid levels and functional prognosis (measured using the modified Rankin Scale [mRS]). Patients who had received reperfusion therapy were excluded since this may have influenced uric acid levels. RESULTS: A total of 73% of patients had mRS scores ≤2; the mean uric acid level was 5.22mg/dL. We found a nonlinear relationship between functional prognosis at discharge and serum uric acid levels at admission when the National Institutes of Health Stroke Scale score was excluded from the analysis. CONCLUSIONS: Serum uric acid levels in patients with acute ischaemic stroke are significantly associated with functional prognosis at discharge, although this relationship is nonlinear. In fact, poorer prognosis is associated both with very low and with very high concentrations of uric acid. This suggests a dual role of uric acid in relation to stroke: on the one hand, as an associated risk factor, and on the other, as a possible neuroprotective factor due to its antioxidant effect.

[Assessment of nutritional interventions and hygiene and health habits in a cohort of primary school students]. / Evaluación de dos intervenciones nutricionales y de hábitos de higiene y salud en una cohorte de alumnos de enseñanza primaria.

OBJECTIVE: To quantify by means of the so-called "Healthy lifestyle pyramid" and after two educational interventions, the changes in food intake, daily activities, and hygiene and health habits in the short and long terms in a cohort of healthy children. MATERIALS AND METHOD: prospective longitudinal study with baseline assessment of dietary and lifestyle habits, and two assessments after two educational interventions. RESULTS: 52 children participated, mean age 7.9 years, 15.4% of them being obese. There was a statistically significant reduction in whole milk intake in both the short and long term. There was a significant decrease in the short term in the intake of processed cold meat and an increase in fruit intake. There was a significant reduction in sweets intake in the short term. There was a statistically significant change in hand washing in the short and long terms, as well as in beach bathing after eating. There also was a significant change in achieving an appropriate posture and not bathing too far away, both in the long run. Finally, there was a significant change in the short term in not using inappropriate sports playing fields. The frequency at which they practise sports in the long term was significantly increased as well as the number of weekly sports, in the short term. CONCLUSIONS: After two educational interventions, the children did significant modifications of their health habits in the short term or the long term, which contributes to modify the risk factors for disease in the adulthood.

Cytokine distribution in mothers and breastfed children after omega-3 LCPUFAs supplementation during the last trimester of pregnancy and the lactation period: A randomized, controlled trial.

OBJECTIVE: To determine whether maternal diet supplementation with omega-3 long chain polyunsaturated fatty acids (omega-3 LC-PUFAs) during the last trimester of pregnancy and the breastfeeding period influences the levels of inflammatory cytokines in mother and infants. MATERIAL AND METHOD: This registered, double-blind randomized study included 46 pregnant women, who were randomly allocated to either an experimental group receiving 400mL/day of a fish oil-enriched dairy drink [320mg docosahexaenoic acid (DHA) + 72mg eicoapentaenoic acid] (FO group, n = 24) or to a control group receiving 400mL/day of a non-supplemented dairy drink (CT group, n = 22), from week 28 of pregnancy until the fourth month of lactation. During the study, maternal dietary patterns were monitored by a nutritionist, who encouraged compliance with current recommendations of fatty acids intake. DHA concentrations and cytokine levels (GM-CSF, IL-2, IL-4, IL-6, IL-10, INF-γ and TNF-α) were measured in maternal plasma at the moment of recruitment and in maternal (n = 46) and infant (n = 46) plasma at birth and 2.5 months after birth. RESULTS: Maternal plasmatic IL-4 levels were higher in FO than in CT subjects (p = 0.009). Additionally, a tendency was observed to higher IL-10 and IL-2 in the FO group. Plasmatic IL-6 however, was higher in CT mothers (p = 0.001). TNF-α was higher in CT infants at birth and 2.5 months after birth (p = 0.005). An analysis of possible relationships between DHA and the concentrations of different cytokines revealed negative correlation between maternal plasmatic IL-6 and DHA (higher plasmatic DHA corresponded to lower IL-6). CONCLUSIONS: Maternal dietary omega-3 LC-PUFAs supplementation during critical periods like pregnancy, lactation and early newborn development may influence the levels of certain inflammatory cytokines, reducing pro-inflammatory cytokines and promoting an anti-inflammatory "environment".

[Estimation of vitamin supplements and minerals consumption dispensed through pharmacy offices in the province of Las Palmas]. / Estimación del consumo de suplementos vitamínicos y minerales dispensados a través de las oficinas de farmacia de la provincia de Las Palmas.

BACKGROUND: Vitamin supplements and minerals consumption (SPM) is increasing in occidental societies due to the growing concern about health by the population. OBJECTIVES: To have a initial approaching to the to SPM consumption in the Province of Las Palmas through 2000 and 2001. To identify SPM proportions that are dispensed as pharmaceutical specialities and those who are sold as parapharmacy products. Finally, to describe the evolution of this consumption throughout a year. METHOD: The information was obtained through the list of the whole pharmaceutical specialities and parapharmacy products through 2000 and 2001 who have at least a vitamin in its composition and/or a mineral. RESULTS: Usually, 297 pharmaceutical specialities and 216 parapharmacy products are currently being sold. Pharmaceutical specialities comprised 65.6% of the whole products sold and within them, vitamins were the most dispensed (41.5%). Regarding parapharmacy products, vitamins and minerals compounds were the products more sold (34.6%). Comparing to 2000, during 2001 there was a statistically significant increase in the consumption of parapharmacy products, remaining without changes the use of pharmaceutical specialities. CONCLUSION: On the basis of sold XX SPM consumption seems to be due mainly by pharmaceutical specialities rather than parapharmacy products. Nevertheless through 2001 there was an increase only in the parapharmacy products.

Diagnosis of iron deficiency in chronic renal failure.

The cause of anemia in chronic renal failure is multifactorial. Decreased erythropoietin (EPO) production is the main pathogenetic factor, but iron deficiency is the primary cause of unresponsiveness to EPO therapy. The diagnosis of iron deficiency in patients with chronic renal failure is difficult. We assessed the sensitivity and specificity of serum ferritin, total iron-binding capacity, transferrin saturation index, erythrocyte ferritin, and serum transferrin receptor in 63 patients with chronic renal failure undergoing dialysis (47 men, 16 women) with iron deficiency anemia. They were selected on the basis of clinical stability and absence of factors that may interfere with iron metabolism. None of the patients had received intravenous iron therapy or recombinant human erythropoietin (rHuEPO). Bone marrow biopsy with iron staining was the reference standard for iron stores. The receiver operating characteristic (ROC) curve and the area under the curve were calculated to assess the sensitivity and specificity of iron metabolism parameters. The parameter with the largest area under the ROC curve was serum ferritin (0.83). A cut point of 121 microgram/L showed a sensitivity and a specificity of 75%. The areas under the ROC curves of serum transferrin receptor and erythrocyte ferritin were 0.69 and 0.68, respectively. The remaining parameters showed areas under the ROC curve less than 0.65. Although serum transferrin receptor and erythrocyte ferritin may be acceptable markers for iron deficiency in stable chronic renal failure patients, serum ferritin level continues to be the most reliable diagnostic parameter. Transferrin saturation index is not a reliable parameter for the diagnosis of iron deficiency in stable patients not treated with rHuEPO.

Role of different routes of tracheal colonization in the development of pneumonia in patients receiving mechanical ventilation.

STUDY OBJECTIVE: To evaluate the importance of the different pathogenic pathways involved in the development of ventilator-associated pneumonia (VAP). DESIGN: Prospective study. SETTING: An 18-bed medical and surgical ICU. PATIENTS: One hundred twenty-three patients receiving mechanical ventilation (MV). INTERVENTIONS: Tracheal, pharyngeal, and gastric samples were obtained simultaneously every 24 h. In cases where VAP was suspected clinically, bronchoscopy with protected specimen brush and BAL were performed. Semiquantitative cultures of pharyngeal samples and quantitative cultures for the remaining samples were obtained. RESULTS: Tracheal colonization at some time during MV was observed in 110 patients (89%). Eighty patients had initial colonization, 34 patients had primary colonization, and 50 patients had secondary colonization. Nineteen patients had VAP, and 25 organisms were isolated. For none of these organisms was the stomach the initial site of colonization. Gram-positive organisms colonized mainly in the trachea during the first 24 h of MV (p<0.001). On the contrary, enteric Gram-negative bacilli (p<0.001) and yeasts (p<0.002) colonized the trachea secondarily. Previous endotracheal intubation (p<0.005) and acute renal failure before admission to the ICU (p<0.001) were associated with colonization by Pseudomonas aeruginosa; prior antibiotics were associated with colonization by Acinetobacter baumanii (p<0.05) and yeasts (p<0.006); and cranial trauma was associated with Staphylococcus aureus colonization (p<0.035). CONCLUSIONS: Although the stomach can be a source of organisms that colonize the tracheobronchial tree, it is a much less common source of the bacteria that cause VAP. The pattern of colonization and risk factors may be different according to the type of organisms involved.

[Mortality and quality of life of patients beyond 65 years one year after ICU discharge]. / Mortalidad y calidad de vida al año del alta de una unidad de cuidados intensivos en pacientes mayores de 65 años.

BACKGROUND: Intensive care in elderly patients is a subject of controversy, because they generally present a high rate of mortality and short expectation of life. Due to the increasing life expectancy, more elderly patients will be treated in Intensive Care Unit (ICU) with an increasing consume of resources. The present study considers the mortality and quality of life (QOL) of patients beyond 65 years after ICU, and theirs predictors. PATIENTS AND METHOD: Retrospective study of patients >= 65 years admitted in multidisciplinaire ICU. Mortality and QOL (with modified EuroQOL Instrument) one year after discharge were studied. To determine mortality and QOL one year independent predicting factors, multiple logistic regression models were used. RESULTS: Of 313 patients studied, 95 (30%) died in ICU, 32 (10%) in hospital and 34 (11%) died after discharge. The independent predicting factors of mortality one year after ICU discharge were: organ failure (p < 0.000; odds ratio [OR], 2.9), cardiac surgery (p < 0.0000; OR, 0.15) and respiratory disease (p < 0.01; OR, 2.8). Of the 152 surviving patients, 21% got worse their previous QOL and only 17% were severely discapitated. The independent predicting factors of QOL one year after ICU discharge were: prior QOL (p < 0.0002; OR, 10.2) and age (p < 0.002; OR, 0.09). CONCLUSION: Despite the high one year after ICU discharge mortality rate (51%), 83% of the survivors were able to live independently. Due to dependence between mortality and multiorganic failure during ICU stay and not age, this latter cannot be the determining factor of the care level.

[Survival and quality of life of patients with multiple organ failure one year after leaving an intensive care unit]. / Supervivencia y calidad de vida de los pacientes con fracaso multiorgánico al año del alta de una unidad de medicina intensiva.

BACKGROUND: The patients' mortality with multiple organ failure (MOF) is very high and patients who consume the most resources are those with uncertain prognosis. In order to use the limited resources adequately, it is necessary to know the cost-benefit relationship of their treatment and in this study cost, mortality, quality of life (QOL) of survivors who developed MOF has been investigated. PATIENTS AND METHODS: Mortality in the Intensive Care Unit (ICU) and mortality QOL (with modified EuroQOL Instrument) one year after discharge were studied in 239 admitted patients who developed MOF. Cost was estimated from administrative dats of cost patients-day. To determine mortality independent predicting factors, a logistic regression model was used. RESULTS: Of the 239 patients studied, 144 (60%) died in ICU and 29 (12%) died after discharge. The independent predicting factors of mortality one year after discharge from ICU were: age (p < 0.1, odds ratio [OR] = 1.02), cardiac surgery (p < 0.0000, OR = 0.1899) and trauma (p < 0.05, OR = 0.2287). Of the 66 surviving patients, 18% were severely discapacitated. Forty one percent recovered their previous QOL, 18% improved it and 39% got worse. Patients with MOF consumed 64% of ICU total resources and of these, 77% was consumed by patients who died and by severely discapacitated. CONCLUSION: A high proportion of resources were used by MOF patients, but patients who died and who remained with worst QOL consumed the highest part. Although the mortality after one year was high (72%), 80% of the survivors achieved an acceptable QOL and for this reason, treatment of these patients should not be limited if survival and QOL predictions are not 100% correct.

[Genetic polymorphism of vitamin D receptor and osteoporosis]. / Polimorfismo genético del receptor de la vitamina D y osteoporosis.

BACKGROUND: Genetic factors condition an important part of bone mass. The role of vitamin D receptor polymorphism (VDR) as genetic marker of osteoporosis is a matter of discussion. We have studied the possible influence of VDR on bone remodelling, calciotropic hormones, on the presence of osteoporosis and osteoporotic bone fractures. PATIENTS, CONTROL POPULATION AND METHODS: A case-control study. We have studied a total of 127 postmenopausal Canarian women from Canary Islands, Spain; 66 healthy controls and 61 with the diagnosis of osteoporosis, which was made by clinical, radiological and densitometric criteria. 17 osteoporotic women have had a fracture: Colles, hip or vertebral (spinal deformity index) fracture. VDR were determined by PCR directed to demonstrate the presence (b) or absence (B) of a restriction target for Bsml in intron 7. We analyzed some biochemical markers of bone remodelling: serum levels of alkaline phosphatase, tartrate resistant acid phosphatase and urine ratios of calcium/creatinine and hydroxyproline/creatinine. We also determined calciotropic hormones: parathyroid hormone and calcitonin. Bone mass was measured by DEXA and TC. RESULTS: There were no significant differences in either biochemical bone remodelling markers or in bone mass between the three genotypes: bb, Bb and BB, either in controls or in osteoporotic women with the exception of alkaline phosphatase which had a significative increase compared to control in women with unfavorable alleles distribution (bB and BB). Distribution of genotypes was similar between controls and osteoporotic women, with or without fractures. CONCLUSIONS: In Canarian women, VDR genotype is not associated with changes in biochemical markers of bone remodelling or in bone mass or with the presence of osteoporosis or osteoporotic fractures.

[Distribution of habits related to health in a female Canarian population]. / Distribución de hábitos relacionados con la salud en una población femenina canaria.

BACKGROUND: To compare several anthropometric variables, obesity and some life-style (tobacco, coffee and alcohol consumption and physical activity during leisure time) in women 45 years old and older. METHODS: From the 1991 electoral roll, we obtained a population of 1221 women aged more than 45 years living in the island of Gran Canaria. A questionnaire and a physical examination including weight and height with light clothes was performed in every woman. Obesity was defined according to the Quetelet index, and weight (in kg) divided by height (in m) at square. RESULTS: Rural women aged more than 45 years old are heavier, have a larger corporal surface, have a higher Quetelet index, smoke less and do greater activity during leisure time than urban women the same age. We found no differences either in alcohol or coffee consumption. CONCLUSIONS: There are statistically significant differences between women that live in rural and urban habitats. Anthropometric variables (weight, corporal surface, Quetelet index) show higher values in rural women than in urban ones. On the other hand, tobacco consumption and sadentarism have a higher prevalence in the urban women compared to rural ones.

[Evolution of mortality attributable to tobacco in the Canary Islands (1975-1994)]. / Evolución de la mortalidad atribuible al tabaco en las Islas Canarias (1975-1994).

BACKGROUND: The objective of this study is that of describing the death rate attributable to tobacco on the Canary Islands throughout the 1975-1994 period. METHOD: Deaths by age, sex and cause from 1975 to 1994 were obtained from the Spanish National Institute of Statistics (Natural Movement of Population). Based on the Spanish and Canary Island Health Surveys, the percentages of those who had never smoked, smokers and ex-smokers for the Canary Island population were taken by age and sex. The relative risks of death were taken from the Cancer Prevention Study II carried out in the United States. The percentages of deaths attributable to smoking were calculated for each year, sex and age group based on the attributable fraction of the population. Likewise, the trend in the death rate attributable for the time period in question was calculated and given in the form of the annual mean percentage change in the age-adjusted death rates by way of a log-linear model. RESULTS: During the 1975-1994 period, the number of deaths attributed to smoking rose by 64%. For major causes, a 108% increase in neoplasias, a 32% drop in cardiovascular diseases and a 15.5% increase in respiratory diseases were found for the period under study. The number of deaths was also found to increase with age, the 65 and over age group having been found to be that in which the most deaths caused by smoking occurred. CONCLUSIONS: On the Canary Islands, over 20% of all deaths in 1994 can be attributed to smoking. This suggests that the measures implemented to control the smoking habit are insufficient.

[New population curves in spanish extremely preterm neonates]. / Nuevas curvas poblacionales de crecimiento en recién nacidos extremadamente prematuros españoles.

INTRODUCTION: Most anthropometric reference data for extremely preterm infants used in Spain are outdated and based on non-Spanish populations, or are derived from small hospital-based samples that failed to include neonates of borderline viability. OBJECTIVES: To develop gender-specific, population-based curves for birth weight, length, and head circumference in extremely preterm Caucasian infants, using a large contemporary sample size of Spanish singletons. PATIENTS AND METHODS: Anthropometric data from neonates ≤ 28 weeks of gestational age were collected between January 2002 and December 2010 using the Spanish database SEN1500. Gestational age was estimated according to obstetric data (early pregnancy ultrasound). The data were analyzed with the SPSS.20 package, and centile tables were created for males and females using the Cole and Green LMS method. RESULTS: This study presents the first population-based growth curves for extremely preterm infants, including those of borderline viability, in Spain. A sexual dimorphism is evident for all of the studied parameters, starting at early gestation. CONCLUSIONS: These new gender-specific and population-based data could be useful for the improvement of growth assessments of extremely preterm infants in our country, for the development of epidemiological studies, for the evaluation of temporal trends, and for clinical or public health interventions seeking to optimize fetal growth.

[Prevalence of vertebral fractures in hip fracture patients]. / Prevalencia de fracturas vertebrales en pacientes con fractura de cadera.

BACKGROUND: Fractures are the clinical complication of osteoporosis. There are no previous studies that describe the prevalence of vertebral fractures (VF) in patients admitted into a hospital due to a hip fracture (HF). OBJECTIVE: To study the prevalence of vertebral fractures in elderly women in the moment of their admission to the hospital due to a hip fracture. METHOD: This is a cooperative, multicentric, case-control study, performed in 21 different hospitals of Spain by the Working Group on Osteoporosis of the Spanish Society of Internal Medicine. A total of 143 elderly women with hip fractures comprised the case group. The control group consists of 138 elderly women admitted into other wards of the hospital due to other diseases with no relationship with osteoporosis. A questionnaire was administered and a lateral thoracic and lumbar X-ray was performed to assess vertebral fractures applying Genant's criteria. RESULTS: The mean age of the patients with HF was 79.8 +/- 6.9 years and the mean age of the controls was 77.7 +/- 8.9 years. Patients suffering from HF had less weight than controls (BMI: 25.9 +/- 4.4 g/m2 vs 27.7 +/- 5.2 kg/m2, p = 0.002). Prevalence of VF was 62.6% in patients with HF, and 50% in controls (p = 0.039). CONCLUSIONS: Elderly women admitted to a hospital due to hip fracture have a very high prevalence of previously undiagnosed VF. Indeed, elderly women admitted into the hospital because of other diseases also have a high prevalence of VF. These facts must be taken into account due to the morbidity and mortality of VF, that increases the HF morbidity and mortality.

Reduction of serum cholesterol and low-density lipoprotein cholesterol levels in a juvenile population after isocaloric substitution of whole milk with a milk preparation (skimmed milk enriched with oleic acid).

OBJECTIVE: To study the effects of serum lipid levels by isocaloric substitution of whole milk intake in a group of children with a milk preparation (fat-free milk enriched with oleic acid containing a small amount of cholesterol) that is frequently consumed in our community. DESIGN: A crossover clinical trial was carried out with random selection. There were 88 children of both sexes, ranging in age from 3 to 9 years, selected at a Primary Care Center. The children were divided into two homogeneous groups. The first group consumed whole milk for the first 7-month study period, whereas the second group drank the milk substitute. At the end of the first test period, serum lipid levels were measured. Then the type of diet was reversed: Group 1 children consumed the milk substitute whereas Group 2 children drank whole milk. The rest of their intake did not vary throughout the study. At the end of the second 7-month period we measured serum lipid levels again. The levels of serum lipid evaluated were total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, Apoprotein A1, Apoprotein B, and lipoprotein (a). For the statistical analysis the nonpaired and paired t tests were used. RESULTS: The mean level of cholesterol after taking whole milk was 4.53 mmol/L (175.26 mg/dl), and the mean level after taking the milk preparation was 4.2 mmol/L (162.65 mg/dl), which indicates a 7.2% decrease. The mean level of low-density lipoprotein cholesterol after whole milk intake was 2.73 mmol/L (106.1 mg/dl), whereas after consuming the milk preparation it was 2.47 mmol/L (96.1 mg/dl), which indicates a decrease of 9.5%. Triglycerides were reduced from 0.83 mmol/L (73.53 mg/dl) after whole milk to 0.72 mmol/L (63.79 mg/dl) after the milk substitute, which suggests a 13.25% decrease. High-density lipoprotein cholesterol, apoprotein A1, apoprotein B, and lipoprotein (a) did not undergo any significant change. CONCLUSIONS: To reduce serum levels of total cholesterol and low-density lipoprotein cholesterol, without reducing caloric intake, it may be beneficial to substitute the whole milk customarily consumed by children with a milk preparation of fat-free milk enriched with oleic acid.

[Factors associated with discontinuance of breastfeeding]. / Factores relacionados con el abandono de la lactancia materna.

OBJECTIVES: To determine possible factors that may influence the decision to stop breastfeeding. METHODS: We carried out a prospective study of 545 women who had given birth in the public hospitals of Gran Canaria. The study encompassed a 6-month postnatal lactation period. The chi-squared test was used to test the hypothesis of an association between variables. Odd-ratios were calculated for factors significantly associated with breastfeeding and were adjusted for the remaining factors using the logit method. RESULTS: Mothers were more likely to continue breastfeeding if they had made the decision to breastfeed before giving birth, had received information from health personnel during pregnancy, if they were older, if they were university graduates, if a short time had elapsed between giving birth and starting breast-feeding, if they had not given the baby a bottle in the first days after birth and if the birth had been normal without complications. The decision to stop breastfeeding was usually taken by the mother herself and was related to lactation problems (shortage of milk, the baby's hunger) and to personal difficulties. CONCLUSIONS: Once breastfeeding has begun, prenatal care factors as well as hospital practices strongly influence its continuation. Bottle feeding in the hospital is negatively associated with breastfeeding at 15 days and at 3 and 6 months. Socioeconomic and cultural factors as well as age are also determining factors. Personal reasons for discontinuing breast-feeding, such as the demands of work, become more frequent over time.