Use of the Superblock model for promoting physical activity in Barcelona: a one-year observational comparative study.

BACKGROUND: The Barcelona Superblock model transforms urban public spaces into active-friendly spaces, a key issue for public health. This study assessed the extent to which a newly developed Superblock in St. Antoni Market Square was used by citizens to perform physical activities and for sedentary behaviour during the first year of implementation. It then compared this citizens' use of the Superblock for physical activities and sedentary behaviour with a comparison site at one-year follow-up, when the Superblock was fully integrated into citizens' daily life. METHODS: This observational comparative study (May 2018-May 2019) used the System for Observing Play and Recreation in Communities (SOPARC). SOPARC assessed citizens' sitting, standing, walking, practice of vigorous activities and use of electric scooter by gender, age group and time of the day. At the Superblock site, two observers completed five weekly observations: the opening week, and at three, five, eight and twelve months. At the comparison site, observers completed one weekly observation at twelve months after the implementation of the Superblock. Observations included 4 days/week (including weekends) and, 4 h/day (morning, midday, afternoon, evening). RESULTS: At baseline, an average of 2,340 citizens/hour were observed using the Superblock but visits reduced by 12% in the next three observation weeks and 17.6% after one-year (mainly elderly and teenagers). At baseline, 92.9% walked in the Superblock, while 3.1% engaged in vigorous physical activity. After one year, citizens' walking decreased by 18.2%, from 2,170 citizens/hour at baseline to 1,930 citizens/hour. Citizens' engagement in vigorous activities also declined by 11%, from 73 citizens/hour at baseline to 65 citizens/hour at one-year follow up. In the comparison site, citizens' usage for walking and vigorous physical activity was similar to the Superblock. CONCLUSIONS: This is the first study to assess the extent to which citizens made use of the Barcelona Superblock model to perform physical activities, an urban built-environment intervention that is both novel and health-enhancing. The Superblock model would benefit from strategies maximizing effectiveness for promoting superblock-based physical activity, with special focus on seniors and teenagers.

From Secondary School to University: Associations Between Domain-Specific Sedentary Behaviors and Lifestyle Risk Behaviors.

This study examined associations between changes in domain-specific sedentary behaviors and changes in health-related lifestyles of Spanish secondary school students (n = 113) to their first year of university. During the transitions from the end of high school to the beginning of university, engagement in sedentary behaviors have emerged as potential additional behavioral risk factors. Understanding how sedentary behaviors interconnect with other (un)healthy behaviors will inform interventions on multiple risk behaviors across this critical life period. A 3-year longitudinal survey assessed associations between domain-specific sedentary behaviors and leisure time physical activity (IPAQ), alcohol and tobacco consumption, and fruit and vegetable intake (24-h dietary recall), using Generalized Estimating Equations. Spending time on sedentary transportation was associated with a greater likelihood of smoking, whereas sedentary weekend homework was associated with a reduced likelihood of consuming alcohol. The lowest and highest tertiles for sedentary screen use and leisure-time PA were also less likely not to meet the recommendations for fruit and vegetable consumption. For specific sedentary behaviors, associations were gender-based or affected by leisure time physical activity. From secondary school to university, specific sedentary behaviors are linked to lifestyle risk factors. Over this transitional period, public health interventions targeting reduced sedentary behaviors may bring multiple benefits by also preventing other harmful behaviors.

Fear of Falling in Older Adults Treated at a Geriatric Day Hospital: Results from a Cross-Sectional Study.

(1) Background: The fear of falling (FOF) is a geriatric syndrome that causes a decrease in daily activities and personal autonomy. Its prevalence is highly variable as are the methodologies used to assess it. This study aimed at estimating the prevalence and describing the main determinants of FOF in older adults attending a geriatric day hospital. (2) Methods: Descriptive, cross-sectional study of individuals aged ≥70 years, who attended an ambulatory functional rehabilitation group in the metropolitan area of Barcelona. FOF was assessed using the Activities-Specific Balance Confidence (ABC) scale. Other recorded outcomes were: sex, age, marital status, living alone, level of education, degree of autonomy, pain, previous falls, visual acuity, and signs of depression. Prevalence was estimated overall and according to the possible determinants. (3) Results: The study included 62 individuals (66.1% women), with a prevalence of fear of falling of 38.7% (95% CI 26.2-51.2%). The identified determinants were pain (OR = 7.4, 95% CI 1.4-39.7), a history of falls (OR = 25.3, 95% CI 2.1-303.4), poor visual acuity (OR = 5.6, 95% CI 1.0-29.8), and signs of depression (OR = 19.3, 95% CI 1.4-264.3). (4) Conclusions: The prevalence and determinants of fear of falling in older adults attending geriatric day hospitals were similar to those described in those dwelling in the community.

ActivPAL™ determined sedentary behaviour, physical activity and academic achievement in college students.

The aim of this study was to examine relationships between activPAL™-determined sedentary behavior (SB) and physical activity (PA) with academic achievement. A total of 120 undergraduates (N = 57 female; 20.6 ± 2.3 years) participated in the study. Academic achievement was measured as the grade point average obtained from all completed courses. Participants wore on the right tight an activPAL™ for 7 days to determine total sedentary time, total number of sedentary breaks, sedentary bouts, standing time, light and moderate-to-vigorous physical activity (MVPA). Separate multiple linear regression models were performed to examine associations between SB variables and academic achievement. Light PA, MVPA, total sedentary time, total standing time, or total number of sedentary breaks were not related to academic achievement. Independently of PA, the amount of time spent in sedentary bouts of 10-20min during weekdays was positively related to academic achievement. Given that college students spend the majority of their workday in environments that encourage prolonged sitting, these data suggest that interruptions in prolonged periods of sitting time every 10-20min via short breaks may optimize cognitive operations associated with academic performance.

The association of context-specific sitting time and physical activity intensity to working memory capacity and academic achievement in young adults.

Background: To examine combined associations between self-reported context-specific sitting time (ST) and physical activity (PA) with working memory capacity (WMC) and academic achievement in a sample of Spanish adults. Design: Undergraduate students (n = 371; 21 years ± 3 years, 44% female) were recruited from University of Vic-Central University of Catalonia. Methods: Participants completed a 54-item survey that assessed socio-demographic variables (e.g. age, gender, academic year), min/week of light (LPA), moderate (MPA) and vigorous (VPA) intensity PA (International Physical Activity Questionnaire), min/day of domain-specific ST (Last 7 days sedentary behavior questionnaire) and academic performance (grade point average). WMC was assessed through a multiple complex span task that included: Operation Span, Symmetry Span and Rotation Span. These tasks interleave a processing task with a short list of to-be-remembered items. General linear models-adjusted by PA, ST and gender-assessed combined associations between ST and PA with WMC and academic achievement. Results: Performing more than 3 h/week of MPA was related to increases in WMC (P < 0.001). However, PA was not associated with academic performance. More than 3 h seated on a weekend day while performing non-screen leisure activities were related to reduced WMC after adjusting for PA (P = 0.012). Similarly, >3 h/weekday spent seated in these sedentary activities or in leisure-forms of screen time were inversely associated with academic performance regardless of PA (P = 0.033; P = 0.048). Conclusions: MPA may benefit working memory; however, specific domains of leisure-time sedentary behavior may have an unfavorable influence on working memory and academic performance regardless of time spent in PA.

Improvements in hip fracture incidence counterbalanced by the rise of other fracture types: data from Spain 2000-2010.

BACKGROUND: In recent years, the incidence of injury in older people has increased. The aim of this study is to address the hypothesis that this increase is due to an increase in the incidence of some injuries that, while less common than hip fractures, are sufficient jointly to counteract the decrease or stabilisation in hip fracture rates observed in most countries. METHODS: We performed a descriptive study of trends using data from the National Hospital Discharge Register. We included individuals 65 years and older who were discharged from a Spanish hospital during the period 2000-2010 with at least one injury diagnosis in the primary diagnosis field on the discharge form. The dependent variables were the following injury groups, classified using the Barell Matrix: hip fracture, shoulder and upper arm fractures, forearm and elbow fractures, thoracic fractures, lower leg and ankle fractures, and TBI type 1 internal injury. Incidence rates were calculated per 100,000 inhabitants (data from National Statistics Institute) and stratified by sex and age group. Trends, in terms of Annual Percent Change (APC), were assessed using Poisson Regression with discharge year as the independent variable. RESULTS: Hip fracture continues to be the most important injury type in older people. Thoracic fractures and TBI internal injuries are more common in men, while fractures in the upper extremities are more common in women. All injuries increased in frequency with age, except lower leg and ankle fractures, which decreased. While a secular decreasing trend in hip fracture was noted, the incidences of fractures of the shoulder and upper arm, forearm and elbow, and lower leg and ankle, as well as of TBI type 1 internal injuries have increased steadily. CONCLUSIONS: Although hip fracture continue to be the most common type of injury in older people, this study has allowed identifying other types of injury that are becoming increasingly common. These trends are driving paradigm changes in the burden of injuries requiring treatment within the hospital system, and must be taken into account in the design of preventative programs and actions.

Incidence trends of injury among the elderly in Spain, 2000-2010.

BACKGROUND: The significant growth in the elderly population expected in the coming years demands a thorough and up-to-date understanding of the incidence of injuries in this group for purposes of prevention polices and their evaluation. The aim of this study was to describe the incidence of injuries in hospital inpatients over 64 years of age in Spain, stratified by sex, age group, and the severity and mechanism of injury, and to analyse trends in incidence during the period 2000-2010. METHODS: Descriptive trends study using data from the National Hospital Discharge Register. The dependent variable was the number of hospital discharges with injury. Stratified incidence rates were calculated per 100,000 inhabitants. Trends, in terms of annual per cent change, were assessed using Poisson regression with discharge year as the independent variable. RESULTS: Rates of injury were higher among women than men, increased with age in both sexes, with individuals aged ≥85 years having a fivefold greater risk than those aged 65-69 years. During the period 2000-2010, incidence increased annually by 1.1% in men and 0.9% in women aged 75-79 years, 2.3% and 1.6% in 80-84-year-olds and 3.3% and 2.4% in ≥85-year-olds, respectively. The incidence of all levels of injury severity and all mechanisms of injury increased during the study period, except for traffic injuries, which decreased. CONCLUSIONS: Incidence of injury in the elderly is rising, particularly in older individuals, indicating that the increase in the number of hospitalisations is not a consequence of population aging only.

Commentary: approaches, strengths, and limitations of avoidable mortality.

Publication of recent papers such as the one by Schoenbaum and colleagues entitled 'Mortality Amenable to Health Care in the United States: The Roles of Demographics and Health Systems Performance' has stimulated this commentary. We discuss strengths and limitations of amenable and avoidable mortality in health-care systems' performance and their contribution to health inequalities. To illustrate, we present a case study of avoidable and amenable mortality in Spain over 27 years. We conclude that amenable mortality is not a good indicator of health-care systems' performance, or for determining whether it could give rise to health inequalities. To understand health problems and to assess the impact of interventions affecting health requires good, basic, and routine monitoring of health indicators and of socioeconomic determinants of health.

[Definition of hospital discharge, serious injury and death from traffic injuries]. / Definición de alta hospitalaria, lesión grave y muerte por lesiones por tráfico.

Road traffic injury surveillance involves methodological difficulties due, among other reasons, to the lack of consensus criteria for case definition. Police records have usually been the main source of information for monitoring traffic injuries, while health system data has hardly been used. Police records usually include comprehensive information on the characteristics of the crash, but often underreport injury cases and do not collect reliable information on the severity of injuries. However, statistics on severe traffic injuries have been based almost exclusively on police data. The aim of this paper is to propose criteria based on medical records to define: a) "Hospital discharge for traffic injuries", b) "Person with severe traffic injury", and c) "Death from traffic injuries" in order to homogenize the use of these sources.

Incidence trends of traumatic spinal cord injury and traumatic brain injury in Spain, 2000-2009.

AIMS: The aim of the present study was to estimate the incidence of hospital discharges for traumatic spinal cord injury (TSCI) and traumatic brain injury (TBI) in Spain by injury circumstances (traffic crashes and others), injury severity, gender and age group and to describe its trends over the period 2000-2009. METHODS: It is a study of trends that includes hospital discharges with a primary diagnosis of TSCI or TBI. Crude and age-standardised rates were calculated per million inhabitants. Changes in rates between 2000 and 2009 were assessed through calculation of the relative risk adjusted for age, using Poisson regression. RESULTS: Between 2000 and 2009 in Spain, 10,274 patients were admitted for traumatic TSCI, and 206,503 for TBI. The annual incidence rate for TSCI was 23.5 per million, that for TBI was 472.6 per million. The overall incidence rate for TSCI fell significantly between 2000 and 2009 by 24.2% (traffic-related 40.9%, other 12.9%), as did that for TBI (23.8% overall, 60.2% traffic-related, with no change for other circumstances). Among people aged 65 years and over, no change was observed for TSCI, incidence of TBI fell significantly when due to traffic crashes, but there was a dramatic increase of 87% in men and 89.3% in women when due to other circumstances. CONCLUSIONS: Over the last decade the incidence of these types of injury has fallen significantly when the injury resulted from traffic crashes, and to a lesser extent when from other circumstances. However TBI incidence among people aged 65 and over injured in non-traffic-related circumstances has risen dramatically.

[Motor vehicle crash fatalities at 30 days in Spain]. / Fallecidos a 30 días por lesiones producidas en accidente de tráfico en España.

OBJECTIVES: To assess level of fulfillment and utility of the hospital discharge register (HDR) as a complementary source of information for estimating the number of deaths at 30 days due to motor vehicle crashes in Spain. METHODS: It is a cross-sectional study were we compared the number of people injured due to motor vehicle crashes hospitalised in a public hospital (HDR), in Spain during 2001, with the number of people severely injured or killed due to motor vehicle crashes reported by the police database (Dirección General de Tráfico, DGT) for the same year. A descriptive analysis was carried out by age, sex and region (Autonomous Community), as well as an estimation of the percentage of under-reporting of deaths by the DGT based on two assumptions. RESULTS: Police reported 27,272 severe injuries and 4,811 deaths during first 24 hours after the crash and after applying a fatality adjustment factor estimated 706 more deaths up to 30 days after the crash. The HDR reported 40,174 urgent hospitalisations. Of these, 1,099 died during the day of hospitalisation or within the following 30 days. The police only notified 68% of all cases that required hospitalisation. According to the number of deaths reported by police and contrasted with hospital register, estimations of the number of deaths at 30 days made by police could represent a level of under-reporting of between 3% and 6.6%, depending on the assumption considered. CONCLUSIONS: This study showed that the HDR is an information source that complements police statistics and is useful to estimate the number of deaths and non-fatal injuries due to motor vehicle crashes in Spain.

[Looking for a needle in a haystack: record linkage techniques in health information systems]. / Buscando una aguja en un pajar: las técnicas de conexión de registros en los sistemas de información sanitaria.

Linking records from two or more data sets with information on an issue allows us to identify those belonging to the same individual. The linkage process can be manual, deterministic, or probabilistic. Probabilistic linkage was developed for those situations where there is no single identifier, the number of identifying variables is limited, and they have little discriminating power. Considering the possibilities for the linkage to be correct or incorrect and based on the degree of agreement among variables and their frequencies, this process weights each variable. This manuscript presents linkage techniques, describes probabilistic linkage step by step, and illustrates it with examples taken from the actual operation of our services.

Prevalence of urinary incontinence in Andorra: impact on women's health.

BACKGROUND: Urinary incontinence (UI) is a frequent public health problem with negative social consequences, particularly for women. Female susceptibility is the result of anatomical, social, economic and cultural factors. The main objectives of this study are to evaluate the prevalence of UI in the female population of Andorra over the age of 15 and, specifically, to determine the influence of socio-demographic factors. A secondary aim of the study is to measure the degree of concern associated with UI and whether the involved subjects have asked for medical assistance, or not. METHODS: Women aged 15 and over, answered a self-administered questionnaire while attending professional health units in Andorra during the period November 1998 to January 2000. A preliminary study was carried out to ensure that the questionnaire was both understandable and simple. RESULTS: 863 completed questionnaires were obtained during a one year period. The breakdown of the places where the questionnaires were obtained and filled out is as follows: 32.4% - medical specialists' offices; 31.5% - outpatient centres served exclusively by nurses; 24% - primary care doctors' offices; 12% from other sources. Of the women who answered the questionnaire, 37% manifested urine losses. Of those,45.3% presented regular urinary incontinence (RUI) and 55.7% presented sporadic urinary incontinence (SporadicUI). In those women aged between 45 and 64, UI was present in 56% of the subjects. UI was more frequent among parous than non-parous women. UI was perceived as a far more bothersome and disabling condition by working, middle-class women than in other socio-economic groups. Women in this particular group are more limited by UI, less likely to seek medical advice but more likely to follow a course of treatment. From a general point of view, however, less than 50% of women suffering from UI sought medical advice. CONCLUSION: The prevalence of UI in the female population of Andorra stands at about 37%, a statistic which should encourage both health professionals and women to a far greater awareness of this condition.