[AIDS: a cause and consequence of poverty]. / El Sida como Causa y Consecuencia de la Pobreza.

The widespread consequences of the HIV/AIDS pandemic are well known; besides the obvious reduction in life expectancy, the epidemic has caused a decrease in economic productivity that has in turn affected entire sectors of society, including agricultural and educational fields. There is a tendency to associate HIV/AIDS with poverty. In other words, an increase in the poverty rate correlates with an increase in the probability of HIV/AIDS. This would seem to suggest that if the conditions of society could be improved, the spread of new infections could be checked. Although this may sound attractive, and may even be thought necessary and just, it would be a mistake to consider that a reduction in poverty is sufficient to prevent HIV/AIDS. HIV/AIDS is not necessarily, nor exclusively, " an infection and a disease of the poor. " Indeed, people with high economic and educational status have also been linked with a higher risk of developing HIV/AIDS. Prevention should be emphasized, taking into consideration that if this approach is to work there should be a change in current sexual behaviour. In order of priority, teenagers should be recommended to delay having sex. Partners should form a relationship based on trust and faithfulness. Lastly, those who do not accept these preventive measures should be advised that the use of condoms may "reduce risks" but not eliminate completely the spread of the disease. All of these preventive measures have been demonstrated as key aspects in the fight against HIV/AIDS in several countries. No country has been able to reduce the prevalence of HIV/AIDS relying solely on the promotion of condoms.

Incidence of eating disorders in Navarra (Spain).

PURPOSE: To estimate the overall annual incidence and age group distribution of eating disorders in a representative sample of adolescent female residents of Navarra, Spain. METHODS: We studied a representative sample of 2734 adolescent Navarran females between 13 and 22 years of age who were free of any eating disorder at the start of our study. Eighteen months into the study, we visited the established centers and the eating attitudes test (EAT-40) and eating disorder inventory (EDI) Questionnaires were administered to the entire study population. We obtained a final response of 92%. All adolescents whose EAT score was over 21 points and a randomized sample of those who scored 21 or below, were interviewed. Any person meeting the DSM-IV diagnostic criteria for Anorexia Nervosa (AN), Bulimia Nervosa (BN) or eating disorder not otherwise specified (EDNOS) was considered a case. RESULTS: We detected 90 new cases of eating disorders. Taking into consideration the randomly selected group whose EAT score was 21 points or below, we estimated the overall weighted incidence of eating disorders to be 4.8% (95% CI: 2.8-6.8), after 18 months of observation, in which EDNOS predominated with an incidence of 4.2% (95% CI: 2.0-6.3). The incidence of AN was 0.3% (95% CI: 0.2-0.5), while that of BN was also found to be 0.3% (95% CI: 0.2-0.5). The highest incidence was observed in the group of adolescents between 15 and 16 years of age. CONCLUSIONS: The overall incidence of ED in a cohort of 2509 adolescents after 18 months of follow-up was 4.8% (95% CI: 2.8-6.8), with EDNOS outweighing the other diagnoses. The majority of new cases of eating disorders were diagnosed between ages 15 and 16.

Distribution and determinants of sedentary lifestyles in the European Union.

BACKGROUND: Many studies have shown the health burden of a sedentary lifestyle. The main goal of this study was to determine the prevalence of sedentary lifestyles in the 15 Member States of the European Union (EU) and to identify the main correlates of a sedentary lifestyle. METHODS: Nationally representative samples (n approximately 1000 subjects in each country; >15 years) completed a questionnaire concerning attitudes to physical activity, body weight, and health; in total 15 239 subjects. Sedentary people were defined in two ways: (1) those expending less than 10% of their leisure time expenditure in activities involving >/=4 metabolic equivalents (MET). (2) Those who did not practice any leisure-time physical activity and who also were above the median in the number of hours spent sitting down during leisure time. Logistic regression models were fitted to analyse the association between sedentary lifestyles and gender, age, body mass index (BMI), educational level, weight change in the last 6 months, and marital and smoking status. RESULTS: Percentages of sedentary lifestyles across European countries ranged between 43.3% (Sweden) and 87.8% (Portugal) according to the first definition. According to both definitions, a lower prevalence of sedentary lifestyle was found in Northern countries (especially Scandinavian countries) as compared with Mediterranean countries, whereas the prevalence was higher among older, obese, less educated, widowed/divorced individuals, and current smokers. Similar relative differences between countries and socio-demographic groups were found independently of the method used to define a sedentary lifestyle. CONCLUSION: Prevalence of sedentary lifestyle in the EU is high, especially among inhabitants of some Mediterranean countries, obese subjects, less-educated people, and current smokers. This high prevalence involves important public health burdens and preventive strategies are urgently needed.

Neuroticism and low self-esteem as risk factors for incident eating disorders in a prospective cohort study.

OBJECTIVE: To assess the role of neuroticism and low self-esteem as risk factors for eating disorders (ED). METHOD: A representative sample of girls 12-21 years old from Navarre, Spain. Girls free from any ED in 1997 were followed up for 18 months and reevaluated using DSM-IV criteria. Multivariable logistic models were used to examine associations between neuroticism (Eysenck Inventory) or low self-esteem (36-item scale) and incident ED. RESULTS: Higher levels of neurotic personality increased the risk of ED (adjusted odds ratio [OR] for the highest quartile, 3.3; 95% Cl; 1.6-4.8). High levels of self-esteem were protective (OR, 0.32; 95% CI, 0.16-0.66). Neuroticism was a more powerful predictor than low self-esteem. DISCUSSION: Our results provide prospective evidence supporting the role of neuroticism and low self-esteem as major determinants of ED.

Parental factors, mass media influences, and the onset of eating disorders in a prospective population-based cohort.

OBJECTIVE: To identify risk factors for eating disorders. METHODS: A community cohort study was conducted in Navarra, Spain. A region-wide representative sample of 2862 girls who were 12 to 21 years of age completed the Eating Attitudes Test (40-item version) and other questionnaires in 1997. Girls who scored high in the Eating Attitudes Test-40 were interviewed by a psychiatrist who applied Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria to diagnose prevalent cases of eating disorders. Girls who were free of any eating disorder in 1997 were reassessed after 18 months of follow-up using the same methods. RESULTS: Ninety new cases of eating disorders according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria were identified during the follow-up. In the multivariate logistic analysis, a higher risk of incident eating disorder was found for several exposures assessed at the beginning of follow-up, such as younger age, usually eating alone (odds ratio [OR]: 2.9; 95% confidence interval: 1.9-4.6), and frequently reading girls' magazines or listening to radio programs (OR: 2.1; 1.2-3.8 for those most frequently using both media). No independent association was found for television viewing or socioeconomic status. A marital status of parents different from "being married" was associated with a significantly higher risk in the multivariate analysis (OR: 2.0; 1.1-3.5). CONCLUSIONS: Our results support the role of mass media influences and parental marital status in the onset of eating disorders. The habit of eating alone should be considered as a warning sign of eating disorders.

[Relative role of physical inactivity and snacking between meals in weight gain]. / Influencia del sedentarismo y el hábito de comer entre horas sobre la ganancia de peso.

BACKGROUND: Diet and life-styles are considered as the main factors that determine the high prevalence of obesity in Western societies. Although some countries have registered a decrease in fat intake, the percentage of overweight and obesity has increased. Therefore, it is thought that fat intake may not be the main factor that determines the current epidemic of obesity. The objective of this study was to determine the role of a sedentary life-style and eating between meals (snacking) as major determinants of a recent weight change (over last 5 years). METHOD: By using cross-sectionally baseline data of the SUN cohort, we adjusted non-conditional logistic regression models to estimate the odds ratio (OR) of gaining weight according to age, physical activity in leisure time, watching television, taking a nap, smoking, snacking and the intake of macronutrients. RESULTS: A statistically significant inverse association between leisure-time physical activity and the probability of gaining weight was found for men (OR = 0.93; CI 95%, 0.88-0.98) and a trend was also present among women. Snacking was positively associated with a higher probability of gaining weight among men (OR = 1.88; CI 95%, 1.40-2.53) and among women (OR = 1.38; CI 95%, 1.10-1.73). CONCLUSIONS: Our data suggest a direct association between snacking and weight gain in middle-aged people.

Self-esteem, personality, and eating disorders: baseline assessment of a prospective population-based cohort.

OBJECTIVE: To study the relationship of self-esteem and personality factors with eating disorders (ED). METHODS: A region-wide representative sample of 2862 girls 12-21 years old from Navarre (Spain) participated in the baseline assessment of a prospective study. A two-stage procedure was used, consisting in a first screening phase followed by a psychiatrist interview (DSM-IV criteria). Multivariable logistic regression models were used to examine the association of self-esteem (36-item scale) and personality characteristics (Eysenck inventory) with psychiatrist-diagnosed ED while controlling for potential confounders. RESULTS: Strong associations for ED were found with low self-esteem (adjusted odds ratio [adjOR] for the lowest quartile: 7.98, 95% CI: 3.4-18.8) and high levels of neuroticism (adjOR for the highest quartile: 9.49, 95% Cl: 3.7-24.5). DISCUSSION: Our results, although based on a cross-sectional design, support the potential role of neuroticism and low self-esteem in the onset of ED.

Percepción de la imagen corporal como aproximación cualitativa al estado de nutrición / Body image perception as an approach to assess nutritional status

Objetivo. Comparar la percepción de la imagen corporal con el índice de masa corporal (IMC) calculado a partir del peso y la talla declarados por los sujetos y valorar su capacidad para clasificar el estado de nutrición. Material y métodos. Se eligió una muestra representativa de la población de España, integrada por 517 hombres y 483 mujeres mayores de 15 años. Las variables fueron sexo, edad, nivel educativo, IMC e imagen corporal percibida. Las diferencias entre grupos se estimaron con la prueba de X2. La capacidad de clasificación de la imagen corporal se comparó con el IMC empleando la sensibilidad y la especificidad. Resultados. El estado nutricional para ambos indicadores mostró mayor sobrepeso en hombres y mayor obesidad en mujeres. Se observó que el sobrepeso y la obesidad se incrementan conforme aumenta la edad, y con mayor educación disminuyen. La percepción de la imagen corporal fue distinta entre sexos, así como por edad y nivel educativo (p<0.01). La comparación entre el IMC y la imagen corporal notificó valores superiores a 0.90 para sensibilidad y especificidad, así como para los valores predictivos positivos y negativos en sujetos que presentaron un estado nutricional que alcanzaba los rangos extremos. La precisión fue mayor para la sensibilidad que para la especificidad. La capacidad de clasificación fue mejor en mujeres que en hombres. La correlación de Spearman fue mayor en mujeres que en hombres (p<0.001) y la concordancia W de Kendal notificó valores altos para ambos sexos. Conclusiones. La percepción de la imagen corporal permitió identificar a los sujetos que presentaban nutrición normal y deficiente o excesiva; por tal motivo, este indicador puede resultar útil en estudios epidemiológicos, aunque tiene algunas limitaciones para diagnósticos individuales