Impact of hospitalization on nutritional status in persons aged 65 years and over (NUTRIFRAG Study): Protocol for a prospective observational study.

BACKGROUND: Malnutrition is a recurring problem that has become more relevant in recent years. The aim of this study is to assess the risk of malnutrition and nutritional status on admission and its evolution until discharge in patients aged 65 and over admitted to medical and surgical hospitalization units in hospitals of the Spanish National Health System. METHODS: Prospective observational study to be carried out in the medical-surgical hospitalization units of 9 public hospitals between 01/09/2022 and 31/12/2024. Using consecutive sampling, a total of 4077 patients will be included (453 in each hospital). Variables included are related to the care process, functionality, cognition and comorbidity, risk profile, nutritional status and dysphagia; as well as frailty, dietary quality and contextual variables. The incidence of risk of malnutrition, undernutrition and dysphagia during the care process and at discharge will be calculated. The association with risk factors will be studied with logistic regression models and multivariate Cox regression models. In addition, an analysis of participants' satisfaction with food services will be carried out. The study was approved by the Ethics and Research Committee on 30/09/2020, approved for funding on 02/12/2021 and with registration number RBR-5jnbyhk in the Brazilian clinical trials database (ReBEC) for observational studies. DISCUSSION: Some studies address nutritional status or dysphagia in older people in various care settings. However, there is a lack of large sample studies including both processes of the impact of hospitalization. The results of the project will provide information on the incidence and prevalence of both pathologies in the study subjects, their associated factors and their relationship with the average length of stay, mortality and early readmission. In addition, early detection of a problem such as malnutrition related to the disease and/or dysphagia during a hospital stay will favor the action of professionals to resolve both pathologies and improve the health status of patients.

Health Determinants Associated with the Mediterranean Diet: A Cross-Sectional Study.

INTRODUCTION: The Mediterranean diet (MD) has been shown to be a good tool for the prevention of obesity and other chronic noncommunicable diseases (NCDs) and to have a low environmental impact. The aim of the present study was to evaluate the relationship between declared morbidity, lifestyles and other sociodemographic factors with high adherence to the MD (AMD) in an adult population in southeastern Spain. MATERIAL AND METHODS: We conducted a cross-sectional study of a sample (n = 2728) representative of a non-institutionalized population ≥16 years. The data corresponded to the 2010-11 Nutrition Survey of the Valencian Community. The AMD was assessed using the Mediterranean Diet Adherence Screener questionnaire. The association of variables and high AMD was assessed by univariate and multivariate logistic regression determining crude and adjusted odds ratios. RESULTS: Multivariate analysis showed that age 45 years or older, living with a partner, eating between meals, and not smoking were associated with high AMD. The age groups 45-64 years and 65 years or older showed the strongest association with high AMD in both sexes. CONCLUSION: The investigation showed a generational loss of AMD. People older than 45 years and living in company are more likely to adhere to DM, the risk group being young people living alone and smokers.

[Lifestyles and sociodemographic factors associated with high adherence to the Mediterranean diet in the adult population of the Comunitat Valenciana (Spain)]. / Estilos de vida y factores sociodemográficos asociados a la alta adhesión a la dieta mediterránea en la población adulta de la Comunidat Valenciana (España).

INTRODUCTION: Background: chronic non-communicable diseases represent a challenge for public health, and the Mediterranean diet (MD) has been identified as an alternative for their prevention. Aim: the study aimed to evaluate, in a sample of the adult population of the Comunitat Valenciana, the association between lifestyle and sociodemographic factors with high adherence to MD. Methods: a cross-sectional study of a sample (n = 2,728) representative of the population ≥ 16 years of age. The data were collected from the Comunitat Valenciana Nutrition Survey 2010-11. MD adherence was assessed using the Mediterranean Diet Adherence Screener questionnaire. The association of the variables with high MD adherence was tested using univariate and multivariate logistic regression, determining the crude and adjusted odds ratios. Results: a multivariate analysis showed that age, type of cohabitation, country of birth, eating between meals, and smoking were associated with high adherence to MD. The age groups of 45-64 years and 65 years or older showed the greatest association with high adherence to MD in both sexes. Living with a partner was positively associated with high adherence to MD in men, women, and the age group of 45-64 years. Conclusion: a generational loss of MD adherence was observed. Younger people and those who do not live with a partner showed the highest risk of not adhering to the Mediterranean dietary pattern.

INTRODUCCIÓN: Introducción: las enfermedades crónicas no transmisibles representan un reto para la salud pública, y la dieta mediterránea (DM) se ha identificado como alternativa para su prevención. Objetivo: el estudio pretendió evaluar, en una muestra de la población adulta de la Comunidat Valenciana, la asociación entre estilos de vida y factores sociodemográficos con la adhesión alta a la dieta mediterránea (DM). Métodos: estudio transversal de una muestra (n = 2728) representativa de la población ≥ 16 años. Los datos correspondieron a la Encuesta de Nutrición de la Comunidat Valenciana, 2010-11. Se evaluó la adhesión a la DM (ADM) mediante el cuestionario Mediterranean Diet Adherence Screener. Se testó la asociación de las variables con la ADM alta mediante la regresión logística univariante y multivariante, determinándose las odds ratios crudas y ajustadas. Resultados: el análisis multivariante mostró que la edad, el tipo de convivencia, el país de nacimiento, el comer entre horas y el hábito tabáquico se asociaban a la ADM alta. Los grupos de edad de 45-64 años y de 65 años o más fueron los que mostraron una mayor asociación a la ADM alta en ambos sexos. La convivencia en pareja se asoció positivamente con la ADM alta en los hombres, las mujeres y el grupo de edad de 45-64 años. Conclusión: se observó una pérdida generacional de la ADM. Las personas más jóvenes y aquellas que no conviven en pareja son las que mostraron mayor riesgo de no adherirse al patrón dietético mediterráneo.

Adaptation and Evaluation of the Nutrition Environment Measures Survey in Stores to Assess Mediterranean Food Environments (NEMS-S-MED).

The Nutrition Environment Measures Surveys are valid and reliable measures of community and consumer food environments. This article describes the adaptation and evaluation of the Nutrition Environment Measures Survey in Stores (NEMS-S) for Mediterranean urban contexts (NEMS-S-MED). Trained raters used the adapted NEMS-S-MED tool to observe and rate food outlets in 21 census tracts and 43 food stores across the city of Madrid, Spain. We evaluated inter-rater and intra-rater reliabilities, construct validity, and the tool's ability to discriminate between store types and between stores by area-level Socio-Economic Status (SES). Overall, the mean NEMS-S-MED score was 20.7 (SD = 9.8), which ranged from 7 to 43. Most food items displayed substantial or almost perfect inter-rater and intra-rater agreements; the percentage agreement across availability items was almost perfect and kappa statistics were also very high (median κ = 1.00 for inter-rater; κ = 0.92 for intra-rater). Furthermore, the NEMS-S-MED tool was able to discriminate between store types and census tracts of different SES. The adapted NEMS-S-MED instrument is a reliable and valid audit tool to assess the consumer food environment in Mediterranean urban contexts. Well-constructed measurement tools, such as the NEMS-S-MED, may facilitate the development of effective policy interventions to increase healthy food access and affordability.

Cultural Adaptation and Evaluation of the Perceived Nutrition Environment Measures Survey to the Mediterranean Spanish Context (NEMS-P-MED).

Individuals' perceptions of their food environments are a mediator between exposure to the environment and people's interaction with it. The Nutrition Environment Measures Surveys (NEMS) are valid and reliable measures to assess food environments. In Spain, there is no adapted instrument to measure the perceived obesogenic environment. This article aims to adapt and evaluate the Perceived Nutrition Environment Measures Survey for a Spanish context (NEMS-P-MED). The Spanish version has 32 questions to measure the perception about availability, accessibility and marketing of 3 types of environment: home, shops and restaurants. We assess feasibility, construct validity and internal consistency reliability through a sample of 95 individuals. The internal consistency was acceptable for most items (Cronbach's alpha coefficients range from 0.6 to 0.9), similar to that of the original scale. The NEMS-P-MED has been shown to be valid and, on certain items reliable, and was useful to assess the population's perceptions of the food environment in the home, restaurants and food stores in a Spanish context. Adapting standardized measurement tools to specific contexts to assess the perceived and observed characteristics of food environments may facilitate the development of effective policy interventions to reduce excess weight.

[Different classification of an adult population by two validated indexes of adherence to the Mediterranean diet]. / Diferente clasificación de una población adulta por dos índices validados de adherencia a la dieta mediterránea.

INTRODUCTION: Background: the Mediterranean diet (MD) has been related to a good state of health. There are different index to evaluate the adherence to Mediterranean dietary pattern. Objective: the purpose of the study was to evaluate the classification of the adult population of the Comunitat Valenciana according to their suitability to the MD using two validated indexes, and analyze the degree of agreement between them. Methods: methodological study of the concordance of classification of a population through two instruments for measuring adherence to MD, of a representative sample of 2,728 adult of the Comunitat Valenciana. Data obtained from Encuesta de Nutrición de la Comunitat Valenciana 2010-2011. The adhesion was determined by "Puntuación Modificada de Dieta Mediterránea" and "Cribado de Adherencia de Dieta Mediterránea". The population was classified as low, medium or high according to each index. A statistical analysis was performed for qualitative and quantitative variables. The concordance of the indexes was evaluated by the Kappa test. Results: in both indixes, the highest percentage (41% and 71%, respectively) of the population was in medium adherence to MD. Between both indexes, the value of the kappa index was 0.169, for men 0.163 and for women 0.174. By age groups: 0.158 for those aged 16-24 years, 0.139 for 25-44 years, 0.185 for 45-64 years, and 0.161 for those over 64 years. Conclusions: the two indexes tested showed a degree of poor agreement and classified the same population differently.

INTRODUCCIÓN: Introducción: la dieta mediterránea (DM) se relaciona con un buen estado de salud. Existen diferentes propuestas validadas de índices para evaluar la adherencia al patrón dietético mediterráneo. Objetivos: la finalidad del estudio fue evaluar la clasificación de la población adulta de la Comunitat Valenciana según su adecuación a la DM, utilizando dos índices validados y analizar el grado de concordancia entre ellos. Métodos: estudio metodológico sobre la concordancia de clasificación de una población a través de dos instrumentos de medición de la adhesión a la DM, sobre una muestra representativa de 2.728 individuos adultos de la Comunitat Valenciana. Datos obtenidos de la Encuesta de Nutrición de la Comunitat Valenciana 2010-2011. La adhesión se determinó mediante "Puntuación Modificada de Dieta Mediterránea" y "Cribado de Adherencia de Dieta Mediterránea". La población se clasificó en adhesión baja, media o alta según cada índice. Se realizó un análisis estadístico para variables cualitativas y cuantitativas. Se evaluó la concordancia de los índices por la prueba Kappa. Resultados: en ambos índices, el mayor porcentaje (41% y 71%, respectivamente) de población se situó en una adhesión media a la DM. Entre ambos índices el valor del índice kappa fue de 0,169, para hombres de 0,163 y para mujeres de 0,174. Por grupos de edad: 0,158 para los de 16-24 años, 0,139 para 25-44 años, 0,185 para 45-64 años y, 0,161 para mayores de 64 años. Conclusiones: los dos índices testados mostraron entre si un grado de acuerdo pobre y clasificaron de forma diferente a una misma población.

Data Collection Instruments for Obesogenic Environments in Adults: A Scoping Review.

The rise in obesity prevalence has increased research interest in the obesogenic environment and its influence on excess weight. The aim of the present study was to review and map data collection instruments for obesogenic environments in adults in order to provide an overview of the existing evidence and enable comparisons. Through the scoping review method, different databases and webpages were searched between January 1997 and May 2018. Instruments were included if they targeted adults. The documents were categorised as food environment or built environment. In terms of results, 92 instruments were found: 46 instruments measuring the food environment, 42 measuring the built environment, and 4 that characterised both environments. Numerous diverse instruments have been developed to characterise the obesogenic environment, and some of them have been developed based on existing ones; however, most of them have not been validated and there is very little similarity between them, hindering comparison of the results obtained. In addition, most of them were developed and used in the United States and were written in English. In conclusion, there is a need for a robust instrument, improving or combining existing ones, for use within and across countries, and more sophisticated study designs where the environment is contemplated in an interdisciplinary approach.

[Effects of an alternative program to promote healthy eating in school canteen]. / Efectos de un programa alternativo de promoción de la alimentación saludable en comedor escolar.

The objective of this study was to determine the effects on school feeding habits in an educational intervention alternative to the conventional model of feeding promotion to a center with school canteens and ecological garden project. Cross-sectional and comparative descriptive observational study of 111 boys and girls between 9 and 12 years old, in the 2013-15 period. A school with alternative intervention was compared with another one that only included contents of the Infant and Primary Education curriculum, by means of evaluation of adherence to the mediterranean diet of the students with a validated Kidmed questionnaire. The intervention center presented greater adherence to the mediterranean diet than the control center. In the intervention center, the percentage of students with optimal diet (64.52%) was higher than those who needed to improve their diet (33.87%), contrary to what occurs in control center (42.86% and 51.02% respectively). The students of the intervention center presented a higher percentage of affirmative answers in Kidmed test. The program of promotion of healthy alternative food of the intervention center could be effective for the acquisition of a diet of greater adherence to the mediterranean diet.

El objetivo del estudio fue determinar los efectos sobre los hábitos alimentarios de escolares en una intervención educativa alternativa al modelo convencional de promoción de alimentación a un centro con comedor y proyecto de huerto ecológico. Estudio observacional descriptivo de corte transversal y comparativo de 111 niños y niñas entre 9 y 12 años, en el periodo 2013-15. Se comparó un colegio con intervención alternativa con otro que únicamente incluía contenidos propios del currículo de Educación Infantil y Primaria, mediante evaluación de adherencia a la dieta mediterránea del alumnado con cuestionario validado Kidmed. El centro de intervención presentó mayor adherencia a la dieta mediterránea que el centro control. En el centro de intervención el porcentaje de alumnado con dieta óptima (64,52%) fue mayor que los que necesitaban mejorar su dieta (33,87%), mientras que en el centro fue inferior (42,86% y 51,02% respectivamente). Los escolares del centro de intervención presentaron mayor porcentaje de respuestas afirmativas en ítems Kidmed. El programa de promoción de alimentación saludable alternativo del centro de intervención podría ser efectivo para la adquisición de una dieta de mayor adherencia a la dieta mediterránea.

[Nutrition and gastronomy in the region of Valencia]. / Nutrición y gastronomía en la Comunitat Valenciana.

INTRODUCTION: Objectives: to analyze the historical development of the Valencian dietary model, establish the relationship between gastronomy and nutrition and explore the role that reclaiming and adapting culinary and gastronomic traditions could play in the promotion of healthy eating. Methods: literature search and content analysis of studies on the subjects under study. Results: traditional Valencian cuisine is characterized by its variety and diversity at local and regional level; however, the extensive use of vegetables in its dishes and recipes renders it unique and was a crucial aspect of the Valencian population's successful food and nutrition transition in the 1960s. Westernization of the Valencian diet and loss of the heritage of the Mediterranean diet in the late 20th century led to a deterioration in the population's nutritional status and the emergence of problems such as overweight and obesity. Faced with this scenario, the modern cuisine spearheaded by the food sector in the Region of Valencia offers an opportunity to reverse this situation, reclaim the region's gastronomic heritage through dialogue between tradition and innovation and help restore healthier eating habits. Conclusions: the culinary grammar of traditional Valencian gastronomy can improve the population's nutrition by providing a healthy, attractive and tasty diet, besides offering a sustainable alternative for production and consumption through its commitment to regional produce.

INTRODUCCIÓN: Objetivos: analizar la evolución histórica que ha experimentado el modelo alimentario valenciano, la relación que cabe establecer entre gastronomía y nutrición y el papel que pueden jugar la recuperación y la adaptación de las tradiciones culinarias y gastronómicas en la promoción de una alimentación saludable. Metodología: búsqueda bibliográfica de trabajos que se han ocupado de los temas objeto de estudio y análisis de sus contenidos. Resultados: la cocina tradicional valenciana se caracteriza por su heterogeneidad y su diversidad comarcal y local, pero la base vegetal de sus platos y recetas le otorga una idiosincrasia gastronómica propia, que resultó clave para completar, en la década de los sesenta, la transición alimentaria y nutricional de la población valenciana. La occidentalización de los regímenes alimentarios de los valencianos y la pérdida de los referentes patrimoniales de la dieta mediterránea que tuvo lugar en las últimas décadas del siglo xx conllevaron un deterioro de su estado nutricional y la emergencia de problemas como el sobrepeso y la obesidad. Frente a semejante panorama, la actualidad y el protagonismo alcanzando por el sector de la gastronomía en la Comunitat Valenciana puede ofrecer una oportunidad para revertir esta situación y, desde el diálogo entre la tradición y la innovación, poner en valor un patrimonio gastronómico que ayude a recuperar hábitos alimentarios más saludables. Conclusiones: la gramática culinaria de la gastronomía valenciana tradicional puede mejorar la forma de nutrirnos al aportar una alimentación saludable, atractiva y sabrosa, además de ofrecer, por su compromiso con el territorio, una alternativa sostenible de producción y consumo.

[Malnutrition and inequalities in developmentalist Spain: rural food and nutrition surveys]. / Malnutrición y desigualdades en la España del desarrollismo: las encuestas rurales de alimentación y nutrición.

INTRODUCTION: the stage of autarky and early years of developmentalism was one of the periods in the contemporary history of Spain when inequalities in food and nutrition became more pronounced. OBJECTIVES: to examine malnutrition among the rural population (municipalities with fewer than 2000 inhabitants), including territorial inequalities and the delayed onset of a rural food and nutrition transition. METHODS: we analysed the rural food and nutrition surveys carried out by the General Commission for Supplies and Transport (Spanish initials: CAT) and the Food and Nutrition Education Programme (Spanish initials: EDALNU) between 1964 and 1972. RESULTS: the rural population presented a deficit of animal proteins, calcium and vitamins A and B2, due to scant consumption of protective foods. Andalucía and inland Spain were the regions with the highest percentage of people whose diet did not meet nutritional requirements. These deficiencies were not only responsible for the prevalence of caries and skin, mucous membrane and eye lesions, but were also behind delayed growth (height and weight). This was not the result so much of poverty as of the persistence of poor eating habits. CONCLUSIONS: besides evidencing the delayed onset of a food and nutritional transition in the Spanish rural population, our findings document policies that sought to encourage the consumption of protective foods in rural areas and empower the population with regard to food and nutrition.

Introducción: la etapa de la autarquía y los primeros años del desarrollismo fue uno de los periodos de la historia contemporánea de España en el que las desigualdades en materia alimentaria y nutricional se hicieron más evidentes.Objetivos: abordar la malnutrición que afectaba a la población rural (municipios de menos de 2000 habitantes), sus desigualdades territoriales y el retraso que mostraba su transición alimentaria y nutricional.Métodos: se han analizado las encuestas rurales de alimentación y nutrición que llevaron a cabo la Comisaría General de Abastecimientos y Transportes (CAT) y el Programa de Educación en Alimentación y Nutrición (Edalnu) entre 1964 y 1972.Resultados: la población rural mostraba un déficit de proteínas animales, de calcio, de vitamina A y de vitamina B2, justificado por el escaso consumo que realizaba de alimentos protectores. Andalucía y la España interior eran las regiones que mostraban mayores porcentajes de personas que no alcanzaban los requerimientos nutricionales. Dichas carencias, que explicaban la prevalencia de caries, así como de lesiones en la piel, en mucosas y oculares, también estaban detrás del retraso en la talla y el peso. No respondían tanto a la escasez de recursos económicos como a la persistencia de hábitos alimentarios inadecuados.Conclusiones: los resultados, además de mostrar el retraso de la población rural española en términos de transición alimentaria y nutricional, avalan las políticas que buscaban estimular en el ámbito rural el consumo de alimentos protectores y empoderar a la población en materia de alimentación y nutrición.

The health educator network as a nutrition education strategy: the example of the EDALNU programme (1963-1994) / La red de promotores de salud como estrategia de educación alimentaria: el ejemplo del Programa EDALNU (1963-1994).

Food and nutrition education is an essential tool to ensure public health. The year 1961 saw the launch of the Food and Nutrition Education Programme (EDALNU), which helped Spanish population to complete their nutrition transition. The aim of this study was to analyze the characteristics of the health education network which was created as part of the program. A total of 46,752 people, 94% of whom were women, received training on food and nutrition. Of these, 89.54% obtained the basic certificate, and 8.80% were awarded the diploma. Some 1,407 courses were given, reaching a peak in 1979 with 131 courses and 4,029 students. The most active provinces were Madrid, with 26.65% of the courses; Valencia, with 7.60%; Murcia, with 7.53%, and Malaga, with 6.75%. The Spanish Ministry of Culture and Education organized the largest number of courses (26.23%), followed by the Women's Section (11.16%) and Catholic Action (5.12%). Diploma courses were taught for 160 hours, while basic courses lasted 40 hours. The training delivered was affected by changes in the EDALNU program and the Spanish administrative and political structure. Our research revealed that the development and gender balance of the network of trainers presented regional inequalities, and that a wide range of institutions were involved in delivering the courses

La educación en alimentación y nutrición es una herramienta fundamental para garantizar la salud. En 1961, se puso en marcha el Programa de Educación en Alimentación y Nutrición (EDALNU), que ayudó a la población española a completar su transición alimentaria y nutricional. El objetivo de este trabajo es analizar las características de la red de promotores de salud que se desarrolló en el marco del programa. Recibieron formación relacionada con alimentación y nutrición 46.752 personas, el 94% de ellas mujeres. El 89,54% obtuvo el título de iniciado y el 8,80%, el de diplomado. Se realizaron 1.407 acciones y en 1979 se alcanzó el momento más álgido, con 131 cursos y 4.029 alumnos. Madrid, con el 26,65% de cursos; Valencia, con el 7,60%; Murcia, con el 7,53%, y Málaga, con el 6,75%, fueron las provincias más activas. El Ministerio de Cultura y Educación fue el encargado de organizar el mayor número de cursos (26,23%), seguido de Sección Femenina (11,16%) y Acción Católica (5,12%). La duración y los contenidos formativos de los cursos eran de 160 horas para los diplomados y 40 para los iniciados. La acción formativa desarrollada estuvo sometida a los cambios que experimentó el Programa y a los que afectaron a la estructura administrativa y política española. La investigación ha mostrado las desigualdades territoriales que acompañaron el desarrollo de la red de formadores, su componente de género y el carácter plural de las instituciones que organizaron los cursos.

Efectos de un programa alternativo de promoción de la alimentación saludable en comedor escolar / Effects of an alternative program to promote healthy eating in school canteen

Resumen El objetivo del estudio fue determinar los efectos sobre los hábitos alimentarios de escolares en una intervención educativa alternativa al modelo convencional de promoción de alimentación a un centro con comedor y proyecto de huerto ecológico. Estudio observacional descriptivo de corte transversal y comparativo de 111 niños y niñas entre 9 y 12 años, en el periodo 2013-15. Se comparó un colegio con intervención alternativa con otro que únicamente incluía contenidos propios del currículo de Educación Infantil y Primaria, mediante evaluación de adherencia a la dieta mediterránea del alumnado con cuestionario validado Kidmed. El centro de intervención presentó mayor adherencia a la dieta mediterránea que el centro control. En el centro de intervención el porcentaje de alumnado con dieta óptima (64,52%) fue mayor que los que necesitaban mejorar su dieta (33,87%), mientras que en el centro fue inferior (42,86% y 51,02% respectivamente). Los escolares del centro de intervención presentaron mayor porcentaje de respuestas afirmativas en ítems Kidmed. El programa de promoción de alimentación saludable alternativo del centro de intervención podría ser efectivo para la adquisición de una dieta de mayor adherencia a la dieta mediterránea.

Abstract The objective of this study was to determine the effects on school feeding habits in an educational intervention alternative to the conventional model of feeding promotion to a center with school canteens and ecological garden project. Cross-sectional and comparative descriptive observational study of 111 boys and girls between 9 and 12 years old, in the 2013-15 period. A school with alternative intervention was compared with another one that only included contents of the Infant and Primary Education curriculum, by means of evaluation of adherence to the mediterranean diet of the students with a validated Kidmed questionnaire. The intervention center presented greater adherence to the mediterranean diet than the control center. In the intervention center, the percentage of students with optimal diet (64.52%) was higher than those who needed to improve their diet (33.87%), contrary to what occurs in control center (42.86% and 51.02% respectively). The students of the intervention center presented a higher percentage of affirmative answers in Kidmed test. The program of promotion of healthy alternative food of the intervention center could be effective for the acquisition of a diet of greater adherence to the mediterranean diet.

[Gender and profession in the historical development of community nursing in Spain]. / Género y profesión en la evolución histórica de la Enfermería Comunitaria en España.

Community and public health is probably the field where nurses have achieved the highest levels of professional independence, and their contribution is most valued. However, there are still major obstacles to full development, some of them linked to gender. It is therefore important to analyse the historical background of this situation in Spain in order to gain a better understanding of the many problems and shortcomings that still persist in Community Nursing today. Community nurses contributed to the development of Public Health in contemporary Spain, starting in the 1920s and culminating in the Second Republic. However, the Franco regime brought a halt to the process of professionalisation. By analysing the public conflict between visiting female nurses and practicantes (professional male medical auxiliary technicians) during the Second Republic and throughout the Franco regime, we examine the impact of gender on the development of nursing in Spain as one of the conditioning factors, and how it continues to influence the structuring of competencies and the distribution of responsibilities and power in this field.

Relación del micro-ambiente obesogénico con el exceso de peso: estudio piloto en la población de una ciudad del sureste español / Relationship between obesogenic micro-environment and excess weight: pilot study in adult population from Spanish southeast

El ambiente obesogénico que se puede definir como la suma de las influencias que los entornos, las oportunidades, o circunstancias de la vida, tienen para promover obesidad en individuos o la sociedad. El objetivo de este trabajo es describir la prevalencia de sobrepeso y obesidad (SP/OB) y su relación con variables del micro-entorno obesogénico en la población de 18-64 años residentes en la ciudad de Elche (España). Para ello se ha realizado un estudio transversal, donde se recogen diversas variables con una muestra piloto de 150 participantes. Se ha calculado la prevalencia de SP/OB y sus correspondientes intervalos de confianza y para medir la relación entre variables se utilizó la prueba Chi-cuadrado. Entre los principales resultados destacan que el 52,0% de la población presenta SP/OB siendo mayor en varones (59,5%); ésta prevalencia se incrementa con la edad. Hay una mayor prevalencia en personas con bajo nivel educativo (60,7%), bajos ingresos (61,1%), y en las personas en desempleo (58,6%). Se observa una mayor prevalencia en las personas que duermen menos de 6 horas (62,5%), en personas sedentarias (66,7%), y en aquellas con bajo nivel de estrés (64,7%). También presentan mayor prevalencia aquellos que frecuentan restaurantes menos veces (58,3%), los que acuden a restaurantes de menú (70,3%) o de comida basura (57,1%), que utilizan máquinas expendedoras (61,9%) y aquellos que comen acompañados (56,5%). Existe una asociación estadísticamente significativa entre el SP/OB con la edad, situación laboral, nivel de estudios, tipo de restauración colectiva de preferencia y comer acompañado(AU)

The important role of the environmental and lifestyle factors in the prevalence of overweight and obesity, has been well established and constituting es the obesogenic environment. The aim of this study is to describe the prevalence of overweight and obesity and its relationship with the micro-obesogenic environment variables in the population of 18-64 years from Elche city (Spain). We have designed a cross-sectional study, which includes several variables and the pilot sample was composed of 150 participants. The prevalence of overweight and obesity and its corresponding confidence intervals has been calculated. In order to establish relationships between variables the chi-square test was used. Among the main results, the prevalence of overweight and obesity is was 52,0%, being greater in males (59,5%) and increased with age. According to socioeconomic variables, there is a higher prevalence in people with a low educational level (60,7%) and a low income (61,1%). Also a higher prevalence in people who sleep less than 6 hours (62,5%), in sedentary people (66,7%) and those with low levels of stress (64,7%). Regarding the micro-environment, a higher prevalence of overweight and obesity in people who visit restaurants occasionally (58,3%), those who frequently follow restaurant menues (70,3%) or fast-food restaurants (57,1%), who use vending machines (61,9%) and those who eat accompanied by other people (56,5%). There is a statistically significant association between overweight and obesity with age, work status, level of studies, type of catering preference and eating accompanied by people(AU)

La dimensión sociosanitaria del hambre: el testimonio de José María Bengoa Lecanda (1913-2010) / The social and sanitary dimension of hunger: the testimony of José María Bengoa Lecanda (1913-2010)

Se analizan algunos de los elementos conceptuales con los que abordó el profesor José María Bengoa Lecanda (1913-2010) la complejidad de factores que están asociados al hambre. Se estudian sus reflexiones sobre la interrelación entre desnutrición, enfermedad y pobreza, así como sus propuestas para romper dicho círculo. Desde los presupuestos de la medicina social, el doctor Bengoa articuló un discurso donde las desigualdades sociales aparecen como uno de los determinantes clave que explican las diferencias socio-sanitarias entre regiones, poblaciones e individuos. El cambio social, con la educación como principal argumento, y la mejora de las condiciones de vida de la población, eran reivindicadas por el doctor Bengoa como las estrategias más adecuadas para abordar la malnutrición en cualquiera de sus manifestaciones(AU)

Some of the conceptual elements through which professor José María Bengoa Lecanda (1913-2010) approached the complexity of factors associated with hunger are analysed. Specifically, his reflections on the interrelation between undernourishment, disease and poverty are studied, as well as his proposals to break said circle. From the assumptions of social medicine, doctor Bengoa articulates a discourse where social inequalities appear as one of the key factors to explain the social and health differences between regions, populations and individuals. Social change, with education as the main argument, and the improvement of life conditions for the population, were claimed by doctor Bengoa as the most appropriate strategies to address malnutrition in any of its forms(AU)