Analysis of Madrid Primary Health-Care staff for the implementation of exercise prescription.

OBJECTIVE: To assess the self-perception of nurses and general practitioners (GPs) toward Physical Activity on Prescription (PAP) in Madrid Primary Health-Care (PHC). DESIGN: A survey-cohort study. SITE: Nurses and GPs of Madrid PHC System. PARTICIPANTS: A total of 319 GPs and 285 nurses' responders. MEASUREMENTS: Data were analyzed under a classification tree analysis by four predictor variables: (i) Health professional (Nurses/GPs); (ii) Exercise prescription collaboration with all health professionals: physicians, nurses, psychologists, physical therapists, sports medicine physicians, sports scientists, nutritionists, and teachers (Yes/No); (iii) PA promotion collaboration with Sports Scientists (Yes/No); and (iv) The stage of change of PHC staff to PA promotion (0-4 Likert scale). RESULTS: Regarding the predictor variable (i), responders without PA guidelines knowledge and positive attitude to collaborate with nurses in PA promotion are more GPs of female sex (nurses n=33 and GPs n=175) than male sex (nurses n=3 and GPs n=59) (p<.001). For the predictor variable (ii) only 9.30% of PHC staff with a positive attitude to collaborate with all health professionals in PA promotion and exercise prescription. For the predictor variable (iii) was shown low collaboration with sports physicians and sports scientists under a multidisciplinary PAP approach (26.50% responders). Finally, in the predictor variable (iv) Staff maintaining PAP for at least 6 months, self-considered active, and with PAP knowledge want to collaborate with Sports scientists (Yes=233; No=133). CONCLUSIONS: Nurses and GPs are conscious of health-related PA benefits despite the lack of PAP knowledge and lack of willingness to collaborate with other health personnel, exercise professionals, and community resources available.

Household food insecurity and its association with overweight and obesity in children aged 2 to 14 years.

BACKGROUND: The objective was to estimate the prevalence of household food insecurity (HFI) depending on sociodemographic factors and its association with lifestyle habits and childhood overweight and obesity. METHODS: Data was collected from 1,938 children aged 2 to 14 years who participated in the "Study about Malnutrition" of the Community of Madrid. Weight and height were obtained through physical examination. Body mass index was calculated as weight/height2 (kg/m2) and the criteria of the WHO were used for determining conditions of overweight and obesity. The participants' parents answered a structured questionnaire about their diet, lifestyle (physical activity and screen time), and food insecurity. The diet quality was assessed with the Healthy Eating Index in Spain and food insecurity, defined as the lack of consistent access to sufficient food for a healthy life, was measured via three screening questions and the Household Food Insecurity Access Scale (HFIAS). Odds Ratios (ORs) and Relative Risk Ratios (RRRs) were estimated using logistic regression models and adjusted for confounding variables. RESULTS: The overall prevalence of HFI was 7.7% (95% CI: 6.6‒9.0), with lower values in children 2 to 4 years old (5.7%, 95% CI: 4.0‒8.1) and significantly higher values in households with low family purchasing power [37.3%; OR: 8.99 (95% CI: 5.5‒14.6)]. A higher prevalence of overweight (33.1%) and obesity (28.4%) was observed in children from families with HFI, who presented a lower quality diet and longer screen time compared to those from food-secure households (21.0% and 11.5%, respectively). The RRR of children in families with HFI relative to those from food-secure households was 2.41 (95% CI: 1.5‒4.0) for overweight and 1.99 (95% CI: 1.2‒3.4) for obesity. CONCLUSION: The prevalence of HFI was high in the paediatric population, especially in households with low family purchasing power. HFI was associated with lower diet quality and higher prevalence of childhood overweight and obesity. Our results suggest the need for paediatric services to detect at-risk households at an early stage to avoid this dual burden of child malnutrition.

Design and Content Validation using Expert Opinions of an Instrument Assessing the Lifestyle of Adults: The 'PONTE A 100' Questionnaire.

Lifestyle, a major determinant of health status, comprises a number of habits and behaviours that form a part of daily life. People with healthy lifestyles have a better quality of life, suffer less disease, and have a longer life expectancy. This work reports the design and content validation of a questionnaire-the 'PONTE A 100' questionnaire-assessing the lifestyle of adults. This collects information across five dimensions-'Eating Habits', 'Physical Activity', 'Smoking and use of Alcohol and other Drugs', 'Emotional Wellbeing', and 'Safety and Non-intentional Injuries'-via the answering of a total 33 items. Psychometric validation of the instrument's content was obtained via expert opinions. This was performed by two rounds of assessment and involved 34 experts representing different health science disciplines (mean experience, 27.4 ± 9.4 years). At the end of each round, adjustments were made according to their recommendations. Agreement between the experts was examined using the Aiken V test. A final V value of 0.95 (95% CI, 0.90-1.00) was obtained for the questionnaire as a whole, highlighting the validity of its content. The questionnaire would therefore appear to be an appropriate instrument for assessing the lifestyle of adults.

[Prevention of eating disorders in secondary education centers]. / Prevención de los trastornos de la conducta alimentaria en centros de educación secundaria.

Introduction: The prevention of eating disorders in secondary schools is important since it is aimed at students with ages in which the individual is most vulnerable and the disorder can become chronic. After reviewing the evidence, outside and within our country, the recommendations assembled will be helpful to design efficient preventive programs for implementation in secondary education. The use of interactive content, approach to risk factors, prevention of obesity, application in early ages, interventions carried out by the center's own staff, inclusion of the gender perspective and evaluation of the programs in a controlled, rigorous and scientific way.

Introducción: La prevención de los trastornos de la conducta alimentaria en los centros educativos de secundaria es importante ya que se dirige a alumnos con edades en las que el individuo es más vulnerable y el trastorno puede cronificarse. Tras la revisión de la evidencia fuera y dentro de nuestro país, se recogen una serie de recomendaciones que nos conducirán a obtener una mayor eficacia a la hora de implementar programas preventivos en la educación secundaria: uso de contenido interactivo, abordaje de factores de riesgo, prevención de la obesidad, aplicación en edades tempranas, intervenciones realizadas por el propio personal del centro, inclusión de la perspectiva de género y evaluación de los programas de forma controlada, rigurosa y científica.

[Prevention of eating disorders in the community]. / Prevención de los trastornos de la conducta alimentaria en la comunidad.

Introduction: Existen ciertos colectivos más vulnerables en la comunidad, como los adolescentes y jóvenes involucrados en actividades lúdicas o deportivas que implican una alta competitividad y que llevan asociada una elevada importancia del peso corporal, que tienen significativamente más riesgo de presentar un trastorno de la conducta alimentaria (TCA). Para una prevención primaria efectiva a nivel comunitario, la evidencia nos indica la conveniencia de dirigir nuestros esfuerzos hacia esos grupos con más riesgo, siendo el paradigma de la promoción de la salud la fórmula más indicada. Se sugiere poner en práctica un enfoque participativo, multimodal e interactivo, basando los programas en la terapia motivacional y la disonancia cognitiva, tratando de que estos sean sostenibles e intentando contar con el apoyo de líderes comunitarios.

Introducción: Existen ciertos colectivos más vulnerables en la comunidad, como los adolescentes y jóvenes involucrados en actividades lúdicas o deportivas que implican una alta competitividad y que llevan asociada una elevada importancia del peso corporal, que tienen significativamente más riesgo de presentar un trastorno de la conducta alimentaria (TCA). Para una prevención primaria efectiva a nivel comunitario, la evidencia nos indica la conveniencia de dirigir nuestros esfuerzos hacia esos grupos con más riesgo, siendo el paradigma de la promoción de la salud la fórmula más indicada. Se sugiere poner en práctica un enfoque participativo, multimodal e interactivo, basando los programas en la terapia motivacional y la disonancia cognitiva, tratando de que estos sean sostenibles e intentando contar con el apoyo de líderes comunitarios.

[Alimentary and nutritional education in eating disorders]. / Educación alimentaria y nutricional en los trastornos de la conducta alimentaria.

Introduction: Eating disorders (ED) are a complex pathology in which numerous etiopathogenic factors intervene, and their approach requires an interdisciplinary approach, which is why nutritional education (NE) should be part of both prevention and treatment programs, since NE aims to modify eating behavior to achieve healthier patterns and, for this, the development of nutritional teaching programs is required, directed to the patients and their environment, focusing on the different factors that condition food choices and attitudes towards feeding. NE in these patients is a fundamental therapeutic tool to achieve normalization of eating behavior, since it will allow to contribute knowledge that facilitates the adoption of healthy behaviors, abandon erroneous ideas, and reduce the irrational fear of certain foods, as well as minimize nutritional risk and normalize eating behavior. The prevalence of eating disorders has been increasing over the years and the concern is such that the different autonomous communities, hospitals, and government entities have developed guidelines and protocols that include NE for the prevention and management of the disease. Scientific evidence and organizations such as the American Society of Parenteral and Enteral Nutrition (ASPEN), the American Dietetic Association (ADA), and the Spanish Society of Clinical Nutrition and Metabolism (SENPE) recognize the importance of NE in the treatment of ED and the participation of nutrition professionals in this area. Therefore, the approach to the prevention of ED must be broad, so that it encompasses vulnerable groups and their environment; in the same way, action protocols for treatment must include NE as one of their pillars, through implementation of nutritional education programs to achieve changes in eating behavior, which can be carried out in the different phases or treatment modalities (hospitalization, day hospital, outpatient clinics, etc.) even though each one has different objectives and addresses different theme areas, and they must be developed in a multidisciplinary way with a delegation of clear functions for each professional, in favor of the recovery and stability of the patient and his sociofamilial environment.

Introducción: Los trastornos de la conducta alimentaria (TCA) son una patología compleja en la que intervienen numerosos factores etiopatogénicos y su abordaje requiere un enfoque interdisciplinar, por lo que la educación nutricional (EN) debe formar parte tanto de los programas de prevención como del tratamiento, ya que la EN tiene como finalidad modificar la conducta alimentaria para alcanzar patrones más saludables y para ello se requiere el desarrollo de programas de enseñanza nutricional dirigidos al paciente y su entorno, incidiendo en los diferentes factores que condicionan las elecciones alimentarias y las actitudes hacia la alimentación. La EN en estos pacientes es una herramienta terapéutica fundamental para conseguir normalizar la conducta alimentaria, ya que va a permitir aportar conocimientos que faciliten la adopción de conductas saludables, abandonar ideas erróneas y disminuir el temor irracional hacia determinados alimentos, así como minimizar el riesgo nutricional y normalizar la conducta alimentaria. La prevalencia de los TCA ha ido en incremento a lo largo de los años y es tal la preocupación, que las diferentes comunidades autónomas, hospitales y entidades gubernamentales han elaborado guías y protocolos donde incluyen la EN para la prevención y el abordaje de la enfermedad. La evidencia científica y organismos como la Sociedad Americana de Nutrición Parenteral y Enteral (ASPEN), la Asociación Americana de Dietética (ADA) y la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE) reconocen la importancia de la EN en el tratamiento de los TCA y la participación de los profesionales de la nutrición en esta área. Por tanto, el enfoque de la prevención de los TCA debe ser amplio, de manera que abarque los grupos vulnerables y su entorno; de la misma forma, los protocolos de actuación para el tratamiento deben incluir como uno de sus pilares la EN mediante la implementación de programas de educación nutricional para conseguir cambios de la conducta alimentaria, programas que pueden llevarse a cabo en las distintas fases o modalidades del tratamiento (hospitalización, hospital de día, consultas externas, etc.) aunque cada uno tenga distintos objetivos y aborde diferentes áreas temáticas. Deberán desarrollarse de forma multidisciplinar con una delegación de funciones clara para cada profesional en pro de la recuperación y estabilidad del paciente y su entorno sociofamiliar.

[Social media and cyberbullying in eating disorders]. / Redes sociales y ciberacoso en los trastornos de la conducta alimentaria.

Introduction: Eating disorders (ED) are a multifactorial pathology. In their origin multiple variables are involved to which nowadays a possible enhancing factor is added: the diffusion and promotion of the culture of thinness and the apology of ED through the social media (SM) used by the youngest people. Through the feedback tools of the social networks (likes, comments, visits, retweets, etc.) and the elements of comparison between equals of the most visual SMs, many users come to develop risk behaviours that in turn give feedback to others. In addition, a sense of belonging to a group or tribe is created through communities whose members feel supported and where very restrictive diets are shared in an affective way, as well as ways of hiding these and other behaviours from those who do not belong to the group; both elements make it difficult for professionals and the family to intervene. Due to the extensive use of SMs, the rapid dissemination of all that is published, and the limited control over shared content, it is virtually impossible to control those sites that advocate and promote behaviours that contribute to the development or maintenance of ED. Cyberbullying or intimidation through digital technologies often uses body image criticisms that damage the self-esteem of the most vulnerable. This cyberbullying is a factor increasingly present in young people who have suffered an ED. The key to prevention is considered to be media literacy in the use of SM, as well as parental supervision of the youngest. People at risk or who have already been diagnosed with ED find in these networks the social support they seek but are biased towards risk behaviours, when it is possible for health professionals to use them to the benefit of promoting healthy habits and for recovery from these disorders.

Introducción: Los trastornos de la conducta alimentaria (TCA) son una patología multifactorial. En su inicio están implicadas múltiples variables a las que se les suma hoy en día un posible potenciador: la difusión y promoción de la cultura de la delgadez y la apología de los TCA a través de las redes sociales (RR. SS.) usadas por los más jóvenes. A través de las herramientas de feedback de las redes (likes, comments, visitas, retweets, etc.) y los elementos de comparación entre iguales de las RR. SS. más visuales, muchos usuarios llegan a desarrollar conductas de riesgo que a su vez retroalimentan a otros. Por otra parte, se crea la sensación de pertenencia a un grupo o tribu a través de comunidades cuyos miembros se sienten apoyados y donde se comparten de forma afectiva dietas muy restrictivas, así como formas de ocultarlas y otras conductas a quienes no pertenecen al grupo; ambos elementos dificultan la intervención por parte de los profesionales y la familia. Debido al uso extensivo de las RR. SS., a la rápida difusión de todo aquello que se publica y al escaso control que hay sobre el contenido que se comparte, resulta prácticamente imposible controlar los sitios donde se hace apología y se promueven las conductas que contribuyen al desarrollo o mantenimiento de los TCA. El ciberacoso o intimidación por medio de tecnologías digitales utiliza con frecuencia críticas sobre la imagen corporal que dañan la autoestima de los más vulnerables, y es un factor cada vez más presente en los jóvenes que han padecido un TCA. Se considera que la clave de la prevención reside en la alfabetización mediática del uso de las RR. SS., así como la supervisión parental de los más jóvenes. Las personas en riesgo o ya diagnosticadas de TCA encuentran en estas redes el apoyo social que buscan, pero sesgado hacia las conductas de riesgo, cuando sería posible explotarlas en beneficio de la promoción de hábitos saludables y para la recuperación de estos trastornos.

[Advertising and the media in eating disorders]. / Publicidad y medios de comunicación en los trastornos de la conducta alimentaria.

Introduction: The media, by means of advertising, convey an ideal of unreal beauty associated with positive traits such as popularity, esteem, acceptance, intelligence, etc. This can be one of the factors that compromise emotional and physical health, being responsible for creating unrealistic expectations and body dissatisfaction, and exerting a very important influence on the triggering or maintenance of bad eating habits that can lead to eating disorders. The youngest population has a low capacity to anticipate the harmful effects of certain messages with commercial interests, and this requires implementing preventive programs based on media education, accompanied by modeling in the family nucleus to promote a healthy lifestyle.

Introducción: Los medios de comunicación, a través de la publicidad, transmiten un ideal de belleza no real asociado con rasgos positivos como popularidad, aprecio, aceptación, inteligencia, etc. Esto puede constituir uno de los factores que comprometen la salud emocional y física, siendo responsables de crear expectativas poco realistas e insatisfacción corporal y ejerciendo una influencia muy destacada en el desencadenamiento o mantenimiento de los malos hábitos alimentarios que pueden abocar en trastornos de la conducta alimentaria. La población más joven tiene una baja capacidad para prever los efectos nocivos de ciertos mensajes con intereses comerciales, por lo que se requiere la puesta en marcha de programas preventivos basados en la educación mediática, acompañada de un modelado del núcleo familiar en el que se promueva un estilo de vida saludable.

Methodology for the estimation of use of tobacco, alcohol and other drugs.

The objective of this article is to revise the methods used for the assessment of the use of tobacco, alcohol and other drugs. Analysing the advantages of using one method or the other, as well as the most frequent methodological difficulties and problems in medication and classification of each one of these indicators. The main sources of information available from European, National and Madrid Autonomous Community levels have been consulted to estimate the most relevant aspects of these forms of substance abuse.

El objetivo de este trabajo es revisar los métodos utilizados para la estimación del consumo de tabaco, alcohol y otras drogas. Analizar las ventajas de utilizar unos u otros métodos, así como las dificultades y problemas metodológicos más frecuentes en la medición y clasificación de cada uno de estos indicadores. Se recogen las principales fuentes de información disponibles a nivel Europeo, Nacional y en la Comunidad de Madrid para estimar los aspectos más relevantes del consumo de este tipo de sustancias.

Quality of life, dependency and mental health scales of interest to nutritional studies in the population.

Quality of life, dependency and mental health are multidimensional constructs that cannot be observed directly yet can be deduced in an indirect manner through indicators or profiles generated from questionnaires. These questionnaires are based on the validity of information transmitted by the respondents about perceptions, feelings and attitudes. For this reason, the information is difficult to contrast with and translate to a measuring system. The use of questionnaires or rapid quality of life and mental health evaluation scales involve a process directed towards an early identification of specific problems so as to establish medical treatment. This work will review the most commonly used scales or questionnaires in determining these variables and their relationship with the nutritional status of the population.

Calidad de vida, dependencia y salud mental son constructos multidimensionales no observables directamente pero que pueden ser deducidos de manera indirecta a través de indicadores o perfiles generados a partir de cuestionarios. Estos cuestionarios se basan en la validez de la información de percepciones, sentimientos y actitudes que trasmite el encuestado. Por esta razón, esta información es difícil de contrastar y traducir a un sistema de medida. El empleo de cuestionarios o escalas de valoración rápida de la calidad de vida, dependencia y salud mental, conlleva un proceso dirigido a identificar precozmente a sujetos con problemas específicos para poder instaurar programas de intervención. Este trabajo revisa las escalas o cuestionarios más empleados en la determinación de estas variables y su relación con el estado nutricional de la población.

[Trans fatty acid content in foods marketed in the community of Madrid(Spain)]. / Contenido de ácidos grasos trans en alimentos comercializados en la comunidad de Madrid (España).

INTRODUCTION: As a consequence of the scientific evidence which show that the high consumption of trans fatty acids is a risk factor of certain illnesses, sanitary authorities recommend less than 1% intake of trans fatty acids of the total energy intake. Moreover, the European Commission must present, by December 2014, a report about the presence of trans fatty acids in the aliments as well as in the diet of the European Union population. Thus, this study can provide useful information to reach this objective. OBJECTIVES: To determine trans fatty acid presence in some types of foods in the Community of Madrid. METHODS: 170 samples of different foods commonly consumed by children and adolescents were selected and analized. All foods had been purchased in big shopping centers in the Community of Madrid during february of 2010. Results are shown as the percentage of each fatty acid compared to the total amount of fat in the aliment. RESULTS: Only 33 products (19.4%) showed the presence of trans fatty acids over the method detection limit (≥ 0.1g per 100g). The highest levels were found in dairy products, with an average content of 0,4%. DISCUSIÓN/CONCLUSIONES: The trans fatty acid content of the analyzed foods can be considered low, compared with the amount reported by other authors in food products marketed in Spain and other countries in the past few years. Further studies should be undertaken to control nutrition security and diet quality of fat intake in the Spanish population, particularly among children and adolescents.

Chinchón declaration; decalogue on low- and no-calorie sweeteners (LNCS).

Multidisciplinary experts in the areas of nutrition and health met in Chinchón, Madrid, on November 25-26, 2013 under the auspices of the Fundación para la Investigación Nutricional (Nutrition Research Foundation) and with the collaboration of the Madrid Regional Government's Health Ministry, the International Sweeteners Association and the Carlos III Health Institute CIBER of Physiopathology of Obesity and Nutrition. They analyzed the current status of scientific knowledge on low- and no-calorie sweeteners (LNCS) and developed a consensus Decalogue on their use; this constitutes the Chinchón Declaration. Sweeteners, including sugar, represent a subject of undeniable interest and are currently a popular topic, although areas relating to their safety and benefits remain unknown to segments of academia and the general public. The nature of LNCS makes them vulnerable to biased and even contradictory information. They are food additives that are broadly used as sugar substitutes to sweeten foods, medicines and food supplements when non-nutritional or non-caloric alternatives are needed. The Chinchón Decalogue is the outcome of a meeting for reflection and consensus by a group of experts with backgrounds in different scientific disciplines (toxicology, clinical nutrition, community nutrition, physiology, food science, public health, pediatrics, endocrinology and nutrition, nursing, pharmaceutical care and food legislation). The Decalogue includes different aspects of LNCS related to regulation, use, benefits and safety. In general, benefits of LNCS have been traditionally neglected in comparison with the tendency for emphasising unexisting or unproven possible risks. The need to strengthen research on LNCS in Spain was emphasized, as well as the need to educate both professionals and the public.

Expertos de carácter multidisciplinar de las áreas de conocimiento de la nutrición y la salud reunidos en Chinchón, Madrid, los días 25 y 26 de noviembre de 2013 , bajo los auspicios de la Fundación para la Investigación Nutricional y con la colaboración de la Consejería de Sanidad del Gobierno de la Comunidad de Madrid, la International Sweeteners Association y el CIBER de Fisiopatología de la Obesidad y la Nutrición del Instituto de Salud Carlos III, analizaron el estado actual del conocimiento científico en torno a los Edulcorantes sin y bajos en calorías (ESBC) y desarrollaron un Decálogo sobre su uso que constituye la Declaración de Chinchón. Los edulcorantes, incluido el azúcar, constituyen un elemento de indudable interés y actualidad, aunque no exento de desconocimiento por algunos sectores tanto académicos como de la población en general. La propia naturaleza de los ESBC los hace susceptibles de informaciones tergiversadas e incluso contradictorias. Son aditivos alimentarios ampliamente utilizados como sustitutivos del azúcar para endulzar alimentos, medicamentos y complementos alimenticios cuando se persiguen fines no nutritivos. El Decálogo de Chinchón es fruto de una reunión de reflexión y consenso por parte de un grupo de expertos procedentes de distintas disciplinas científicas (toxicología, nutrición clínica, nutrición comunitaria, fisiología, bromatología, salud pública, atención primaria, pediatría, endocrinología y nutrición, enfermería, atención farmacéutica y legislación alimentaria). El decálogo incluye diferentes aspectos de los EBSC relacionados con la legislación, uso, beneficios y seguridad. En general, los beneficios de los EBSC han sido tradicionalmente desatendidos en comparación con la tendencia de destacar posibles riesgos inexistentes o que no han sido probados. Hace especial hincapié en la necesidad de fortalecer la investigación de los EBSC en España, así como la necesidad de formar en este ámbito a los profesionales y a los consumidores en general.