Control of cardiovascular risk factors with tailored recommendations: A randomized controlled trial.

This study analyzed the efficacy of tailored recommendations to control cardiovascular risk factors at 1-year follow-up in a population-based randomized controlled trial in individuals aged 35-74 years with no history of cardiovascular disease at baseline. Total, low-density lipoprotein (LDL), and high-density lipoprotein cholesterol and systolic and diastolic blood pressure (BP) were measured at baseline and at 1-year follow-up. The primary outcome was the quantitative change in total cholesterol. To estimate the differences within and between groups, McNemar and Student t-tests were applied according to an intention-to-treat strategy. We enrolled 955 individuals [52.3% women; mean age, 50 years (standard deviation 10)]. Finally, 1 participant in each group presented a cardiovascular event and 768 were reexamined at 1-year follow-up. Intervention and control groups showed significant increases in total cholesterol [5.49 (standard deviation 1.02) to 5.56 (1.06) mmol/L and 5.34 (0.94) to 5.43 (0.93) mmol/L, respectively]. Men in the intervention group showed significant decreases in systolic and diastolic BP [117.2 (14.6) to 115.6 mmHg (14.1) and 77.9 (9.7) to 76.5 mmHg (9.7), respectively]; no changes were found in the rates of total cholesterol <5.2 mmol/L and LDL cholesterol <3.0 mmol/L. In the control group, both values were significantly decreased (43.5 to 36.4% and 26.4 to 20.8%, respectively) in men. In the stratified analysis, women showed no differences in any of the outcomes. In conclusion, an intervention with tailored recommendations increased mean total cholesterol values. The intervention effect was higher in men who maintained blood lipids at optimal levels and had decreased BP values.

The Temporal Dimension in Maternal Sensitivity Predicting Organized Attachment in Children.

This study analyzed Maternal Sensitivity in the interaction of mother-infant dyads to distinguish different dynamics associated with their attachment group membership - Insecure-Avoidant (A), Secure (B), or Insecure-Resistant (C), with no Disorganized traits - that they developed at 15 months. Participants were 26 eight-month old infants interacting with their mothers in a free-play setting. The analyses used sequential streams of infant actions and maternal responses, and state-space grids to study the temporal organization of the sequences. We examined appropriateness and promptness of the maternal response to infant behavior and a dynamic analysis of the interactive process. In Group B, when the antecedent behavior was infant social approach, the appropriateness of the maternal profile (sensitive vs. intrusive responses) was related to their children's subsequent security. However, how promptly mothers responded was not predictive. Conversely, when the antecedent behavior was infant play, how promptly the mothers responded was associated with securely attached children while mothers' profile of appropriate responses did not distinguish the subsequent quality of attachment. The indices derived from state-space grids were associated with attachment type and distinguished Group C from Groups B and A. However, results from analysis of a specific region of states, 'maternal interfering response to infant social approach,' showed significant discriminant function that correctly classified 78% of Group B, 73% of Group A, and 83% of Group C. Group B infants received less intrusive behavior than their counterparts, and when they did, it involved positive affection or playfulness. Finally, regarding attractors, although more Group B dyads showed multi-stability of coexisting attractors, than Groups A or C, the differences were not statistically significant.

Mother-Infant Verbal and Nonverbal Interaction as Predictor of Attachment: Nonlinear Dynamic Analyses.

This longitudinal study examined flexibility in early mother-infant interaction at the age of approximately 6 months (N=30) and whether flexibility indices predicted (in) secure child attachment at 15 months. Dyadic flexibility was measured using dynamic systems-based modelling of patterns during mother-child free play in terms of NDS variables derived from SSG: the propensity to change states (dynamic flexibility), number of states visited (diversity) and predictability (dispersion). Results showed significant discriminant functions on the attachment type groups, A, B & C, for the total grid, which included verbal and non-verbal, and for the reciprocal verbal region. Specifically, the prediction outcomes seem to work better in total grid for A-dyads and in the reciprocal verbal region for B and C-dyads. Diversity emerged as the most relevant index in dyadic flexibility: A-dyads showed the least diversity, distinguished them from B-dyads in the verbal regions, (both the reciprocal and non-reciprocal, 'child verbal-mother non-verbal' one), and, from C-dyads in the reciprocal non-verbal region. A-dyads showed remarkably low activity in the regions involving child verbal behavior, showing that children who became avoidant attached at 15 months of age, were mostly silent at approximately 6 months, when they interacted with their mothers. Findings in this study contribute to advancing conceptually informed measurement of dyadic interaction to provide a new perspective on maternal sensitivity and early markers of child insecure/secure attachment.

Nutritional Quality of the Mid-Afternoon Snack of Schooled Children between the Ages of 3 and 12 Years in Three Areas in Spain.

BACKGROUND: The aim of this study was to analyze the nutritional quality of mid-afternoon snacks for schooled children aged 3 to 12 years in three areas of Catalonia (Spain). METHODS: A descriptive observational study collected information on habits and the mid-afternoon snack of 782 schooled children aged 3 to 12 years in three cities, Barcelona, Girona, and Lleida, located in Catalonia (Spain). The children's families voluntarily agreed to complete an online questionnaire that collected information about demographic data and snacking habits in the afternoon, as well as a record of mid-afternoon snack intake over three school days. RESULTS: A total of 2163 mid-afternoon snacks were analyzed from a sample of 764 families with 3 to 12 year-old children. Sandwiches emerged as the most prevalent choice, accounting for 41.89%, followed by pastries at 23.86%, fruit at 14.38%, and a combination of fruit and pastries at 6.29%. Of the mid-afternoon snacks recorded, 22.19% were healthy, 20.90% were quite healthy, 12.85% were quite unhealthy, and 44.06% were unhealthy. CONCLUSIONS: The nutritional quality of mid-afternoon snacks for a large majority of schooled children should be improved. It is essential to develop food education programs to improve the quality of this intake from early childhood and to consider it as an opportunity to adjust the daily dietary requirements of Spanish children.

Mother-infant interaction and quality of child's attachment: a nonlinear dynamical systems approach.

The traditional classification of infant attachment described three distinct types (Ainsworth et al. 1978): Secure (B), Insecure-avoidant (A), and Insecure-resistant (C). Research shows that the quality of infant attachment reflects the child's history of interaction with their primary caregiver and, therefore, maternal sensitivity and appropriateness of maternal responses during the first year of life has been found to predict infant attachment. In this study Nonlinear Dynamic Systems (NDS) approach was applied to broaden the study of maternal sensitivity into the overall temporal organization of mother-infant relationship exchanges. The study focuses on understanding the differences between secure and insecure attached children by applying NDS in two temporal scales: real time and a developmental scale, with the notions of 'flexibility' and 'self-organization', respectively. Infants, classified as securely or insecurely attached at 15 months, had free-play situations with their mothers, at 6 and 12 months of age, videotaped and coded in real time. Results showed that at 6 months dyads from the B group, compared to the non-B group, showed higher flexibility through several NDS indices derived from the State-Space Grid method (SSG). The dyads at 12 months did not show differences in those indices. Moreover, B group showed self-organization by decreasing the number of attractors, from 6 to 12 months of infant's age, in contrast with A and C groups that either showed less self-organization, by increasing the number of attractors, or stayed basically as they were at 6 months. Furthermore, the B group showed an increase in the proportion of attractors with higher values from time 1 to time 2, in contrast to the non-B groups. Findings provide some grounds for using a SSG approach to deepen the construct of maternal sensitivity in dyadic terms.

Social Inequalities in Breakfast Consumption among Adolescents in Spain: The DESKcohort Project.

Breakfast has a critical role in energy balance and dietary regulation. Consequently, it is considered an important component of a healthy diet, especially in adolescence, when there are great opportunities to consolidate habits and establish future patterns of healthiness in adulthood. Socioeconomic position (SEP) causes inequalities that are reflected in health behaviors, physical activity, mental health, and diet. Therefore, we conducted a cross-sectional study using data from the 2019-2020 DESKcohort project (Spain) to explore the relationships between breakfast and sociodemographic characteristics, health-related behaviors, and school performance of 7319 adolescents. Our findings showed that the prevalence of skipping breakfast every day was 19.4% in girls and 13.7% in boys and was related to students' SEP. The risk of skipping breakfast was 30% higher in girls from the most disadvantaged SEP, in comparison to those in the most advanced SEP (prevalence ratio (PR) = 1.30; 95% confidence interval (CI) = 1.11-1.54). Also, boys from the most disadvantaged SEP showed 28% higher risk of skipping breakfast than those in the most advanced SEP (PR = 1.28; 95% CI = 1.04-1.59). In conclusion, future public policies should be adapted considering a SEP and gender perspective to avoid increasing nutritional and health inequalities.

The temporal dimension in the understanding of maternal sensitivity in caregiver-infant interactions: The 'Early Mother-Child Interaction Coding System'.

Caregiver-child interaction is known to play a central role in children's socioemotional development, yet the diversity of measures commonly used to evaluate it call into question the nature of the construct being assessed. Contingency within caregiver-child interactions has been identified as a key dyadic process that requires taking a temporal perspective to evaluating interactions. The Early Mother-Child Interaction Coding System is a psychometrically sound measure that sequentially code the flow of interactive and non-interactive behaviours within a caregiver-infant system. Its use of the framework of nonlinear dynamical systems (NDS) expands our understanding of contingent caregiver-infant dyadic behaviour.

Efficacy of tailored recommendations to promote healthy lifestyles: a post hoc analysis of a randomized controlled trial.

Prevention is the key to stopping the ravages of cardiovascular diseases, the main cause of death worldwide. The objective was to analyze the efficacy of tailored recommendations to promote healthy lifestyles. Parallel-arm randomized controlled trial with 1 year follow-up. Individuals aged 35-74 years from Girona (Spain) randomly selected from a population with no cardiovascular diseases at baseline were included. Participants in the intervention group received a brochure with tailored healthy choices according to the individual risk profile and a trained nurse explained all recommendations in detail in a 30 min consultation. One year changes in smoking, Mediterranean diet adherence, physical activity, and weight were analyzed with McNemar, Student's t, Wilcoxon, and Fisher exact tests according to an intention-to-treat strategy. Of 955 individuals (52.3% women; mean age 50 [±10] years) randomly allocated to the intervention or control group, one participant in each group presented a cardiovascular event and 768 (81%) were reexamined at 1 year follow-up. The prevalence of nonsmokers increased in both the intervention and control groups (78.1%-82.5%, p = <.001, and 76.7% to 78.8%, p = .015, respectively); however, significance persisted only in the intervention group when stratified by sex, age group, and educational level. Adherence to a Mediterranean diet increased in the intervention group (22.3%-26.5%, p = .048). In conclusion, a brief personalized intervention with science-based recommendations according to individual risk profiles appears to improve healthy lifestyles, particularly nonsmoking and adherence to a Mediterranean diet. This promising intervention system offers evidence-based recommendations to develop healthy lifestyles.

[Weight, dietary patterns and exercise habits in first-year primary school children: the AVall study]. / Estado ponderal, hábitos alimentarios y de actividad física en escolares de primer curso de educación primaria: estudio AVall.

OBJECTIVE: To evaluate weight, dietary patterns and exercise habits in children attending the first year of primary school in the city of Granollers (Spain). METHODS: We performed a cross-sectional study of children enrolled in the schools of the city of Granollers. All the children were born in 2000. Data were collected from September to October 2006. Weight and height were measured in each schoolchild. The parents completed a questionnaire on the frequency of food intake and physical activity and the Krece Plus test. The International Obesity Task Force cut-offs for body mass index were used to define overweight and obesity. RESULTS: A total of 566 schoolchildren were included. The prevalence of overweight was 19.6% and that of obesity was 8.5%. Only 3.8% of the children had an adequate breakfast and 17.1% ate five portions of fruit and vegetables a day. Some families consumed a low amount of fruit (22%), vegetables (37%), bread/pasta/ rice/cereals (14%), fish (32%), legumes (13%) and nuts (9%). Children who had lunch at school ate more fruits (38% vs 29%), vegetables (35% vs 25%) and fish (82% vs 73%) than those who did not have lunch at school. A total of 82% of the schoolchildren exercised regularly. CONCLUSIONS: A quarter of the children who participated in the study were overweight. The schoolchildren who had lunch at school had better dietary patterns. Inappropriate family habits can determine children's dietary habits.

Validity of a method for the self-screening of cardiovascular risk.

BACKGROUND: The validity of a cardiovascular risk self-screening method was assessed. The results obtained for self-measurement of blood pressure, a point-of-care system's assessment of lipid profile and glycated hemoglobin, and a self-administered questionnaire (sex, age, diabetes, tobacco consumption) were compared with the standard screening (gold standard) conducted by a health professional. METHODS: Crossover clinical trial on a population-based sample from Girona (north-eastern Spain), aged 35-74, with no cardiovascular disease at recruitment. Participants were randomized to one of the two risk assessment sequences (standard screening followed by self-screening or vice versa). Cardiovascular risk was estimated with the Framingham-REGICOR function. Concordance between methods was estimated with the intraclass correlation coefficient (ICC). Sensitivity, specificity, and positive and negative predictive values were estimated, considering 5% cardiovascular risk as the cutoff point. ClinicalTrials.gov Registration #NCT02373319. Clinical Research Ethic Committee of the Parc de Salut Mar Registration #2014/5815/I. RESULTS: The median cardiovascular risk in men was 2.56 (interquartile range: 1.42-4.35) estimated by standard methods and 2.25 (1.28-4.07) by self-screening with ICC=0.92 (95% CI: 0.90-0.93). In women, the cardiovascular risk was 1.14 (0.61-2.10) by standard methods and 1.10 (0.56-2.00) by self-screening, with ICC=0.89 (0.87-0.90). The sensitivity, specificity, and positive and negative predictive values for the self-screening method were 0.74 (0.63-0.82), 0.97 (0.95-0.99), 0.86 (0.77-0.93), and 0.94 (0.91-0.96), respectively, in men. In women, these values were 0.50 (0.30-0.70), 0.99 (0.98-1), 0.81 (0.54-0.96), and 0.97 (0.95-0.99), respectively. CONCLUSION: The self-screening method for assessing cardiovascular risk provided similar results to the standard method. Self-screening had high clinical performance to rule out intermediate or high cardiovascular risk.

Parental and Infant Gender Factors in Parent-Infant Interaction: State-Space Dynamic Analysis.

This study aimed to investigate the influence of parental gender on their interaction with their infants, considering, as well, the role of the infant's gender. The State Space Grid (SSG) method, a graphical tool based on the non-linear dynamic system (NDS) approach was used to analyze the interaction, in Free-Play setting, of 52 infants, aged 6 to 10 months, divided into two groups: half of the infants interacted with their fathers and half with their mothers. There were 50% boys in each group. MANOVA results showed no differential parenting of boys and girls. Additionally, mothers and fathers showed no differences in the Diversity of behavioral dyadic states nor in Predictability. However, differences associated with parent's gender were found in that the paternal dyads were more "active" than the maternal dyads: they were faster in the rates per second of behavioral events and transitions or change of state. In contrast, maternal dyads were more repetitive because, once they visited a certain dyadic state, they tend to be involved in more events. Results showed a significant discriminant function on the parental groups, fathers and mothers. Specifically, the content analyses carried out for the three NDS variables, that previously showed differences between groups, showed particular dyadic behavioral states associated with the rate of Transitions and the Events per Visit ratio. Thus, the transitions involving 'in-out' of 'Child Social Approach neutral - Sensitive Approach neutral' state and the repetitions of events in the dyadic state 'Child Play-Sensitive Approach neutral' distinguished fathers from mothers. The classification of dyads (with fathers and mothers) based on this discriminant function identified 73.10% (19/26) of the father-infant dyads and 88.5% (23/26) of the mother-infant dyads. The study of father-infant interaction using the SSG approach offers interesting possibilities because it characterizes and quantifies the actual moment-to-moment flow of parent-infant interactive dynamics. Our findings showed how observational methods applied to natural contexts offer new facets in father vs. mother interactive behavior with their infants that can inform further developments in this field.

[Early mother-infant interaction and factors negatively affecting parenting]. / Interacción temprana madre-hijo y factores que afectan negativamente a la parentalidad.

The social information-processing model contributes to identifying the psychological processes underlying the construct "sensitivity" in early mother-child interaction. Negative emotional states associated with inadequate self-regulation in coping with stressors affect the mother's attention skills and the processing of the baby's signals. This leads to less synchronous parental practices, particularly unsatisfactory when the baby is unhappy, or crying because the required self-regulation is not provided. This micro-social research studies the sequential profile of maternal reactions to the baby's positive/neutral vs. difficult behaviours and compares them in two groups of dyads, one with mothers who reported high levels of distress and other negative factors for parenting and another group with low levels. The unfavourable circumstances of the high stress group and their negative effects on interaction were observed in some indiscriminate maternal responses and particularly as they reacted to their baby's difficult behaviour, when the mother's regulatory role is more necessary.

Intimate Partner Violence in Self-Identified Lesbians: A Systematic Review of Its Prevalence and Correlates.

This article presents the first systematic review on intimate partner violence (IPV) in self-identified lesbians in same-sex couples. Studies published from January 1990 to December 2013 were analyzed. Of the 687 studies reviewed, 59 were preselected, of which 14 studies were selected that met the inclusion and methodological quality criteria. A summary is presented of the characteristics of the studies, the participants, the prevalence of IPV victimization and perpetration, and its correlates. All the studies were carried out in the United States and used a nonprobabilistic sampling method. The majority of participants were White with a high educational level. The results indicate that all the forms of violence occur, but the most prevalent is emotional/psychological violence. The correlates positively associated with IPV are certain personality characteristics, fusion, previous IPV experience, a family history of violence, and alcohol consumption. This review finds significant limitations in the analyzed literature. Methodological recommendations are made for future studies.

Food frequency questionnaires.

Food Frequency Questionnaires are dietary assessment tools widely used in epidemiological studies investigating the relationship between dietary intake and disease or risk factors since the early '90s. The three main components of these questionnaires are the list of foods, frequency of consumption and the portion size consumed. The food list should reflect the food habits of the study population at the time the data is collected. The frequency of consumption may be asked by open ended questions or by presenting frequency categories. Qualitative Food Frequency Questionnaires do not ask about the consumed portions; semi-quantitative include standard portions and quantitative questionnaires ask respondents to estimate the portion size consumed either in household measures or grams. The latter implies a greater participant burden. Some versions include only close-ended questions in a standardized format, while others add an open section with questions about some specific food habits and practices and admit additions to the food list for foods and beverages consumed which are not included. The method can be self-administered, on paper or web-based, or interview administered either face-to-face or by telephone. Due to the standard format, especially closed-ended versions, and method of administration, FFQs are highly cost-effective thus encouraging its widespread use in large scale epidemiological cohort studies and also in other study designs. Coding and processing data collected is also less costly and requires less nutrition expertise compared to other dietary intake assessment methods. However, the main limitations are systematic errors and biases in estimates. Important efforts are being developed to improve the quality of the information. It has been recommended the use of FFQs with other methods thus enabling the adjustments required.

Los cuestionarios de frecuencia de consumo son herramientas ampliamente utilizadas en los estudios epidemiológicos que investigan la relación entre ingesta dietética y enfermedad o factores de riesgo desde comienzos de la década de los 90. Los tres componentes principales de estos cuestionarios son la lista de alimentos, la frecuencia de consumo y el tamaño de la ración consumida. La lista de alimentos debe reflejar los hábitos de consumo de la población de estudio en el momento en que se recogen los datos. La frecuencia de consumo puede preguntarse de forma abierta u ofreciendo categorías de frecuencia de consumo. Los cuestionarios cualitativos no preguntan por la ración consumida; los semi-cuantitativos presentan raciones estándar y los cuestionarios cuantitativos solicitan al encuestado que estime el tamaño de la ración consumida en medidas caseras o en gramos. Esta última opción supone un esfuerzo importante para el participante. Existen versiones exclusivamente cerradas en un formato estandarizado y otras que incorporan preguntas abiertas sobre algunos hábitos y prácticas alimentarias específicas y permiten añadir alimentos y bebidas consumidos que no están incluidos en la lista. Pueden ser auto-administrados, en papel o en soporte web, o bien mediante entrevista personal o telefónica. Por su formato estandarizado, especialmente los cerrados, y por la forma de administración, son un método con un alto rendimiento en términos de coste-efectividad que ha favorecido su extendido uso en grandes estudios epidemiológicos de cohortes y también con otros diseños. También el coste de codificación y proceso de la información recogida resulta menos costoso y requiere menos experiencia en temas nutricionales que otros métodos de evaluación de la ingesta. Sin embargo, presenta el inconveniente de incorporar errores sistemáticos y sesgos importantes, por lo que en la actualidad se buscan procedimientos para mejorar la calidad de la información y se recomienda utilizarlos junto a otros métodos que permitan realizar los ajustes necesarios.

Improving child maltreatment detection systems: a large-scale case study involving health, social services, and school professionals.

OBJECTIVES: The purpose of this 5-year study was to improve detection in two consecutive phases: (a) To close the gap between the number of identified cases and the actual number of cases of child abuse by increasing detection; and (b) To increase the possibility of a broader spectrum of detection. METHOD: The Balearic Islands (one of the Autonomous Communities of Spain, with 161,287 children under 18 years old) was selected as the study area. Phase 1: front-line professionals (181) from all the health and social services agencies were trained in detection. Phase 2, school professionals (251) from all schools in the territory were also trained. The independent factor was the intervention provided to the professionals with training and support. A pre-post design was used over the area, divided in territories, in which the program was gradually implemented to provide within-territory and between-territories controls. RESULTS: Phase 1: Comparison before-after implementation of the program showed that detection was tripled in the Balearic Islands (from .58 to 1.77 per 1,000 children). An unplanned generalization effect was found, and post hoc analysis considering only the islands showed the expected increase. Phase 2: A subsequent increased detection rate was found in Child Protection Services cases 2.18 per 1,000. Of those new cases, 24.5% came from schools, after controlling for duplication. CONCLUSIONS: This detection system showed positive changes after training and supporting frontline health and social services professionals. However, these professionals only have occasional contacts with the child population. Therefore, to broaden the spectrum of detection and to reach more maltreated children, who are less likely to be visible to CPS, it is necessary to train and support school professionals because of the frequency of their contacts with children on an almost daily basis.

Medium-term evaluation of an educational intervention on dietary and physical exercise habits in schoolchildren: the Avall 2 study.

OBJECTIVE: To assess whether the benefits seen in nutrition, physical activity. and body mass index were maintained at 2 years of completion of the educational intervention. MATERIAL AND METHODS: An experimental, longitudinal, 4-year, two-arm, parallel study with cluster randomization to assess an intervention program aimed at children in their first year of primary schooling attending schools in the city of Granollers. Intervention consisted of promoting healthy dietary habits and increasing physical activity through the educational pedagogy Investigation, Vision, Action and Change (IVAC), applied over 2 school years (2006-2008). Weight and height of each child wee measured in situ, and families self-completed a physical activity survey and the Krece Plus quick test in 2006, 2008, and 2010. RESULTS: A greater increase in body mass index was seen in 2010 in children from the control group (2.84 ± 0.22 vs 1.96 ± 0.163 kg/m(2), <.001). Prevalence of overweight and obesity increased by 8% and 0.5% respectively in schoolchildren in the control group, while the intervention group showed a 5.3% increase in prevalence of overweight and a 3.6%decrease in prevalence of obesity. Prevalence of excess weight therefore increased by 8.5% in the control group and by 1.8% in the intervention group. Reduction in body mass indexincrease was maintained 2 years after completion of educational intervention regardless of sex, origin, maternal obesity, and educational level of parents. CONCLUSIONS: These results confirm that school-based interventions may help contain the current increase in childhood obesity.

Assessment of a school-based intervention in eating habits and physical activity in school children: the AVall study.

BACKGROUND: Obesity has become a global public health problem, which also affects children. It has been proposed that the educational interventions during childhood could be a key strategy in the prevention of obesity. OBJECTIVE: To evaluate the efficacy of an intervention on food habits and physical activity in school children. METHODS: A 2-year cluster-randomised prospective study with two parallel arms was used to evaluate an intervention programme in children in their first year of primary schooling (5-6 years of age) in schools in the city of Granollers. The intervention consisted of the promotion of healthy eating habits and physical activity by means of the educational methodology Investigation, Vision, Action and Change (IVAC). At the beginning and at the end of the study (2006 and 2008) the weight and height of each child was measured in situ, while the families were given a self-report physical activity questionnaire and the Krece Plus quick test. RESULTS: Two years after the beginning of the study, the body mass index of the children in the control group was 0.8 kg/m(2) higher than that of the intervention schools. The intervention reduced by 62% the prevalence of overweight children. Similarly, the proportion of children that ate a second piece of fruit and took part in an after-school physical activity increased in the intervention group. In the control group, the weekly consumption of fish was reduced. CONCLUSIONS: The educational intervention in healthy eating habits and physical activity in the school could contribute to lessen the current increase in child obesity.

Mother-infant interaction and children's socio-emotional development with high- and low-risk mothers.

Charting the dynamic character of mother-infant interaction requires using observational systems of sequential coding in real time. A longitudinal study was designed to approach maternal sensitivity in a more complex way using sequential analysis. The study was conducted with 20 high- and 20 low-risk mothers and their infants (aged: 3, 12 and 15 months) to examine the relation among mothers' risk status for physical abuse and their maternal interactive profiles, using micro-social sequential analyses, and the subsequent quality of attachment developed by their children at 15 months of age. Results showed significantly different timings in maternal responses in high- and low-risk groups, that the high-risk mothers were less sensitive: more intrusive and less discriminate regarding their infant's behavior. Significant differences between groups were also found after infant difficult behavior. High-risk mothers' infants were significantly more likely to develop insecure attachment. Sensitivity is proposed as a constellation of timings in early mother-infant interaction.

Trends in dietary habits and food consumption in Catalonia, Spain (1992-2003).

OBJECTIVE: To analyse trends in food habits and food consumption from 1992 to 2003. DESIGN: Two consecutive cross-sectional nutrition surveys were carried out on random samples of the Catalan population (Evaluation of Nutritional Status in Catalonia (ENCAT) 1992-93 and ENCAT 2002-03). Dietary intake was assessed by means of two 24-hour recalls on non-consecutive days and a food frequency questionnaire was used to ascertain tendencies in the frequency of food consumption. SETTING: Catalonia region, Northeastern Spain. SUBJECTS: Analysis is based on a total of 4701 individuals: 2641 from ENCAT 1992-93 (1210 men and 1431 women) and 2060 from ENCAT 2002-03 (954 men and 1106 women), aged 10-75 years. RESULTS: The trends from 1992 to 2003 showed an increase in eating between meals and outside the home. There was also an upsurge in consumers for fast food, especially among young adults. Notable decreases in fruit consumption (from 301 to 224 g day(-1)) as well as in vegetables, potatoes, meat (red meat and chicken), fish (whitefish and seafood) and offals were observed. In contrast, there was an increase in dairy product consumption, in general (from 255 to 312 g day(-1)), as well as low fat and skim milk derivatives. Fruit juice, nuts and olive oil consumption also increased, the latter being consumed daily by 96% of the population. Little variation was observed for the rest of the food groups in the period studied. Overall, Catalonia is characterised by a model of consumption that is quite favourable, inherent to Mediterranean countries but with important differences according to age. CONCLUSION: Based on the food consumption trends observed in Catalonia, an increase in the consumption of fruits and vegetables, as well as whole grain cereals and fish, should be promoted, along with a reduction in the consumption of meat and sausages.

Trends in energy and nutrient intake and risk of inadequate intakes in Catalonia, Spain (1992-2003).

OBJECTIVES: To analyse trends in energy and nutrient intakes and nutritional adequacy from 1992 to 2003. DESIGN: Two consecutive cross-sectional studies carried out on random samples of the Catalan population ENCAT 1992-93 and ENCAT 2002-03. Dietary intake was assessed by means of two 24-hour recalls on non-consecutive days. Spanish food consumption tables were used. Energy and nutrient data were adjusted for intraindividual variability, and the Spanish recommend nutrient intakes (RNIs) were used in the analysis. SETTING: Catalonia region, North Eastern Spain. SUBJECTS: Analysis is based on a total of 4701 individuals; 2641 from ENCAT 1992-93 (1210 men and 1431 women) and 2060 from ENCAT 2002-03 (954 men and 1106 women), aged 10-75 years. RESULTS: No relevant changes in energy intake trends were observed, although a decrease was observed in the daily consumption of proteins (-7 g), cholesterol (-56 mg), potassium (-245 mg), vitamin A (-283 RE microg), retinoids (-71 microg), carotenoids (-1520 microg), niacin (-29 mg), folates (-15 microg), vitamin B12 (-1.6 microg) vitamin D (-0.5 microg), fibre and iron, and an increase in the consumption of calcium (+57 mg) and a slight increase in lipids and fatty acids (% energy). In general, the most outstanding trends were those of vitamin A (as a result of the decreased consumption of offal), proteins, vitamin D and B12 (due to the decreased consumption of meat and fish) and calcium (as a consequence of the increased consumption of dairy products). CONCLUSION: No changes were observed in the energy intake of males or females; therefore, the obesity changes may possibly be attributed to changes in physical activity patterns. However, an increase in energy sources of a poorer nutritional profile has been identified, especially for between meal snacks.