A Clustering Study of Dietary Patterns and Physical Activity among Workers of the Uruguayan State Electrical Company.

Recent studies have shown that certain nutrients, specific food groups, or general dietary patterns (DPs) can promote health and prevent noncommunicable chronic diseases (NCCDs). Both developed and developing countries experience a high prevalence of NCCDs due to poor lifestyle habits, DPs, and low physical activity levels. This study aims to examine the dietary, physical activity, sociodemographic, and lifestyle patterns of Uruguayan State Electrical Company workers (the IN-UTE study). A total of 2194 workers participated in the study, providing information about their sociodemographics, lifestyles, and dietary habits through different questionnaires. To identify DPs from 16 food groups, principal component analysis (PCA) was performed. A hierarchical cluster algorithm was used to combine food groups and sociodemographic/lifestyle variables. Four DPs were extracted from the data; the first DP was related to the intake of energy-dense foods, the second DP to the characteristics of the job, the third DP to a Mediterranean-style diet, and the fourth DP to age and body mass index. In addition, cluster analysis involving a larger number of lifestyle variables produced similar results to the PCA. Lifestyle and sociodemographic factors, including night work, working outside, and moderate and intense PA, were significantly correlated with the dietary clusters, suggesting that working conditions, socioeconomic status, and PA may play an important role in determining DPs to some extent. Accordingly, these findings should be used to design lifestyle interventions to reverse the appearance of unhealthy DPs in the UTE population.

Is Energy Expenditure or Physical Activity Considered When Energy Intake Is Measured? A Scoping Review 1975-2015.

The health-transitions humans have delivered during the 20th Century associated with the nutrition is that from undernutrition to obesity, which perseveres in the current years of the 21st Century. Energy intake (EI) is a contributing factor and therefore a fascination in nutritional sciences. However, energy expenditure (EE) has not been usually considered as a conjoint factor. Thus, this study aimed to review if studies on adults consider data on dietary intake, specifically EI, and included data on EE and physical activity (PA). A search of MEDLINE from 1975 to December 2015 was managed. Our scoping review consisted of keywords related to EI, dietary allowances, and nutritional requirements. From 2229 acknowledged articles, 698 articles were finally taken fulfilling inclusion and quality criteria. A total of 2,081,824 adults (53.7% females) were involved, and most studies had been conducted in EEUU (241), Canada (42), Australia (30), Japan (32), and Brazil (14). In Europe, apart from UK (64), the Netherlands (31) and France (26) led the classification, followed by Sweden (18), Denmark (17), and France (26). Mediterranean countries are represented with 27 studies. A total of 76.4% did not include EE and 93.1% did not include PA. Only 23.6% of the studies contained both EI and EE. A large methodological diversity was perceived, with more than 14 different methods regarding EI, and more than 10 for EE. PA was only analyzed in scarce articles, and scarcely considered for interpretation of data and conclusions. Moreover, PA was often measured by subjective questionnaires. Dietary surveys show a large diversity regarding methodology, which makes comparability of studies difficult. EE and PA are missing in around 80% of studies or are not included in the interpretation of results. Conclusions regarding EI or diet adequacy in adults should not be taken without analyzing EE and PA.

Malnutrition in all its forms by wealth, education and ethnicity in Latin America: who are more affected?

OBJECTIVE: To summarise the findings from this supplemental issue on the distribution of malnutrition (stunting/short stature, anaemia and overweight) by wealth, education and ethnicity within and between ten Latin American countries. DESIGN: We retrieved information from each country's article and estimated the average difference in the prevalence of malnutrition between groups. We estimated the associations between countries' malnutrition prevalence and GDP, percentage of women with high education and percentage of non-indigenous ethnicity. SETTING: Nationally representative surveys from ten Latin American countries conducted between 2005 and 2017. PARTICIPANTS: Children (<5 years), adolescent women (11-19 years) and adult women (20-49 years). RESULTS: Socially disadvantaged groups (low wealth, low education and indigenous ethnicity) had on average 15-21 (range across indicators and age groups) percentage points (pp) higher prevalence of stunting/short stature and 3-11 pp higher prevalence of anaemia. For overweight or obesity, adult women with low education had a 17 pp higher prevalence; differences were small among children <5 years, and results varied by country for adolescents by education, and for adults and adolescents by wealth and ethnicity. A moderate and strong correlation (-0·58 and -0·71) was only found between stunting/short stature prevalence and countries' GDP per capita and percentage of non-indigenous households. CONCLUSIONS: Overweight was equally distributed among children; findings were mixed for ethnicity and wealth, whereas education was a protective factor among adult women. There is an urgent need to address the deep inequalities in undernutrition and prevent the emerging inequalities in excess weight from developing further.

Clustering of Dietary Patterns and Lifestyles Among Spanish Children in the EsNuPI Study †.

Dietary patterns (DPs) are known to be tied to lifestyle behaviors. Understanding DPs and their relationships with lifestyle factors can help to prevent children from engaging in unhealthy dietary practices. We aimed to describe DPs in Spanish children aged 1 to <10 years and to examine their associations with sociodemographic and lifestyle variables. The consumption of toddler and young children milk formulas, enriched and fortified milk within the Spanish pediatric population is increasing, and there is a lack of evidence whether the consumption of this type of milk is causing an impact on nutrient intakes and if they are helping to reach the nutrient recommendations. Within the Nutritional Study in the Spanish Pediatric Population (EsNuPI), we considered two study cohorts and three different age groups in three year-intervals in each of them. The study cohort included 740 children in a representative sample of the urban non-vegan Spanish population and 772 children in a convenience cohort of adapted milk consumers (AMS) (including follow-on formula, toddler's milk, growing up milk, and fortified and enriched milks) who provided information about sociodemographics, lifestyle, and dietary habits; a food frequency questionnaire was used for the latter. Principal component analysis was performed to identify DPs from 18 food groups. Food groups and sociodemographic/lifestyle variables were combined through a hierarchical cluster algorithm. Three DPs predominated in every age group and study sample: a palatable energy-dense food dietary pattern, and two Mediterranean-like DPs. However, children from the AMS showed a predominant dietary pattern markedly related to the Mediterranean diet, with high consumption of cereals, fruits and vegetables, as well as milk and dairy products. The age of children and certain lifestyle factors, namely level of physical activity, parental education, and household income, correlated closely with the dietary clusters. Thus, the findings provide insight into designing lifestyle interventions that could reverse the appearance of unhealthy DPs in the Spanish child population.

Plate Waste Generated by Spanish Households and Out-of-Home Consumption: Results from the ANIBES Study.

Food waste is a major environmental issue that must be tackled in order to achieve a sustainable food supply chain. Currently, in Spain there are no studies that examine the amounts and sources of plate waste (PW) produced by both household and out-of-home consumption. The present study aims to provide this information from a representative sample from the Spanish population. A total of 2009 individuals aged 9-75 years, from the ANIBES study ("anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain"), completed a three-day dietary record, collected by a tablet device. Photographs of all foods and beverages consumed both at home and outside were taken before and after meals. Median PW across the total population was 7.3 (0.0-37.3) g/day and was significantly higher in females than males (p < 0.05) and in children vs. adolescents, adults, and elderly (p < 0.01). Regarding meals, PW across all age groups was higher at lunch (40%), dinner (27%), and breakfast (11%). The highest PW was observed for bread (25%) main courses (16%), first and second courses (15%), vegetables and fruits (12%), ready-to-eat meals (10%), cereals and grains (10%), oils and fats (10%), pulses (10%), meat products (8%), sauces and condiments (8%), and starters (8%). Our results reinforce the need for new strategies to focus on reducing plate leftovers, which are crucial from a nutritional, economic, and environmental point of view. Additionally, this evidence is important for relying on more accurate information on actual intakes when using dietary surveys.

Pérdidas económicas y prevalencia de Fasciola hepática en bovinos sacrificados en dos provincias cubanas / Economic losses and prevalence of Fasciola hepatica in cattle slaughtered in two cuban provinces

RESUMEN Objetivo. Determinar las pérdidas económicas producidas por el decomiso de hígados afectados y la prevalencia de Fasciola hepatica en bovinos sacrificados en las provincias de Holguín y Camagüey, Cuba. Materiales y m étodos. Fueron utilizados los resultados del diagnóstico anatomopatológico realizado en los mataderos Felipe Fuentes y César Escalante durante el periodo comprendido entre enero de 2012 y diciembre de 2018. A partir de la cantidad de animales sacrificados y los afectados se calcularon las pérdidas que alcanzaron un valor de $80.312 USD (Holguín) y $32.7152 USD (Camagüey) para todo el período. Se realizaron análisis de comparación de proporciones para los animales afectados por F. hepatica y las pérdidas económicas por decomiso de hígados, mediante una prueba Chi-cuadrado para determinar la existencia o no de diferencias significativas entre las proporciones y un análisis de medias (ANOM) para determinar cuáles proporciones son significativamente distintas del promedio general. Resultados. Se observó que en 11 meses los animales afectados difirieron significativamente (p<0.001) entre los mataderos excepto en el mes de julio, mientras que las pérdidas totales por decomisos de hígados afectados mostraron diferencias significativas (p<0.001) en todos los meses para el periodo evaluado. Conclusiones. Los mayores valores para las pérdidas económicas y prevalencia por el decomiso de hígados afectados por F. hepatica se presentaron en la provincia de Camagüey lo que pudiera estar relacionado con las condiciones climáticas diferentes, por lo que se recomienda evaluar la dinámica de los hospederos intermedios y las etapas larvarias de este trematodo en las dos provincias estudiadas.

ABSTRACT Objective. To determine the economic losses resulting from condemnation of affected livers and the presence of Fasciola hepatica in slaughtered cattle in the provinces of Camagüey and Holguín, Cuba. Materials and Methods. This study was based on the results from an anatomo-pathological examination performed at Felipe Fuentes and César Escalante slaughterhouses between January 2012 and December 2018. The losses, which totaled $ 80 312 USD (Holguín) and $ 327 152 USD (Camagüey), were estimated from the number of slaughtered and affected animals throughout the period. Analyses for the comparisons of proportions were made to animals affected by F.hepatica, whereas the economic losses due to liver condemnation were analyzed by Chi-square to determine the existence of significant differences among the proportions. Analysis of means (ANOM) was made to determine the significantly different proportions within the general average. Results. Significant differences (p<0.001) were observed in animals from different slaughterhouses in 11 months, excluding July. Meanwhile, the total losses due to condemnation of affected livers underwent significant differences (p<0.001) in all the months of the evaluation period. Conclusions. The highest values of economic losses and prevalence due to condemnation of livers affected by F.hepatica were observed in the province of Camagüey, which may have been linked to varying climatic conditions. Hence, evaluation of intermediary host dynamics and the larval stages of the trematode in the two provinces studied were recommended.

Adequacy of Critical Nutrients Affecting the Quality of the Spanish Diet in the ANIBES Study.

Diet is one of the key modifiable behaviors that can help to control and prevent non-communicable chronic diseases. Therefore, it is important to evaluate the overall diet composition of the population through non-invasive and independent indexes or scores as diet quality indexes (DQIs). The primary aim of the present work was to estimate the adequacy of the intake of critical nutrients in the Spanish "Anthropometry, Intake, and Energy Balance Study" (ANIBES) (n = 2285; 9-75 years), considering, as a reference, the European Food Scientific Authority (EFSA) values for nutrients for the European Union. We also assessed the quality of the diet for adults and older adults using four internationally accepted DQIs, namely the Healthy Diet Indicator (HDI), the Mediterranean Diet Score (MDS), the Mediterranean Diet Score-modified (MDS-mod), and the Mediterranean-Diet Quality Index (MED-DQI), as well as the ANIBES-DQI, stratified by education and income. The ANIBES-DQI was based on compliance with EFSA and Food and Agriculture Organization recommendations for a selected group of nutrients (i.e., total fat, saturated fatty acids (SFAs), simple sugars, fiber, calcium, vitamin C, and vitamin A), with a total range of 0-7. Misreporting was assessed according to the EFSA protocol, which allowed us to assess the DQIs for both the general population and plausible reporters. The majority of the Spanish population had high intakes of SFAs and sugars and low intakes of fiber, folate, and vitamins A and C. In addition, about half of the population had low DQI scores and exhibited low adherence to the Mediterranean diet pattern. Overall, older adults (>65-75 years) showed better DQIs than adults (18-64 years), without major differences between men and women. Moreover, primary education and low income were associated with low MDS and ANIBES-DQI scores. For the ANIBES-DQI, the percentage of the population with low scores was higher in the whole population (69.5%) compared with the plausible energy reporters (49.0%), whereas for medium and high scores the percentages were higher in plausible reporters (41.2% vs. 26.2% and 9.8% vs. 4.3%, respectively). In conclusion, the present study adds support to marked changes in the Mediterranean pattern in Spain, and low education and income levels seem to be associated with a low-quality diet. Additionally, the misreported evaluation in the ANIBES population suggests that this analysis should be routinely included in nutrition surveys to give more precise and accurate data related to nutrient intake and diet quality.

The Influence of Place of Residence, Gender and Age Influence on Food Group Choices in the Spanish Population: Findings from the ANIBES Study.

Socioeconomic factors (SEF) can exert a great impact on food choices. However, limited data are available from the Spanish population. Our aim was to describe the influence of place of residence and habitat size on food group intakes. Data were obtained from the ANIBES study. A 3-day dietary record provided information on food and beverage consumption. Data analysis compared gender, age, Nielsen geographic areas, and habitat population size (urban, semi-urban, and rural). Place of residence did not appear to be a determinant for specific food group consumption during childhood and adolescence, as only higher intakes of non-alcoholic beverages were observed among children aged 9 to 12 years living in the East, when compared to those from the Northwest of Spain (p < 0.05). Food choices within adults (18 to 64 years) and seniors (65 to 75 years) were conditioned: sugar and sweets intake was significantly higher (p < 0.05) for adult men living in the Northwest than those from the South, and senior males from North Central areas had significantly higher consumption of eggs (p < 0.05) compared to the Northeast. Basic food group consumption was only affected during childhood and aging. Adults who inhabited rural areas consumed greater quantities of fats and oils than those from higher population densities (p < 0.01). Our results indicate that place of residence and habitat size have a limited influence on food choices, regardless of age and gender in the ANIBES study population. It is fundamental to acknowledge that other SEF variables are important and further studies are needed to monitor and assess these influences are warranted.

Reported Dietary Intake, Disparity between the Reported Consumption and the Level Needed for Adequacy and Food Sources of Calcium, Phosphorus, Magnesium and Vitamin D in the Spanish Population: Findings from the ANIBES Study.

Calcium, phosphorus, magnesium and vitamin D have important biological roles in the body, especially in bone metabolism. We aimed to study the reported intake, the disparity between the reported consumption and the level needed for adequacy and food sources of these four nutrients in the Spanish population. We assessed the reported intake for both, general population and plausible reporters. Results were extracted from the ANIBES survey, n = 2009. Three-day dietary reported intake data were obtained and misreporting was assessed according to the European Food Safety Authority (EFSA). Mean ± SEM (range) total reported consumption of calcium, phosphorus, magnesium, and vitamin D for the whole population were 698 ± 7 mg/day (71-2551 mg/day), 1176 ± 8 mg/day, (331-4429 mg/day), 222 ± 2 mg/day (73-782 mg/day), and 4.4 ± 0.1 µg/day (0.0-74.2 µg/day), respectively. In the whole group, 76% and 66%; 79% and 72%; and 94% and 93% of the population had reported intakes below 80% of the national and European recommended daily intakes for calcium, magnesium and vitamin D, respectively; these percentages were over 40% when the plausible reporters were analysed separately. The main food sources were milk and dairy products for calcium and phosphorus, cereals and grains for magnesium and fish for vitamin D. In conclusion, there is an important percentage of the Spanish ANIBES population not meeting the recommended intakes for calcium, magnesium and vitamin D.

Strong Associations Exist among Oxidative Stress and Antioxidant Biomarkers in the Circulating, Cellular and Urinary Anatomical Compartments in Guatemalan Children from the Western Highlands.

BACKGROUND: A series of antioxidant enzymes and non-enzymatic compounds act to protect cells from uncontrolled propagation of free radicals. It is poorly understood, though, to what extent and how their interaction is harmonized. OBJECTIVES: To explore associative interactions among a battery of urinary and blood biomarkers of oxidative stress and enzymatic and non-enzymatic markers of the antioxidant defense system in children from low income households. METHODS: For this cross-sectional descriptive study, urine, red cells, and plasma were sampled in 82 preschool children attending three daycare centers in Quetzaltenango Guatemala. The urinary oxidative stress biomarkers studied were F2-isoprostanes and 8-hydroxy-deoxy-guanosine. Red cell enzyme activities measured were: catalase, superoxide dismutase, glutathione peroxidase and glutathione reductase. Circulating non-enzymatic antioxidants selected were: retinol, tocopherols, ß-carotene and coenzymes Q9 and Q10. RESULTS: In a Spearman rank-order correlation hemi-matrix, of 55 paired combinations of the 11 biomarkers, 28 (51%) were significantly correlated among each other (p ≤ 0.05), with the strongest association being retinol and tocopherols (r = 0.697, p<0.001), and 4 associations (9%) showed a trend (p> 0.5 to ≤ 0.10). F2-isoprostanes showed the greatest number of cross-associations, having significant interactions with 8 of the 10 remaining biomarkers. Goodness-of-fit modeling improved or maintained the r value for 24 of the significant interactions and for one of the 5 borderline associations. Multiple regression backward stepwise analysis indicated that plasma retinol, ß-carotene and coenzyme Q10 were independent predictors of urinary F2-isoprostanes. CONCLUSION: Numerous significant associations resulted among biomarkers of oxidation and responders to oxidation. Interesting findings were the apparent patterns of harmonious interactions among the elements of the oxidation-antioxidation systems in this population.

The FINUT healthy lifestyles guide: Beyond the food pyramid.

The WHO has proposed that health be promoted and protected through the development of an environment that enables sustainable actions at individual, community, national, and global levels. Indeed, food-based dietary guidelines, i.e., food pyramids, have been developed in numerous countries to disseminate nutritional information to the general population. However, wider recommendations are needed, with information on an active healthy lifestyle, not just healthy eating. The objective of the present work is to propose a three-dimensional pyramid as a new strategy for promoting adequate nutrition and active healthy lifestyles in a sustainable way. Indeed, the Iberoamerican Nutrition Foundation (FINUT) pyramid of healthy lifestyles has been designed as a tetrahedron, with its 3 lateral faces corresponding to the facets of food and nutrition, physical activity and rest, and education and hygiene. Each lateral face is divided into 2 triangles. These faces show the following: 1) food-based guidelines and healthy eating habits as related to a sustainable environment; 2) recommendations for rest and physical activity and educational, social, and cultural issues; and 3) selected hygiene and educational guidelines that, in conjunction with the other 2 faces, would contribute to better health for people in a sustainable planet. The new FINUT pyramid is addressed to the general population of all ages and should serve as a guide for living a healthy lifestyle within a defined social and cultural context. It includes an environmental and sustainability dimension providing measures that should contribute to the prevention of noncommunicable chronic diseases.

Trends 2001 to 2008 in incidence and immediate postoperative outcomes for major joint replacement among Spanish adults suffering diabetes.

OBJECTIVES: To analyze the trend of incidence rates of primary total knee (TKA) and primary total hip arthroplasty (THA) due to osteoarthritis among Spanish adults suffering diabetes (type-1 and 2) from 2001 to 2008 and analyze in-hospital mortality (IHM), length of stay (LOS) and hospital charges compared with non-diabetic patients. METHODS: From the Spanish National Hospital Database, we selected 250,205 patients with TKA and 122,926 patients with THA; 12 and 9% of patients undergoing TKA and THA, respectively, were diabetes sufferers, of them, 1.6% was classified as type 1 in each procedure. RESULTS: Incidence of both procedures increased over the period, but diabetic patients had a larger increment compared with non-diabetic patients. The ratio of diabetes versus non-diabetes sufferers undergoing TKA increased from 0.10 in 2001 to 0.16 in 2008 and from 0.08 to 0.11 for THA. Unadjusted IHM was higher among type-2 diabetic adults in both procedures. IHM rate did not show a secular time trend among diabetic patients. LOS was significantly longer among patients with diabetes type-1 and 2 undergoing THP when compared with non-diabetic patients. Hospital charges were higher among diabetic versus non-diabetic patients for both procedures showing a significant increase over the period. CONCLUSIONS: Immediate postoperative outcomes for major joint replacement are worse among persons with than without diabetes, and prevalence of diabetes is increasing in patients undergoing these surgeries.

[Epidemiology of community-acquired rotavirus gastroenteritis in Fuenlabrada (Madrid)]. / Epidemiología de la gastroenteritis por rotavirus adquirida en la comunidad en el área de Fuenlabrada (Madrid).

INTRODUCTION: Rotavirus is the main aetiological agent of severe acute gastroenteritis in childhood. MATERIAL AND METHODS: A prospective study on the incidence and cost of acute gastroenteritis in children under 5 years. RESULTS: Rotavirus was the most frequent aetiological agent. The cumulative incidence of hospitalisation decreased over the study period. CONCLUSIONS: Rotavirus is the most common cause of acute community acquired gastroenteritis requiring hospital admission in the area of Fuenlabrada (Madrid).

Factors associated to infant mortality in Sub-Saharan Africa.

Half of the 10 million children who die annually in the world are from Sub-Saharan Africa (SSA). The reasons are known, but lack of will and resources avoid the development of sustainable policies. Associated factors to the high infant mortality rate (IMR) in SSA have been investigated in this research. An ecological multi-group study was designed comparing rates within SSA. The dependent variable is the IMR and health services, economic and development indicators are the independent variables. Information and data sources were WHO, World Bank, UNICEF and UNDP (1997-2007). IMR mean value is 92.2 (per 1000 live births) and a relationship with several of the factors could be observed. In the bi-variate analysis direct relationship was observed with maternal mortality rate and an inverse relationship was observed with prenatal care coverage, births assisted by skilled health personnel, gross national income per capita, per capita government expenditure on health, social security expenditure, adult literacy rate, net primary school enrolment rate, population with access to safe drinking water (in urban and rural areas) and with population with access to basic sanitation in rural areas. In the multi-variate analysis IMR had an inverse relationship with children under 5 years with diarrhoea who receive oral re-hydration, with social security expenditure as percentage of general government expenditure on health and with per capita government expenditure on health. The situation in SSA would change if their inhabitants received education and information to demand more equitable polices and better investments from their governments.

Usability assessment of ASIBOT: a portable robot to aid patients with spinal cord injury.

The usability concept refers to aspects related to the use of products that are closely linked to the user's degree of satisfaction. Our goal is to present a functional evaluation methodology for assessing the usability of sophisticated technical aids, such as a portable robot for helping disabled patients with severe spinal cord injuries. The specific manipulator used for this task is ASIBOT, a personal assistance robot totally developed by RoboticsLab at the University Carlos III of Madrid. Our purpose is also to improve some aspects of the manipulator according to the user's perception. For our case study, a population of six patients with spinal cord injury is considered. These patients have been suffering spinal cord injuries for a period of time longer than 1 year before the tests are carried out. The methodology followed for the information gathering is based on the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST). Different daily functions, such as drinking, brushing one's teeth and washing one's face, are considered to assess the user's perception when using ASIBOT as a technical aid. The human factor in this procedure is the main base to establish the specific needs and tools to make the end product more suitable and usable.

Trends of adverse drug reactions related-hospitalizations in Spain (2001-2006).

BACKGROUND: Adverse drug reactions (ADR) are a substantial cause of hospital admissions. We conducted a nationwide study to estimate the burden of hospital admissions for ADRs in Spain during a six-year period (2001-2006) along with the associated total health cost. METHODS: Data were obtained from the national surveillance system for hospital data (Minimum Basic Data Set) maintained by the Ministry of Health and Consumer Affairs, and covering more than 95% of Spanish hospitals. From these admissions we selected all hospitalization that were code as drug-related (ICD-9-CM codes E), but intended forms of overdoses, errors in administration and therapeutics failure were excluded. The average number of hospitalizations per year, annual incidence of hospital admissions, average length of stay in the hospital, and case-fatality rate, were calculated. RESULTS: During the 2001-2006 periods, the total number of hospitalized patients with ADR diagnosis was 350,835 subjects, 1.69% of all acute hospital admissions in Spain. The estimated incidence of admissions due to ADR decreased during the period 2001-2006 (p < 0.05). More than five percent of patients (n = 19,734) died during an ADR-related hospitalization. The drugs most commonly associated with ADR-related hospitalization were antineoplastic and immunosuppressive drugs (n = 75,760), adrenal cortical steroids (n = 47,539), anticoagulants (n = 26,546) and antibiotics (n = 22,144). The costs generated by patients in our study increased by 19.05% between 2001 and 2006. CONCLUSIONS: Approximately 1.69% of all acute hospital admissions were associated with ADRs. The rates were much higher for elderly patients. The total cost of ADR-related hospitalization to the Spanish health system is high and has increased between 2001 and 2006. ADRs are an important cause of admission, resulting in considerable use of national health system beds and a significant number of deaths.

Participation and influence of migrant workers on working conditions: a qualitative approach.

Workers participation in the management of employment and working conditions is an important determinant of both positive and negative effects of work on human health. Through a qualitative approach, this study analyzes the degree of control and influence that migrant workers in different Spanish cities have over their own working conditions (Immigration, Work, and Health [ITSAL] Project). Results showed that migrant workers had little influence on employment and working conditions. Immigrant workers are mostly interested in issues such as salaries, hiring, and hours of work. Fear of dismissal makes immigrant workers reluctant to demand improved working conditions. We received limited information about immigrant workers' understanding of their rights and their perceptions of the possibilities to influence working conditions through trade union activity. Informal social networks play an essential role in disseminating information on workers' rights, although the effect is not always positive. Unions need to increase attention to and adapt measures for this particularly vulnerable group of workers.